Section 1
5 WHY Process
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/TPM-Tool-for-Root-Cause-Analysis-RCA.jpg)
Causes of Losses are Often Complicated:
Common Failure scenario:
1. Management system breakdown
2. Failure to implement countermeasures
3. Premature equipment failure
4. Employees fail to follow the procedure
5. Failure to ID & Respond
6. Large Loss Results
5 Why Analysis is Proactive Addresses the Underlying Causes of Losses:
- 5 Why identifies the Root Causes of Losses
- Supports Implementation of Countermeasures
- Promotes Transfer of Learning
Where Does 5 WHY Fit in the Focused Improvement Process?
Focused Improvement Process
- Collect Data
- Identify, Prioritize & Select Projects.
- Ensure Equipment Is Restored
- Establish the Team
- Use the CAP-Do Process (5 Why is used here)…….. to manage the improvement cycle
- Monitor and Hold the Gains
- Document the Project (Kaizen Summary Sheet, Kaizen database)
- Celebrate Success
- Replicate Where Applicable.
- Share Learnings (Kaizen database, CI and Pillar CoP)
How is 5 WHY used in CAP-Do?
1. CHECK
a. Identify the problem
b. Understand the Ideal Situation
- Machine: equipment sketches and the operational principle
- Material: samples of material involved in the problem
- Method: Flow charts of the process
- Man: Forms, procedures
c. Identify the Phenomenon 5W1H Analysis
2. ANALYZE
Root Cause Analysis tools: 5 WHY
3. PLAN
a. Action Plans (Immediate, Intermediate, Long Term)
4. DO
- Safety Comes First!
- OPL’s
- Implement Actions
- Observe Results & Hold the Gains
Before Starting a 5 WHY ANALYSIS …
- The CHECK phase of CAP-Do must be completed . . .
– The problem identified
– The Ideal Situation understood
– The Phenomenon identified through the 5W 1H Analysis
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/5Ws-1H-Stratification-1024x718.jpg)
How Do You Start the 5 WHY Analysis once you identify the Phenomenon (5W 1H Analysis)?
- The 5 WHY Analysis involves asking the question “WHY ?” multiple times (typically 5) until you arrive at the root cause.
- The Phenomenon Statement from the 5W1H is the starting point for the first WHY.
EXAMPLE (see picture above) – Transition from 5W1H (CHECK Phase) to 5 WHY (ANALYZE Phase)
- Why does Line X Capper experience spill at the entrance after the changeover to 475 ml?
Ask Why…? Ask Successive Whys…?
(Follow Phenomenon – (Be)Cause Relationship)
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/Follow-Phenomenon-BeCause-Relationship-1024x419.jpg)
Develop a Cause Tree to Order your Thinking
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/Develop-a-Cause-Tree-to-Order-your-Thinking-1024x396.jpg)
5 WHY Analysis Using the 4 M’s
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/5-WHY-Analysis-Using-the-4-M’s-1024x627.jpg)
Causes to Consider:
Equipment Branch (Machine)
- Improper Equipment Ordered
- Poorly Designed Equipment
- Inadequate Maintenance
- Wear & Tear
- Abuse or Misuse
Materials Branch (Material)
- Materials out of spec:
- Product
- Packaging
- Ingredients
- Materials damaged:
- by machine
- from storage
- from supplier
Procedural (Method)
- Lack of Procedures
- Inadequate Procedures
- Misunderstood Procedures
- Failure to Warn or Respond
Note: Large losses often occur because of failure to take timely action
Behavioural Branch (Man)
- Lack of Knowledge
- Lack of Skill
- Physically Incapable
- Lack of Motivation
5 Why Analysis Pitfalls to Avoid
- Failure to step SLOWLY and METHODICALLY through the process
- Tendency to jump several “Why” s at once
- Tendency to assign pre-conceived causes
- Failure to consider ALL of the causes
- Use the 4-M approach to help avoid this pitfall
5 Why Analysis – Recommendations
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/5-Why-Analysis-Recommendations-1024x652.png)
What to do with the Recommendations?
. . .Follow CAP-Do . . .
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/What-to-do-with-the-Recommendations-1024x713.png)
How to go from 5 Why to the PLAN Phase of CAP-Do?
- For each of the last Why answers, identify recommendation(s) (countermeasures):
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/last-why-answers-1024x341.png)
- Develop an Action Plan for each of the countermeasures:
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/Develop-an-Action-Plan-1024x302.png)
Carry Out “Do” Phase of CAP-Do
Implement the Action Plan
Hold the Gains by Developing Standards:
- Cleaning, Inspection & Lubrication Standards
- Processing Standards
- Maintenance Standards
- Training Standards (i.e. One Point Lessons)
- Engineering Standards
One Point Lesson
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/Blank-TPM-lesson.png)
Section 2. Application of the 5 WHY Process
The Loss Pyramid
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/The-Loss-Pyramid-1024x625.png)
Application of 5 Why
Enables Identification of Problems BEFORE They Escalate Up the Pyramid
- Identifying Sources of Contamination, Stoppages (AM Pillar)
- Tool for Analyzing Cause / Losses in Focused Improvement (FI Pillar)
- ID Reasons for Breakdowns (EM Pillar)
- ID Causes of Minor Defects, Out of Spec
(QM Pillar) - ID Causes of Near Misses, First Aids (SHE Pillar)
Section 3 Field Case Studies
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/Cap-do-steps-1024x762.png)
Root cause analysis
![](https://leanmanufacturing.online/wp-content/uploads/2017/08/Root-cause-analysis-5-whys-1024x822.png)