Today we are continuing our “How to Create an A3” blog series with Step 3 – Root Cause Analysis.  In previous posts we covered defining the Problem Statement and the Current Condition.

Today’s blog will cover Step 3: Root Cause Analysis.  Just like defining the current condition, this is not a sit-down exercise.  Once at the workplace, while observing processes, you can utilize a method known as the “5 Whys.”  This method provides a level of inquiry deep enough to get to the root cause of a problem by asking “Why?” five times.  Each Why question is dependent upon the answer to the previous question.  It goes something like this:

My college-age son just received a failing grade on an advanced calculus exam.  My assumption was that he is in over his head by taking too difficult a course.  But, I must get at the root cause for his failing grade before I can give him any advice on what to do.

Question 1:      Why did you not score well on the quiz?
Answer:           I didn’t study.

Question 2:      Why did you not to study?
Answer:           I overslept the morning of the quiz.

Question 3:      Why did you oversleep?
Answer:           I stayed up too late the night before.

Question 4:      Why were you up so late?
Answer:           I was socializing.

Question 5:      Why were you socializing instead of thinking about your studies?

Clearly from this answer, I will take a different course of action than what I originally planned.

Recall the phlebotomy problem statement from our previous example and on-going discussion:

Phlebotomy draws by nursing staff often result in the wrong tube being used.  The problem started about 12 months ago when the laboratory issued 4 different reference guides and did not include photos.  This has resulted in re-draws of 25% and an increase in TAT of 50%. 

The 5 Whys for this problem could look like this:

Question 1:      Why did the nurse use the wrong tube?
Answer:           She was confused about which tube was correct to use.

Question 2:      Why was she confused?
Answer:           She could not find the answer in the lab guide.

Question 3:      Why couldn’t she find it in the guide?
Answer:           She stopped looking after 5 minutes.

Question 4:      Why did she stop after 5 minutes?
Answer:           She did not have time to look in all 4 guides.

Question 5:      Why are there 4 reference guides?
Answer:           ??

Now, we know that we have to focus our problem-solving efforts on the reference guides.  Jumping to solutions too quickly can mean solving the wrong problem or merely alleviating a symptom and not the problem.  Use the “5 Whys” as skillfully as a surgeon uses his scalpel and you will be well on your way to effective problem solving.

Next week we will continue our walk through each step in A3 problem solving with Part 4 – Target Condition and Countermeasures.


Today’s blog was written by Dan Littlefield, Director at HPP.

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including Imaging, Laboratory, Nursing, Pharmacy, and Physician Offices.  Dan began his healthcare career as a nuclear pharmacist and has also severed as Director of Operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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