Exam 2 Flashcards
What is the importance of critical thinking and nursing?
Involves skillful directed thinking
Identifie an essential skill
Making sound clinical judgment and safe patient care decisions
What are the eight elements of thought
the problem question concern or issue being thought about
The purpose or goal of thinking
The point of view, the thinker holds
The assumption the thinker holds true about issue
The central concepts, ideas, principles and theories, the thinker uses in reason
The evidence that information provided
The interpretation inferences reasonings of formulated thought that leads to the thinkers conclusion
The implications and consequences
What is interpretation?
Clarifying data and circumstances to determine meaning and significance
What is analysis?
Determining a problem or issue issue based on assessment data
What is an inference?
Drawing a conclusion
What is the evaluation?
Determining if expected, outcomes have or have not been met, and if the outcomes have not been met, why
What is explanation?
Justifying actions with evidence
What is self regulation?
Examining one’s practice for strengths and weaknesses, in a critical thinking and promoting continuous improvement
What is reactive thinking?
Serves as an automatic reaction to situations
Often result in errors
Restricts innovation and maintain status quo
Leaks to vague or inaccurate reasoning
What is reflective thinking?
Involves deliberate, thinking and understanding, using one’s own personal experience and knowledge
Uses what is known and needs to be known and how to bridge the gap between
Promote shared decision-making
What is intuitive thinking
An instant understanding of knowledge, without supporting evidence, or based upon a background
Result and nurse, taking quick action in the delivery of safe effective. Patient care.
How can a nurse, leader and manager use reflective thinking
Create a sense of trust and safety on the unit
What type of critical thinking do you want to avoid?
Reactive, thinking
What are the two types of decisions?
Patient care decisions, or those that affect direct patient care
Condition of work decisions, or those that affect the work environment
What are the steps to decision-making making?
Gathering information
Analyzing information and creating alternatives
Selecting a preferred alternative
Implementing
Following up on implementation
What is the decide model
Defined the problem
Establish criteria
Consider the alternatives
Identify the best alternative
Develop an implemented plan of of action
Evaluate and monitor for solution
Seek feedback if necessary
What is the decision-making grid analysis
List, options and factors on a table or grid in a sign a numeric score to each option to indicate poor to very good or not likely to very likely
What Is the SWOT analysis?
Read factors by strength, weakness, opportunities, and threats
What is shared decision-making
Includes staff
Requires nurse leaders and managers to involve staff
And powers nurses to provide effective, efficient, safe and compassionate quality care
Positively impact nurse satisfaction, recruitment retention, patient satisfaction and reduction of adverse effects
What is appreciative inquiry?
A problem-solving strategy that capitalizes on the positive characteristics of an outcome by valuing in building on them
Results in culture change, or development of a plan
Engages staff, and healthy exchange of knowledge
What are the four stages of appreciative inquiry?
Discovery
Dreaming
Design
Destiny
What is problem Solving
Identify a problem and implement an active systematic process to solve it
What is clinical reasoning
The process by which nurses make judgments
What is a clinical judgment
Involves an interpretation about the patient’s needs, and the decisions to take action or not modified standard approaches or improvise new ones
 what are the four aspects of clinical judgment model?
Noticing- a perceptual grasp of the situation
Interpreting -developing sufficient understanding of the situation
Responding -deciding on an appropriate course of action
Reflecting -attending to the patient’s response to action, while reviewing outcomes
The nurse leaders of a large, acute care facility have decided to implement the shared decision-making on each nursing unit and expect to see what results
Improve retention of nurses
More nurses applying for leadership positions
Decrease nurse to patient ratio
Elimination of medication errors
 improve retention of nurses
The staff nurses from an orthopedic surgery unit are dissatisfied with the admission process of a patient following surgery. The nurse states that there may be 4 to 5 admissions within one hour period as they are discharged from the post anesthesia recovery unit with many patients arriving at the same time the staff does not feel able to give the patients the closest assessment. They deserve and complete the admission process. The Director of the nurse suggest that these nurses observe the system that the woman’s health unit uses for multiple Admissions That happens at the same time due to deliveries and female surgeries. What problem-solving technique is the director using
Critical thinking
Shared decision making
Decide model
appreciative inquiry
Critical thinking
 appreciative inquiry
The nurse manager knows that which of the following is the first step in critical thinking process
Reflection
Judgment
Evaluation
Criticism
Reflection
The nurse manager has been evaluating the nursing unit, strengths, and weaknesses, and effort to ensure that the unit continues to improve safety practices and using cognitive skills of critical thinking process in this exercise
Interpretation
Self regulation
Analysis
Evaluation
Self regulation
The nurse manager knows that which of the nurses on MedSurg unit will be the best best at using intuitive thinking
The nurse who graduated from nursing school six months ago and has worked on the unit for three months
The nurse just started working on the unit, but has worked on a pediatric unit for two years
The nurse who worked in the intensive care unit for one year and has worked on this unit for four months
The nurse who worked in a long-term care facility for six years and has worked on this unit for six months
The nurse who worked on the intensive care unit for one year and has worked on this unit for six months
The nurse leader manage a nursing unit that has a pre-endurance of nurses who have graduated from nursing school with the last 12 months, and knows that what type of thinking will provide the best guidance to the nursing staff
Reactive
Intuitive
Reflective
Automatic
Reflective
The nurse manager has determined that nursing unit should see a reduction in medical errors by 50% and knows that this decision equates to what part of the nursing process
Assessment
Diagnosis
Outcomes identification
Planning
Outcomes identification
The nurse manager has determined that patient care on the unit would be more efficient if a different nursing model was used in plants to use use that tool for decision-making that gives the manager the opportunity to look at more than one feasible alternative
Decision making grid
Decide model
SWOT analysis
Shared decision making
Decision-making grid
The nurse manager has decided to begin to share decision-making model on nursing unit and knows that individual staff nurses will receive what benefit from this decisions
Sense of entitle
Sense of empowerment
Sense of inquiry
Sense of intellect 
Sense of empowerment
The nurse manager is holding a unit meeting and ask each staff member to share one thing that the individual believes works best on the unit. What technique is the nurse manager using in this meeting?
Critical thinking
Share decision making
Appreciative inquiry
Reflective thinking
Appreciative inquiry
A nurse leader is explaining the process of appreciative inquiry to a group of nurses who hope to use this process and bringing changed to their nursing unit. The leader shares that what are the stages of appreciative inquiry
Discovery
Dreaming
Dramatics
Design
Destiny discovery, dreaming design destiny
The nurse manager is planning to use the side model to assist in improving nursing staff self scheduling and is explaining the use of this tool by comparing it to the nursing process and knows that the ECI of the model corresponds to which parts of the process
Assessment
Diagnosis
Identification of outcomes
Planning
Evaluation
Diagnosis, identification of outcomes
What is the bureaucratic management theory
Focused on the structure of organization and authority of management, rules regulations to improve success of the organization
Was believed it would protect employees from our arbitrary decisions
What is the principles of management theory?
Best known for identifying management, functions of planning, organization, command, coordination, and control
What is the scientific management theory
Use scientific knowledge in mathematical formulas to manage the amount of work that could be a accomplished
Introduce the concept of using financial rewards
What is the human relations theory
Explored the underlying differences in human behavior, characteristics and roles of a group
What are the classical organizational theories?
Bureaucratic management
Principles of management
Scientific management
Human relations theory
What are the contemporary organizational theories
General systems theory
Complexity, theory
Learning organization theory
Hi reliability theory
Why was contemporary organizational theories created?
To approach as a cyclical, rather than linear to be able to require organizations to react with speed and flexibility
Bill on top of classical theories
What is the general systems theory?
The hole is greater than the sum of its parts
Based on an open and close system
What is a close system?
Has little to no interaction with system outside
It is overly focused on internal functions
What is an open system?
Interteracte with the systems inside and out
 is composed of interrelated elements, including inputs through puts and outputs
Is a constant cycle
What is input in open system?
Resources such as staff, patient equipment and supplies
The nurses knowledge
What is the throughput in an open system?
The work of the organization
What is the output in an open system?
The outcome of the work
What is an example of an open system?
A hospital
What is the difference between an open and a closed sub system?
Open subsystems have a permeable boundaries in her constant interaction with other sub systems in contrast, close sub systems. Do not interact with other sub systems.
What is the complexity theory?
Derived from the general systems theory
Suggest relationships are key to everything
What are attractors in a complexity theory
Points of attraction that describe behavior in a complex system, in which patterns of energy attract more energy
What is the hierarchical structure in a complexity theory?
Structure with a top-down management approaches

no longer effective in healthcare today
What must nurse leaders and managers do in a complexity theory?
Embrace the complexity of healthcare to promote a relationship oriented structure
Constantly monitor balance between stability and chaos
Focus on outcomes be able to act with speed and adaptability through chaos
What is the learning organizational theory?
People continuously, expand their capacity to create in result, continue to learn and improve process
What are the five disciplines of the learning organization theory
Systems thinking
Personal mastery
Mental models
Building shared vision
Team learning
What does systems thinking mean in the learning organization theory
Everything is connected and interdependent
What is personal mastery in the learning organization theory?
Developing high-level proficiency
What is the mental models in the learning organization theory?
Through reflection, one can achieve awareness of attitudes and perception to help avoid bias
What is building shared vision in the learning organization theory?
Establish mutual purpose that fosters genuine commitment to vision and organizational goals
What is team learning in the learning organizational theory?
Dismissal of assumptions, free-flowing exchange between workers focused towards common goal
What must the nurse leaders and managers do in the learning organization theory
Involve staff and problem-solving and decision making
Promote interprofessional and interrupt, professional, teamwork
Improve communication
What is the high reliability theory?
Principles of organizational design and leadership, that prevent patient harm and promote quality and safety
Leaders, assume risk, exist, and device strategies to cope with it
What is collective mindfulness in high reliability
A mental orientation that is continuously evaluating the environment
What is a high reliability organization?
An organization that operates in complex high risk domains and constantly delivers services without serious accidents or failures
What are the five key characteristics of a hi reliability organization
Sensitivity to operation
Reluctance to simplify
Preoccupation with failure
Deference to expertise
Resilience
What is the continuum of care?
Covers the delivery of healthcare over a period of time as expensive as from birth to end of life
Ensure safe and quality care
What is a for-profit organization?
Owned by stockholder, shareholders are corporate owners
Money brought in, must be reinvested into the organization
Funds may not always be readily available
What do you use money brought in for in a for-profit organization
Maintenance expansion purchasing of equipment and supplies
What is a not for profit organization?
Sources of funding include public and government funding grants in private donations
Service a large number of nonpaying patients
May have to cut services or make other changes to ensure positive cash flow
What organization employees more nurses than anywhere else?
Hospitals
What is the primary care?
First line of defense focuses on health, education and screening
Healthcare providers office
What is secondary care?
Involves emergency care and acute care
Focuses on diagnosis, treatment, and limiting disabilities
Hospitals and urgent care
What is tertiary care?
Involves restoration and rehabilitation focuses on maintaining improving current state of health
Rehabilitation centers assisted-living
What is the organizational structure
Outlines who is accountable and responsible for work
What is the chain of command?
A formal line of authority from the top to the bottom of the organization
What is the unity of command?
Each individual employee is accountable to only one manager expectations clearly defined and well understood
What is the span of control?
Defines a manager, scope of responsibility and reflects the number of employees who reportto a given manager
What is the centralized structure?
Authority for decision is held by a few individuals at the tap level of management
Minimal innovation or creativity
Flo from top to bottom tightly controlled
Results and delayed decision making
What is a decentralized structure?
Authority for decision-making is shared by a number of individuals
Problems can be solved at the level they occur
Flow of communication is bottom up in between units
Nurses participate in decisions
What is organizational culture?
An informal group, philosophy, or worldview, that guides behaviors of the members
What is the mission statement in an organizational culture?
Describes the organizations overall purpose
What is a vision statement in the organizational culture
Reflects the image for the future of the organization plans to create
What is the philosophy of an organizational culture?
States the organizations beliefs, values concepts, and principles that reflect its ideas
What is strategic planning?
How an organization defines its future
Align with defined goals
Forecast the future success
Maximizes organizational performance
What is SWOT
Strategy used in planning process
Evaluate strengths, weaknesses, opportunities, threats
What is a positive Internal SWOT
Strength
What is a positive external SWOT
Opportunities
What is a negative internal SWOT
Weaknesses
What is a negative external SWOT
Threats
What is the future of strategic planning?
Shift from traditional business approach to a focus on patient experiences and safety and quality of care
What is strategic foresight?
Seeing the relevant opportunities that could emerge from the future and strategizing how to make the most of them
What is future thinking?
Bringing vision to the planning process, seeing relevant opportunities that are emerging and creating a desired future
What are regulations?
Directly an indirectly influenced nursing practice
Regulatory policies
Who are regulations developed by?
Federal state and local governments, as well as private organizations
What is accreditation
Ensures that healthcare organizations meet certain national quality standards
And agency decides whether an organization has met Medicare and Medicaid certifications
Required by Medicare and Medicaid and most insurance companies through accreditors, including the joint commission and the DNV, GL
What is the joint commission?
Mission to continually improve healthcare for the public by evaluating health care organizations and inspiring them take cell and providing safe and effective care
Credits organizations
What is the DNV GL
 accreditation for healthcare
Has standard space on Medicare conditions
What is a magnet recognition program?
Designated by American Academy of nursing task force through a studio, nursing practice in hospitals,
What are the three goals that are required to be met in a magnet recognition program?
Promote quality in a setting that supports professional practice
Identify excellence in the delivery of nursing services to patient
Disseminate best practices in nursing services
What are the five model components of magnet recognition program?
Transformational leaders
Structural empowerment
Exemplary, professional practice
Knowledge, innovation, and improvements
Empirical quality results
What is transformational leadership in magnet recognition program?
Nurse leaders at all levels must use future thinking and demonstrate advocacy and support on behalf of staff and patients
What is structural empowerment in the magnet recognition program
Nurse leaders must develop direct and empower staff to participate in achieving organizational goals and its desired outcomes
What is the exemplary professional practice in the magnet recognition program?
Comprehensive understanding of the role of nursing, strong intra-and interprofessional teamwork, ongoing application of new knowledge
What is new knowledge, innovations, and improvements in the magnet recognition
Focuses on redesigning and redefining practice to be successful in the future
What is the imperial quality results in the magnet recognition program?
Participate in establishing quantitative benchmarks for measuring outcomes related to nursing
What are the benefits of a magnet recognition program?
Allows to recruit and retain top-notch nursing talent
Improve patient care, safety
Increased patient satisfaction
The nurse leader is using general systems theory to assist in implementing changes on the nursing unit and knows that what nursing activities are considered throughput
Nursing skills
Nursing education
Nursing management of care
Nursing beliefs
Nursing management of care
The nurse leader has begun to look for new positions in different healthcare organizations because the present organization is a close system. The nurse leader is aware that this system has led to what issue on the nursing unit.
The nurse leader has had to be open to new ideas
The nurse leader had difficulty recognizing the nursing unit as a part of the whole organization
The nurse leader did not like the flexibility required as part of this type of system
The nurse leader was not prepared for self renewing, self organized that aspect of the nursing unit
The nurse leader had difficulty recognizing the nursing unit was a part of the whole organization
The nurse manager for profit healthcare facility explains to a new staff nurse that the profits from care are used in what capacity
Pay for a new MRI machine
Increase the pay for all staff
Provide for extra services for patients
Give bonuses to executives
Pay for a new MRI machine
The nurse manager in a knot for profit, healthcare facility is aware of what issues may arise due to the funding for this type of organization
The care provided to the patient is low quality than the caregiving in for-profit healthcare
There’s a possibility that staff must be reduced because of decreased available funds
The healthcare organization will move all inpatient to outpatient care
If available, funds are reduced managers will be let go
There’s a possibility that staff might be reduced
Nurse managers know that what category of worker and healthcare organizations is employed more than any other
Nursing
Maintenance
Dietary
House keeping
Nursing
A nurse manager is planning to take on the responsibility for a nursing unit that specializes in tertiary care. The nurse manager knows that this unit will be responsible for the care of what type of patient.
Giving birth
Treated for pneumonia
Seeking treatment for knee strain
Those having knee replacement and receiving rehabilitation
Those having a knee replacement and receiving rehabilitation
The nurse manager reports directly to the Director of nursing, and knows that this defines what type of command
Span of command
Chain of command
Unity of command
Organizational structure
Unity of command
The nurse manager is conducting a swot analysis as a part of a strategic planning process that arranges for the new electronic health record being used in the nursing unit to be featured in the local newspaper. This corresponds with what part of SWOT
Strength
Weakness
Opportune
Threats
Opportunities
The nurse managers recognize that what is fostered at all levels in a centralized healthcare organiz
Authority to hire and fire
Feelings of autonomy
Ability to make changes at all level
Tap to bottom communication
Feelings of autonomy
The nurse manager is involved in a strategic planning, and knows what is the reason for this process to be in instituted
Strategic planning defines the future of the organization
Strategic planning reflects the image image of the future the organization plans to create
Strategic planning reflects the attitudes, ideas and convictions of the organization
Strategic planning reflects the direction in which organization intends to head
Strategic planning defines the future of the organization
The Director of nursing is encouraging the nurse managers to begin seeking magnet status for facilities, and knows that the status is associated which with positive outcomes for both nurses and patients
Increase patient satisfaction
Decrease morbidity with static mortality rates
Decrease number of peripheral intervenous infiltrations
More nursing autonomy
Decreased nurse burnout
Increase patient satisfaction
More nursing autonomy
Decreased nurse burn out
What are two distinct steps of effective communication
Adequately, articulating ideas
Understanding the listening audience with whom you are communicating
Who is the sender in basic communication?
The person who begins the transfer of information, thoughts, or ideas
What is encoding in the basics of communication
The process the center uses to transmit the message
What is the message in the basics of communication?
The information or contact the sender is transferring
What is the sensory channel in the basics of communication?
The manner in which the messages sent
What is the receiver in the basics of communication
The person or person whom the sender intended to receive the message
What is decoding in the basics of communication
The process of interpreting the message
What is feedback in the basics of communication
Determines if the message was received as intended important not to overlook
What is verbal communication?
Occurs face-to-face by telephone and through written message
What are the five steps of active listening?
Receiving
Attending (engaging)
Understanding
Responding
Remembering
What are factors that impact communication?
Gender
Men are more assertive
Women are more likely to be collaborative and use nonverbal cues
Age
Culture
Values perceptions
Personal space
Environment
What is formal communication?
Intended to share information avoid useless, slang, establish professional rules it is planned
Interviewing
What does informal communication
Talking to patients about personal business
What is grapevine communication
Rumors starting
What is downward communication?
Reflects the higher article, nature of organization
Directives to employees expectations for employees
What is lateral communication?
Sharing information among nurse, leaders, and managers or other staff at the same level
Coordinating between units
What is diagonal communication?
Communication to others, and then organization, who are not at the same level
Manager communicates to medical Director
What is upward communication?
Sending of information a hierarchal chain
Nurses to managers
 what is interprofessional team rounding
Members of team gather at specified times to discuss the programs of the patient’s plan of care
Contributions from all members
What is a huddle?
Short interprofessional meeting at beginning of shift to share information and highlight concerns
What is teamSTEPPS
Optimizing patient safety outcomes by improving communication and teamwork skills focused on concise information exchange
What is the two challenge rule in teamSTEPPS
Nurse voice concern, at least twice to receive acknowledgment from another team member
Use when standard care is not followed
What is the call out in teamSTEPPS
Simultaneously informed team members of important information and assigned task during critical event used when emergency situation arises
What is the check back in TEAMSTEPPS
Use closed loop communication verify information is being received, correct
What is intraprofessional communication?
Working with other nursing staff to deliver safe and quality care
What are potential causes of error in nurse nurse transition of intraprofessional communication
Environmental distractions in Little, or no prior information to receiving nurse on the patient’s history
The nurse manager is aware that preventable medical errors are associated with what communication failure
Lack of interprofessional communication
Lack of upward communication
Lack of intra-professional communication
Lack of downward, communication
Lack of interprofessional communication
The nurse manager plans to implement which communication strategy that has been found to reduce errors and improve patient’s safety while increasing patient satisfaction
Team steps
Interprofessional team round
Diagonal communication
Oral report in the conference room
Interprofessional team rounding
The nurse from the PACU is giving report to the unit nurse at bedside of a patient who had just had surgery of a total hip replacement approximately 20 minutes after the patient admission to the unit the patient experiences a period of respiratory distress that was attributed to the medication received in the PACU what error occurred during the nurse nurse handover
The PACU nurse was giving report helping transfer the patient into bed
The PACU nurse arrived with the patient 15 minutes later than expected
The unit was not available for the nurse to nurse handover
The unit nurse was familiar with the patient from the previous hospitalization
The PACU nurse was giving report Will hand being the answer for the patient into bed
The nurse leader was working to improve communication on the nursing unit and knows that effective communication requires in articulate sharing of ideas, and what other important element
Nurse manager must understand the audience for which the message is intended
The staff on the nursing unit must agree with the ideas of the nurse manager
The nurse manager must ensure that the ideas presented are important to the staff of the nursing
The staff on the nursing unit must have a person person contact for the communication to be received
The nurse manager must understand the audience for which the message is intended
The nurse manager recognizes that communication that is congruent is more likely to be received. Which statement by the nurse manager to a staff. Nurse is an example of a congruent communication.
The nurse manager is smiling. This latest episode of tardiness may cause you to be terminated from this job.
The nurse manager is standing with arms crossed. You have been 10 minutes late three times this month.
The nurse manager is shaking her head. It’s good to see that you have finally decided to come back to work.
The nurse manager stares at the floor. You were making a habit of being late. You can feel free to talk to me anytime.
The nurse manager is standing with arms crossed. You have been 10 minutes late three times this month.
The nurse manager is aware that the element of communication is essential to the transmission of relational information
Feedback
Nonverbal communication
Respond
Receiving
Feedback
The nurse manager would suggest that communication tool to assist staff nurse in organization and prioritizing information before communicating with the healthcare provider
Interprofessional team rounding
TeamSTEPPS
SBAR
Call out
SBAR
A nurse manager is aware that SBAR MAYBE BE USED IN WHAT NON-CLINICAL ISSUES
Staffing level
Nursing pay levels
Nursing clinical ladder issues
Required, continuing education
Staffing levels
The nurse is communicating to the healthcare provider, the patient’s current medication’s allergies, vital science and current laboratory values, and is using which section of SBAR and giving this information
 Situation
Background
Assessment
Recommendation
Background
The nurse manager is aware that communication is considered verbal. Select all that apply.
Email messages
Facebook post
Facial grimace
Telephone message
Arms and legs crossed
Email Facebook telephone
The nurse manager is preparing to the use of SBAR for interprofessional communication. The nurse manager has this decision on the benefits of the tool
Assertive dialogue between professionals
Most essential information delivery
Safer delivery of patience, care
Decrease continuity of patient care
Increase time spent in interprofessional communication
Assertive dialogue between profession
Most essential information delivery
Safer delivery of patient care
What is error of omission?
Action that should be standard of care is not taken/admitted
What is error of commission?
Wrong action is taken/committed
What is an unsafe act?
Occurs in presence of potential hazard not an error
What is slip slaps mistake?
Actions that do not result in attended outcome
What is a near Miss?
Potential error that was discovered before carrying act out
What is a sentinel event?
Patient safety event that results in death permanent harm or severe temporary harm
How do you prevent medical errors?
Standardize as many processes as possible
What is culture of safety?
Blame free environment
Staff feels comfortable reporting errors/near Misses
Non-punitive emphasis, accountability and honesty, supports nurses
What are the three stages of the culture of safety?
Safety management based on rules and regulations
Good safety becomes organizational goal
Safety performance is continuously improving
Steve is encouraged to voice concerns using cus what does that stand for
I am concerned
I am uncomfortable
This is a safety issue
What is quality improvement?
Systematic and continuous serious of actions that lead to measurable improvement in healthcare
What are the four key principles in quality improve?
Quality improvement works as a system and processes
There is a focus on patient
There’s a focus on being part of a team
There is a focus on use of data
What is the Donabedian model
Three categories of information that can be collected to draw inferences
Structure
Process
Outcomes
What is the lean model?
Assume that all processes contain waste, and involves the thought process of doing more with less
Empower staff to identify problems and make improvements
What are the four principles of the lean model?
I’ll work processes, highly specified
Customers in supplier relationships are clear
Pathways between people and process steps are specified and consistent
Improvements are made based on scientific methods
What is the six sigma model?
Used to define the number of acceptable errors produced by the process
What are the five steps of the six sigma model?
Define
Measure
Analyze
Improve
Control
What are the three fundamental questions of the IHI model of improvement?
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make? That will result an improvement
What is planned do study act? PDSA do.
Developer plan to initiate a small change
What does a run chart allow?
QI team to see changes
What is the most common method of a QI tool?
Bar chart
What does a fishbone diagram identify?
Many possible causes of problems
Can determine root of problem
