To ensure an effective QI system, we shall incorporate the following steps in it (Colton, 2000): (a) define quality by the internal and external customer, (b) evaluate the process systematically and identify any variation, (c) improve the process throughout the life cycle of the service or product, (d) continuously monitor the service or process, (e) use indicators to compare the service and production to norms, and (f) lead and commit to this process by top management. For simplicity, we are calling the paradigm as “quality improvement” (QI) Assuring quality by rejecting the “bad apple” is gradually overtaken by a paradigm called “continuous quality improvement” (CQI)Įmphasising proactive measures to build quality into the product, service, and process and “do it right the first time”. Quality assurance personnel are trained to inspect and detect “bad apples” and reject them. In those days, quality by inspection, which was rightly called “Theory of Bad Apples”īy Berwick ( 1989), pervaded the engineering industry. In the early days, Ishikawa diagram was mainly used in the engineering industry to investigate for root causes for defects or failures of products detected by quality assurance personnel. the head of the fish is the “effect” and the bones represent potential causes (see Fig. This diagram is also known as fishbone diagramīecause it looks like the skeleton of a fish, i.e. ” or “Ishikawa diagram” named after Professor Kaoru Ishikawa of Tokyo University, a highly respected Japanese expert in quality management who introduced this methodology in 1940s (Ishikawa & Loftus, 1990). This method of analysis is known as “cause and effect analysis” which will result in a “cause and effect (CE) diagram Simplistically, problem in one or more of the above factors can lead to Simon’s absence which is called the “effect”. We will get back to this process of gathering information later. Eric may need to gather more information from several parties including talking to his son and school teachers in order to find out the actual cause. The potential causes may involve several factors such as social, behavioural, facilities, and school environment. The above scenario entails a root cause analysis to find out why Simon was absent from school. Many potential causes rattled through his head: sickness, behavioural problem (truancy), bullying at school, transportation problem, and conflict with school teacher. Eric was a single parent after a divorce. He was upset and anxious and would like to find out the causes for Simon’s absence. I wish to find out how he is doing,” said Mike courteously.Įric was unaware of his 17-year-old son’s absence from school. “Your son, Simon, was absent from school for the past three days. This process is experimental and the keywords may be updated as the learning algorithm improves. These keywords were added by machine and not by the authors. The success in establishing and implementing an Ishikawa diagram entails amalgamation of skills in science and art. With skill and experience, a practitioner can apply Ishikawa diagram in a three dimensional way in which the third dimension is the intertwining of the various potential causes criss-crossing each other. It can also be applied creatively to interlink a series of timeline events. The processes in gathering and organizing the potential causes may include identifying the barriers, facilitators and incentives for a behaviour, reviewing literatures, analysing flow charts, conducting failure mode and effect analysis (FMEA), surveying, interviewing, brain storming, conducting focus group discussion, and applying problem driven iterative adaptation (PDIA) approach. It provides a structured and systematic approach to identify and collate potential causes for an effect. Ishikawa diagram can be applied in clinical fields and mental/ behavioural health proactively.
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