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Discovering the cause of an issue

In this article we further explore techniques to help visualise the issues behind your innovation.
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In Step 1.11 we looked at how to brainstorm the innovation, however there are other techniques available to help you identify the cause of a problem.

Cause and Effect (or Fishbone) Diagram

The cause and effect diagram is an excellent way to get colleagues thinking about the cause of an issue or problem (i.e. why this is occurring). This is an important step in planning innovation as it is important to be able to identify the root cause of a problem, as only then may you be able to fully demonstrate the importance of your innovation to your service. The cause and effect diagram helps display the relationship of the causes to the effect or outcome being observed, and helps colleagues visualise and identify potential areas for improvement.

How to use cause and effect analysis

  1. Begin by defining and writing the effect you wish to change on the right hand side of a page (You may find it helpful to use a large piece of paper, mounted on a wall or whiteboard). Draw a box around the effect.
  2. Draw a horizontal line across the page, starting from the box and moving to your left, across the width of the page.
  3. Decide on categories of the causes. Some easy predefined ones are: Equipment, Environment, Materials, Methods and people.
  4. Draw diagonal line above and below the horizontal line to create fishbones. Label each fishbone with one of the categories in step 3.
  5. Under each category, compile a list of possible causes that contribute to the overall effect. Draw additional branch bones to the causes to show secondary causes. (A helpful technique in developing the causes is to continually ask ‘why?’ until you have reached an appropriate level of detail. This can normally be achieved by asking ‘why?’ five times.
Cause and effect diagram © Adapted from FabienLange, Ishikawa Fishbone diagram
An example template of a cause and effect diagram is also available in the Downloads below.
A driver diagram is a graphical representation of stakeholders view of what drives or contributes to achieving the project aim. It helps illustrate the relationship between overall aim and the factors that contribute to achieving the aim. The diagram illustrates the relationship between the primary drivers (or key drivers) and secondary drivers, which are specific aspects of the key drivers. As you would expect, primary drivers are the most important factors influencing achieving your aim.

How to use a Driver Diagram

Driver diagram © Adapted from East London NHS Foundation Trust, Quality Improvement
A template for a driver diagram is also available in the Downloads below.
The above techniques are tried and tested methods to help identify areas for innovation in your current service. When we consider measuring your current service we will return to these concepts and expand upon them, however for the moment these are some of the most helpful techniques in identifying areas for innovation.
However, we must not forget that healthcare science is a rapidly expanding subject and new techniques are being added constantly, as new research is applied to clinical practice. Horizon scanning and remaining constantly vigilant to new advances and considering how these can be implemented within clinical practice is also an important source to identify innovation. Remember though, a new test identified through research will not always be better than the existing test when introduced into routine clinical service. You will still need to consider the techniques above in order to evaluate fully.
In the UK, The NIHR Innovation Observatory is a good source of new information and latest developments that might impact on clinical service.


Use the comments section to propose areas for improvement within your workplace and critique these with other learners. For each suggestion, you may wish to consider, what is the aim, what are the drivers behind the proposal and have all potential causes been considered.
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Understanding Innovation in the Healthcare Sciences

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