The Fishbone diagram gets its name from its distinctive shape - it looks like the bony shape of a fish. 

Fishbone diagrams allow teams to identify, explore and display all possible causes related to a problem or issue.  They are a great team exercise, getting people talking about what might be sitting behind your area of concern.   They can be used when you start out on your journey, and again as you learn more about your system and what might be making a difference.  They are best done with a group that knows something about the area you are exploring.

Example of a blank Fishbone template (see embedded file at end of article):


Make sure everyone agrees with the problem statement.  This is your starting point.  The rest of the exercise will help you to explore the what, who, how, when of your issue.   

Your central line represents the backbone.  You should now draw on the major headings that you think are important to this issue.  These can either be what you feel are ‘causes’ behind your issue, or steps in the process. Connect them to the backbone of the fish.

There is no perfect set or number of headings to use in your fishbone, and you should allow them to fit the problem and not try to shoe-horn your problem into a set of standard headings.  However, many teams start off with a possible six headings and work from there (see diagram below) - you may find these useful to get the team discussions going. 


You don’t need to use all six, and you may want to change some.  For example, you might want a category for Patients and/or Families.   Skills/Knowledge might fit better than methods. 

Tailor this for your needs.

Some teams prefer to use different parts of a process as their category headings.  This can work really well if you have explored your process using a process map or flow chart and want to get into more detail about how different parts of the process might affect the problem you want to address. 

Once you have agreed your headings and drawn out your fishbone, start to brainstorm your list of ideas.  Use sticky notes to allow you to move the ideas around the diagram until the group is happy with what they have prepared.   You can either add the sticky notes to the category as you go along, or spend time to brainstorm the full list of ideas and then allocate.  Both work - the key thing is to keep the flow of ideas coming.  If you start to focus on individual categories too early, you may find you lose some of this creativity.   

Once you have added some information to each of the ‘bones’ – ask yourself why these things happen.  The ‘5 Whys’ tool may be useful to help structure your conversation, but any conversation to explore what is going on is fine.  This should help you to identify the root causes, or likely root causes sitting behind your problem. This information can be used to help define your aim. 

The fishbone diagram does not need to be ‘pretty’ because it is a working diagram and as you progress your project and learn more, you may wish to add to it.  However, the diagram becomes most useful when you start to put together your driver diagram on Life QI; each of the elements of the fishbone are likely to be drivers that you would include in a driver diagram.  You may also find that thinking about the drivers has also helped you to identify change ideas that the project team can test.  Capture these on your driver diagram as you construct it. 

You can use a template Fishbone diagram here: IA Fishbone Template

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