I love poking around the internet looking for what I call “real world” examples. I ran across this example of Amazon CEO Jeff Bezos whiteboarding his own, quick & dirty 5 whys. It demonstrates that doing root cause analysis is not time intensive. It also demonstrates that root cause analysis does not take long to accomplish. This post comes from Pete Abilla’s blog. I hope you enjoy it as much as I have.
This is a post from Pete Abilla’s shmula blog.
Jeff Bezos and Root Cause Analysis
I’m always impressed when CEO’s demonstrate Deming-like behavior as they lead; it’s rare, but there’s almost a magical, mobilizing, and inspiring force that happens when CEO’s or corporate leaders behave in a respectful, inspiring, common-sense, and thoughtful way.
Today, I’m reminded of an experience back in 2004 while I worked for Amazon.com — something Jeff Bezos did that I still carry with me to this day.
During Q4, Bezos and his leadership team have a tradition of visiting the Amazon.com Fulfillment Centers, spends time with the associates, and also physically works on the floor alongside everyone else.
During one visit, there had just been a safety incident where an associate had damaged his finger. When Jeff learned of this during a meeting, he was very disturbed and got very emotional — angry at first, then felt very bad for this associate and his family. Then, he did something remarkable.
He got up, walked to the whiteboard and began to ask the 5-why’s (I quote the below from memory):
So, the likely root cause of the associate’s damaged thumb is that he simply needed a table, there wasn’t one around, so he used a conveyor as a table. To eliminate further safety incidences, we need to provide tables at the appropriate stations or provide portable, light tables for the associates to use and also update and a greater focus on safety training. Also, look into preventative maintenance standard work.
Why did the associate damage his thumb?Because his thumb got caught in the conveyor.
Why did his thumb get caught in the conveyor?Because he was chasing his bag, which was on a running conveyor.
Why did he chase his bag?Because he placed his bag on the conveyor, but it then turned-on by surprise
Why was his bag on the conveyor?
Because he used the conveyor as a table
There are several things amazing about this experience:
- Jeff Bezos cared enough about an hourly associate and his family to spend time discussing his situation.
- Jeff properly facilitated the 5-why exercise to arrive at a root cause: he did not blame people or groups — no finger pointing.
- He involved a large group of stakeholders, demonstrated by example, and arrived at a root cause and he didn’t focus on symptoms of the problem.
- He is the founder and CEO of Amazon.com, yet he got involved in the dirt and sweat of his employees’ situation.
- In that simple moment, he taught all of us to focus on root causes — quickly — not heavily relying on data or overanalysis of the situation, and yet he was spot-on in identifying the root causes of the safety incident.
Every company has its warts and zits, but, make no mistake — Jeff Bezos is a Lean and Six Sigma fanatic and, in my opinion, makes a strong effort to run his company in a very Deming-like way.
How will you apply the 5-why’s today? Will you focus on the root causes of your challenges and not just on the symptoms?