QI Tools Root Cause Analysis - Iowa Department of Public Health

QI ToolsRoot Cause AnalysisShaela Meister, MPAIowa Department of Public Health

• Problem Solving• Treating the Symptom vs. Treating theCause• Symptom – sign or indication• Cause – what actually makes somethinghappenRoot Cause Analysis

• Addressing the symptom instead of thecause leads to a temporary or partial fix• Problem will occur again• Can create more problems unintentionally• Address the problem at its cause(s) ismore efficient and effective“Avoid the bandaid approach!”Root Cause Analysis

• Identifies & categorizes issues• Organizes ideas• Shows relationships• Reveals potential problems• Facilitates process understanding• Easy to use• Useful reporting toolBenefits

• Fishbone Diagram• Cause and Effect Diagram• Ishikawa DiagramQI Tool

• Why use a fishbone diagram?◦ To allow a team to identify, explore, andgraphically display – increasing detail – all ofthe possible causes related to a problem orcondition to discover its root cause(s).• What does it do?◦ Enable a team to focus on the content of theproblem versus the history of the problem orpersonal interests of the team.◦ Creates a snapshot of the collective knowledgeand consensus of a team around a problem◦ Focuses the team on causes, not symptoms.Fishbone Diagram

Fishbone Diagram

• Construct your problem statement on theright-hand side within your “fish head”• This problem statement is known as theeffect• An arrow or “fish spine” should pointtowards the problem statementFishbone – Problem Statement

Fishbone – Problem Statement

• Decide what your main causes of theproblem are• Use these as the headers• Arrows should connect the headers to thespine• Examples of headers:◦ Manpower, Machinery, Materials, Methods(4 M’s)◦ People, Plant, Procedures, Policies◦ Lifestyle, Environment, FormsFishbone – Major Causes

Fishbone – Major Causes

• Use the 5 whys• Continuing to ask why can help ensurethat you don’t focus on “low hanging fruit”• Symptoms may returnFishbone – Sub-Causes

Fishbone – Sub-Causes

Highest-Level Cause – ROOT CAUSEHigher-Level CauseFirst-Level CauseVisible ProblemSymptomsFishbone – 5 Why’s Technique

Fishbone – Detailing 5 Why’s

• It is an easy exercise to use and apply• Helps you avoid the low-hanging fruit• Can help you find the root causeFishbone – 5 Why’s Advantage

• The 5 Why’s may not lead to a root causeidentification when the cause is ultimatelyunknown• The problem may have more than onecause• The 5 Why’s method is dependent uponthe skill level of how it is applied to theanalysis• The method is not necessarily repeatable• It has difficulty distinguishing betweencausal factors and root causesFishbone – 5 Why’s Limitations

• Choose the items you want to focus on◦ Looks for causes that repeat within the majorcategories◦ Choose causes that the team can control orinfluence◦ Select through consensus◦ May need to use other tools suchas check forms or surveys andother data collectionRoot Cause Analysis – Next Steps

Root Cause Analysis Rating Form

Root Cause Analysis Rating Form

Root Cause Analysis Rating Form

• Things to remember◦ Work on the cause – NOT the symptoms orlow-hanging fruit◦ Fishbone diagram is useful for identifying rootcauses◦ Use the 5 why’s◦ The Root Cause Analysis Rating Form can helpdetermine which is the most important causeto work onWrap Up