Table 1.

Tools used in root cause analysis and when to use them

ToolWhen to UseBenefitsLimitations
Fishbone/Ishikawa/cause and effect diagramsTo brainstorm about the main causes of a quality of care outcomes/problem and the subcauses leading to each main causeVisually displays potential root causes and allows for easy analysis; helps engage team members in an in-depth discussion of the problem, which educates the whole team; prioritizes additional analysis and helps you take corrective actionIt does not single out the root cause of the problem, because all causes look equally important; it may identify causes that have little effect on the problem; it is on the basis of opinion rather than evidence
Process mappingTo understand all of the different steps and improvement opportunities that take place in a complicated systemProvides the opportunity to bring together multidisciplinary teams and create a culture of ownership, responsibility, and accountability; provides an overview of the complete process, helping staff to understand, often for the first time, how complicated the system is; acts as an aid to help plan effectively where to test ideas for improvements that are likely to have the most effect on the improvement aims; provides an end product, a process map that is easy to understand and highly visualInefficient if selecting a process that is not a priority to most of the team; need all stakeholders to be present when creating the process map; therefore, it is labor intensive and requires many resources
Pareto chartsTo visualize which causes represent the two or three most common causes of the quality of care problem/outcome; a Pareto chart uses actual data to identify root causes, which can then be addressed with change ideasBreaks big problem into smaller pieces; identifies most significant factors contributing to a problem/outcome; shows where to focus improvement efforts; allows better use of limited resources by focusing on the main contributors of a problemThe most common causes of problems/outcomes identified by Pareto charts may not be amenable to fixing; requires accurate identification of causes of problems/outcomes via Ishikawa diagrams