Fall 2014
Supervision in Care Management: Managing Quality

Find the Root Cause: Ask Why 5 Times

Phyllis Mensh Brostoff, CISW, CMC

How do you manage challenging situations when you or someone you are supervising has made a mistake and a client is upset with you or someone working for you?  One method is a form of root cause analysis: asking “why” 5 times.

This is a relatively easy way to get beneath the surface and determine the reason for a mistake, find an effective solution, and avoid this problem in the future.  Its purpose is to foster a culture where it is safe to admit a mistake and avoid a culture of blame.

Case Study

Mr. and Mrs. A reluctantly accepted care management and care giving services after they were both seriously hurt in a car accident when Mr. A was driving. When the Care Manager assessed the As, what they wanted was someone to drive them to the mall twice a week so they could have lunch and meet their friends. The Care Manager got an angry call from Mr. A complaining about the caregiver and her car.  The Care Manager asks, “Why are you so angry?”  “My wife just can’t get into her car and it’s always breaking down.”

Since one of the requirements for assigning this caregiver was that she had a car, the Care Manager asks her “why is your car breaking down frequently and why is it so hard for Mrs. A to get into?”  The caregiver explains that the car she is using is an old, two-door model.  She has a nicer car with four doors but she doesn’t want Mrs. A in that car because Mrs. A insists on going to the mall in clothes soiled by feces and urine. Why was this happening when giving Mrs. A a bath was in the care plan?  Mrs. A has refused to allow the caregiver to assist her with a bath, insisting that she has already taken a bath before the caregiver arrives.

Why was the Care Manager not aware of this problem? The caregiver was reluctant to admit that she couldn’t get Mrs. A to take a bath.  Why was the caregiver reluctant to admit this?   She was embarrassed but afraid that the Care Manager would be angry with her. The Care Manager reassures the caregiver that she will address this with the As.  She talks frankly to Mr. and Mrs. A about the need to bathe and dress in clean, dry clothing if they want the caregiver to take them to the mall in her better car.  Mrs. A agrees to take a bath on the two days a week the caregiver comes to the home, so that she can go to the mall, and the caregiver agrees to drive her 4 door car on those days.

When you are confronted with a challenging situation you are supervising, ask “why” 4 or 5 times and see if you can uncover the underlying cause and figure out a solution.




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