The Diagram

Concept of Fish Bone Diagram

A fishbone diagram enables the team members to visually diagram the root
cause and effects of a problem rather than concentrating only on the symptoms.
In other words fish bone diagram is a discovery tool that reveals the cause and
effect which enables to rule out the reasons for various defects or failures in a
system.

Steps

1. Prepare a problem statement. Here the problem statement is A patient

feels (s)he received false laboratory report. Place the problem statement
on the right side of the paper at the head end of the fish. Then a line with
an arrow needs to be drawn towards the head of the fish which is called
as the fish's backbone.
2. Categorization is the next step. Brainstorm the categories involved in the
procedure. These needs to be connected to the backbone and are referred
to as ribs. For example in the sample collection and lab investigation
scenario possible categories are client, process, staff/lab
professional/technician, environment, method, supplies etc.
3. Identify the contributing factors. Find out the problem causes and attach
them to the appropriate ribs. For example under the category
technician/lab professional the following causes can be attached: lack of
expertise, staff shortage, burnout.
4. Ask why. Which means when a factor is listed identify why that factor is
present. For example staff lack expertise may be due to lack of proper
training, why don't they attend training (due to lack of funds) etc.
5. Continue to push deeper for better understanding and creating mini ribs
if necessary.
6. Test for the root cause. It is the one which appears repeatedly within the
categories
7. Possible categories for generating a fish bone diagram in association with
false lab value received by a client are client, process, staff, environment,
method and supplies. Client factors that may affect the response are lack
of knowledge regarding the test performed, lack of knowledge regarding
the disease condition, lab values and its normal range as well as the
clients fear and anxiety regarding diagnosis of a critical or unexpected
condition. Contributing factors related to process are lack of a proper
written procedure that is communicated among the staff, incorrect
patient information collected which may lead to generation of results to
the wrong individual. Staff factors related to false results may be lack of
expertise and skills related to lack of proper training, lack of confidence,
lack of experience etc, shortage of staff and burnout syndrome due to
heavy workload. Environmental factors contributing to the mistake may
be workload and burnout. In addition to it less staff friendly atmosphere
can also cause lack of interest in work and associated errors. Methods
followed in the lab can also be a factor which includes changes in the
reference values and faulty techniques followed while executing a
procedure. Related to supplies due to lack of funds supplies may be
deficient, inadequate utilization of necessary resources as well as failure
of equipment may also contribute to errors.