Quality Improvement: Cause and Effect Diagram

Overview

• Also Known As: Fish bone diagram, Ishikawa diagram
• Purpose: Helps identify root causes of a problem or issue, typically an adverse event or error
• Design: Resembles the skeletal system of a fish
• Originator: Dr. Akira Ishikawa, a quality expert from Japan

Structure of the Diagram

• Main Component: The problem or issue is placed in the box to the right
• Spines: Labeled with categories
• Typical Categories: Four or five, depending on the issue nature

Usage

• Often used in conjunction with root-cause analysis
• Organizations may need to submit these diagrams for documentation of investigations

Common Categories

• Classic Categories:

  • Machines
  • Methods
  • Materials
  • People

• Other Possible Categories:

  • Equipment
  • Space
  • Policies
  • Procedures
  • Environment
  • Measurement

• Examples in Healthcare:

  • Functions: Prescribing, Filling, Dispensing, Administering

Detailed Example: Medication Error

• People Involved:
  • Doctor: Writes the order
  • Nurse: Takes the order
  • Nurse Assistant: Sends it to the pharmacy
  • Pharmacy Tech: Receives order
  • Director of Pharmacy: Might be involved
  • Patient: Can check medicine
  • Family: Might be involved if patient cannot communicate

Detail Level

• The level of detail depends on the complexity of the issue
• Diagram branches out with more specific details as necessary

Conclusion

• The cause and effect diagram is vital in quality improvement programs
• It should be part of your toolkit for effective problem-solving