Cause and Effect (“Fishbone”) Diagram

Definition/Purpose: Graphically displays potential causes of a problem. The layout

shows cause and effect relationships between potential causes. Used in the Analysis
phase.

Instructions: To use as a template, please save a copy by clicking on the save icon.
1. Place the effect or problem statement on the right side of the paper, half-way
down; draw a horizontal line across the paper with an arrow pointing to the effect
or problem statement.
2. Determine general, major categories for the causes; connect them to the horizontal
line with the diagonal lines.
a. Use five inputs of every process:
 Persons
 Environment
 Method of Delivery
 Electronic Records
 Other Factors
3. Note the major causes and place them under the general categories. Use
brainstorming techniques as needed.
4. List sub-causes and place them under the main causes. To determine sub-causes,
ask why five times.
5. Evaluate the diagram. Check that the branches on your cause-and-effect diagram
are worded as possible causes and are arranged in a logical sequence.

Effective Use:
1. Have a narrowly defined problem or effect to start.
2. Causes on the diagram must be verified with data to confirm that they are real
causes.
3. Do not use this tool as an alternative form of outlining.
4. Do not use this tool to list potential solutions.

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 Cause and Effect (“Fishbone”) Diagram

Persons Method of Delivery Environment

Clinical Instructor This was Chaotic

performed outside
of hospital policy

Assigned Unit Clinical instructor Busy

Nurse was not present,
the nurse forced
student to do it.
Nurses on the unit
Student Nurse Act performed out under pressure to
of convenience administer meds
on time Double dose
the student noticed given and
was given orange improper
Student nurse that the night shift
juice and documentation
noted no record of nurse had
breakfast, and was
insulin coverage retroactively
monitored for
charted prior to charted the
signs and
med admin time of medication The client’s blood
symptoms of
insulin administration of sugar was checked
hypoglycemia
two units of 30 and 60 minutes
regular insulin for Client was after the insulin
0700 notified of the was administered.
The nursing mistake. Incident The blood glucose
program’s report was levels were found
medication completed under to be within
administration the supervision of normal limits.
policy required the staff nurse
students to check
with the clinical Electronic Records Other Factors
instructor that the
dose
, medication,
client, time, and
route were
correct prior to
administration.

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