Cause & Effect (Fishbone) Diagram

Cause & Effect (Fishbone) Diagram helps you identify the likely root causes of a specific problem and track down the reasons for imperfections, variations, defects, or failures. The diagram resembles a fish’s skeleton with the problem at its head and the causes for the problem feeding into the spine.
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  • Guide
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REFERENCES

 

Fukuda, R. (1996).CEDAC. A Tool for Continuous Systematic Improvement (Corporate Leadership. Portland, Oregon: Productivity Press.

Institute for Healthcare Improvement. “Cause and Effect Diagram”. Web. Retrieved from: http://www.ihi.org/resources/Pages/Tools/CauseandEffectDiagram.aspx 18 May 2017.

Simon, K. “The Cause and Effect (a.k.a. Fishbone) Diagram”.  Retrieved from: https://www.isixsigma.com/tools-templates/cause-effect/cause-and-effect-aka-fishbone-diagram/.  18 May 2017

Sollecito, W. A., Johnson, J. K. (2013). Continuous Quality Improvement in Health Care Fourth Edition.Burlington, MA: Jones & Bartlett Learning.

Spath, P. L. (2013). Introduction to Healthcare Quality Management, Second Edition.Chicago, IL: Health Administration Press.

Tam, R.Handbook for Basic Process Improvement.10 June 1996. Website retrieved: 17 May 2017

White, S. V. (2012). Q Solutions: Essential Resources for the Healthcare Quality Professional.  Quality and Performance Improvement. Third Edition.Glenview, IL; National Association for Healthcare Quality

REFERENCES

Introduction

These diagrams are often used to help a team focus on the context and content of an effect or issue rather than on personal interests.

The Fishbone is also used to:

  • Gather collective knowledge of a team around the effect/issue
  • Build support for solutions
  • Focus the team on causes rather than symptoms

Materials You'll Need:

  • Sticky notes or index cards & tape
  • Markers, for writing
  • Large surface area (work table, flip chart, white board, blank wall)
  • Team members from all areas of the organization

The Steps:

Decide on the Effect/Problem Statement

Place the Effect Statement or Problem Statement to the far right of the flipchart or whiteboard. Draw a horizontal arrow from left to right pointing to the statement. Be sure everyone agrees on the statement before proceeding to the next steps.
A blank fishbone diagram with only a central spine and an arrow pointing to a box labeled "Effect or Problem Statement," allowing full customization

Brainstorm the Major Categories

Brainstorm the major categories that influence the Statement.

Commonly used categories: Policies, Procedures, People, Plant, Environment, Equipment, Materials, Machines.

Build out the Fishbone

Write the major categories as branches from the main arrow.
A blank fishbone diagram with four labeled main categories—Environment, Procedures, Equipment, and People—branching into a central spine that leads to a box labeled "Effect or Problem Statement."

Brainstorm the "Why"

Brainstorm possible causes that influence the statement. Ask “Why does this happen?” As each idea is given, add them as a branch to the appropriate category. Some causes may fit in more than one category.
A partially completed fishbone diagram with “People” as the main category and contributing factors such as “Walk-ins,” “Patients too early,” and “Doctor not available,” with sub-causes like “Only two docs” and “Charting” leading to the problem “Long Wait Times on Tuesdays.”

Dive Deeper

Again ask "Why does this happen?" about each cause you just added, and add sub-causes branching off these causes. Continue to ask "Why?" and generate deeper levels of causes. Continue this process until the team is satisfied that the major causes have been identified.
A fully populated fishbone diagram with four categories—Environment, Procedures, Equipment, and People—each contributing multiple causes that lead to the central problem “Long Wait Times on Tuesdays.”

Fishbone Diagram Video:

Determining Cause and Effect

This brief video will show you the basics of a Fishbone diagram and how to use it in your transformation work.

A medical team of doctors discussing and planning a work strategy at a meeting in the conference room top view.

Key Takeaway

The Cause and Effect (Fishbone) method encourages teams to move beyond the symptoms and focus on the broader context and contributing factors.

By gathering collective knowledge, it promotes team alignment, builds support for targeted solutions, and lays the foundation for more effective and lasting improvements.

How Can We Help Your Team Work?