The fishbone aka ‘cause and effect diagram’ aka ‘the Ishikawa diagram’. Any of us working in audit, quality and patient safety will be familiar with whatever name we adopt.
For those unfamiliar with the fishbone: 1) where have you been, and 2) it is simply a tried and tested visualisation tool for categorising the potential causes of a problem in order to identify the root causes. Do a quick Google search and you’ll find lots of definitions and videos.
What is interesting is that in 2019… everybody out there is encouraging the use of fishbone diagrams. We have NHS Improvement, NHS Networks, HQIP and lots of individual Trusts, etc. Generating a fishbone diagram is now seen as a pre-requisite in any good root cause analysis (RCA) investigation looking into an error, problem or failure.
The problem is… if you search Google for ‘fishbone + NHS’ you’ll be staggered at how few actual fishbone diagrams you will be able to find. There should be thousands and thousands readily available! Plus, we should be generating whalebones that give us all a head start working out why common errors happen, e.g. patient falls, development of a pressure sore, medication errors, etc.
It is great that the theory is… ‘use a fishbone to understand a problem’, but why are so many fishbones being kept secret and consigned to internal RCA reports? There is a case for the NHS to introduce a Tony Hart style ‘fishbone gallery’ whereby all those using fishbones in whatever capacity then upload these to a central portal so we can all share and learn. Maybe we need to create a fishbone to understand why so few fishbones remain lost in an ocean of wider patient safety paperwork rather than being netted and put on display?
PS Get ready for next week's blog... we are sticking with the fishbone theme as we have created a fishbone that highlights wider failings of national clinical audits. This is based on feedback from our annual survey and local conversations with local audit experts