To complete the Fishbone Diagram assignment, follow the structured approach outlined below. This example focuses on improving patient flow in a clinical setting, but you can adapt it to your specific clinical experience or outcome.
### Fishbone Diagram Assignment
#### 1. Effect to Influence
**Effect:** **Delayed patient discharge leading to increased wait times for incoming patients.**
#### 2. Categories and Causes
**Category 1: People**
– **Staffing Issues**
– Inadequate number of discharge planners
– High turnover rates among nursing staff
– Insufficient training for new staff on discharge procedures
– **Communication Gaps**
– Lack of coordination between nursing staff and discharge planners
– Poor handoff between shifts
**Category 2: Processes**
– **Discharge Procedures**
– Complex discharge paperwork
– Inefficient discharge protocol
– Delays in processing prescriptions and follow-up appointments
– **Documentation**
– Incomplete or inaccurate patient records
– Delays in updating patient status in the electronic health record (EHR)
**Category 3: Equipment**
– **Technology Issues**
– Malfunctioning EHR system
– Slow or unreliable internet connections
– Lack of access to necessary discharge tools (e.g., electronic prescription systems)
– **Supplies**
– Shortage of discharge-related materials (e.g., patient education materials)
**Category 4: Environment**
– **Facility Layout**
– Inefficient layout for discharge operations
– Poor signage directing patients to discharge areas
– **Physical Space**
– Overcrowded waiting areas
– Lack of dedicated discharge areas
**Category 5: Policies**
– **Administrative Policies**
– Ineffective discharge planning policies
– Strict discharge timelines not aligned with patient needs
– **Regulatory Compliance**
– Delays due to regulatory compliance issues
– Inconsistent application of discharge policies
#### 3. Testing a Change
**Where to Start:**
**Test of Change:** **Streamline the discharge procedure process.**
**Why:**
Starting with streamlining the discharge procedures addresses a core component of the problem. This area includes many specific causes (complex paperwork, inefficient protocol, delays in prescriptions), making it a good starting point for testing changes. By improving the efficiency of the discharge process, the overall flow can be enhanced, potentially reducing wait times and improving patient outcomes.
**Steps for Testing Change:**
1. **Assess Current Protocol:** Review the existing discharge procedure and identify bottlenecks.
2. **Develop a Simplified Protocol:** Create a more streamlined discharge protocol, focusing on reducing paperwork and enhancing efficiency.
3. **Implement Pilot Program:** Test the new protocol with a small group of patients.
4. **Measure Impact:** Evaluate the effect on discharge times, patient satisfaction, and staff efficiency.
5. **Adjust and Scale:** Refine the protocol based on feedback and data, then implement it across the entire clinical site.
This approach will help identify the most effective changes to improve patient flow and address the delays in patient discharge.
Reflecting on your clinical experience thus far and the EBP approaches you have learned in class, choose one thing you would like to see changed in your clinical site: a patient outcome, flow issue, communication issue etc. Use the attached diagram as your template. A minimum score of 8 must be achieved to fulfill this requirement.
1. Write the effect you would like to influence in the box on the right side of the paper (1 point)
2. In each of the 5 categories generate a list of causes and subcauses (see example in the IHI instructions) until each cause is specific enough to test a change and measure its effects. (1.5 points for each category, 7.5 total)
3. Identify where you think a test of change should start and why (1.5 points)
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