Modeling Causal Relationships in Quality Improvement.

Taking the time to plan a quality improvement project before starting the project improves the likelihood of success. Understanding the tools that can be utilized for identification of a problem, the causes behind it, and the development of the theoretical framework of the planned improvement are crucial. Fishbone diagrams or cause and effect diagrams are often utilized to identify the root causes leading to an identified problem. Keydriver diagrams can provide the structure for a quality improvement project, establishing the aim and identifying the drivers and interventions that lead to change. This paper reviews these two quality improvement tools. When beginning a quality improvement project, several tools can be used to begin identifying where to target efforts. Utilizing process maps and failure modes and effects analysis (FMEA) can help define a process, identify failures, and develop interventions to be considered. Process maps identify potential gaps or excess steps and reveal sequential relationships. FMEAs aid in the development of causal relationships between a failure mode and its effects, priming the quality improver to create interventions. An additional way to model causal relationships is with fishbone diagrams and key driver diagrams. The fishbone diagram enables teams to consider why a problem has occurred and search for the root causes. The key driver diagram provides the ultimate aim of the project, identifies the drivers which will affect accomplishing the aim, and the interventions that affect the identified drivers. This paper will carefully examine both fishbone diagrams and key driver diagrams.