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    Root Cause Problem Solving - Fishbone Diagram

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    Nigthstalker
    The document provides instructions on how to conduct a root cause analysis using a fishbone diagram. It explains that a fishbone diagram is a tool that can help identify underlying causes of problems or issues. It outlines the steps to create a fishbone diagram which include: 1) describing the problem, 2) preparing the diagram by drawing the bones and categories, 3) identifying root causes by asking why and adding factors to the bones, and 4) analyzing the diagram to prioritize causes and develop action plans. An example fishbone diagram for long lab turnaround times is included to illustrate how the tool can help analyze a process and identify root causes.

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    Root Cause Problem Solving - Fishbone Diagram

    Uploaded by

    Nigthstalker
    514 views9 pages
    The document provides instructions on how to conduct a root cause analysis using a fishbone diagram. It explains that a fishbone diagram is a tool that can help identify underlying causes of problems or issues. It outlines the steps to create a fishbone diagram which include: 1) describing the problem, 2) preparing the diagram by drawing the bones and categories, 3) identifying root causes by asking why and adding factors to the bones, and 4) analyzing the diagram to prioritize causes and develop action plans. An example fishbone diagram for long lab turnaround times is included to illustrate how the tool can help analyze a process and identify root causes.

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    RCA and Fishbone

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    The document provides instructions on how to conduct a root cause analysis using a fishbone diagram. It explains that a fishbone diagram is a tool that can help identify underlying causes of problems or issues. It outlines the steps to create a fishbone diagram which include: 1) describing the problem, 2) preparing the diagram by drawing the bones and categories, 3) identifying root causes by asking why and adding factors to the bones, and 4) analyzing the diagram to prioritize causes and develop action plans. An example fishbone diagram for long lab turnaround times is included to illustrate how the tool can help analyze a process and identify root causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    514 views9 pages

    Root Cause Problem Solving - Fishbone Diagram

    Uploaded by

    Nigthstalker
    The document provides instructions on how to conduct a root cause analysis using a fishbone diagram. It explains that a fishbone diagram is a tool that can help identify underlying causes of problems or issues. It outlines the steps to create a fishbone diagram which include: 1) describing the problem, 2) preparing the diagram by drawing the bones and categories, 3) identifying root causes by asking why and adding factors to the bones, and 4) analyzing the diagram to prioritize causes and develop action plans. An example fishbone diagram for long lab turnaround times is included to illustrate how the tool can help analyze a process and identify root causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    The key takeaways are that a fishbone diagram is a tool for root cause analysis that visually displays potential causes for a problem. It categorizes causes into main categories and uses a systematic approach to identify root causes.

    A fishbone diagram is an analysis tool that provides a systematic way of looking at issues/effects and potential causes that may cause or contribute to an issue. It is also known as a cause-and-effect diagram.

    The steps to create a fishbone diagram are to: 1) Describe the problem, 2) Draw the fishbone diagram and label the categories/bones, 3) Brainstorm potential causes within each category, 4) Prioritize the likely causes, and 5) Create action plans to address the root causes.

    ED PIP: Diagnostic Phase

    Tools: Root Cause Problem Solving Fishbone Diagram

    Fishbone Diagram

    Root Cause Problem Solving: Fishbone Diagram Overview


    Outcome Understand the underlying causes of issues or effects An analysis tool that provides a systematic way of looking at issues and effects and potential causes that may cause or contribute to the issue Also known as a cause and effect diagram To assist teams in categorizing and/or organizing the many potential problems of issues or problems Identify root causes of the issues identified Tip for integrating Lean principles into healthcare: Part of successfully implementing Lean in healthcare is adopting common language that may have originated in manufacturing and internalizing how it is used in a healthcare environment Root Cause Problem Solving in general is the technique of identifying what is causing symptoms to present themselves. Sometimes the Root cause is many steps removed from the actual problem Using Fishbone diagrams help to understand specific things that have a direct effect on the problem

    Definition: What is it?

    Objectives: What is it used for?

    Benefits:

    Cause and effect analysis identifies core problems which, when modified, may significantly impact a process and its outcomes Whenever multiple possible explanations exist for a single issue, root cause analysis enables the team to better understand the issues and prioritize their improvement efforts Generates a large quantity a variable ideas in a short space of time May identify foci for data collection Need to understand why a process is not performing properly or producing the desired or intended results

    When to use

    Fishbone Diagram

    Fishbone Diagram Instructions For Use (1/4)


    1 2 3

    Describe Prepare

    Problem

    ID Root Cause

    Develop Actions

    1. As a general guideline, the team can use the following questions to formulate their initial discussion:
    What is the problem? Why does the problem need to be fixed? Where is it occurring (e.g. which department)? Who is involved? (e.g. doctors, nurses, staff)? When has this occurred? How often does it occur? How have you validated the problem exists? Who needs to buy into the solution?

    2. The team should make sure they document in writing the description of the problem and scope of the possible solution space (See Template at end of Root Cause Problem Solving Section of Toolkit)

    In the long run, the team will benefit from developing a clear description of the challenge. They should make sure to:
    Identify the problem often, it relates to quality, service delivery and/or cost Make sure the problem exists Gather the necessary information (facts)

    Fishbone Diagram

    Fishbone Diagram Instructions For Use (2/4)


    1
    Prepare

    Describe Problem

    ID Root Cause

    Develop Actions

    1. Assemble necessary resources and supplies:


    flip chart, white or black board, writing utensils, data and information required to support discussion

    2. Draw the fishbone diagram:

    List the problem or issue at the head of the fish Label each bone of the fish with the following categories manpower, materials, machines, methods, measurement and environment (more categories can be added to address the issue)

    3. Use an idea generating technique (e.g. brainstorming) to identify the factors in each category that may be contributing to the issue or effect being studied 4. For each category, ask what may be causing or contributing to the issue

    For example, what machine related issues are we having? Answer: not reliable, breaking down, can find them, not capable, etc... Continue until you no longer get useful responses to the question5 whys. Add sub-factors to the appropriate bone

    5. Repeat this procedure with each factor and create sub-factors by asking why is this happening?.

    The fishbone diagram can be thought of as a visual representation of the information generated during a 5 whys exercise. In fact, 5 why analysis forms the basis of constructing a fishbone diagram

    Fishbone Diagram

    Fishbone Diagram Instructions For Use (3/4)


    1 2 3

    Describe Prepare

    Problem

    ID Root Cause

    Develop Actions

    Manpower

    Method

    Machines

    CONSIDER... What Factors contribute to the issue/effect in each category? Note there may be sub factors...

    Issue / effect

    Environment

    Materials

    Measurement

    Consider the use of ground rules for the team. Dialogue should be: Respectful, Non-judgemental, Objective, Open, Honest, Blame-free, Pertinent and Factual Hint: The team may not have to ask why five times to identify the root cause. In some cases, teams may have to ask why nine times and in other cases they may only have to ask why three times

    Fishbone Diagram

    Fishbone Diagram Instructions For Use (4/4)


    1 2 3

    Describe Problem

    ID Root Cause

    Develop Actions

    1. Analyse the fishbone diagram: Look for themes or causes that appear in more than one column (e.g. a lot of time spent looking for people or things, training) as these are the most likely causes List most likely causes and determine which ones are the actual likely causes; you and the team may need to gather more information about these potential causes by observing the process as it occurs In many cases, a large number of the sub-factors are relevant and need improvement. Prioritise these based on impact versus effort 2. 3. Prioritise improvement work based on the list of actual and most likely causes of the issue Create written and detailed action plans for improvement work

    Decision matrices that incorporate impact and effort are simple and useful tools to prioritise improvement work (e.g. high impact/ low effort causes would be a priority while low impact/ high effort would not)

    Fishbone Diagram

    Lets use an example to help illustrate how fishbone diagrams help identify the root causes...
    Manpower
    MD order illegible MD not avail to read results

    Method
    Many handoffs Batching work Porter Do not follow redirected FIFO

    Machines
    Pager malfunction

    Slow Down time capability

    Lab equip
    Inadequate training

    Fishbone diagram for Lab Turn Around Times

    Porter busy Lab tech busy not available work back up

    Computer down Lab supplies

    Dont question MD Transcription error Clocks Dont agree Many requisitions

    Long turn around time for lab results

    Specimen vials Breakage Out of stock spoiled

    Breakage Out of stock spoiled

    Environment

    Materials

    Interpretation...

    Based on this interpretation, the team can prioritize appropriately

    Using the Materials bone of the fish as an example, it says that the reason there are long turn around times for lab results related to materials are: There is a supply issue (caused by breakage, out of stock or spoiled materials) There are specimen issues (caused by breakage, out of stock or spoiled materials) There is a high volume of requisitions.
    6

    Source: Institute for Healthcare Improvement. Process Analysis Tools

    Fishbone Diagram

    In some cases, you may find that using a process to understand root cause using the fishbone diagram tool is more intuitive for the team members to discuss
    Fishbone diagram for Lab Turn Around Times

    No requisition

    Wrong test Incomplete specimen

    Dispatcher busy Wrong test communicated

    Phlebotomist unavailable Phlebotomist sent to wrong patient

    Order in wrong place

    Physician orders test

    Secretary calls dispatcher


    Handwriting illegible Transcription error Gave wrong information

    Dispatcher sends to Lab supplies Phlebotomist

    Long turn around time for lab results

    Heavy workload

    Source: Institute for Healthcare Improvement. Process Analysis Tools

    Fishbone Diagram

    Tips & tricks for fishbone diagrams

    Establish and use a parking lot to address problems or issues that are identified but out of scope for the current root cause analysis Remember to use the 5 why technique to create the sub-factors in a fishbone diagram

    Establish team norms and rules before embarking on root cause analysis specifically, teams must resist the temptation to assign blame, intent or emotion

    Stay focused it is very easy for individuals and teams to go on tangents

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