Next: The team performed the root cause analysis to find the causes of problems in workflow by using fishbone analysis and the Five Whys - Strategies:
- The team agreed on a problem statement: the pre-examination phase of workflow (PPW) needs improvement.
- The team leader drew a line across the center of the whiteboard from left to right and wrote the problem statement at the end of the line.
- The team identified the primary categories (steps for PPW) above and below the line in sequential order and the leader put lines from the categories to the main arrow (see first image).
- Subcategories pertaining to each main category were identified by the group. The leader then attached them to the lines going from the main categories to the main arrow (see second image).
- The team then brainstormed each category and subcategory to determine what if any problems exist and if improvements can be made. The ideas for each category and subcategory were put on a separate whiteboard next to the whiteboard with the fishbone figure.
- The team then using the Five Whys asked, "Why is this problem occurring?" They also looked for improvement ideas for each category. They then asked, "Can they be implemented and how?"
- Once the problems (causes) and or improvements were identified the group brainstormed solutions and followed up by prioritizing the best to least effective.
Although this process can be cumbersome and time-consuming it has the advantage of finding good solutions and creating buy-in because of the broad representation on the team. Because of limited time in most medical environments, the planners might want to do this process through several sessions looking at only one or two categories per session.
