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How to benefit from a Fishbone or Ishikawa Diagram for Root Cause Analysis


 What is root cause analysis?

Root cause analysis is a structured process that helps healthcare, manufacturing and service sector managers and leaders in identifying contributing factors or causes of an accident, error, problem, event or occurrence.
An accident, error, problem, event or occurrence are usually a result of a system rather than an individual mistakes. Understanding the system itself and contributing factors or causes of a system failure can help in preventing recurrences.
Actions that are taken to address system failure helps in sustaining the improvements or corrective actions.

What is a fishbone or ishikawa diagram?

Each and every outcome or effect is an end result of actions taken/omitted or in general causes/
A cause and effect diagram representing this relationship between cause and effect is called a called a fishbone or ishikawa diagram.
A fishbone diagram is a visual way to represent cause and effect. It is a more structured approach for brainstorming causes of a problem.
Fishbone or ishikawa diagram can be described as a risk visualizer!

How do you create a fishbone or ishikawa diagram?

In order to understand the underlying causes of an incident, one needs to understand the process or system used to obtain the results or outcomes.
Often in a busy healthcare or manufacturing setting it is not possible to take large chunk of time to review each and every minute details of a work process to find a cause or contributing factors. This is when the fishbone can be created with the help from frontline staff and experts using  a simple brainstorming session to identify possible causes.
To create a fishbone, the problem/occurrence or effect is displayed at the right hand side of the diagram as a head or mouth of the fish.
The team brainstorms the possible contributing factors. Typically these contributing factors can be naturally grouped into certain categories or headings - known as "bones"  or primary causal categories.
A fishbone diagram can be helpful in identifying possible causes for a problem that might not otherwise be considered by directing the team to look at the categories and think of alternative causes. Include team members who have personal knowledge of the processes and systems involved in the problem or event to be investigated.

How have you used root cause analysis? 

There are many ways to conduct root cause analysis. Which root cause analysis method is your favorite?  Please comment below or join the conversation on LinkedIn. I have used the fishbone / root cause analysis process in analyzing risks and evaluating risk controls. If your ERM program is stuck in neutral and needs a boost to get moving again, contact me to discuss how you can get a tailored action plan to achieve your ERM goals. We would also love you to trial our FREE fishbone tool! visit us at


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