[background music] [Text on screen QI HUB Presents: Fishbone Diagram THE OHIO STATE UNIVERSITY COLLEGE OF MEDICINE THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER] [Image on screen A map of Ohio highlighting the QI Hub network and its connected locations across the state.] Narrator: When dealing with a difficult problem, it can be challenging to identify the source of the issues and understand why they are happening. [Text on screen Problem Source] [Image on screen A speech bubble with the word problem connected to a complex circle of loops titled source] This is often because in real world scenarios involving people and complex systems, problems are seldom the result of a single root cause. [Text on screen + Single root cause] [Image on screen Image A) A group of people Image B) A diagram of a complex gear system Image C) The word single root cause is crossed out] Much like a tree with many branching roots under the surface, each issue is interconnected with various factors feeding into one another, making it difficult to pinpoint one simple explanation. [Text on screen People Equipement Processes Medications Difficult to pinpoint one simple explanation] [Image on screen A png of tree roots] Solving these challenges demands a holistic approach where each branch is examined and the underlying connections are carefully untangled. [Text on screen Possible Root Causes: People Processes Equipment Medications] In many cases, teams may find that they need a more robust approach to finding possible root causes. [Text on screen Need a more robust approach to finding root causes] [Image on screen A large black arrow head connects the root causes to the explanation] One approach is using a fish bone tool, also known as an Ishikawa or cause and effect diagram. [Text on screen Fishbone diagram (Ishikawa or cause-and-effect] [Image on screen A fishbone diagram is drawn with each of the root causes at one branch] This tool helps to guide and document a brainstorming session around root reasons or causes to a problem. [Text on screen Potential root causes Potential root causes Problem] [Image on screen Arrows point to the potential root causes on the top and bottom of the fishbone. The word problem is at the head of the diagram] It is a structured tool for thinking through multiple areas that are part of the process or system. A fish bone diagram helps to break down complex issues into smaller manageable components by visualizing the relationships between a problem and its multiple potential causes. [Text on screen Fishbone Diagram • Structured tool • Break down complex issues into smaller, manageable components • Visualize relationships between a problem and potential causes] Let's discuss an example. Your hospital team has noticed an increase in medication errors affecting patient safety. [Video on screen An animation of a group of people talking zooming into a speak bubble stating "medication errors". In the speech bubble there is an arrow indicating a rise in errors and some pills. The words "patient safety" also appear.] You decide to create a fish bone diagram to visualize the process. [Video on screen An animation returning to the group of people with a text bubble appearing from one of the people.] [Text on screen Fishbone Diagram] You start by drawing a horizontal arrow pointing towards an empty circle. [Text on screen Fishbone Diagram Problem] [Image on screen A horizontal arrow pointing to a circle with the word problem in it] In the empty circle, your team writes a statement that describes the problem to focus on. The problem is that there is an increase in medication errors. [Text on screen Increase in medication errors] Next, you will start to list common issues. [Text on screen List common issues] One approach is to brainstorm a list of issues and then determine which categories they best fit within. [Image on screen A vertical line splits the screen. A text bubble appears on the left half] [Text on screen Management Policies Procedures Staffing] Another approach is to select some initial categories that might be related to the problem and use those categories to start to brainstorm. [Text on screen Medications- drug labels packaging Environment- workspace distractions Management- policies staffing] [Image on screen A text bubble appears on the right hand of the screen] When brainstorming, it can be helpful to look at the existing literature. [Text on screen When brainstorming, can be helpful to look at the existing literature.] [Image on screen A png of an open book] Some commonly used categories include methods, equipment, people, materials, communication, the environment, and many more. [Text on screen Categories Methods Equipment People Materials Communication Environment ...many more] The categories will vary depending on the context in which the problem exists, and you can add more categories if needed. [Text on screen Categories • Vary depending on context •Add more categories if needed] Often, you will see this tool with 6 categories, but sometimes there could be less or more, depending on the situation. [Video on screen An animation of the fishbone diagram adding categories and removing categories, returning to having none.] Once your team has chosen the categories, those become branches off the horizontal line. [Image on screen The fishbone diagram grows four branches] Your team decides on the following categories, people, medications, environment, management. [Text on screen People Medications Environment Management] [Video on screen The words are separated on to different branches] Next, your team brainstorms the possible causes of the problem by asking, why does this happen? [Video on screen An image of a group of people returns with another person asking the question "why does this happen". The final group member states "we could use the 5 why's exercise"] [Text on screen Why does this happen? We could use the 5 Why's exercise] The 5 Whys exercise may help your team brainstorm at this stage. [Text on screen Possible causes Packaging Drug labeling Distractions Workspace policies] As your team begins determining possible causes, you place them in the category they are most related to. [Text on screen People Medications Drug labeling packaging Environment Workspace Distractions Management Policies] It is quite common for a cause to belong to multiple categories, so it's OK if a cause is written in multiple groupings. [Text on screen Staffing issues Staffing issues] [Video on screen The word "staffing issues" are added to the groups of "people" and "management"] Your team lists the following causes. For people, staff fatigue, lack of knowledge on new systems, for medications, drug names that look and sound alike, mislabeled drugs. [Video on screen The fishbone diagram reappears. The different concerns are added respectively.] [Text on screen People - Staff fatigue - Lack of knowledge on new systems Medications -similar drug names - Mislabeled drugs Environment - High noise - cluttered med storage Management -Understanding 0Lack of clear error-reporting system] This process of listing causes would continue for each category. Now that you have written down several causes, your team asks, why do these causes happen? and draw branches from each initial cause to represent these new causes. [Text on screen Why do these causes happen? Recent construction] [Video on screen A branch breaks off from "high noise" and is drawn out for "recent construction"] Your team repeats this process until no new ideas are generated. [Text on screen Repeat until no new ideas] [Image on screen A replay arrow] Now that your team has completed this step, you analyze these causes and offer possible solutions. [Text on screen Causes -> solutions] [Video on screen The fishbone diagram grays out while the text of the problems remains opaque] It can be especially important and helpful to look to the literature during this stage. [text on screen Important and helpful to look at literature] [Image on screen A png of an open book] Using the fishbone diagram, your team was able to identify key factors contributing to the complex problem of medication errors. [Video on screen The animation of a group of people reappears. At the top of the screen the fishbone diagram appears] This visual exercise gives teams a robust, structured approach to better understanding the organization's processes and the problems within them that lead to inefficiencies. [Text on screen Fishbone Diagram • Gives teams a robust, structured approach • Better understanding organization's processes and problems that lead to inefficiencies] [background music] [Video on screen QI Hub logo appears] [Text on screen Thank you! Scan the QR code for references and resources. The Ohio State University College of Medicine The Ohio State University Wexner Medical Center] [Image on screen a QR code links to: https://go.osu.edu/qihub]