Quality Improvement Zone

A visual display that includes:

• The name of the problem stated a way that does not pre-judge its causes.
• Major cause areas / categories for the causes of the problem, for example materials, processes, people, environment and equipment
• The reasons and root causes associated with each category / cause area
• Possible solutions for each root cause
• A cause and effect diagram is sometimes called a fishbone diagram after its resemblance to the bones of a fish or an Ishikawa diagram after its creator

• To allow a team to explore the possible reasons, root causes and possible solutions for a problem
• To visually represent the reasons, root causes and possible solutions for a problem
• To help identify change ideas and develop an improvement plan
• To enable team to focus on content of the problem, not on the history or differing personal interests. 

Tips for Facilitation:

• Agree the problem statement and where possible include the what, where, when and how much of the problem. Use data to specify the problem.
• Give the problem a name that avoids pre-judging the cause(s). On flipchart paper write the name in the problem statement in a box (fish head) on the right-hand side of the paper. Draw bones of the fish.
• Go where the problem arises and gather facts, not opinions about the problem.
• Brainstorm the reasons. Write them individually on yellow post-its.
• From the post-its agree the major cause areas / categories the team should focus their thinking on. Write each of these at the end of a fishbone (e.g. people, materials, methods, machines).
• Place each of the yellow post-its to the left of the appropriate bone. Sometimes this will spark more discussion where further ideas are generated.
• For each effect on the post-its ask the “5 Whys?” and continue to do so to determine the true root cause of the problem. If there is disagreement about the root cause gather more facts.
• Use pink post-its to record the agreed root causes. Place them beside the relevant yellow post-its. 
• When complete take a photograph of the Fishbone and /or type it up to allow all team members to reflect on it for agreement.
• Use this to develop an improvement plan. Guide the team to prioritisation of improvements based on ease of implementation and impact.