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How to question your way to the root of an investigation

Three years ago Robert Francis QC published his findings into the appalling events that took place at the Mid-Staffordshire NHS Foundation Trust. He reported on the suffering of many patients within a culture of secrecy and defensiveness. 

Subsequently, this highlighted a whole system failure and showed where checks and systems that should have ensured the patients were treated with dignity and suffered no harm were overlooked.

Since then, there have been even more examples of shortcomings in the system throughout many healthcare organisations, with one happening in recent months.

So the questions to ask is, have lessons been learnt from these shortcomings?  And if so, is there an issue with the introduction of them into the workplace?How To Question Your Way To The Root Of An Investigation

We’ve recently been delivering a lot of Advanced Investigation Skills (AIS) and Root Cause Analysis (RCA) training for organisations who are working closely with their people to prevent failings, such as these, from happening.

One of the first stepping stones to investigations when an incident occurs is the five whys. Questioning is the true key to uncovering the reasoning behind an occurrence, and can highlight further areas of need of analysis.

Here, we take a look at the five whys and the steps you need to take to initiate an investigation in your organisation.

Using the five whys in investigations 

Now also used within Six Sigma, the technique was formally developed by Sakichi Toyoda and was used within the Toyota Motor Corporation during the evolution of its manufacturing methodologies.  It forms a crucial component of their problem solving training and is part of the induction into the Toyota production system.

Why use the five whys? 

  • It helps you define the root causes of a problemHow to question your way to the root of an investigation
  • It is one of the simplest analysis tools as it's easy to complete without statistical analysis
  • It is easy to learn and use 

The Why?, Why?, Why? is a systematic and probing form of questioning designed to get to the root cause and effects.

A number of answers may be found, and for each of these the next ‘Why?’ is asked: ‘Why is that? The whole process is repeated until five consecutive ‘Why?’ questions have been asked and answered.

An illustrative example: Elderly people do not take advantage of health clinics

1. Why?

Elderly people do not take advantage of health clinics.


2. Why?

Because they have no convenient transport.


Because they are not aware of what health clinics are about.


3. Why?

Because public transport is insufficient.



Because they have insufficient money to pay for taxis.



Because of low expectations?




Because Health Education does not reach them.



4. Why?

Because of increased privatisation.



Because pensions don’t keep up with inflation.



Because of tradition and experience.



Because Health Education is not targeted towards the elderly.


5. Why?





Points to remember

  • Avoid moving into 'what’s the solution' mode too quickly as this may mean you end up “fixing” the symptoms and not the root cause. Use the five whys to ensure that the cause of the problem is being addressed
  • Plan your questions. It sounds obvious, but if you don’t ask the right questions then you won’t get the right answers
  • For more complex investigations try using a cause and effect diagram (aka Fishbone Diagram) to help you visualise the categories of the potential causes of a problem

Those in the healthcare profession will be well aware that when a formal complaint is made, or an adverse incident takes place, there is a legal and moral obligation to investigate and reduce the risk of the incident or complaint happening again.

Find out more about how we can help your people understand how to thoroughly investigate an incident, produce reports that can stand up to interrogation and, importantly, put measures into place to prevent incidents from occurring. 


Stuart Ford, Learning Solutions Sales Consultant, Bray Leino Learning

In my series of blogs I will talk through my thoughts on some of the key challenges facing Learning and Development professionals, along with useful tips and advice.

Follow @BrayLearning

Copyright © 2015 Bray Leino Learning

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