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Fishbone Diagram
The one QI tool that resonated with me is the use of the fishbone or cause and effect

diagram. It provides a visual tool for individuals and team members to focus on the problem

rather than focusing on the symptoms. The advantages of using this tool is that it helps teams

understand that there are many causes that contribute to an effect, it identifies areas for

improvement and as mentioned before it visually displays the relationship of the causes to the

effect and to each other. The limitations of using this method is that the visual representation is a

structured way of expressing a hypotheses and not real facts and hence means that these

hypotheses need to be tested.

This tool can be used to test various situations in a health care setting, for example I used

this tool to further understand the hypothetical causes of why prescriptions may be dispensed

with the wrong medication (looking only at the filling process). With just 3 relationships

(process, technician, pharmacist) the diagram identifies potential issues that may lead to a misfill

and also does not include all potential relationships.

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References:

Fishbone Diagram (Cause and Effect Diagram) - Minnesota Dept. of Health. (n.d.). Retrieved

October 11, 2017, from http://www.health.state.mn.us/divs/opi/qi/toolbox/fishbone.html

Cause-and-Effect Analysis. (2004, March 02). Retrieved October 11, 2017, from

https://www.usaidassist.org/resources/cause-and-effect-analysis