The problem with ‘5 whys’

The ‘5 whys’ technique is one of the most widely taught approaches to root-cause analysis (RCA) in healthcare. Like most such tools, though, its popularity is not the result of any evidence that it is effective. Instead, it probably owes its place in the curriculum and practice of RCA to a combination of pedigree, simplicity, and pedagogy.

When used carefully, ‘5 whys’ may play a powerful role in the classroom. It can illustrate both the need for depth (as a positive example) and the need for breadth (as a negative example) when analysing complex problems.

As a tool for conducting RCAs, however, especially in the area of patient safety, the use of ‘5 whys’ should be abandoned. As the (apocryphal) quote goes: “For every complex problem, there is an answer that is clear, simple and wrong”. When it comes to accident investigation, ‘5 whys’ is that answer.

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