Find the Root Cause of a Late Certificate
Use Five Whys to identify a process cause behind a delayed death-certificate filing.
The Walker cremation is delayed because the physician signature is missing from the death certificate on the morning cremation was expected to proceed. Five Whys: move from symptom to controllable process cause by asking why until the cause can be changed. The shortcut is to blame the arranger for not following up. That may be emotionally satisfying, but it does not reveal why the same delay can happen on the next hospice case. Why 1 Why was cremation delayed? The death certificate lacked the physician signature. This is the event, not the root cause. It names what blocked the crematory.…
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