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Five Whys and Five Hows

Page history last edited by E. Sage Colombo 6 years, 4 months ago

Quality in Healthcare

Five Whys and Five Hows

By Ron Bialek, Grace L. Duffy, and John W. Moran

What It Is

  • The five whys and five hows constitute a questioning process designed to drill down into the details of a problem or a solution and peel away the layers of symptoms.

  • The technique was originally developed by Sakichi Toyoda. He states “that by repeating why five times, the nature of the problem as well as its solution becomes clear.”

  • The five whys are used for drilling down into a problem and the five hows are used to develop the details of a solution to a problem.

  • Both are designed to bring clarity and refinement to a problem statement or a potential solution and get to the root cause or root solution.

  • Edward Hodnet, a British poet, observed, “If you don’t ask the right questions, you don’t get the right answers. A question asked in the right way often points to its own answer. Asking questions is the ABC of diagnosis. Only the inquiring mind solves problems.”

When to Use It

  • When we want to push a team investigating a problem to delve into more details of the root causes, the five whys can be used with brainstorming or the cause-and-effect diagram.

  • The five hows can be used with brainstorming and the solution-and-effect diagram to develop more details of a solution to a problem under consideration.

  • Both methods are techniques to expand the horizon of a team searching for answers. These two techniques force a team to develop a better and more detailed understanding of a problem or solution.

How to Use It

  • Draw a box at the top of a piece of flip chart paper and clearly write down the problem or solution to be explored.

  • Below the statement box draw five lines in descending order.

  • Ask the “Why” or “How” question five times and write the answers on the lines drawn from number one to five.

  • It may take less or more than five times to reach the root cause or solution.

Examples of five whys and five hows are below.

Five whys of less vigorous exercise:

Too much TV and video games


Few community-sponsored recreation programs


No family recreational activities


No safe play area


Lack of resources


Five hows of more vigorous exercise:

Less TV and video games


More community-sponsored recreation programs


More family recreational activities


Safe play areas


Additional resources


Excerpted from Ron Bialek, Grace L. Duffy, and John W. Moran, The Public Health Quality Improvement Handbook(Milwaukee, WI: ASQ Quality Press, 2009), pages 168–170.

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