Analysing your System

• Where are the quality problems and which problems should I tackle first?
• Ishikawa / Fishbone / Cause & Effect Diagrams
• Process Mapping
• Five Whys
• Pareto Charts
• Failure Modes & Effects Analysis
• Root Cause Analysis

Analyse Your System:
Where are the Quality Problems and Which Problems Should I Tackle First? 

What problems with the system should I tackle first?  Often in a Quality Improvement (QI) project, there is no shortage of different things that a team will want to try to fix.  Sometimes teams argue about which causes of a problem are the most important.  Others jump into fixing a problem without really thinking through whether or not it is the most important problem to be working on. 

QI science offers a variety of tools to help you decide where the problems with quality are coming from.  This helps you focus your efforts on where to test ideas for improvement.  The table below lists each of these tools, their purpose and pros and cons.  Click on the link for each tool for more information. 


 

Tool	Description	Pros	Cons
Ishikawa / Fishbone / Cause & Effect Diagram	Tool to brainstorm about the main causes of a quality problem, and sub-causes leading to each main cause.	Easy to apply. Essential step for understanding the system.	Does not give data on which causes are most important.
Process Mapping	Plot graphically the sequence of steps needed to provide a health care service. Identify bottlenecks, inconsistencies, poor handoffs, non-value added steps.	A fundamental, “must do” analysis for any quality improvement project. Essential for understanding the system.	If team can’t agree on where the problematic processes are, will need to collect data.
Pareto Chart (using data, e.g. from defect check sheet)	Plot on a bar chart the frequency of different quality problems, with bars ordered from most to least frequent. Focus your efforts on the most frequently occurring problems.	An objective method – gives you hard data to help you select priorities for improvement based on what are the most common problems with quality.	Does not account for the relative severity of consequences of different problems with quality (e.g. rare events leading to death may be higher priority than frequent events with minor side effects).
Failure Modes & Effects Analysis	Brainstorm about all the ways a process can go wrong. For each possible failure, estimate on a scale of 1 to 10 the frequency, severity, and likelihood of catching the failure before it occurs. Multiply these 3 to get a risk priority number (RPN). Focus improvements on preventing failures with highest RPN.	Unlike the Pareto chart, accounts for both frequency and severity of quality problems when setting priorities for improvement. Popular for patient safety projects.	Subjectivity in rating the risk priority number.
Root Cause Analysis	A set of activities aimed at identifying the underlying causes of a critical incident. May incorporate any of the above tools.	Used particularly for examining critical incidents.