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Also Called: CauseandEffect Diagram, Ishikawa Diagram

Variations: cause enumeration diagram, process fishbone, timedelay fishbone, CEDAC (causeandeffect diagram with the
addition of cards), desiredresult fishbone, reverse fishbone diagram

The fishbone diagram identifies many possible causes for an effect or problem. It can be used to structure a brainstorming
session. It immediately sorts ideas into useful categories.

When to Use a Fishbone Diagram

When identifying possible causes for a problem.
Especially when a teams thinking tends to fall into ruts.

Fishbone Diagram Procedure

Materials needed: flipchart or whiteboard, marking pens.

1. Agree on a problem statement (effect). Write it at the center right of the flipchart or whiteboard. Draw a box
around it and draw a horizontal arrow running to it.
2. Brainstorm the major categories of causes of the problem. If this is difficult use generic headings:
Methods
Machines (equipment)
People (manpower)
Materials
Measurement
Environment
3. Write the categories of causes as branches from the main arrow.
4. Brainstorm all the possible causes of the problem. Ask: Why does this happen? As each idea is given,
the facilitator writes it as a branch from the appropriate category. Causes can be written in several places if they
relate to several categories.
5. Again ask why does this happen? about each cause. Write subcauses branching off the causes.
Continue to ask Why? and generate deeper levels of causes. Layers of branches indicate causal relationships.
6. When the group runs out of ideas, focus attention to places on the chart where ideas are few.

Fishbone Diagram Example

This fishbone diagram was drawn by a manufacturing team to try to understand the source of periodic iron
contamination. The team used the six generic headings to prompt ideas. Layers of branches show thorough
thinking about the causes of the problem.

Fishbone Diagram Example

 For example, under the heading Machines, the idea materials of construction shows four kinds of equipment
and then several specific machine numbers.

Note that some ideas appear in two different places. Calibration shows up under Methods as a factor in the
analytical procedure, and also under Measurement as a cause of lab error. Iron tools can be considered a
Methods problem when taking samples or a Manpower problem with maintenance personnel.

Excerpted from Nancy R. Tagues The Quality Toolbox, Second Edition, ASQ Quality Press, 2005, pages 247
249.

Create a Fishbone Diagram

Analyze process dispersion with this simple, visual tool. The resulting diagram illustrates the main causes and
subcauses leading to an effect (symptom). Start using the Fishbone tool(Excel, 39 KB).

The Cause and Effect (a.k.a. Fishbone)

Diagram
Kerri Simon 18
When utilizing a team approach to problem solving, there are often many opinions as to the problems root cause.
One way to capture these different ideas and stimulate the teams brainstorming on root causes is the cause and
effect diagram, commonly called a fishbone. The fishbone will help to visually display the many potential causes for a
specific problem or effect. It is particularly useful in a group setting and for situations in which little quantitative data is
available for analysis.

The fishbone has an ancillary benefit as well. Because people by nature often like to get right to determining what to
do about a problem, this can help bring out a more thorough exploration of the issues behind the problem which will
lead to a more robust solution.
 To construct a fishbone, start with stating the problem in the form of a question, such as Why is the help desks
abandon rate so high? Framing it as a why question will help in brainstorming, as each root cause idea should
answer the question. The team should agree on the statement of the problem and then place this question in a box at
the head of the fishbone.

The rest of the fishbone then consists of one line drawn across the page, attached to the problem statement, and
several lines, or bones, coming out vertically from the main line. These branches are labeled with different
categories. The categories you use are up to you to decide. There are a few standard choices:

Service Industries Manufacturing Industries Process Steps

(The 4 Ps) (The 6 Ms) (for example)

Policies Machines Determine Customers

Procedures Methods Advertise Product
People Materials Incent Purchase
Plant/Technology Measurements Sell Product
Mother Nature Ship Product
(Environment) Provide Upgrade
Manpower
(People)
You should feel free to modify the categories for your project and subject matter.

Once you have the fishbone completed, you are well on your way to understanding the root causes of your problem.
It would be advisable to have your team prioritize in some manner the key causes identified on the fishbone. If
necessary, you may also want to validate these prioritized few causes with a larger audience.

Step 1: Identify the Problem

First, write down the exact problem you face. Where appropriate, identify who
is involved, what the problem is, and when and where it occurs.
Then, write the problem in a box on the left-hand side of a large sheet of paper, and
draw a line across the paper horizontally from the box. This arrangement, looking like
the head and spine of a fish, gives you space to develop ideas.

Example:
In this simple example, a manager is having problems with an uncooperative branch
office.

Figure 1 Cause and Effect Analysis Example Step 1

Tip 1:
Some people prefer to write the problem on the right-hand side of the piece
of paper, and develop ideas in the space to the left. Use whichever
approach you feel most comfortable with.

Tip 2:
It's important to define your problem correctly. CATWOE can help you
do this this asks you to look at the problem from the perspective of
Customers, Actors in the process, the Transformation process, the overall
World view, the process Owner, and Environmental constraints.
By considering all of these, you can develop a comprehensive
understanding of the problem.

Step 2: Work Out the Major Factors Involved

Next, identify the factors that may be part of the problem. These may be
systems, equipment, materials, external forces, people involved with the
problem, and so on.

Try to draw out as many of these as possible. As a starting point, you can use
models such as the McKinsey 7S Framework (which offers you Strategy,
Structure, Systems, Shared values, Skills, Style and Staff as factors that you
can consider) or the4Ps of Marketing (which offers Product, Place, Price,
and Promotion as possible factors).
Brainstorm any other factors that may affect the situation.
Then draw a line off the "spine" of the diagram for each factor, and label each
line.
Example:
The manager identifies the following factors, and adds these to his diagram:

Site.
Task.
People

Equipment.
Control.
Figure 2 Cause and Effect Analysis Example Step 2

(Click image to view full size.)

Step 3: Identify Possible Causes

Now, for each of the factors you considered in step 2, brainstorm possible
causes of the problem that may be related to the factor.

Show these possible causes as shorter lines coming off the "bones" of the
diagram. Where a cause is large or complex, then it may be best to break it
down into sub-causes. Show these as lines coming off each cause line.
Example:
For each of the factors he identified in step 2, the manager brainstorms
possible causes of the problem, and adds these to his diagram, as shown in
figure 3.

Figure 3 Cause and Effect Analysis Example Step 3

(Click image to view full size.)

Step 4: Analyze Your Diagram

By this stage you should have a diagram showing all of the possible causes
of the problem that you can think of.

Depending on the complexity and importance of the problem, you can now
investigate the most likely causes further. This may involve setting up
investigations, carrying out surveys, and so on. These will be designed to
test which of these possible causes is actually contributing to the problem.

Example:
The manager has now finished his analysis. If he hadn't looked at the
problem this way, he might have dealt with it by assuming that people in
the branch office were "being difficult."
Instead he thinks that the best approach is to arrange a meeting with the
Branch Manager. This would allow him to brief the manager fully on the
new strategy, and talk through any problems that she may be experiencing.

Tip:
A useful way to use this technique with a team is to write all of the
possible causes of the problem down on sticky notes. You can then group
similar ones together on the diagram.

This approach is sometimes called CEDAC (Cause and Effect Diagram

with Additional Cards) and was developed by Dr. Ryuji Fukuda, a
Japanese expert on continuous improvement.

Key Points
Professor Kaoru Ishikawa created Cause and Effect Analysis in the 1960s.
The technique uses a diagram-based approach for thinking through all of
the possible causes of a problem. This helps you to carry out a thorough
analysis of the situation.

There are four steps to using the tool.

1. Identify the problem.

2. Work out the major factors involved.
3. Identify possible causes.
4. Analyze your diagram.
You'll find this method is particularly useful when you're trying to solve
complicated problems.
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