Should We Be Asking “Why Aren’t We Questioning This Method?” about the Five Whys?

​Asking “why?" five times (“the five whys") is a widely taught method for conducting root-cause analysis (RCA), but it is flawed in many ways when it comes to healthcare, argues the author of an article in the recent issue of BMJ Quality and Safety. The idea behind the five whys is that employing the technique allows an organization to dig deeper into an adverse event, creating an “aha moment" by revealing information that might otherwise have gone undiscovered. But, the author argues, this process offers an incomplete analysis. For one, he says, it relies on “off-the-cuff deduction" rather than observation. The number of whys, the author says, is also arbitrary. The correct answer may come after the second why or the seventh why.