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Quality & Patient Safety -College of Medicine
UF Health<br />

Cause-and-Effect Diagrams

At a Glance

A cause-and-effect diagram helps healthcare teams uncover root causes, organize contributing factors and guide collaborative problem-solving to drive meaningful quality and patient safety improvements.

On This Page You Will:

  • Describe the purpose and structure of a cause-and-effect diagram in quality improvement.
  • Understand how the diagram supports root cause analysis by organizing potential contributing factors into categories.

What is a Cause-and-Effect Diagram?

A cause-and-effect, fishbone or Ishikawa diagram is a structured approach to identify and analyze the potential root causes of a specific problem. It is an essential tool for quality improvement and patient safety initiatives that helps healthcare teams focus on underlying issues rather than surface symptoms to pinpoint areas for improvement.

Often used as part of a Root Cause Analysis process, the cause and effect diagram resembles a fish skeleton (hence fishbone diagram), with the “head” representing the problem or effect and the “bones” representing the causes grouped in categories.

Stylized Ishikawa fishbone diagram illustrating a quality improvement process. A central fish spine connects to four curved bones, each labeled as a category (01–04), with smaller text elements indicating contributing factors (labeled "Lorem Ipsum") branching above and below each category. The head of the fish represents the effect or outcome, with a large eye and a pointed mouth. The overall design is clean and modern with a gray base fish and varying shades of blue for the bones.

Completing a cause and effect diagram in the improvement process:

  • Encourages diverse collaborations for a comprehensive analysis.
  • Promotes systematic thinking by organizing causes into meaningful categories.
  • Supports proactive problem-solving, focusing on identifying root causes rather than symptoms or placing blame.

Creating a Cause-and-Effect Diagram

  1. Define the Problem (Effect): Clearly articulate the issue to the right at the “head” of the diagram.
  2. Identify Major Categories: Group causes into broad categories.
    • Often used categories include:
      • Manpower (labor)
      • Method (care delivery)
      • Machine (including facilities, tools, systems, and equipment)
      • Materials (items and physical resources use for delivering care)
      • Mother Nature (external environmental factors)
      • Measurement (Data, metrics, and inspections)
  3. Brainstorm Causes: Collaborate with your team to identify possible factors within each category.
  4. Analyze and Prioritize: Highlight the most significant causes and prioritize them for action.
  5. Validate Findings: Verify with data or observations to ensure accuracy.

Resources

The Fishbone Diagram

In this brief video, Dr. Katharina Busl explains essential features of the Fishbone Diagram. This video is excerpted from the free CME course, Implementing a Change.

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