Quality Improvement Project: Using Problem and Solution fishbone diagrams
RN, NP, PhD
Sonoma State University
Evidence-Based Practice, Quality Improvement
Graduate Students, Pre-Licensure BSN, RN to BSN
Classroom, Clinical Setting
Online or Web-based Modules
- I start out with this quote: Albert Einstein: "We can't solve problems by using the same kind of thinking we used when we created them."
- I have used these fishbone diagrams for classroom discussions, didactic assignments and clinical assignments. They are effective in each setting.
- I have used these as the basis of discussion/assignments related to these Adverse Events: The Lewis Blackman Story Video (http://www.qsen.org/video/) and First Do No Harm (http://www.p4ps.net/guides/p4psbrochure.pdf). The post-licensure BSN students rated this as one of the most helpful assignments they had in an EBP/Research course.
- Use both the problem and solution diagrams. The problem one is common and I developed the solution one to assist students in making evidence-based practice recommendations. They need to use both to make the connection between problems and solutions. I tried using just one as a stand-alone activity and it didn’t work.
- Sources of evidence: Use of the diagrams emphasizes that EBP draws from nurse expertise, patient preference and the literature. Have them find and incorporate an EBP article pertinent to the solution.
- Have students bold the items they assess as key to the problem and the solution. This helps students prioritize causes and identify a key solution.
File format: Here is a website for the QSEN Quality Improvement Project Fishbone problem and solution assignment: http://www.sonoma.edu/users/k/koshar/n303/qsen.htm. They are set up similarly in each course. You will also find a link to well-done QI problem and solution fishbone diagram examples. Feel free to use all or any part of this information and just cite us as the source.
Here is the evaluation rubric I developed
Quality Improvement Grading Criteria
Completes the Fishbone Problem and Solution Diagrams. Clearly states the problem and solution. Bold the item(s) (i.e. under people, equipment) that you assess as being key to the problem and solution.
Includes at least one item in each of the six categories (i.e. People, Processes, etc).
Uses the 6 areas of competencies: Patient Centered Care, Teamwork and Collaboration, Evidence-Based Practice, Quality Improvement, Safety and Informatics.
Evidence: uses each of the 3 sources of evidence (patient preference, nurse expertise, the literature)
Cites at least one EBP article in the solution diagram. Briefly explain how it informs your solution.