The Diagram

Concept of Fish Bone Diagram

A fishbone diagram enables the team members to visually diagram the root cause
and effects of a problem rather than concentrating only on the symptoms. In other
words fish bone diagram is a discovery tool that reveals the cause and effect which
enables to rule out the reasons for various defects or failures in a system.

Steps

1. Prepare a problem statement. Here the problem statement is A patient feels
(s)he received false laboratory report. Place the problem statement on the
right side of the paper at the head end of the fish. Then a line with an arrow
needs to be drawn towards the head of the fish which is called as the fish's
backbone.
2. Categorization is the next step. Brainstorm the categories involved in the
procedure. These needs to be connected to the backbone and are referred to
as ribs. For example in the sample collection and lab investigation scenario
possible categories are client, process, staff/lab professional/technician,
environment, method, supplies etc.
3. Identify the contributing factors. Find out the problem causes and attach
them to the appropriate ribs. For example under the category technician/lab
professional the following causes can be attached: lack of expertise, staff
shortage, burnout.
4. Ask why. Which means when a factor is listed identify why that factor is
present. For example staff lack expertise may be due to lack of proper
training,  why don't they attend training (due to lack of funds) etc.
5. Continue to push deeper for better understanding and creating mini ribs if
necessary.
6. Test for the root cause. It is the one which appears repeatedly within the
categories
7. Possible categories for generating a fish bone diagram in association with
false lab value received by a client are client, process, staff, environment,
method and supplies. Client factors that may affect the response are lack of
knowledge regarding the test performed, lack of knowledge regarding the
disease condition, lab values and its normal range as well as the clients fear
and anxiety regarding diagnosis of a critical or unexpected condition.
Contributing factors related to process are lack of a proper written procedure
that is communicated among the staff, incorrect patient information collected
which may lead to generation of results to the wrong individual. Staff factors
related to false results may be lack of expertise and skills related to lack of
proper training, lack of confidence, lack of experience etc, shortage of staff
and burnout syndrome due to heavy workload. Environmental factors
contributing to the mistake may be workload and burnout. In addition to it
less staff friendly atmosphere can also cause lack of interest in work and
associated errors. Methods followed in the lab can also be a factor which
includes changes in the reference values and faulty techniques followed
while executing a procedure. Related to supplies due to lack of funds
supplies may be deficient, inadequate utilization of necessary resources as
well as failure of equipment may also contribute to errors.