Write the effect you wish to influence in a box on the right-hand side of the page

1. Consider factors contributing to the problem: Think about the individual (s), the system, and a combination of factors.  Use this to fill in the fishbone diagram.
   1. Develop the causes by asking “Why?” until you have reached a useful level of detail that is, when the cause is specific enough to be able to test a change and measure its effects.
2. Write the effect you wish to influence in a box on the right-hand side of the page.
3. Draw a horizontal line across the page to the left, starting at the box you drew.
4. Decide on at least six categories of causes for the effect.  The standard categories in a classic cause and effect diagram are:
   1. Materials (unavailable, expired, incorrect)
   2. Methods (how the methods in place are affecting the outcome)
   3. Equipment (design, availability, and maintenance)
   4. Environment (staffing levels &skills, administrative & managerial support, physical space)
   5. People
5. Draw diagonal lines above and below the horizontal line to create “fishbones” and label each line at the end with one of the categories you have chosen.  Draw a box around each label.
6. For each category, generate a list of the causes that contribute to the effect.  List the causes by drawing “branch bones”. Identify a minimum of two items in each category.
7. Write out the AIM statement to guide the causes and effects of the problem.
8. Provide three or greater relevant scholarly articles/documents/websites cited according to APA format, 7^th edition.  Publication date within five years.  Submit a separate page for the references.