The problem with ‘5 whys’ (September 2017)

Summary

‘The problem with…’ series, from the BMJ Quality & Safety, covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.

The ‘5 whys’ technique is one of the most widely taught approaches to root-cause analysis (RCA) in healthcare. Its use is promoted by the WHO, the English National Health Service, the Institute for Healthcare Improvement, the Joint Commission and many other organisations in the field of healthcare quality and safety. Like most such tools, though, its popularity is not the result of any evidence that it is effective.

This article argues that healthcare is complex and why finding the solution via the 5 whys should be abandoned.