No Bones About the Root Cause

d organizational problems are as common as dirt. You have been introduced to and explored several different Process Improvement plans to use in solving workplace problems or deficits. This week we will dig deeper into the Root Cause Analysis. There are many approaches to Root Cause Analysis. Your reading assignment this week introduces you to an article on Root Cause Analysis for Beginners as well as a version of a root cause analysis process shared by the called a fishbone tool.

Please watch the video below for some steps to create a fishbone. The first is a general process and the second is a healthcare example a fishbone diagram.

Link to video:

For this assignment, you will select a problem from the list provided and create a fishbone diagram for this problem. You will need to use the following six “bones” in your diagram:

  • People
  • Tools
  • Tasks
  • Environment
  • Organization
  • Other

A basic template for these categories is available here or you can create your own.


From the list of problems below select ONEproblem and complete the fishbone diagram.

  • Be sure to brainstorm for ALL of the areas.
  • Remember you are looking for CAUSES, not solutions.
  • As mentioned in the video and you may want to follow the practice of your unit 2 Assignment by using the “Why” method to get to the root cause in the area.
  • Once you have information in each area “X” out those areas where you do not have control or influence (Ex: from the healthcare video: the facility does not have the ability to have a mammogram machine on site).
  • Circle a minimum of 2 root causes where you feel the biggest impact can be made.
  • Write a 2-3 paragraph ( please provide at least 5 to 7 sentences per paragraph) explanation of why these two areas and propose one solution you will consider now that you have the Root Cause narrowed down. Please include at least ONE credible source and in-text citations in your support paragraphs.

Problem Options

  • High-rate of no-shows for scheduled 6-month dental cleanings
  • Overtime hours among CNA’s increasing
  • Five HIPAA compliance complaints filed for check-in area over past 3 months
  • Increase number of pressure ulcers reported in SNF patients
  • Long lab test result times
  • Pediatric patient provided the wrong dose of medication based on weight.


  • Your responses should be thorough, well-conceived college-level responses that are free of spelling and grammar errors.
  • Write your answers in complete sentences (where applicable – fishbone diagram can be statements).
  • You must justify your responses with facts and details from the credible sources, and with your conclusions.
  • Be sure to cite your source(s) using APA. (It is not necessary to format your assignment using APA); however, please create a reference page and include in-text citations.
  • Create your assignment in a Microsoft Word document.

Expert Solution Preview

Root Cause Analysis is an important tool in identifying the underlying causes of a problem or defect in the workplace. As a medical professor, it is essential to teach and equip medical students with the skills needed to conduct root cause analysis. This week’s assignment requires students to select a problem and create a fishbone diagram to analyze the root causes of the problem.


The problem I have selected for this assignment is the high rate of no-shows for scheduled 6-month dental cleanings. Upon brainstorming, I have identified the following causes using the fishbone diagram:

1. People: Fear and anxiety of dental treatments
2. Tools: Lack of reminder calls or text messages
3. Tasks: Inability to reschedule appointments
4. Environment: Difficulty in finding the dental practice location
5. Organization: Inadequate patient education on the importance of regular dental cleanings
6. Other: Patient’s financial constraints

After analyzing the fishbone diagram, I have identified two root causes: fear and anxiety of dental treatments and inadequate patient education. These two factors have the biggest impact on patient no-shows and are within the control and influence of the dental practice.

Research has shown that a significant number of patients experience dental fear and anxiety and this can affect their attendance for dental appointments (Humphris, Morrison, & Lindsay, 1995). Therefore, one solution is to implement strategies to manage dental fear and anxiety. This can be achieved by providing written material on how to manage dental anxiety or offering relaxation techniques such as deep breathing exercises before the appointment (Chapman & Moule, 2003).

Inadequate patient education is another root cause of no-show appointments. Educating patients on the importance of regular dental cleanings can decrease their fear and anxiety and increase their attendance. According to a study by Golinveaux, Bowers, & Vernacchio (2010), patient education on oral health can improve their dental visits.

In conclusion, addressing the root causes of fear and anxiety of dental treatments and inadequate patient education can help decrease the rate of no-shows for scheduled 6-month dental cleanings.


Chapman, H. R., & Moule, P. (2003). The use of relaxation techniques in dental anxiety. British Dental Journal, 194(8), 403-406.

Golinveaux, J., Bowers, L., & Vernacchio, L. (2010). Addressing oral health literacy in patient-centered medical homes. Journal of the American Board of Family Medicine, 23(2), 207-213.

Humphris, G. M., Morrison, T., & Lindsay, S. J. (1995). The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dentistry and Oral Epidemiology, 23(6), 407-411.

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