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QUALITY IMPROVEMENT
TOOL
S
SEVEN BASIC TOOLS FOR
QUALITY IMPROVEMENT
 Cause-and-effect diagram (also known as the "fishbone" or
Ishikawa diagram)
 Check sheet
 Control chart
 Histogram
 Pareto chart
 Scatter diagram
 Stratification (alternately, flow chart or run chart)
QUALITY
IMPROVEMEN
TRoot cause analysis (RCA) is a class of problem solving
methods aimed at identifying the root causes of
problems or events.
Systems need designed-in redundancy so that desired
outcomes don’t depend on “the being more
careful . . .”
ROOT CAUSE
ANALYSIS
The practice of RCA is predicated on the belief that problems are
best solved by attempting to correct or eliminate root causes, as
opposed to merely addressing the immediately obvious
symptoms. By directing corrective measures at root causes, it is
hoped that the likelihood of problem recurrence will be
minimized. However, it is recognized that complete prevention of
recurrence by a single intervention is not always possible. Thus,
RCA is often considered to be an iterative process, and is
frequently viewed as a tool of continuous improvement.
QUALITY
IMPROVEMEN
T
Safety-based RCA descends from the fields of
accident investigation and occupational safety
and health.
Root causes tend to be viewed as failed or missing
safety barriers, unrecognized risks or hazards, or
inadequate safety engineering.
WHEN FAILURES
OCCUR
QUALITY
IMPROVEMEN
TGeneral principles of root cause analysis
• Aiming corrective measures at root causes is more
effective than merely treating the symptoms of a
problem.
• To be effective, RCA must be performed systematically,
and conclusions must be backed up by evidence.
• There is usually more than one root cause for any given
problem.
QUALITY
IMPROVEMEN
T
General process for performing RCA
• Define the problem.
• Gather data/evidence.
• Identify problems that contributed to problem (Causal Factors).
• Find root causes for each Causal Factor.
• Develop solution recommendations.
• Implement the solutions.
10
HOW TO IDENTIFY THE
PROBLEM
• Is it a real problem?
• Do we have enough reliable data to prove that it is a problem?
• What is the scope of the problem?
• Who are the Stakeholders?
• What is the impact of this problem on Patient Care?
• Is the solution within the scope of the team?
11
HOW TO WRITE A
PROBLEMSTATEMENT
•A good problem statement
Should be:
• specific
• measurable
• supported by data
• objective
And should not:
• include any causes or solutions or blame anybody
Problem
ISHIKAWA (FISHBONE)
DIAGRAM
CONT
ENT
What is fishbone?
What is fishbone analysis?
Usage
Why ?
How to use?
Tips
Examples
Types of root-cause analysis?
FISHBO
NE
Dr. Kaoru Ishikawa, a Japanese quality control statistician,
invented the fishbone diagram. Therefore, it may be
referred to as the Ishikawa diagram. The design of the
diagram looks much like the skeleton of a fish. Therefore, it
is often referred to as the fishbone diagram. It is also called
as cause-and-effect analysis.
WHAT IS FISHBONE/CAUSE-AND-EFFECT
/ISHIKAWA ANALYSIS ?
A cause-and-effect analysis generates and sorts
hypotheses about possible causes of problems within a
process by asking participants to list all of the possible
causes and effects for the identified problem
Cause-and-effect diagrams can reflect either causes that
block the way to the desired state or helpful factors
needed to reach the desired state.
WHEN SHOULD A FISHBONE
DIAGRAM BE USED?
•Need to study a problem/issue to determine the root
cause?
•Want to study all the possible reasons why a process is
beginning to have difficulties, problems, or breakdowns?
•Need to identify areas for data collection?
•Want to study why a process is not performing properly
or producing the desired results?
WHY
FISHBONE :
The fishbone analysis is mostly used by teams at
the deepen stage of the remodeling process. It does not tell
which is the root cause, but rather possible causes.
HOW TO USE CAUSE-AND-EFFECT
ANALYSIS
Steps
1. Draw a horizontal line (central spine) near the centre of
a page. Label one end with the problem or goal.
2. Collect information from the participants on aspects of
the situation. For the main aspects, draw lines off the
central spine. Aspects related to a particular main spine
are then drawn off that spine.
3. Set priorities. Select the most important main spine
then rank the items drawn off that spine. Continue
this process with the other main spines.
4. If the top priority spine has no branches, use this
aspect of the situation for the next step in problem
solving.
TIPS /
COMMENTS
•It can show much of a situation's structure.
•It can however become messy for complicated situations.
•Moreover, positive and negative aspects of the situation
are not being distinguished.
FISHBONE DIAGRAM
EXAMPLE 1
This fishbone diagram was drawn by a manufacturing
team to try to understand the source of periodic iron
contamination. The team used the six generic headings to
prompt ideas. Layers of branches show thorough thinking
about the causes of the problem.
METHO
D:
•Agree on a problem statement (effect). Write it at the center
right of the flipchart or whiteboard. Brainstorm the major
categories of causes of the problem.
•Generic headings: Methods, Machines (equipment), People
(manpower), Materials, Measurement and Environment.
•Write the categories of causes as branches from the main
arrow.
•Brainstorm all the possible causes of the problem.
•Ask: “Why does this happen?” As each idea is given, the
facilitator writes it as a branch from the appropriate
category. Causes can be written in several places if they
relate to several categories.
•Again ask “why does this happen?” about each cause.
•Write sub-causes branching off the causes. Continue to
ask “Why?” and generate deeper levels of causes.
•When the group runs out of ideas, focus attention to
places on the chart where ideas are few.
MachinesManpowerEnvironment
Methods
MATERI
ALSMeasurement
FISHBONE
EXAMPLE 2
A local office in a government department found that
papers and articles (scientific ones) took months to
circulate to all the people on the circulation list. In a one
hour session, an action team brainstormed possible reasons
and causes and created the following fishbone. A voting
exercise highlighted three items as being the main causes
and they then went on to tackle and resolve them.
TYPES OF CAUSE-AND-EFFECT
ANALYSES
•Fishbone diagram
•Tree diagram
Fishbone diagram, organized around categories of cause,
will help to broaden their thinking. A tree diagram,
however, will encourage team members to explore the
chain of events or causes.
THE FISHBONE DIAGRAM HELPS TEAMS TO
BRAINSTORM ABOUT POSSIBLE CAUSES OF A
PROBLEM, ACCUMULATE EXISTING
KNOWLEDGE ABOUT THE CAUSAL SYSTEM
SURROUNDING THAT PROBLEM, AND GROUP
CAUSES INTO GENERAL CATEGORIES.
Tree diagram, which highlights the chain of causes. It
starts with the effect and the major groups of causes and
then asks for each branch, "Why is this happening?
What is causing this?"
The tree diagram is a graphic display of a simpler
method known as the Five Why’s. It displays the layers
of causes, looking in-depth for the root cause.
FISHBONE ANALYSIS DIAGRAM FOR 4P’S
SFishbone or Cause-and-Effect for 4P’s (Plant, People, Policies and Procedure)
4P’s
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
CauseHere
NameYour
EffectHere
36
CAUSE-AND-EFFECT
DIAGRAM
• Determine and define the major categories which
describe the system or process under review, e.g.,
5ps: (or) 5ms:
People Manpower
Policies Materials
Plant Machines
Procedures Methods
Place Measurements
37
BASIC LAYOUT OF
CAUSE AND EFFECT
DIAGRAMS
EFFECT
Manpower
(People)
Methods
(Procedures)
Materials
(Policies)
Machines
(Plant)
Environment
FISHBONE ANALYSIS DIAGRAM FOR 4S’S
Fishbone or Cause-and-Effect for 4Ss (Surroundings, Suppliers, Systems, Skills)
4S’s
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
CauseHere
NameYour
EffectHere
FISHBONE ANALYSIS DIAGRAM FOR 6M’S
Fishbone or Cause-and-Effect for 6M’s (Man, Machine, Management, Measurement,
Material and Method)
6M’s
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
CauseHere
Name Your
CauseHere
Name Your
CauseHere
NameYour
EffectHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
Name Your
CauseHere
LATE ATTENDANCE – MINOR STAFF
Late
Attendance
People
Equipment
Methods
Environment
Missed Bus/Train
Raining
Traffic Block
Drug effect -Sleepy
Forget to set alarm
Vehicle Breakdown
Drop children to school
Drop spouse at work
Alcoholism
More work at home
Late to get up
Not interested in work
43
O v e r c r o w d i n g a t P C U
44
Construct a PROBLEM TREE showing the cause and
effect relationships between the problems.
Review the problem tree, verify its validity and
completeness, and make necessary adjustments
PROBLEM TREE
45
46
WHY – WHY
DIAGRAMS
Why-Why diagrams organize the thinking of a problem
solving group and illustrate a chain of symptoms leading
to the true cause of a problem.
Ask Why? – Five times
WHY – WHY DIAGRAM
Why
Why
Why
Why
Why
Why Why Why Why Why
Why Why Why
Why
Why Why Why Why Why Why Why Why
Why Why
Why Why
48
49
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Quality improvement tools

  • 2. SEVEN BASIC TOOLS FOR QUALITY IMPROVEMENT  Cause-and-effect diagram (also known as the "fishbone" or Ishikawa diagram)  Check sheet  Control chart  Histogram  Pareto chart  Scatter diagram  Stratification (alternately, flow chart or run chart)
  • 3.
  • 4. QUALITY IMPROVEMEN TRoot cause analysis (RCA) is a class of problem solving methods aimed at identifying the root causes of problems or events. Systems need designed-in redundancy so that desired outcomes don’t depend on “the being more careful . . .”
  • 5. ROOT CAUSE ANALYSIS The practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By directing corrective measures at root causes, it is hoped that the likelihood of problem recurrence will be minimized. However, it is recognized that complete prevention of recurrence by a single intervention is not always possible. Thus, RCA is often considered to be an iterative process, and is frequently viewed as a tool of continuous improvement.
  • 6. QUALITY IMPROVEMEN T Safety-based RCA descends from the fields of accident investigation and occupational safety and health. Root causes tend to be viewed as failed or missing safety barriers, unrecognized risks or hazards, or inadequate safety engineering.
  • 8. QUALITY IMPROVEMEN TGeneral principles of root cause analysis • Aiming corrective measures at root causes is more effective than merely treating the symptoms of a problem. • To be effective, RCA must be performed systematically, and conclusions must be backed up by evidence. • There is usually more than one root cause for any given problem.
  • 9. QUALITY IMPROVEMEN T General process for performing RCA • Define the problem. • Gather data/evidence. • Identify problems that contributed to problem (Causal Factors). • Find root causes for each Causal Factor. • Develop solution recommendations. • Implement the solutions.
  • 10. 10 HOW TO IDENTIFY THE PROBLEM • Is it a real problem? • Do we have enough reliable data to prove that it is a problem? • What is the scope of the problem? • Who are the Stakeholders? • What is the impact of this problem on Patient Care? • Is the solution within the scope of the team?
  • 11. 11 HOW TO WRITE A PROBLEMSTATEMENT •A good problem statement Should be: • specific • measurable • supported by data • objective And should not: • include any causes or solutions or blame anybody
  • 13.
  • 14. CONT ENT What is fishbone? What is fishbone analysis? Usage Why ? How to use? Tips Examples Types of root-cause analysis?
  • 15.
  • 16. FISHBO NE Dr. Kaoru Ishikawa, a Japanese quality control statistician, invented the fishbone diagram. Therefore, it may be referred to as the Ishikawa diagram. The design of the diagram looks much like the skeleton of a fish. Therefore, it is often referred to as the fishbone diagram. It is also called as cause-and-effect analysis.
  • 17.
  • 18. WHAT IS FISHBONE/CAUSE-AND-EFFECT /ISHIKAWA ANALYSIS ? A cause-and-effect analysis generates and sorts hypotheses about possible causes of problems within a process by asking participants to list all of the possible causes and effects for the identified problem Cause-and-effect diagrams can reflect either causes that block the way to the desired state or helpful factors needed to reach the desired state.
  • 19.
  • 20. WHEN SHOULD A FISHBONE DIAGRAM BE USED? •Need to study a problem/issue to determine the root cause? •Want to study all the possible reasons why a process is beginning to have difficulties, problems, or breakdowns? •Need to identify areas for data collection? •Want to study why a process is not performing properly or producing the desired results?
  • 21. WHY FISHBONE : The fishbone analysis is mostly used by teams at the deepen stage of the remodeling process. It does not tell which is the root cause, but rather possible causes.
  • 22. HOW TO USE CAUSE-AND-EFFECT ANALYSIS Steps 1. Draw a horizontal line (central spine) near the centre of a page. Label one end with the problem or goal. 2. Collect information from the participants on aspects of the situation. For the main aspects, draw lines off the central spine. Aspects related to a particular main spine are then drawn off that spine.
  • 23. 3. Set priorities. Select the most important main spine then rank the items drawn off that spine. Continue this process with the other main spines. 4. If the top priority spine has no branches, use this aspect of the situation for the next step in problem solving.
  • 24.
  • 25. TIPS / COMMENTS •It can show much of a situation's structure. •It can however become messy for complicated situations. •Moreover, positive and negative aspects of the situation are not being distinguished.
  • 26. FISHBONE DIAGRAM EXAMPLE 1 This fishbone diagram was drawn by a manufacturing team to try to understand the source of periodic iron contamination. The team used the six generic headings to prompt ideas. Layers of branches show thorough thinking about the causes of the problem.
  • 27. METHO D: •Agree on a problem statement (effect). Write it at the center right of the flipchart or whiteboard. Brainstorm the major categories of causes of the problem. •Generic headings: Methods, Machines (equipment), People (manpower), Materials, Measurement and Environment. •Write the categories of causes as branches from the main arrow.
  • 28. •Brainstorm all the possible causes of the problem. •Ask: “Why does this happen?” As each idea is given, the facilitator writes it as a branch from the appropriate category. Causes can be written in several places if they relate to several categories. •Again ask “why does this happen?” about each cause. •Write sub-causes branching off the causes. Continue to ask “Why?” and generate deeper levels of causes. •When the group runs out of ideas, focus attention to places on the chart where ideas are few.
  • 30. FISHBONE EXAMPLE 2 A local office in a government department found that papers and articles (scientific ones) took months to circulate to all the people on the circulation list. In a one hour session, an action team brainstormed possible reasons and causes and created the following fishbone. A voting exercise highlighted three items as being the main causes and they then went on to tackle and resolve them.
  • 31.
  • 32. TYPES OF CAUSE-AND-EFFECT ANALYSES •Fishbone diagram •Tree diagram Fishbone diagram, organized around categories of cause, will help to broaden their thinking. A tree diagram, however, will encourage team members to explore the chain of events or causes.
  • 33. THE FISHBONE DIAGRAM HELPS TEAMS TO BRAINSTORM ABOUT POSSIBLE CAUSES OF A PROBLEM, ACCUMULATE EXISTING KNOWLEDGE ABOUT THE CAUSAL SYSTEM SURROUNDING THAT PROBLEM, AND GROUP CAUSES INTO GENERAL CATEGORIES.
  • 34. Tree diagram, which highlights the chain of causes. It starts with the effect and the major groups of causes and then asks for each branch, "Why is this happening? What is causing this?" The tree diagram is a graphic display of a simpler method known as the Five Why’s. It displays the layers of causes, looking in-depth for the root cause.
  • 35. FISHBONE ANALYSIS DIAGRAM FOR 4P’S SFishbone or Cause-and-Effect for 4P’s (Plant, People, Policies and Procedure) 4P’s Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere NameYour CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere NameYour CauseHere NameYour EffectHere
  • 36. 36 CAUSE-AND-EFFECT DIAGRAM • Determine and define the major categories which describe the system or process under review, e.g., 5ps: (or) 5ms: People Manpower Policies Materials Plant Machines Procedures Methods Place Measurements
  • 37. 37 BASIC LAYOUT OF CAUSE AND EFFECT DIAGRAMS EFFECT Manpower (People) Methods (Procedures) Materials (Policies) Machines (Plant) Environment
  • 38. FISHBONE ANALYSIS DIAGRAM FOR 4S’S Fishbone or Cause-and-Effect for 4Ss (Surroundings, Suppliers, Systems, Skills) 4S’s Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere NameYour CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere NameYour CauseHere NameYour EffectHere
  • 39. FISHBONE ANALYSIS DIAGRAM FOR 6M’S Fishbone or Cause-and-Effect for 6M’s (Man, Machine, Management, Measurement, Material and Method) 6M’s Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere NameYour CauseHere Name Your CauseHere Name Your CauseHere NameYour CauseHere Name Your CauseHere Name Your CauseHere NameYour EffectHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere Name Your CauseHere
  • 40.
  • 41.
  • 42. LATE ATTENDANCE – MINOR STAFF Late Attendance People Equipment Methods Environment Missed Bus/Train Raining Traffic Block Drug effect -Sleepy Forget to set alarm Vehicle Breakdown Drop children to school Drop spouse at work Alcoholism More work at home Late to get up Not interested in work
  • 43. 43 O v e r c r o w d i n g a t P C U
  • 44. 44 Construct a PROBLEM TREE showing the cause and effect relationships between the problems. Review the problem tree, verify its validity and completeness, and make necessary adjustments PROBLEM TREE
  • 45. 45
  • 46. 46 WHY – WHY DIAGRAMS Why-Why diagrams organize the thinking of a problem solving group and illustrate a chain of symptoms leading to the true cause of a problem. Ask Why? – Five times
  • 47. WHY – WHY DIAGRAM Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why Why
  • 48. 48
  • 49. 49