Draw a horizontal line across the page to the left, starting at the box you just drew. Decide on five or six categories of causes for the effect. The standard categories in a classic cause and effect diagram are Materials, Methods, Equipment, Environm

TOOLKIT: Cause and Effect Diagram Institute for Healthcare Improvement ∙ ihi.org Instructions

1. Write the effect you wish to influence in a box on the right-hand side of the page.
2. Draw a horizontal line across the page to the left, starting at the box you just drew.
3. Decide on five or six categories of causes for the effect. The standard categories in a classic cause and effect diagram are Materials, Methods, Equipment, Environment, and People.
4. Draw diagonal lines above and below the horizontal line to create “fishbones,” and label each line at the end with one of the categories you have chosen. Draw a box around each label.
5. For each category, generate a list of the causes that contribute to the effect. List the causes by drawing “branch bones.” As necessary, draw additional branch bones from the causes to show sub-causes. o Tip: Develop the causes by asking “Why?” until you have reached a useful level of detail — that is, when the cause is specific enough to be able to test a change and measure its effects.
6. Write the effect you wish to influence in a box on the right-hand side of the page.
7. Draw a horizontal line across the page to the left, starting at the box you just drew.
8. Decide on five or six categories of causes for the effect. The standard categories in a classic cause and effect diagram are Materials, Methods, Equipment, Environment, and People.
9. Draw diagonal lines above and below the horizontal line to create “fishbones,” and label each line at the end with one of the categories you have chosen. Draw a box around each label.
10. For each category, generate a list of the causes that contribute to the effect. List the causes by drawing “branch bones.” As necessary, draw additional branch bones from the causes to show sub-causes. o Tip: Develop the causes by asking “Why?” until you have reached a useful level of detail — that is, when the cause is specific enough to be able to test a change and measure its effects.