Unpicking A Problem:

A Quick Guide To Using

Fishbone Diagrams
What the presentation will cover:
What is a
Fishbone Why do we
Diagram? use them? When should
you use one?

How do you create a

Fishbone Diagram;
- What do you need? Handy Tips
- What are the steps?
 WHAT IS A FISHBONE DIAGRAM?

• ‘Cause & effect’ diagram

• A visual way of showing the potential causes of a problem

• Looks bit like skeleton of a fish

 WHY DO WE USE FISHBONE DIAGRAMS?

Provides structure Facilitate deeper

thinking about
possible causation Visualise possible
Helps group possible
causes of a problem
causes into categories

To help determine Helps to work

why a particular towards addressing
problem is happening the problem

Get a snapshot
Gain a shared
Discover root causes before you of collective
insight into the
start to think of a solution knowledge
problem
 WHEN TO USE A FISHBONE DIAGRAM?

• When there is an issue which has various causes

• When there are processes that don’t work

• When you need different points of view to look at a problem

• Before you think about making changes

 HOW DO YOU CREATE A FISHBONE DIAGRAM?

What do you need?

Right people involved in the exercise

- Representation from everyone who might be affected by the
problem

Time
- Dedicated time booked in diaries

Equipment
- Pens
- Flipchart/whiteboard
- Post-it notes
HOW DO YOU CREATE A FISHBONE DIAGRAM?
What do you do? A template
 BRAINSTORMING

Ways of collecting ideas

• Traditional ‘all call out’
Everyone calls out their ideas
Notekeeper writes/types up ideas onto the fishbone diagram

• ‘Silent brainstorming’
Everyone has some post-its
Individuals given time to think about the possible causes & to write these down individually
Ideas on the post-its are then added to the diagram one-by-one and categorised
 HOW DO YOU CREATE A FISHBONE DIAGRAM?
What do you do? A example

Environment Process

Long Waiting
Times

Equipment People
HOW DO YOU CREATE A FISHBONE DIAGRAM? - What do you do?

Environment Methods
Not enough Poor scheduling
treatment
Process takes
rooms Transport arrives early
too long

Too much
Small building Corridor
Targets paperwork
blocked

Waiting Time
Poor maintenance
Staff sickness Incorrect referrals

Wheelchairs Lifts broken

not available Unexpected patients
Lateness
Missed
Equipment People
appointments
EXAMPLE OF A FISHBONE DIAGRAM
 WHAT TO DO WITH YOUR COMPLETED
FISHBONE DIAGRAM

• Use the fishbone to facilitate discussion about what to work on

• Helps to focus on what you want to work on first

• Identify some quick wins that you can work on

SUMMARY

• A tool to start to understand causes impacting on a problem you want to

improve

• Allows people to think deeper into the problem

• Provides a visual record

• Can help focus on where to start improvements

• A way for the whole team to contribute

 Handy Tips

• Get everyone involved & engaged in agreeing problem statement at the start

• Have representation from across the team

• Ideally causes should appear only in one category

• Encourage no criticism of any ideas & try include all the suggestions of possible
causes

• No discussion during quiet brainstorming to allow everyone time to think

If you like to learn more about Quality Improvement tools & how
they can help you to make improvements please get in touch

QITeam@shsc.nhs.uk