Craig Cochran  |  01/29/2009

Don’t Fail Your Customers With the 5 Whys

Problem solving begins by understanding the big picture.

So you have a customer complaint. It’s not just any complaint, but a huge one from your biggest customer. The problem affects millions of dollars in business and threatens the survival of your company. Are you going to take action? Of course! You put together a team of top players and attack it head-on.

Team members investigate the problem and perform a detailed 5-Why analysis. They start with the problem statement and ask, “Why did that happen?” repeatedly, drilling down deeper with each iteration:

Problem: There were seven data errors in reports issued to our largest customer in the last month

Why? Because lab reports are getting in the wrong project folders.

Why? Because the project numbers are written illegibly on the folders.

Why? Because the customer service representatives are rushed when preparing folders.

Why? Because there are only two representatives taking calls for all divisions.

Why? Because business expanded rapidly in the past year and management neglected to re-examine the work load of the customer service representatives.

After 5 Whys, the team has found what it believes to be the root cause of the problem: customer service representatives who are overworked. The team takes action to remove the root cause, which is the addition of a third customer service representative. A person is quickly transferred and trained, and the action is deemed effective by objective observers. A pizza lunch follows, including a congratulatory address by the president of the company. A week later, three more reports have data errors in them. Your company is dropped by its largest customer. Everybody was certain the problem solving was effective, but it obviously wasn’t. What happened?

Why the 5 Whys alone don’t work

Asking why one time after another assumes that the problem is perfectly linear, with one cause directly related to another. If we keep asking “why?” we’ll eventually get back to the root cause. However, real problems are much more complex than this. One cause does not always lead directly to another cause. There are contributing factors and hidden variables that mess up our ingenious chain of causes. If we try to treat every problem as nothing more than the result of a single chain of causes, we’ll miss the complexity that exists in the process.

The other reason that the 5 Whys is ineffective is that it focuses only on today’s causes. People enter the problem-solving process by asking, “In this exact problem that occurred, what was the chain of causes that led to it?” The 5 Whys ignore the causes of tomorrow. For problem solving to be truly effective, we can’t only consider the causes we know about now. We’ve got to consider the potential causes of tomorrow. The 5 Whys will expose some of the current causes, but it will rarely reveal potential causes. We need to consider the entire universe of causes: actual and potential, present and future, large and small, obvious and elusive. The key to uncovering this is gaining an understanding of the process that produces the problem.

Understand the process first, and then ask why

To address customer complaints in a thoughtful way, we must achieve an intimate understanding of our process. I don’t mean what the process should be; I mean what the process actually is. Whatever process is involved in the complaint must be described, step by step, as it is actually happening now. Existing procedures may not be much help to us in this regard. Procedures often describe how a process is supposed to operate, without any obstacles, surprises, errors, or creativity on the part of employees, but the world deals up all of these things on a regular basis. Put away your procedure when investigating a complaint. Instead, assemble a team of people intimately knowledgeable about the process. The people you want are the ones who actually do the work and get their hands dirty. Utilize people from different perspectives: production, quality, engineering, logistics, and purchasing. Managers should be represented also, but their perspective is often woefully uninformed about the tasks and activities taking place.

Explain to your team that you’re working to address a complaint and you need to understand the process that results in the complaint. The team will create a flowchart for the process as it actually exists. This will lead to an exploration of causes, but only after we’ve gained an understanding of the process from start to finish. Here are the supplies you’ll need to facilitate a session:

Flip chart


Large sticky notes


Plan on keeping your flowchart exercise very simple. Fancy symbols won’t help you understand your process any better. In fact, the only “symbol” you’ll use will be large sticky notes. Also, avoid the temptation to use a laptop computer or other electronic device to help you construct the flowchart. Creating the flowchart on a flip chart will enable all team members to crowd around and personally contribute to the process. You don’t want to introduce any barriers to the creative process. Computers, by their nature, relegate the majority of team members to observers, which is the opposite of what you want.

If possible, tell team members a day or two in advance that they’ll be making a flowchart for the process. Ask them to think about the various tasks, activities, and decisions that are part of the process. This way they’ll be well-prepared when the session begins and the team will use its time more efficiently.

Here are the key steps to constructing a flowchart that we can use in problem solving:

Determine boundaries. Decide on starting and stopping points for the flowchart, and keep in mind that many problems originate on the periphery of the process. Make your starting point far enough upstream in the process to capture the early planning and logistics steps. Likewise, make the stopping point far enough downstream that you capture inspection, storage, and follow-up steps.

Identify each step in the process. Beginning at our assigned starting point, identify the first step (task and decision) of the process. Write this on a large sticky note, writing only as many words as will fit. Continue doing this sequentially for each step in the process. Decide if each is a task or a decision, and put a “T” or a “D” in the lower right-hand corner of the sticky note to indicate this. It’s also helpful to write the decision steps in the form of a question to fully differentiate them from the task steps. Encourage participation and dynamic discussion of the process as a team. Anybody who attempts to dominate the process should be gently reminded to allow everyone to take part.

Arrange the steps in order. Determine the sequential order of the tasks and begin placing them on the flip chart. The first step will go at the top, with subsequent steps flowing downward. As the team begins assembling the flowchart with the sticky notes, forgotten tasks and decisions almost always spring to mind. That’s the point of using sticky notes--they can be easily moved. Add new tasks as necessary and rearrange existing tasks until everybody agrees that the flowchart accurately represents the process.

Connect the steps with arrows . Connect the tasks and decisions with arrows, indicating the flow of the process. Each task has a single arrow exiting it. Each decision has two arrows exiting it, with each arrow representing a different decision outcome. Make sure to label the arrows that exit the decision boxes indicating which answer to the decision outcome that they represent. The most common labels for decision arrows are yes and no, although they can be labeled with anything that makes sense in reference to the decision required by the decision box.

Check for accuracy. No matter what kinds of preparations are made or how smart the team members are, there are bound to be errors with a flowchart. When the team is finished constructing the flowchart, verify it by “walking the process.” Take your flowchart to where the work is actually being done and check that you haven’t forgotten any steps or made errors in sequencing. Make corrections as necessary.


Identify causes

The big benefit of starting with a flowchart is that it forces us to consider the entire process, not just the parts that we know best or are most likely to be involved. The team can now begin to identify the actual and potential causes that occur at each step of the process. Start at the top of the flow diagram and brainstorm what could possibly go wrong and lead to our customer complaint. Instruct the team members to think about the following possibilities at each step:

Mistakes that can be made

Confusing tasks

Incomplete instructions

Conflicting goals

Communication barriers

Anything else that can go wrong

Cast a wide net as you speculate on causes. Hunches are OK, and no proof is needed. The spirit of this is the same as brainstorming: All ideas are treated as potentially significant, without criticism. Write each of the potential causes on the flowchart next to the steps to which they apply.

Another way to think about causes is to call them failures. Ask the question, “What failures could lead to our customer complaint?” Whether they’re called causes or failures doesn’t really matter. The point is be to as inclusive as possible, taking a full inventory of what could go wrong at each step of the process as it actually exists. At the end of the exercise, your team will have identified dozens of potential causes. Now it’s time to narrow the field.

Narrow the causes to the most significant

It’s unlikely that you have the resources to act on all the actual and potential causes. That’s why you have to narrow your focus. One of the easiest ways to do this is through a multiple-voting process. Each person on the team is assigned four votes to use for what he or she believes to be the most significant causes. Team members can cast their votes anyway they wish: placing one vote on each of four separate causes, placing two votes on two causes, whatever they decide. Choose a colored marker that is different from the ones used for constructing the flowchart and writing the causes. The votes can be cast as check marks beside the causes to which they relate.

After all votes are cast, the facilitator will tally up the number of votes for each cause. You’re going to take action on not one root cause, but on a number of significant causes that contribute to the complaint in question. How many causes should the team act on? There’s no magic number, but taking action on five to seven causes for relatively obvious problems and 10 or more causes for complex problems seems to work well. List the top causes, as indicated by the number of votes they received, on a separate flip chart. It’s helpful at this point to allow a brief discussion on each of the top causes. The facilitator can begin this by saying, “Who would like to say a few words about this cause?” The point is to bring everyone up to speed on each of the top causes. This builds a richer understanding of the causes and creates a basis for taking action.

Plan and implement action

Now we come to the most important step of all--action. Each of our top causes must be matched with an action that will remove it or reduce it to an acceptable level. The team will consider each cause in turn and agree on an action for it. Here are the specific variables that should be identified:

Action to be taken. Be as specific as possible in defining the action to be taken.

Responsible party. Who will lead the implementation of the action? Preferably, each action should be assigned to someone who has participated in the problem-solving session. Team members are invested in the process, due to their involvement up to this point, and they have an understanding of the process variables.

Required resources. List the money, people, supplies, time, and other resources that will be required to carry out each action.

Expected completion date. State when the team believes that the action can be completed. Because you’re striving to assign actions to team members, you can get commitment from each responsible party on the completion date.


Agree on a date when the team will reconvene and review the progress on action items. Let it be known that top management will be present during the review meeting. This will highlight the importance of making progress on the assigned actions. Team members don’t want to appear remiss in front of their peers, but they’re mortified to appear remiss in front of top management. Visibility and accountability ensure that nobody drops the ball.

Keep your customer abreast of the progress you’re making on the complaint. Because the actions were triggered by customer feedback, it only makes sense to provide some feedback of your own. “Here’s what we’re doing to improve our service to you,” sends a powerful message. It also cements the organization’s commitment to follow-through on the actions being implemented. The ultimate result of the entire process I’ve described is to create customer loyalty. Focusing on the entire process when attacking customer complaints, instead of just asking 5 Whys, will achieve this.



About The Author

Craig Cochran’s picture

Craig Cochran

Craig Cochran is a project manager with Georgia Tech’s Enterprise Innovation Institute. Cochran is the author of The Seven Lessons: Management Tools for Success; Problem Solving in Plain English; ISO 9001 in Plain English; Customer Satisfaction: Tools, Techniques, and Formulas for Success; The Continual Improvement Process: From Strategy to the Bottom Line; and Becoming a Customer-Focused Organization, all available from Paton Professional. His most recent book is ISO 9001:2015 in Plain English, also available from Paton Professional.


5why in interreaction with other tools

As a matter of fact, 5why need to be always treated as part of this kind of methodology like 8D in problem solving aspecially in complaints

Keeping this great tool with Cause and Effect Diagram, prioritization matrix can really be effective

Process Improvement

Very well framed and meaningfullly articulated.....some very subtle yet helful tips

The bigger picture

Another excellent article by Craig, that speaks to the issues of effective business management.
I would like to add: viewing the bigger picture quite literally, in my experience, enables a fast track improvement process that leads to positive action.
A gap exists (read chasm) between the common view of business system being heavily linear in appearance and understanding. While linear is necessary, a non linear view of process and system is IMO required to see the bigger picture of where we are, and where we want to be regarding business systems.
I have found that using a graphical format for expressing process and system, enables linear and non linear aspects of a business system to be more appreciated as continuously evolving rather than being a static unappreciated pattern of processes.
Solving the issues associated with business systems in this portion of the century, must needs IMO, be more aligned to whole brained thinking, as Dan Pink states in his excellent book “A whole new Mind.
Great writing Craig.