Out of Our Control

Root causes can originate from external and internal factors. Teams often discard apparent external root causes because they believe  the causes are outside of their control to address. As a result, they move on to “more controllable” causes which have less impact on the performance gap that they are trying to close. But are all root causes that appear to be generated externally by outside departments or organizations unpreventable and uncontrollable by you? When encountered by this situation with Lean Six Sigma teams, I’m often reminded of a famous question posed by W. Edwards Deming in his Red Bead demonstration – “How would they know?”

Sources of Root Causes

Before you shrug your shoulders and say, for example; “We can’t pay vendors on time because it’s out of our control when they submit incorrect invoices”, consider the sources of root causes. Most root causes originate from two major sources – procedures (methods, processes, policies, schedules, and algorithms) and people. So, the question might be, how do procedures contribute to the vendors submitting invoices with errors? If you applied the 5 Whys, you might discover that your contract requirements and the payment instructions that vendors use to get paid are unclear, out of date, or non-existent. So, how would the vendors know how to submit the invoices correctly? You can do something about that. Or how about those physicians that have long patient wait times due to overbooking? If you applied the 5 Whys, you might discover that the instructions developed by your department for applying the scheduling template weren’t clear. Or that the scheduling staff wasn’t properly trained to use the template. So, how would they know how to apply the template correctly?

When exploring for root causes, I have found the following line of questions regarding procedures  helpful:

  1. Is there a standard procedure for people to follow?
  2. If there is, is the procedure clear and easy to understand by anybody using it?
  3. If it is, then is the procedure up to date?

If the answers are “yes” to the above, then proceed as follows regarding people:

  1. Are the people trained?
  2. If they are, then are the training materials consistent with the procedures?
  3. If so, are the people properly trained? This includes ongoing coaching, mentoring, and feedback until they comply with the desired behavior on the job.

Finally, if everything was in order up to this point, then the causes may lie with the work environment itself. For example, communication, staffing levels, and employee retention rates can all affect worker effectiveness. These should also be explored from the “procedures and people” approach and the 5 Whys. Inappropriate staffing levels could be caused because the hiring process is out of step with the current rate of employee turnover, or communication schedules don’t take into account workforce diversity or the needs of various locations. Perhaps we can actually influence these.

Summary

Root causes can originate from external and internal sources. When you consider the sources of most root causes, and apply the 5 Whys, you may discover that you actually have more control over externally generated causes than you think.

January 17, 2024 - News