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Cause-and-Effect Diagram

A cause-and-effect diagram is an analysis tool that provides a systematic way of looking at effects and the
causes that create or contribute to those effects. It was develop by Dr. Kaoru Ishikawa of Japan in 1943 and
is sometimes referred to as an Ishikawa Diagram or a Fishbone Diagram because of its shape.

When should we use a cause-and-effect diagram?

A cause-and-effect diagram is a tool that is useful for identifying and organizing the known or possible
causes of quality, or the lack of it. The structure provided by the diagram helps team members think in a very
systematic way. Some of the benefits of constructing a cause-and-effect diagram are that it:

helps determine the root causes of a problem or quality characteristic using a structured approach;

encourages group participation and utilizes group knowledge of the process;

uses an orderly, easy-to-read format to diagram cause-and-effect relationships;
indicates possible causes of variation in a process;
increases knowledge of the process by helping everyone to learn more about the factors at work and
how they relate; and
identifies areas where data should be collected for further study.

How do we develop a cause-and-effect diagram?

When you develop a cause-and-effect diagram, you are constructing a structured, pictorial display of a list of
causes organized to show their relationship to a specific effect (Viewgraph 1). Notice that the diagram has a
cause side and an effect side.

Steps in constructing and analyzing a cause-and-effect diagram:

Step 1: Identify and clearly define the outcome or EFFECT to be analyzed.
Step 2: Use a chart pack positioned where everyone can see it. Draw the SPINE
and create the EFFECT box.
Step 3: Identify the main CAUSES contributing to the effect being studied.
Step 4: For each major branch, identify other specific factors which may be the
Step 5: Identify increasingly more detailed levels of causes and continue
organizing them under related causes or categories. You can do this by
asking a series of WHY questions.
Step 6: Analyze the diagram.
STEP Identify and clearly define the outcome or EFFECT to be analyzed.


Decide on the effect to be examined. Effects are stated as particular quality characteristics, problems
resulting from work, planning objectives, and the like.

Use operational definitions. Develop an operational definition of the effect to ensure that it is clearly
Remember, an effect may be positive (an objective) or negative (a problem), depending upon the
issue that is being discussed.
o Using a positive effect which focuses on a desired outcome tends to foster pride and
ownership over productive areas. This may lead to an upbeat atmosphere that encourages the
participation of the group. When possible, it is preferable to phrase the effect in positive
o Focusing on a negative effect can sidetrack the team into justifying why the problem occurred
and placing blame. However, it is sometimes easier for a team to focus on what causes a
problem than what causes an excellent outcome. While you should be cautious about the
fallout that can result from focusing on a negative effect, getting a team to concentrate on
things that can go wrong may foster a more relaxed atmosphere which sometimes enhances
group participation.

You must decide which approach will work best with your group.
STEP Use a chart pack positioned where everyone can see it. Draw the
SPINE and create the EFFECT box.

Draw a horizontal arrow pointing to the right. This is the spine.

To the right of the arrow, write a brief description of the effect or outcome which results from the
Example: The EFFECT is late pizza delivery. (Viewgraph 2)

Draw a box around the description of the effect.

STEP Identify the main CAUSES contributing to the effect being studied.
These are the labels for the major branches of your diagram and become categories under which to list the
many causes related to those categories.

Establish the main causes, or categories, under which other possible causes will be listed. You should
use category labels that make sense for the diagram you are creating. Here are some commonly used
3Ms and P Methods, Materials, Machinery, and People
4Ps Policies, Procedures, People, and Plant
Environment - a potentially significant fifth category
Write the main categories your team has selected to the left of the effect box. Draw some above AND
below the spine.
Draw a box around each category label and use a diagonal line to form a branch connecting the box
to the spine.

Example: Viewgraph 3 uses the 3Ms and P to start developing the diagram we began in Step 2.
STEP For each major branch, identify other specific factors which may be
the CAUSES of the EFFECT.
Identify as many causes or factors as possible and attach them as sub-branches of the major branches.
Example: The possible CAUSES for late pizza delivery are listed under the appropriate categories in
Viewgraph 4

Fill in detail for each cause. If a minor cause applies to more than one major cause, list it under both.

STEP Identify increasingly more detailed levels of causes and continue

organizing them under related causes or categories. You can do this
by asking a series of WHY questions.
Example: Well use a series of why questions to fill in the detailed levels for one of the causes listed
under each of the main categories.

What is the reason team members DON'T show



There is no teamwork
Q: Why there is no teamwork?
A: There is no training


Why is there high turnover?


Low pay


Why was the oven too small?


No capacity for peak periods


Poor use of space

Q: Why poor use of space?
A: Poor training


Why was handling of large orders poor?


Lack of experience
Q: Why was experience lack?
A: High turnover


Why was dispatching poor?


Dont know town

Q: Why wasnt the town known?
A: High turnover


Why did the ingredients run out?


Inaccurate ordering
Q: Why was ordering inaccurate?
A: High turnover
A: Poor use of space
Q: Why poor use of space?
A: Lack of training

Viewgraph 5 shows how the diagram looks when all the contributing causes that were identified by the series
of why questions have been filled in. As you can see, there may be many levels of causes contributing to the
NOTE: You may need to break your diagram into smaller diagrams if one branch has too many subbranches. Any main cause (3Ms and P, 4Ps, or a category you have named) can be reworded into an effect.
STEP Analyze the diagram.
Analysis helps you identify causes that warrant further investigation. Since cause-and-effect diagrams
identify only possible causes, you may want to use a pareto chart to help your team determine the cause to
focus on first.

Look at the balance of your diagram, checking for comparable levels of detail for most of the
A thick cluster of items in one area may indicate a need for further study.
A main category having only a few specific causes may indicate a need for further
identification of causes.
o If several major branches have only a few sub-branches, you may need to combine them
under a single category.
Look for causes that appear repeatedly. These may represent root causes.
Look for what you can measure in each cause so you can quantify the effects of any changes you
Most importantly, identify and circle the causes that you can take action on.

Example: Let us analyze the diagram we have been constructing.


The level of detail is pretty well balanced.


The causes poor/no training, high turnover are repeated.

No training and high turnover appears to be the causes for which you could develop
Moreover, no training and high turnover appear to be the causes that you can take action on. It
is circled in Viewgraph 6 to earmark it for further investigation.

Brainstorming is a method used to generate a large number of ideas from a
group of people in a short period of time, without judgment or restriction.

When should we conduct brainstorming?

Brainstorming is useful when you want to generate a large number of ideas
about issues to tackle, possible causes of problems, approaches to use, or
actions to take. Brainstorming helps a team break free of old, ineffective ideas. This free wheeling technique
for generating ideas may produce some that seem half-baked, but it can lead to new and original solutions to
It also:

Encourages creativity
It expands your thinking to include all aspects of a problem or a solution. You can identify a wide
range of options.

Rapidly produces a large number of ideas

By encouraging people to offer whatever ideas come to mind, it helps groups develop many ideas
Equalizes involvement by all team members
It provides a non-judgmental environment that encourages everyone to
offer ideas. All ideas are recorded.
Fosters a sense of ownership
Having all members actively participate in the brainstorming process
fosters a sense of ownership in the topic discussed and in the resulting
activities. When the people in a team contribute personally to the
direction of a decision, they are more likely to support it.
Provides input to other tools
You may want to merge the brainstormed ideas. And, if appropriate, you can work with the team to
reduce the number of ideas by multi-voting.

How do we conduct brainstorming?

For all participants to enjoy a creative and productive brainstorming experience, the facilitator needs to
review and get team members buy-in on the ground rules for the session. These are the rules:

Active participation by all team members. Everyone expresses his or her ideas, even if they seem
silly or fat out.

No criticisms, compliments, or other comments during the brainstorming session.

Build on ideas generated by other team members.
All ideas written exactly as presented and displayed where everyone can
see them.
Set a time limit. Brainstorming should be a rapid generation of ideas, so
do it quickly; 5-10 minutes works well.
Clarify and combine.

After the brainstorm, go over the list to make sure that all team members
understand the ideas. Remember that you are only clarifying the ideas, not
making judgment about them. See whether two or more ideas that appear to be the same can be combined.

Brainstorming Sequence

Review the rules

Review the rules for brainstorming. Describe how the session will be conducted by going over the
points below.

Set a time limit

Set a time limit for brainstorming, assign a timekeeper and data recorder, and start the clock.
Brainstorming should be a rapid generation of ideas so do it quickly; 5-15 minutes works well. If the
time limit has expired and ideas are still being generated, you can extend the time limit at five-minute
State the question
State the topic to be brainstormed in the form of a question. Write it down and post it where everyone
can refer to it. Ensure that everyone understands it.
Collect ideas
Collect everyones ideas. After allowing a few minutes for the participants to think about the
question, ask them to give their ideas. Establish either a structured or unstructured format for calling
out ideas.
o Structured
The facilitator establishes a rotation that enables each person in the group to contribute an
idea in turn. Any individual who is not ready with an idea when his or her turn comes can pass
until the next round, when he or she may offer an idea or pass gain.
o Unstructured
Team members call out ideas as they come to mind. This method calls for close monitoring by
the facilitator to enforce the ground rules and ensure that all team members have a chance to
Record and display ideas
Record ideas on a chart pack as they are called out, or collect ideas written
by team members on post-its. Display the ideas where everyone can see
them. Having the words visible to everyone at the same time avoids
misinterpretation and duplication and helps stimulate creative thinking by
other team members.
o When recording ideas, ensure that they are written down exactly as
spoken by the team member. Dont interpret.
o Try to generate as long a list as possible. Keep brainstorming until all participants have passed
or the allotted time has expired
Clarify the meaning
Clarify each idea after all ideas have been presented, to ensure that all members have the same

understanding of it. Pointing to each idea on the chart pack in turn, ask the participants whether they
have any questions about its meaning. You may have to ask the contributor to explain the idea in a
different way.
Eliminate duplications
If two or more ideas appear to mean the same thing, you should try to combine them or eliminate the
duplicates. Before you can wrap the like ideas into a single item or eliminate any items on the list, all
of those who contributed the similar ideas must agree that they mean the same thing. Otherwise, they
remain as separate items.

Prioritization Matrix
The prioritization matrix is a useful technique you can use with your team members or with your users to
achieve consensus about an issue. The matrix helps you rank problems or issues (usually generated through
brainstorming) by a particular criterion that is important to your organization. Then you can more clearly see
the problems that should be solved first.

When should we use prioritization matrix?

The prioritization matrix may be used when you need to prioritize problems, or to achieve consensus about
an issue.

How do we develop a prioritization matrix?

1. Brainstorm - Conduct a brainstorming session on the problems users or team members have with
your program or service. You may visit the brainstorming tool to learn how to conduct a group
brainstorming session.
2. Fill out the prioritization matrix chart with the group:
Problem Frequency Importance Feasibility


4. In the first column, write down the problems that were mentioned in the brainstorming session.
5. In the second to fourth columns, define your criteria. Examples of some typical criteria are:
o Frequency: How frequent does the problem occur? Does it occur often or on rare occasions


Importance: From the point of view of the users, what are the most important problems?
What are the problems that you want to resolve first?
Feasibility: Is it realistic that we can resolve the problem? Will it be easy or difficult?

You can choose other criteria if they better fit in the situation you are discussing. For example,
for a more quantitative comparison, you could use cost, amount of time, or other numerical
indicators as the criteria.
6. Rank/Vote. Each participant now votes three times for each criteria. Each participant votes nine times
in total.
7. Sum up all the votes. The totals help you see clearly how to prioritize the problems.