Examples of 5 Whys Root Cause Analysis

There are many creative ways to solve business problems and one quality tool that is commonly used is called the 5 Whys.

This tool involves an exercise that identifies a problem and asks the question why? five times. Allowing you to quickly drill down to the root cause of a problem.

It is tempting to jump to the first conclusion when trying to solve a problem. However, it is important to make sure that what is thought to be the root of the problem truly is. That is the beauty of using this tool!

Let’s look at this example.

Problem:  Children’s ministry has to turn away children because there are not enough workers to comply with teacher-to-student ratio.

Ok let’s look at this problem and ask the question why 5 times?

    1. Why?  The first answer might be – All of the scheduled workers did not show up for their shift.
    2. Why?  When calling the workers who did not show up for their shift a few answered “I didn’t know I was scheduled.”
    3. Why? Worker didn’t receive their monthly schedule in the mail.
    4. Why? Schedules were mailed and this worker was on the list to go out but didn’t receive the mail.
    5. Why? Worker moved and didn’t notify the office of address change.

There are many creative ways to solve business problems and one quality tool that is commonly used is called the 5 Whys.Now if you look at the answer to the first why and stop there, you may be tempted to lay blame on the worker and jump to a conclusion that the worker is not responsible and unreliable.

But as you dig down into the fourth and fifth time you ask the question, you quickly realize the problem is very different than originally thought.

One of my favorite quotes is, it’s not about the people – it’s about the process and that if you put good people in bad processes the outcomes don’t improve.

When problems arise it is only human nature to try to find the culprit and lay blame on someone but more times than not the person is working in a broken process that limits their ability to perform well.

Lets look at another example, let’s say you are getting a lot of complaints that the receptionist doesn’t know the answers to many of the questions she gets asked on the telephone and continues to transfer callers to the wrong person or wrong department.

You can discipline that employee or you can try to learn what in the process is not working. Going through the 5 whys could flush out reasons and possible solutions. Let’s look at another example.

Problem:  Complaints about receptionist.

  1. Why?  The receptionist doesn’t know the answer to questions or gives out wrong information.
  2. Why?  The receptionist manual does not have accurate answers to common questions.
  3. Why?  The receptionist manual is not updated as scheduled.
  4. Why?  Changing information is not given to the receptionist to update the manual.
  5. Why?  The administrative assistant who takes minutes at manager’s meeting does not pass information along to the receptionist.
  6. Why?  Administrative assistant was not instructed to do so during a review of her job description.

As you can see from this example, the problem is a training issue but not with the receptionist. This level of detail as to the cause of the problem would not have been identified without asking the question why – at least 5 times.

These examples demonstrate that once you separate the person from the problem, you can drill down to the root causes and fix the process. Which will ultimately fix the person.

I’m a firm believer that employees come to work and want to do a good job. In order for them to be able to do that, those who manage them are responsible to make sure the work processes make sense and helps the employee do a good job.

 photo by: TimGreen


  1. Pamela West, RN, BSN, MPA says

    I thoroughly enjoy your articles on quality. Your insight is very helpful in completing my performance metrics projects. I am a RN with more than ten years as a Clinical Data Analyst and former Quality Officer of a Medicare contract. Honestly, I’m still searching for the right place to use my analytics and quality experience. I see that you have definitely found yours!!!! Keep up the good work and helping me, as well.


    • Patricia says

      Hi Pam! I’m glad the article was helpful for you. I did healthcare quality in a former life so I understand your challenges all too well. Thanks for the comment and good luck in all you do!



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