application of ishikawa diagram in forirgn helthcare: case study SUB.- Opration Panning and control

2.  An analysis tool that provides a
systematic way of looking at effects and
their respective causes.
 Developed by Dr. Kaoru Ishikawa of
Japan in 1943 and is sometimes referred
to as an Ishikawa Diagram or a Fishbone
Diagram because of its shape, similar to
side view of a fish skeleton.
 It was first used in the 1960s,and is
considered one of the seven basic tools
of quality management,[1] along with
the histogram, Paretochart, check sheet,
control chart, flowchart and scatter
diagram.

3.  These can be found using the 5 Whys
technique. When the most probable causes
have been identified, they are written in the
box along with the original effect. The more
populated bones generally outline more
influential factors, with the opposite applying
to bones with fewer”branches”. Further
analysis of the diagram can be achieved with a
paretochart. The fishbone concept can also be
documented and analysed through depiction in
a matrix format.[1]

5.  It helps determine the root causes of a problem using a
structured approach.
 It encourages group participation and utilizes group
knowledge of the process.
 It uses an orderly, easy-to-read format to diagram cause-and-
effect. relationships
 It indicates possible causes of variation in a process.
 It increases knowledge of the process by helping everyone to
learn more about the factors at work and how they relate.
 It identifies areas where data should be collected for further
study.
 It increases knowledge of the process by helping everyone to
learn more about the factors at work and how they relate.
 It identifies areas where data should be collected for further
study.

6. • Look for causes that appear repeatedly. These may
represent root causes.
• Look for what you can measure in each cause so you can
quantify the effects of any changes you make.
• Most importantly, identify and circle the causes that you
can take action on.
• Write the main categories your team has selected to the
left of the effect box. Draw some above and below the
spine.
• Draw a box around each category label and use a
diagonal
line to form a branch from the box to the spine.

7. >POSITIVE
– pride and ownership over productive areas
– upbeat atmosphere that encourages the participation of the group
 NEGATIVE
– justifying why the problem occurred and placing blame
– easier for a team to focus on what causes a problem than what
causes an excellent outcome
– concentrate on things that can go wrong may foster a more relaxed
atmosphere which sometimes enhances group participation
– A thick cluster of items in one area may indicate a need for further
study.
– A main category having only a few specific causes may indicate a
need for further identification of causes.
– If several major branches have only a few sub-branches, you may
need to combine them under a single category

8. Materials
Inaccurate
Submission of
Billing to Client
MethodsMethods People
MachineryMachinery
Main Causes

9. Materials
Inaccurate
Submission of
Billing to Client
Methods People
Machinery
Ignorance
People fail to inform
client thru call/e-mail
Unreliable
mail system
Erroneous
sorting
of billing
statementsInvalid
list of
updates
Phone line
disconnected
Erroneous
Information
in BIS
No file for
record of billing
statements
in clients’
folders

10.  Business process is certainly a complex one and
in this hyper-competitive market the
complexity is even of more extremity. In this
turbulence outset, every firm strive to make
their every activity as efficient as possible. In
doing so, they analyze and evaluate the current
position and by that process they find-out areas
where they can correct themselves and go
forward towards obtaining excellence in
operation (Southern, 1995).

11.  Over the years academicians and researchers has
been working intensely to provide business
operators different models and analysis tools.
The objectives to provide such tools is to assists
the business professionals to uncover the key
issues of business and take corrective actions for
continuous improvement (Balanced Scorecard
Institute, 2007). Among those models “The
Fishbone Analysis” is without any doubt a
popular one. This study is about “The Fishbone
Analysis” and its application to find out the
problems and providing solutions to the case
studies of St James Hospital, W.H.O geneva,
H.A.R.H and Lucas Engineering system
(Balanced Scorecard Institute, 2007).

12.  The fishbone analyze is a tool for analyzing the
business process and its effectiveness. It is also
commonly referred as “Ishikawa Diagram”
because it was invented and incorporated by Mr.
Kaoru Ishikawa, a Japanese quality control
statistician. It is defined as a fishbone because of
its structural outlook and appearance. In normal
stature it looks like a skeleton of a fish. The
fishbone diagram and analysis typically
evaluates the causes and sub-causes of one
particular problem and therefore assists to
uncover all the symptoms of any business

13.  For that particular reason it is also termed as
“Cause-Effect analysis”. In a typical fishbone
diagram the main problem which is required to be
resolved has been put on the head of the diagram
and the causes are put as the bones and then
smaller bones are created as the resemblances of
the sub-causes Ultimately after completion of the
diagram it’s a comprehensive evaluation of the
causes of the main problems and also reveals the
root causes as well (Balanced Scorecard Institute,
2007). There are six classic categories of a fishbone
diagram which are categorized as the main causes
of any problems of business process

14.  Those are people, equipment, materials,
environment, management and process. The
analysis of these six variables reveals the
reasons of a problem irrespective of its type or
severity (Ishikawa, 1986). In this study the
same thing will be done for the St James
Hospital , W.H.O geneva ,H.A.R.H and Lucas
Engineering system. First of all the fishbone
analysis will be done with six classic variables
and in the second analysis those will be further
analyzed with more causes or bones.

15.  This case studies on Hospitals ,W.H.O,. reveals a quite
interesting picture. It is about the supply chain management
and directed toward achieving highest possible efficiency in
that. The case study reveals that the hospital is facing
immense problem to ensure sound supply chain
management. There is no coordination among every action
and everywhere there is haphazardness. Too many people
are giving orders, sometimes they are experiencing
overstocking and sometimes there is no stock to fulfil the
demand of the patients, the numbers of suppliers are too
many and too many people are interfering in the supply
chain management system.

16.  There are other problem areas as well like staffs
are not linked in the system, peoples are
unwilling to share information and people are
direction less. As a result the hospital is
increasingly failing to maintain its well
established and long lasted reputation. In this
fishbone analysis the causes of the inefficient
supply chain management of the hospitals and
orgnizations will be uncovered and
simultaneously solution will be provided to get
back to the operational excellence (Bence,
1995).

17.  The case studies St James Hospital , W.H.O
geneva ,H.A.R.H and Lucas Engineering system of
reveal that the major issue of the hospital that has
been highlighted here is its supply chain
management system. Supply chain management is
comprehensively defined as the summation and
integration of all the sub-systems that require
providing goods or services to the customers
(Gregory, 1992). Here, this hospital is a service
organization and its supply chain consists of
inventory management, ordering, stock-keeping,
delivery, patient admission, tracking of order,
information system and all other process require
running the hospital smoothly.

18.  Like every organization this process has been carried
out by people and it comprises of the operation of
different classic items of the fishbone diagram like
process, materials, equipment (Bence, 1995). In addition
all of this takes place in the environmental set-up of the
hospital and it carried-out by the management. The
first fishbone analysis reveals that the major issue of the
hospital is to ensure smooth system of supply chain. If
that has been fulfilled then there is no reason why the
organization can’t achieve its historical success
(Ishikawa, 1990). But why it is not happening? Where
the problem exists? Whether peoples are inefficient, or
the entire process is faulty? The second fishbone
analysis will give the answer.

19. For mitigating and resolving the process
problem the hospital need to adopt an
Electronic ordering system. That system will
track all the stocks and will order automatically
when it is necessary. The electronic system will
solve the problems of overstocking, stock out
as well as faulty ordering process. The hospital
also needs to select specific suppliers as too
many suppliers are spoiling the party (Bence,
1995). They also can undertake BPR or JIT
strategy.

20.  The fishbone analysis is definitely a very effective
tool to find out the causes of problems. The
fishbone analysis was really helpful to find out the
reasons for supply chain problems of the St James
Hospital and also come up with solutions to solve
those problems. However, in few literatures some
drawbacks of the method have been pointed out.
Here in this article a brief overlook of those will be
provided. Fishbone analysis outlines the causes of
the problems but it does not clarify the sequence of
the causes (Public Health Infrastructure, 2008). In
real life world a problem may occur due to several
reasons but the magnitude or extremity of every
reason cannot be the same. The fishbone diagram
also fails to satisfy this issue (Ruhm, 2004).

21.  It also seldom defines the categories clearly and
the verification among the causal relationships is
also inadequate. It is a gist of outcomes and
therefore fails to represents details of the relevant
cases (Watson, 2004). Few researchers (Ruhm,
2004, Straker, 2010 and Watson, 2004) outlined
that the fishbone diagram and analysis identifies
causes under pre-defined categories only and
does not relate causes to each other and to each
category as well. Another major failure of the
diagram is it does not isolate major issues of the
problems and presents each in a same way.

22. ANALYSIS
The level of detail is well-balanced.
The causes poor/no training and manual file
organization/system are repeated several times.
These causes stated above are the ones that should be
attended to and given action on ASAP.

23. RECOMMENDED SOLUTIONS:
1.Poor/No Training - Give tutorials and seminars to new
and old employees alike. Have people check employees’
performances every once in a while.
2.Manual File System - Have a computer-based
information system to maintain the organization. It will
not only give you back-up files but make the system
work faster. Make sure it is maintained and updated at
all times.
RECOMMENDED SOLUTIONS:
1.Poor/No Training - Give tutorials and seminars to new
and old employees alike. Have people check employees’
performances every once in a while.
2.Manual File System - Have a computer-based
information system to maintain the organization. It will
not only give you back-up files but make the system
work faster. Make sure it is maintained and updated at
all times.

24. Advantages:-
 Helps determine root causes
 Uses an orderly, easy-to-format
 By using a fishbone diagram, you are able to focus the
group on the big picture as to possible causes or factors
influencing the problem or need.
 Even after the need has been addressed, the fishbone
diagram shows areas of weakness that once exposed
can be rectified before causing more sustained
difficulties.
 Encourages group participation
 Indicates possible causes of variation
 Increases process knowledge
 Identifies areas for collecting data.

25. Disadvantages:-
 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.
 Unless you have an extremely large space on which
to draw and develop the fishbone diagram, you
may find that you are not able to explore the cause
and effect relationships in as much detail as you
would like to

26. This diagram is of resembles the skeleton of a fish, it also
focus on causes rather than symptoms of a problem and
This diagram emphasizes group communication and
brainstorming and mainly stimulates discussion The Cause
Mapping approach builds upon and refines some of the
fishbone diagrams original concepts. The concepts,
example and exercises involved with Cause Mapping
improve the way people analyze, document, communicate
and solve problems. The purpose of an investigation is to
find the best solutions to prevent an incident from
occurring, and a Cause Map helps reach this ideal by
efficiently laying out on one map-the organizations goals,
problems and the systems of evidence supported causes.
So this Diagram helps to determine the root causes of a
problem or Quality characteristic, Encourages group
participation and increase the knowledge of process.

27. As presented in the previous section, the
fishbone analysis has some limitations and
requires some sorts of enhancement. It only can
be done through academic and scientific
researches. Future researches on this method
can be taken place in areas like sequencing the
cause and also how to put more emphasize on
the causes of higher magnitudes. Research also
can be done in the areas of design of the
diagram and drawing of relationships between
causes of different categories and sub-
categories.

28. FROM GIVEN EXAMPLE:
Q: Why is there an invalid list of updates?
Ans: Because the data was mixed up.
Q: Why was the data mixed up?
Ans: There was a problem with the manual organization of
the files.
Q: Why is there a problem with the manual organization of
the files?
Ans: Because there are no back-up files and since it was
manually prearranged, inaccuracy is inevitable.