FISH BONE DIAGRAM IS OFTEN USED FOR SOLVING PROBLEMS AND IS ALSO AN IMPORTANT TOPIC FOR M.D. COMMUNITY MEDICINE POST GRADUATES .THIS PRESENTATION COULD BE OF SOME HELP TO THEM .
Ultimate guide about fishbone diagram: definition, benefits, history of fishbone diagram, useful tips to create fishbone diagram and simple methods for cause and effect analysis.
We all understand why improvement and a focus on excellence are important, so what we need is a method to use to help with our improvement efforts.FOCUS-PDCA is an improvement methodology that many organizations use to guide their improvement efforts. It’s simply a formalized process for improvement.
Ultimate guide about fishbone diagram: definition, benefits, history of fishbone diagram, useful tips to create fishbone diagram and simple methods for cause and effect analysis.
We all understand why improvement and a focus on excellence are important, so what we need is a method to use to help with our improvement efforts.FOCUS-PDCA is an improvement methodology that many organizations use to guide their improvement efforts. It’s simply a formalized process for improvement.
Recorded webinar: http://slidesha.re/1dBzYpO
Subscribe: http://www.ksmartin.com/subscribe
Karen’s Books: http://ksmartin.com/books
This webinar was held with guest presenter, Mark Graban of http://www.leanblog.org/
Suggestion box programs, while well intended, usually fail to engage employees in any improvement, yet alone continuous improvement. As one healthcare professional said, referring to their old suggestion box, “That’s where good ideas go to die!”
In comparison, the "kaizen" model for improvement, from Lean and Toyota Production System, however, is alive and thriving in many organizations. This webinar will focus on key differences between suggestion box programs and the kaizen model, giving specific tips and ideas that your organization can adopt to make continuous improvement a daily reality.
Guest Mark Graban shared practical methods and strategies from his new book, co-authored with Joe Swartz, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, that will help you engage employees in meaningful, lasting improvement.
Fishbone Diagram, Ishikawa Diagram Training, Learn Fishbone in 3 Easy StepsBryan Len
What is Fishbone Diagram ?
Fishbone Diagram, an interesting name. It looks like a fish. Fishbone Diagram is one of the best techniques used in root cause analysis.
The diagram is named after Dr. Kaoru Ishikawa, University of Tokyo in 1943, who first developed and used fishbone diagram. That’s why, Fishbone diagram got another name as “Ishikawa”.
How is Fishbone Diagram Used ?
The great benefit of the fishbone diagram is its broad application. It can be applied to identify the causes of almost any problems like mechanical failures of a product, or designing to psychological issues.
Advantages of Fishbone Diagram:
Advantages of Fishbone method are,
Straightly easy to learn and apply
Good way to focus a brainstorming session
Effective learning method to the whole team.
Focuses discussion on the target issue
Encourages “system thinking” via visual connections
Puts further assessments and corrective actions in order
How to Develop Fishbone Diagram?
There are miscellaneous ways to develop a fishbone diagram and conduct it.
One way is to put the categories of possible causes on the “bones” of the fish, each line representing one category, such as:
Man (personnel)
Machine
Methods
Materials
Measurements
Mother Nature (environment)
Who Should Take Fishbone Diagram Course ?
Audience,
Tonex Training offers 2-days course and designed for all the individuals who want to learn and apply simple problem analysis tools. This hands-on seminar is ideal for the people like,
Senior executives, strategic leaders
Managers, quality managers
Product managers, manufacturing managers
R&D managers.
Learning Opportunities :
Learn about,
Concept of fishbone diagram
Learn when to use a cause & effect diagram
Creating effective fishbone diagram.
Fishbone diagram benefits in root cause analysis
Various approaches for fishbone diagram building.
Course Topics :
Fishbone Diagram Training topics can be adjusted as per your custom requirements,
Fundamentals of Fishbone diagram.
Fishbone Diagram Procedure
TONEX Fishbone Diagram Hands-On Workshop
Want To Learn More ?
Visit tonex.com for Fishbone Diagram Training, Ishikawa Training courses and workshop detail.
Fishbone Diagram, Ishikawa Diagram Training, Learn Fishbone in 3 Easy Steps
https://www.tonex.com/training-courses/fishbone-diagram-training-ishikawa-training/
Root Cause Analysis - Tools, Tips and Tricks to Get to the Bottom of Root CauseCraig Thornton
This webinar discusses and investigates how to conduct root cause analysis. Root cause analysis is something that companies really struggle with. There will be plenty of practical advice in the webinar to help with you understand the concepts and the tools.
If you would like to watch the recording of this webinar then copy and paste the below link into your web browser:
http://www.mangolive.com/blog-mango/root-cause-analysis-tools-webinar
Name : Dr. Narayanan Namboothiri, MBBS, MD (Community medicine)
Designation : Senior resident, MES Medical college, Perinthelmanna
ppt done during pg period, post graduation
Recorded webinar: http://slidesha.re/1dBzYpO
Subscribe: http://www.ksmartin.com/subscribe
Karen’s Books: http://ksmartin.com/books
This webinar was held with guest presenter, Mark Graban of http://www.leanblog.org/
Suggestion box programs, while well intended, usually fail to engage employees in any improvement, yet alone continuous improvement. As one healthcare professional said, referring to their old suggestion box, “That’s where good ideas go to die!”
In comparison, the "kaizen" model for improvement, from Lean and Toyota Production System, however, is alive and thriving in many organizations. This webinar will focus on key differences between suggestion box programs and the kaizen model, giving specific tips and ideas that your organization can adopt to make continuous improvement a daily reality.
Guest Mark Graban shared practical methods and strategies from his new book, co-authored with Joe Swartz, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, that will help you engage employees in meaningful, lasting improvement.
Fishbone Diagram, Ishikawa Diagram Training, Learn Fishbone in 3 Easy StepsBryan Len
What is Fishbone Diagram ?
Fishbone Diagram, an interesting name. It looks like a fish. Fishbone Diagram is one of the best techniques used in root cause analysis.
The diagram is named after Dr. Kaoru Ishikawa, University of Tokyo in 1943, who first developed and used fishbone diagram. That’s why, Fishbone diagram got another name as “Ishikawa”.
How is Fishbone Diagram Used ?
The great benefit of the fishbone diagram is its broad application. It can be applied to identify the causes of almost any problems like mechanical failures of a product, or designing to psychological issues.
Advantages of Fishbone Diagram:
Advantages of Fishbone method are,
Straightly easy to learn and apply
Good way to focus a brainstorming session
Effective learning method to the whole team.
Focuses discussion on the target issue
Encourages “system thinking” via visual connections
Puts further assessments and corrective actions in order
How to Develop Fishbone Diagram?
There are miscellaneous ways to develop a fishbone diagram and conduct it.
One way is to put the categories of possible causes on the “bones” of the fish, each line representing one category, such as:
Man (personnel)
Machine
Methods
Materials
Measurements
Mother Nature (environment)
Who Should Take Fishbone Diagram Course ?
Audience,
Tonex Training offers 2-days course and designed for all the individuals who want to learn and apply simple problem analysis tools. This hands-on seminar is ideal for the people like,
Senior executives, strategic leaders
Managers, quality managers
Product managers, manufacturing managers
R&D managers.
Learning Opportunities :
Learn about,
Concept of fishbone diagram
Learn when to use a cause & effect diagram
Creating effective fishbone diagram.
Fishbone diagram benefits in root cause analysis
Various approaches for fishbone diagram building.
Course Topics :
Fishbone Diagram Training topics can be adjusted as per your custom requirements,
Fundamentals of Fishbone diagram.
Fishbone Diagram Procedure
TONEX Fishbone Diagram Hands-On Workshop
Want To Learn More ?
Visit tonex.com for Fishbone Diagram Training, Ishikawa Training courses and workshop detail.
Fishbone Diagram, Ishikawa Diagram Training, Learn Fishbone in 3 Easy Steps
https://www.tonex.com/training-courses/fishbone-diagram-training-ishikawa-training/
Root Cause Analysis - Tools, Tips and Tricks to Get to the Bottom of Root CauseCraig Thornton
This webinar discusses and investigates how to conduct root cause analysis. Root cause analysis is something that companies really struggle with. There will be plenty of practical advice in the webinar to help with you understand the concepts and the tools.
If you would like to watch the recording of this webinar then copy and paste the below link into your web browser:
http://www.mangolive.com/blog-mango/root-cause-analysis-tools-webinar
Name : Dr. Narayanan Namboothiri, MBBS, MD (Community medicine)
Designation : Senior resident, MES Medical college, Perinthelmanna
ppt done during pg period, post graduation
Cause and Effect Analysis is a technique for identifying all the possible causes (inputs) associated with a particular problem / effect (output) before narrowing down to the small number of main, root causes which need to be addressed.
Learn about, the problem solving method, problem definition, generating solutions, analysing and selecting solutions, planning your next steps, recording lessons learned,
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Elliott, h. evolution of systems thinking (for NARS)ajitmaru
This is a presentation made by Howard Elliott on "Evolution of Systems Thinking Towards Agricultural Innovation Systems". It is uploaded on Howard's behalf.
population medicine has been referred to as hygiene, public health, preventive medicine, social medicine or community medicine. All these aim for promotion of health and prevention of disease.
Pre-exposure prophylaxis (PReP) is the new tool to fight and prevent the spread of HIV. Its a very useful strategy to prevent HIV for those who indulge in high risk sexual behavior and unsafe sex.
The ppt is aimed at helping UG/PG students of medical and allied health sciences to understand the system of socio- economic classification and prevailing systems in India.The ppt has been updated till Jan 2018
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
4. BOXOFFICE
FLOP
SCRIPT BUDGET
ENVIRONMENT MARKETING
Poor story
Lag in story telling
Dramatic dialogues
Dull opening
Political
Other films released
Heavy budget
Huge film sets
Song locations
Teaser and trailer
Heavy expectations
Over marketing
Detached story
Unrealistic
Delay in shoot
Not Season
Multistar
Cast and crew
4
5. OVERVIEW
• History
• Root cause analysis
• Principles of RCA
• Fishbone analysis
• History and Introduction
• Goals and objectives
• Categories
• Field of application
• How to draw and analyze a fishbone diagram
• Applications of fishbone analysis
• Critical analysis
• Conclusion
• References
5
6. “Quality is not an act , it is a habit.”
“Total quality management or TQM is an integrative
philosophy of management for continuously improving
the quality of products and processes.”
*Marketing management,Kottler&Keller
6
8. ROOT CAUSE ANALYSIS
“ Root cause analysis is a structured team process that
assists in identifying underlying factors or causes of an
adverse event or near-miss ”
*Marketing management,Kottler&Keller
8
10. BASIC IDEA OF RCA
• RCA is based on the basic idea that effective management
requires more than merely “putting out fires” for problems that
develop, but finding a way to prevent them.
• Essentially, RCA means finding the specific source(s) that
created the problem so that effective action can be taken to
prevent recurrence of the situation.
10
11. 1. RCA is a diagnostic and analytical tool
2. Effective RCA is a systematic process
3. Effective implementation of RCA requires a fundamental
shift in attitudes and mindset
4. RCA requires supportive organizational and
management cultures
5. Persistence and sustainability in the RCA effort
PRINCIPLES OF RCA
11
12. 6. RCA is an efficient and economical process
7. Effective problem statements and event descriptions are
helpful, or even required
8. RCA can help transform a reactive culture into a forward-
looking culture and it also reduces the frequency of
problems occurring over time within the environment
9. RCA requires a collaborative, multidisciplinary team effort
10. The focal points of RCA are corrective measures of root
causes and not simply treating the symptoms of a problem or
event
Contd..
12
16. KAORU ISHIKAWA(1915-1989)
QUOTES BY ISHIKAWA
1) “ Quality control starts and
ends with training..”
2) “ In Management, the first
concern of the company is the
happiness of people who are
connected with it. If the people
do not feel happy and cannot
be made happy, that company
does not deserve to exist..”
16
17. HISTORY
• Dr. Kaoru Ishikawa, invented the fishbone diagram (1960’s)
• In KAWASAKI IRON FUKAI WORKS, JAPAN
• Therefore, it is often referred to as the Ishikawa diagram
• He was the first quality guru to emphasize the importance of the
“internal customer,” the next person in the production process.
• He stressed that quality initiatives should be pursued at
every level of the organization and that all employees should be
involved
*Japaneese quality control,1963
17
18. DEFINITION
• Also called as CAUSE & EFFECT DIAGRAM
“ Fish bone diagram is a visualising tool for
categorizing the potential causes of a problem in
order to identify its root causes ”
*Ishikawa,1952
18
19. INTRODUCTION
Visual diagram, named for its resemblance to a fish backbone
and ribs
Fishbone analysis begins with a problem and the fishbone
provides a template to separate and categorise the causes
19
20. GOAL
• The main goal of the Fishbone diagram is :
“ To illustrate in a graphical way the relationship
between a given outcome and all the factors that
influence this outcome ”
20
21. OBJECTIVES
• The main objectives of this tool are:
1. Determining the root causes of a problem.
2. Focusing on a specific issue without
resorting to complaints and irrelevant discussion.
3. Identifying areas where there is a lack of data.
21
22. CATEGORIES OF FISHBONE DIAGRAM
MANUFACTURING
(5 M’s)
1. Machine
2. Method
3. Material
4. Measurement
5. Man power
MARKETING
(8 P’s)
1. Product
2. Place
3. Price
4. Promotion
5. Process
6. People
7. Performance
8. Physical evidence
SERVICE
(5 S )
1. Surroundings
2. Suppliers
3. Systems
4. Skills
5. Synchronization
* Guide to quality control,1968 22
24. 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?
24
25. DELAY FOR OPD
CONSULTATION
PEOPLE PROCESS
EQUIPMENT MANAGEMENT
Delay in MRD file
Appointment system (only 10 patients)
Wrong reporting
Busy schedule
of doctors
Communication
gap between
Doctor and Staff
OT
Cases
Rounds
Emergency Cases
Walk in patients
Patients take time in filling
registration form
Language problem
Breakdown of equipment
HIS system is slow
Non availability of pen
Unexpected leave by consultant
Difficulty in taking lift and finding place
Queue
system
not
followed
Non
availabil
ity of
Queue
barriers
Height of the desk is
more
Delay in Registration process
Doctors will be available in IMS instead of
HRC OPD (Sometimes)
*Mrs.Sindhusree,Ajims25
26. FIELD OF APPLICATION
1. Focus attention on one specific issue or problem.
2. Focus the team on the causes, not the symptoms.
3. Organize and display graphically the various theories about
what the root causes of a problem may be.
4. Show the relationship of various factors influencing a problem.
5. Reveal important relationships among various variables and
possible causes.
6. Provide additional insight into process behaviours
26
28. STEPS IN FBD
STEPS IN FISH BONE DIAGRAM
Prerequisite to be met
I. Identify the problem
II. Work out the major factors
involved
III. Identify Possible causes
IV. Identify Specific Factors
V. Detailed levels of causes
VI. Analyze your diagram 28
29. Prerequisite
• Gather a group of people that are knowledgeable about the problem
for a Brainstorming process
• The group should be made up of all staff available from the service
• They should start with a mind-mapping exercise to evoke ideas and
issues (causes) that are related to or affect the problem (effect);
• Use paper so the final diagram can be written up
• A facilitator should act as a note taker and keep the group on track
• It is for Preventing members from being side-tracked by tangents,
which detracts from the event at hand and could prevent them from
developing a strong action
29
30. Step 1 - Identify and clearly define the
outcome or effect to be analyzed
• Write down the exact problem you face
• Where appropriate, identify who is involved, what the problem
is, and when and where it occurs
• Everyone must clearly understand the nature of the problem
and the process/product being discussed
30
31. EXAMPLE
• For example: Pilot study of My thesis
• My thesis topic : “A Comparitive Study Of Clinico-
epidemiological Profile Of Depression Among Geriatric
Population In Urban And Rural Field Practice Area Of A
Medical College In Mangalore”
• Problem is : Increased time on finishing questionnaire while
doing Data collection of Pilot study
Increased time to
finish questionnaire
31
32. Step 2 - Using a chart pack positioned so that everyone can
see it, draw the spine and create the effect box
• Draw a horizontal arrow pointing to the right. This is the spine.
• To the right of the arrow, write a brief description of the effect
or outcome which results from the process.
• Draw a box around the description of the effect.
32
33. EXAMPLE
Problem :
• Increased time on finishing questionnaire while doing Pilot
study
Increased time to
finish
questionnaire
(Spine)
(Effect/Problem)
33
34. Step 3 - Identify the main causes contributing
to the effect being studied
• Labelling the major branches of the diagram
• Establish the major causes, or categories, under which other
possible causes will be listed.
• Write the main categories your team has selected to the left of
the effect box, some above the spine and some below it.
• Draw a box around each category label and use a diagonal line
to form a branch connecting the box to the spine.
34
35. EXAMPLE
• We identified the following factors, and adds these to the
diagram.
MATERIAL METHOD PEOPLE ENVIRONMENT
35
37. Step 4 - For each major branch, identify other specific
factors which may be the causes of the effect
• Identify as many causes or factors as possible and attach them
as sub branches of the major branches
• Fill in detail for each cause
• If a minor cause applies to more than one major cause, list it
under both
37
38. INCREASED TIME
TO FINISH
QUESTIONNAIRE
MATERIAL METHOD
ENVT PEOPLE
GDS too long
Too many questions
Difficult to comprehend
Morning hrs
inmates busy
Working hours
Rainy season
Self administered questionnaire
Language barrier
Compliance with filling questionnaire
Difficulty in understanding
Not cooperative
Old age
Similar questions
Interpretation of Likert
scale tough
Time consume
Due to rain,
approach to houses
are difficult
Suspicious
Not interested
38
39. Step 5 - Identify increasingly more detailed levels of
causes and continue organizing them under
related causes or categories
• You can do this by asking a series of why questions.
• You may need to break your diagram into smaller diagrams if
one branch has too many sub branches.
39
40. Step 6 – Analysis of the problem
• You should have a diagram showing all of the possible causes of
the problem that you can think of
• Analysis helps you identify causes that warrant further
investigation.
• Since Cause-and-Effect Diagrams identify only
Possible Causes, you may want to use a Pareto Chart to help
your team determine the cause to focus on first.
• Depending on the complexity and importance
of the problem, you can now investigate the
most likely causes further.
40
41. Contd..
• Look at the “balance” of your diagram, checking for comparable
levels of detail for most of the categories.
i. A thick cluster of items in one area may indicate a need for
further study.
ii. A main category having only a few specific causes may
indicate a need for further identification of causes.
• Look for causes that appear repeatedly. These may represent
root causes.
41
42. INCREASED TIME
TO FINISH
QUESTIONNAIRE
MATERIAL METHOD
ENVT PEOPLE
GDS too long
Too many questions
Difficult to comprehend
Morning hrs
inmates busy
Working hours
Rainy season
Self administered questionnaire
Language barrier
Compliance with filling questionnaire
Difficulty in understanding
Not cooperative
Old age
Similar questions
Interpretation of Likert
scale tough
Time consume
Due to rain,
approach to houses
are difficult
Suspicious
Not interested
42
46. 1. INADEQUATE HIV SCREENING
* Assessment and improvement of HIV screening rates in a Midwest primary care practice : a quality
improvement study,BMJ 2015 46
47. 2. A CASE STUDY
• A group of staff from an outpatient clinic wanted to understand
what caused the common problem of long waiting times for
outpatient appointments.
• They held a meeting with all the key staff involved in the
outpatient clinic, so as to include all parties in the exercise.
• The group asked a member of their trust’s service improvement
team to facilitate the session and support them in writing up
• The team involved in the outpatient clinic met together and
started by agreeing the problem statement, which the facilitator
then wrote on a flipchart
*Nursing Times 16.04.13/ Vol 109 No 15 / www.nursingtimes.net 47
61. ADVANTAGES
Helps determine root causes
Encourages group participation
Uses an orderly, easy-to-read format diagram of cause and
effect relationships
Indicates possible causes of variation
Increases knowledge of the process by helping everyone to
learn more about the factors at work and how they relate
61
62. DISADVANTAGES
They create a divergent approach to problem solving, where the
team expends a great deal of energy speculating about potential
causes, many of which have no significant effect on the
problem.
This approach can leave a team feeling frustrated and hopeless.
They are typically based on opinion rather than evidence.
The simplicity of a fishbone diagram can be both its strength
and its weakness.
As a weakness, the simplicity of the fishbone diagram may make
it difficult to represent the truly interrelated nature of problems
and causes in some very complex situations.
Extremely large space required to draw
62
63. CONCLUSION
Fishbone analysis provides a template to separate and categorise
possible causes of a problem by allowing teams to focus on the
content of the problem, rather than the history.
It is useful in root cause analysis, which is increasingly being used in
health services to improve safety and care quality
A successful way of using fishbone analysis is to encourage a group of
staff who are involved with a service or clinical pathway to work
together to identify all possible causes of a problem
On completing this exercise, the solutions will likely be identified and
an action plan for next steps can be drawn up
63
65. REFERENCES
1. Esmail A (2011) Patient safety in your practice. Pulse; 71: 3, 22-23.
2. Galley M (2012) Improving on the Fishbone - Effective Cause-and-effect Analysis:
Cause Mapping. www.fishbonerootcauseanalysis.com
3. Hughes B et al (2009) Using root cause analysis to improve management.
Professional Safety; Feb: 54-55.
4. American Society for Quality, Fishbone diagram http://www.asq.org/learn-about-
quality/causeanalysis- tools/overview/fishbone.html
5. Balanced Scorecard Institute, Basic tools for process improvement, Module 5 –
Cause and Effect diagram http://www.balancedscorecard.org/files/c-ediag.pdf
6. Ishikawa, Kaoru (1986). Guide to Quality Control. Tokyo, Japan: Asian Productivity
Organization.
7. Walton, Mary (1992) The Deming Management Method, Mercury Business Books
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65
66. 9. Quality circle - effective management tool in biomedical waste handling, d.
Debdatta, L moushum. Source: academy of hospital administration, vol 26, no 1,
jan-jun 2014
10. Total Quality Management by Poornima M
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Scotland. www.clinicalgovernance.scot.nhs.uk
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Guide. Coventry:
13. NHSIII. tinyurl.com/nhsi-leaders
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rather than on the individual. International Journal of Nursing Practice; 11: 141.
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66