As long as the discussion keeps going, people are still brainstorming. #3: Keep brainstorming until the ideas run out. People are often unsure of how many causes to identify. A common one is to start with the “People” category, but by the time 10 causes are identified under that category, you may choose to split it, for example as: “Nurses” and “Doctors.” Sometimes a main category can become too big. For example, “front desk is short-staffed” could be placed under the category of People, but also Culture. As a facilitator, remind the participants that listing the cause is more important than where it goes. #2: The cause is more important than the category. People often get confused or stuck on what category a cause should go into. Whereas “front desk is short-staffed” focuses on a potential cause (what to fix).

For example, if the problem is delays at patient check-in, “add front desk personnel” offers a solution (how to fix). Simply acknowledge any comments by writing them to the side (don’t disregard any comments, it’s demoralizing) and help everyone remember the difference between the two. #1: Help the team focus on identifying causes, not solutions. It’s common for people to brainstorm solutions (how to fix), rather than causes (what to fix). Here are the top three tips for leading a successful fishbone: A successful fishbone diagram is led by a facilitator-one individual on the team who’s job is to remain impartial to the discussion, write down the identified causes on the fishbone diagram, and let the participant discussion flow freely.

Ishikawa fishbone diagram template