A1.3. Data gathering and evidence and ‘5 Whys’

The data gathered can be reviewed and shared and will help to:

• Identify the problem
• Create a set of data as part of defining the problem and asking why
• Think about the problem differently
• Clarify what the real problem is and what is a target for improvement
• Indicate what is causing the problem. This is useful in targeting an area for improvement.

Data refers to whatever type of evidence, facts or information you collect.

When gathering data you learn about the area you are aiming to improve and gain a greater understanding of the problem. Data can help to assess if you have a problem but it won't necessarily explain why the problem exists.

5 Whys may be used as part of the PDSA cycle to help you study and evaluate a problem.

There are many ways that data can be collected but a simple way is to use the 5 Whys?

The idea of using 5 whys is to simply ask why something is done as it is. To the response another why is asked. This continues until you drill down to an understanding of the basis for an action or process.

Benefits of the 5 Whys:

• Help identify the problem/what you are trying to achieve and get agreement on the problem before you embark on any improvement/change.
• One of the simplest tools; easy to complete but can give a great deal of information.

If you are looking at a process or problem it helps to develop an understanding of that process and why it is done in a certain way: accepting how it has always been done may not help and asking why can help you clarify and understand more about the problem.

It can help the process by identifying evidence/data and facts that support why you do something.

When is 5 Whys most useful?

In any situation in day-to-day work life where you need to understand more about a process/problem/action.

How to complete the 5 Whys

• Write down the specific problem/issue.
• Writing the issue helps you define the problem and describe it completely.
• It also helps you or teams to focus on the same problem.
• Ask Why the problem happens or Why did a process fail and write the answer down below the problem.
• If the answer you just provided doesn't identify the root cause of the problem that you initially wrote down, ask Why again and write that answer down.
• If the second answer still doesn't identify the root cause of the problem, ask Why again and write that answer down.
• Continue asking Why until the team is in agreement that the problem's root cause is identified. This may take fewer or more times than five Whys.

A key phrase to keep in mind in any 5 Why exercise is "people do not fail, processes do".

Moving into 'fix-it' mode too quickly might mean dealing with symptoms but leaving the problem unresolved, so use the 5 Whys to ensure that the cause of the problem is being addressed.

If you don't ask the right questions, you don't get the right answers. A question asked in the right way often points to its own answer.

Data gathering can feed into other tools such as Process Mapping and may form part of a PDSA cycle. If you use the 5 Whys to understand the problem you will be more prepared to start looking at developing a solution/improvement.

A real example:

The problem:
The patient was late in theatre, it caused a delay.

Why? There was a long wait for a trolley.

Why? A replacement trolley had to be found.

Why? The original trolley's safety rail was worn and had eventually broken.

Why? It had not been regularly checked for wear.

Why? There was no equipment maintenance schedule

The root cause - there is no equipment maintenance schedule. Setting up a proper maintenance schedule helps ensure that patients should never again be late due to faulty equipment. This reduces delays and improves flow. If you simply repair the trolley or do a one-off safety rail check, the problem may happen again sometime in the future.

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