Dr. Kaoru Ishikawa,A Japanese quality control expert has invented the fishbone diagram to help employees.To avoid solutions that hardly address the symptoms of a much larger problem.


A fishbone diagram, also called a cause and effect diagram or Ishikawa diagram.it is a visualization tool for capturing the causes of a problem in order to identify its root causes.


  • A fishbone diagram is useful in brainstorming sessions to focus conversation between facilitator and focus group.
  • After the group has brainstormed all the possible causes for a problem,
  • the facilitator helps the group to rate the causes according to their level of importance and diagram a hierarchy.
  • The design of the diagram looks like a skeleton of a fish.
  • Fishbone diagrams are typically worked right to left, with each large “bone” of the fish branching out to include smaller bones containing more detail.

How To Create A Fish Diagram

  • Create a head, which lists the effects, problem or issue to be studied.
  • Create a backbone for the fish, straight line which leads to the head.
  • Identify at causes that contribute to the problem. Connect these causes with arrows to the spine. These will create the first bones of the fish.
  • This cause could be as follow
  1. people
  2. process
  3. machine
  4. material
  5. environment


  • Brainstorm around each cause to document those things that contributed to the cause. Use the 5 Whys or another questioning process to keep the conversation focused.
  • Continue breaking down each cause until the root causes have been identified.


Here is another example to understand root causes for a long waiting time in a hospital

sample fd

Five important points you need to understand before dealing into root cause analysis using fishbone diagram in healthcare industry

  1. Visual diagram always gives an edge in analyzing clinical problems.
  2. More number of healthcare professionals are using fishbone diagram to analyze their problems.
  3. It is advisable to appoint a group moderator or facilitator while doing the brainstorming sessions.
  4. Having a moderator helps to avoid digressive discussions and to bring the group together to identify action items.
  5. Discussing the causes in a detailed way helps the organization to identify modern solutions which you haven’t considered earlier.
  6. Being open towards root cause analysis helps to identify the actual root cause and the relationship with it to the effect in turn to identify an effective solution.


About K.Bhavani Prasad

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