The Fishbone Diagram

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The page below is a sample from the LabCE course Risk Management in the Clinical Laboratory. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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The Fishbone Diagram

Another tool that can be used when performing a root cause analysis is the cause-and-effect diagram, popularly referred to as the "fishbone diagram" because of its appearance.
Cause-and-Effect (Fishbone) Diagram Example
This type of diagram graphically helps identify and organize known or possible causes for a specific problem or area of concern.
In this theoretical example, the identified problem is a "near miss." Two units of red blood cells were taken to the dialysis area for transfusion of two different patients. The first unit was hung by one clinical person and started just as another clinical person noticed that the unit picked up for transfusing another patient had the wrong identifying information. The blood was stopped immediately on the first patient.
Some of the benefits of constructing a "fishbone diagram" are that it:
  • helps determine root causes using a structured approach.
  • encourages group participation and utilizes group knowledge.
  • indicates possible variations in a process.
  • indicates areas where more data should possibly be collected.