What a fishbone can do for your patients?

Inpatients not getting the medicines on time or discharged patients waiting for hours before they can leave the room..Not uncommon you would say and you could even list a hundred other things that dont work in your hospital or clinic. So what does a fishbone have to do with getting it right? Lots i would say..it could be the key to rallying everyone to work on this problem and getting to the bottom of the problem. So what i am talking about? Well if you havent worked much in quality improvement, you may not have heard of it. If you have worked in quality improvement, it is probable that you have used it but you could still be underestimating the power of the fishbone diagram. Before i sound like a preacher extoling the power of an image, let me try to explain what it is and what i can do? Well it is a diagramtic representation (in the form of a fishbone) of all the possible causes for a particular problem. Here is an example ..

But what is most important is the way it is created and that is where quality improvement workers can go wrong. The power of the fishbone does not lie in merely listing out the reasons and giving direction to the efforts of the project team. The real power, when this tool is used properly lies in bringing together people from disparate parts of the organization to come together and focus on a problem they knew was happening (and often blamed the other divisons or departments for). And now they see that the cause of the problem is spread all over and there is something that each one can do about it..