Cause & Effect Diagram

Cooper White, MDJen Powell, QI Consultant

Cause & Effect Diagram

• A graphic tool used when you need to identify and explore and display the possible causes of a specific problem or condition.

• Developed to represent the relationship between some “effect and all the possible “causes” influencing it.

• The effect or problem is stated on the right side of the chart and the major influences or ‘causes’ listed to the left

• Causes might be summarized under the categories of Materials, Methods, Equipment, Environment, Leadership and People

Source : IHI Process Analysis Tools, Cause and Effect Diagram, the Memory Jogger Plus, 1996, GOAL/QPC

Benefits to QI Teams

A cause and effect has these benefits:• It helps teams understand that there are many

causes that contribute to an effect• It graphically displays the relationship of the

causes to the effect and to each other• It helps to identify areas for improvement

Source: IHI Process Analysis Tools, Cause and Effect Diagram

Directions: Cause and Effect Diagram

• Find on-line template @ http://www.isixsigma.com/tools-templates/cause-effect/cause-and-effect-aka-fishbone-diagram/ (word and excel formats)

• Draw a diagram using the IHI Handout instructions, posted on the CQN website under QI Tools or on the IHI website @ http://www.ihi.org/search/pages/results.aspx?k=fishbone%20diagram

Cooper White's PracticeCause and Effect Diagram

staff turnover amount of vigilance: asthma data review each 6 mo level of attention at any given time

for OPPE patient literacy issues conduct daily huddles; spirometry patients identified

Cause lack of systematic Causereminders of importance Question overload for parents with staff/clinicians MD level of commitment variable

(more resistance from PT MD's) new hire orientation does not include asthma and EF

Cause busy days: staff tend to forgetsense that the 'numbers remain good'

EMR: no differentiation Outcome data displayed, in screen color

but not consistently and not monthly for asthmatics(no flag)

EF placed on clipboard with pensCause in each exam (but not a trigger)

Cause database requires more

work to extract the data MA hands out EF when identified Cause using EMR generated med list

Effect:Use of Encounter Form at 60%-- (Goal is 100%)

Leadership/Environment People

Method

Measurement Equipment Material

Cause

Cause

Cause

Cause

Cause

Cause

Cause

Cause

Cause