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Identifying and understanding the issue


Are you unsure what you want to specifically change or improve? Are you wanting to implement the latest evidence based best practice? Or you know the area that you want to work on, but need some help deciding where to focus first? Or maybe you know what to work on but you are still considering what approach to take and how to develop you team along with who are to be involved? 


This section will help you think through these questions. Please click on the buttons below to access tools, videos and information related to the tool you need to start thinking through these issues.

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Pareto charts

A Pareto chart is a type of bar chart in which the various factors that contribute to an overall effect are arranged in order according to the magnitude of their effect. This ordering helps identify the "vital few" — the factors that warrant the most attention.

Using a Pareto chart helps a team concentrate its efforts on the factors that have the greatest impact. It also helps a team communicate the rationale for focusing on certain areas.

Fishbone diagrams

A cause and effect diagram, also known as an Ishikawa or "fishbone" diagram, is a graphic tool used to explore and display the possible causes of a certain effect. 

A cause and effect diagram has a variety of benefits:

  • It helps teams understand that there are many causes that contribute to an effect.

  • It graphically displays the relationship of the causes to the effect and to each other.

  • It helps to identify areas for improvement.

5 Why's

One way to identify the root cause of a problem is to ask “Why?” five times. When a problem presents itself, ask “Why did this happen?” Then, don’t stop at the answer to this first question. Ask “Why?” again and again until you reach the root cause.

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Data collection 

Data collection planning is a process to ensure that the data you collect for performance improvement are useful and reliable, without being unnecessarily costly and time-consuming to obtain.


Simple data collection planning has a variety of benefits:

  • It helps to ensure that the data gathered contain real information, useful to the improvement effort.

  • It prevents errors that commonly occur in the data collection process.

  • It saves time and money that otherwise might be spent on repeated or failed attempts to collect useful data.


Spaghetti and measles diagram

The Spaghetti Diagram is a tool to help you establish the optimum layout for a department or ward based on observations of the distances travelled by patients, staff or products, e.g. x-rays.

The spaghetti diagram is useful when you want to assess time wasted through unnecessary movement through a ward, clinic, department or whole hospital.

A Measles diagram is a defect location check sheet (also known as a defect map or a measles chart), it is a structured way of collecting and analysing data that provides a visual image of the item being evaluated, so that data can be collected visually rather than merely collecting a count of the number of defects.

A measles chart can be useful to track where incidents are happening e.g. slippages in a kitchen.


Process Mapping

Process maps serve as means to document and communicate business processes, which are often found in training, maintenance, technical and quality manuals. A process map is an important tool in improvement and it is a tool that visually describes the system you are looking at; the flow of work, exposing any areas of waste (TIM WOODS). They are used to find ways to simplify, streamline, or redesign processes, by understanding and controlling the inputs, it is possible to reduce variation within the process which will lead to continuous process improvement. Process maps show a series of events that produce an end result.

There are several different types of process maps:

  • Process flow maps

  • Swim lane diagrams

  • Value stream mapping

  • SIPOC (Supplier Inputs Processes Outputs Customer)

  • Spaghetti Diagram.

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