For about ten years, I have dealt with back problems. Within the last year, the issues worsened to the point where my quality of life was affected. For the first time, I considered surgery but wanted to consider all possible options before succumbing to the knife.
I eventually went to a chiropractor. I am not healed but my pain level has considerably dropped.
My intention here is not to write about my back or the benefits of chiropractic care. Going to the "pop doctor" reminded me of an important concept in problem solving: Don't address a problem's symptom, find and eliminate the problem's root.
I heard many stories of people having multiple back surgeries. The first one worked for about three years but others were needed. One possible reason is that the initial procedure addressed the symptom of the problem and not the root. With the "root" still present, the pain would inevitably return.
During my first visit, the chiropractor x-rayed my back. What he showed and explained to me was a misalignment of my vertebra. I could see it in the pictures. So, asking multiple whys(five the rule of thumb) to find root cause:
Q1. Why does my back hurt?
A1: My disk is pushing against a nerve
Q2: Why is my disk pushing against a nerve?
A2: My vertebra are out of alignment
One could argue that back surgeons stop at question one while chiropractors go to question two. Now, I'm not advocating one over the other. As I said, my pain stays with me every day and I probably will end up on an operating table. I see this as an excellent example of symptom versus root cause.
To find root cause, always ask why multiple times. The rule of thumb is five but keep asking as long as the answers provide meaningful information.
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4 comments:
Stephen,
I have a strong comment, prompted by your biological rather than manufacturing example. You need many, many more than five whys! Biology and biological systems are incredibly complicated.
In the area of biology where I have most recently worked, a National Institutes of Health researcher commented that for the last fifteen or twenty years the main messaged he has gotten from his work is that "it is more complicated than we thought". That was the quote that the New York Times was left with when they were looking hard for some flashy breakthrough to spice up their copy.
So my point is that one should remember that the PDCA cycle is a never-ending process. There should be at least one "why" for each time around at the "check" step. If the process is an important one, like one's personal health, it deserves a new why even when it seems like there are no more whys to ask. I don't think they stop asking at Toyota either.
Stew,
Great points!
Do Doctors ask multiple whys or do they opt to treat the symptom? Better yet, do they help patients look beyond the first why?
Or do liabilities prevent Doctors from offering too much opinion? For example, I have seen a neurosurgeon about my back and at no time did he ever suggest possible causes for my problem. He only found what was causing me pain and gave me options for addressing the pain. We never talked about the root of my problem.
Stephen,
I guess it's an old story. I think that many doctor's do not ask multiple whys due to a conflict of different aspects of quality. It is definitely part of the training of an MD to ask multiple whys with the goal of maximizing the quality of care. An example of this in practice was a program that addressed possible cardiac problems in an emergency room. The procedure adopted was not to try to establish proof of a cardiac cause but rather to assume that cardiac was probably the basis and then try to rule it out. This approach required multiple whys to explain every aspect of the symptoms in non-cardiac terms. The overall result (as I remember it reported) was lower death rate and lower complication rate at that emergency room. I am not sure but I think that costs were lowered as well.
Sadly, however, it is often true that quality of care conflicts with quality in terms of facility efficiency. Doctors are often under a pressure to finish assessing a patient in a certain amount of time. While this approach can improve the number of people seen, and probably increases the quality of overall care in some sense, it reduces the number of whys. This clearly (to me at least) reduces the quality of care for more complex of confusing cases.
This conflict is under continuing discussion but it is a long way from being resolved. I wonder if there are analogous conflicts in quality measures in manufacturing that you (or others reading this blog) have witnessed.
On a more personal note, my own experience with health issues has generally come down to pushing the whys myself where ever I can. Some physicians are open to this and some are not but the burden of being proactive (asking many whys) has mostly fallen on me. In my own cases liability was not an issue so its hard for me to address that specifically. It is definitely something to keep in mind when evaluating responses from physicians. Much though they are trained not to be intimidated by such things, they are human.
So keep up your search for the root or roots of the problem. It's complicated both within the organism (you) and within the enterprise (heatlthcare).
It is easier sad than done in manufacturing. We often do not have the luxury of time to solve problems. We operate in an "emergency room" environment. To find the true root requires patience and rational thought. When the customer is pushing hard for an answer, rational thought and patience frequently vanish.
The critical point to me is that a five why approach must be your culture. It is the way you operate. To the Japanese, this is the way they are raised to think. So, it is not some topic for a seminar. It is all they know.
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