B.
6-1, Level 6, Menara Wisma Sejarah
250, Jalan Tun Razak,
50400 Kuala Lumpur
[Link]
Tel: +603-2681 2232 Fax:+603-2681 3199
Patient Safety Workshop
23rd June 2019
Dr Muhammad Hafiz Bin Sulaiman
MD, MScPH (Health Economics)
Malaysian Society for Quality in Health
USING FISHBONE DIAGRAM AS
PROBLEM SOLVING TOOLS
Identifying the Likely Cause of theProblem
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WHAT IS FISHBONE DIAGRAMS?
A graphic tools that helps to solve problems by
conducting an analysis of a situation in a diagram
that looks like afishbone
Also known as the ‘Ishikawa Diagram’ after the
Japanese quality management expert who created
it
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PROBLEM ADDRESSED
Helps to identify, sort, display and analyse
possible causes of a specific problem
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THE PROCESS
A team leader presents the main problem that needs
to be examined by drawing of a diagram on
chalkboard or flipchart.
The member of the group then determine the main
causes. These causes are subsequently drawn in the
diagram on the board.
Next, the team member making suggestions, and
eventually the entire Fishbone Diagram is filledout.
Team member discussed on the most likely root
causes of the problem. These causes indicate
items to be actedupon.
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Steps in Implementation (i)
What problem to be examined? (be specificand precise)
What are the characteristics of the problem? (draw as the
“backbone” of the fish)
What are the main causes of the problem? (divide the causes
into categories and assign one “large bone” coming off the
backbone foreach category
What are the areas that contributes to the problem (for
each main cause)? (draw as the “middle bones” that run out
from the largebones)
What are the secondary causes of the main causes? (analyse
and add as “small bones”)
What are the reasons of the causes to happen? (include as a
horizontal line “fine bones” to the small bones)
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Steps in Implementation (ii)
The Fishbone Diagram helps to see the larger
problem more clearly and identify the smaller
problems that contribute to the larger ones
Look back the whole process and observe how
much extra work is required and how much extra
time is wasted
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Ishikawa Diagram
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Fishbone Suggested Categories
Services Industries
4 Ps: 6 Ms:
Policies Machines
Procedures Methods
People Materials
Plant/Technology Measurements
Mother Nature
(Environment)
Manpower (People)
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Example Fishbone Diagram to establish the cause and
effect of delays in product development
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RESOURCES REQUIRED
The Fishbone Diagrams usually constructed using
brainstorming techniques
It bring members of a team together to focus on a
common problem
Resources required: time allocated to the exercise
by a team of workers who will act as the
brainstorm group and drawing materials (e.g. Big
flipchart/large sheets of paper, masking tape,
flipchart markers/pens, brainstorm ideas)
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POSITIVE IMPACT
Major Benefit:
Consider all possible causes of the problem rather than
just the ones that are most obvious
Helps determine the root causes of a problem or quality
characteristic using a structuredapproach
Encourage group participation and utilize group
knowledge of the process
Use an orderly, easy to read format to illustrate cause-
and-effect relationships
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Major Benefits (Cont’d):
Indicate possible causes of variation in a process
Increase knowledge of the process
Identify areas where data should be collected for further
study
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“Live your life each day as you would climb a mountain.
An occasional glance towards the summit keeps the goal
in mind, but many beautiful scenes are to be observed
from each new vintagepoint.”
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