Delete this box and insert your

company logo here.

Incident title
Location of Incident:

Cause Mapping

Date of Incident:

Problem Solving Incident Investigation Root Cause Analysis Risk Mitigation

Investigation File

Version Number:
Version Date:

The purpose of this file is to organize all relevant information.

The following worksheets are contained in this workbook:

Area

Healthcare

Investigation Information

Start here

Need Help?

Step 1. Define the Problem

Step 2. Conduct the Analysis
Step 3. Select the Solutions

Additional Information & Tools

281-412-7766 phone
281-412-7761 fax
info@thinkreliability.com
Basic Healthcare Cause Mapping Template
October 23, 2013

Examples & Resources

Worksheet (links)

Description

Title Page
Versions
Contacts
CM Steps
1. Problem
2. Cause Map
3. Solutions
Timeline
Diagram
Photos
Work Process
Notes
Info To Get
END
Excel Tips
Examples

This worksheet
Evolution of this workbook and contributors
People / Contact info of those involved with the analysis
Cause Mapping Method, Steps and Tools (layout)
Problem Outline
5-Why basic Cause Map to get started
Action Items table listing solutions, owner, due dates
Sequence of events with date, time, description
Diagrams, drawings and images
Photographs and pictures
Steps of related work processes written as a flowchart
Notes, emails, documents
Information to collect or To Dos during the investigation
Extra material past this worksheet
Tips for using the template in Microsoft Excel
Example Cause Maps

Copyright 2013 ThinkReliability, Novem, Inc.

(clock)

Version Date

Type

Description

Time

Total Investigation Hours

311892675.xlsx

(in hours)

Duration Update By

Contributors

0.00

04/01/2016 04:10:15

Organization

Name

Location

Role

Email

Office

Houston, TX

Training & Facilitation Services

info@thinkreliability.com

281-412-7766

Mobile

Note

www.thinkreliability.com

Cause Mapping

Problem Solving Incident Investigation Root Cause Analysis Risk Mitigation

Step 1

Problem

Additional Tools - Use as needed to capture specific information during the investigation.

Timeline

Diagram

Photos

Work Process

Notes

Any photos or images.

The flow of any particular work

process or task that is relevant to
the incident.

Notes related to the

investigation.

Define the Problem in the Problem Outline

Capture specifics about the problem as well as the impact to

each of the organization's overall Goals.
- Answer each question in the Outline.
The sequence of events.

Step 2

Analysis

Any diagrams, drawings

or sketches.

...add as much detail as necessary to thoroughly explain the issue

Start with 3 to 5 Why questions (Causes)...

Info To Get

Lay out the cause-and-effect relationships for the incident.

- Write down one of the Goals that was affected.
- Write the impact to that Goal in the next box.

Any information gathering or support tasks

required for the investigation.

- Answer the question "Why did that happen?" Ask Why again.
- In the more detailed analysis, ask as many Why questions as
necessary to thoroughly explain the issue.

Step 3

Solutions
Identify the specific actions that will be taken to reduce the
risk of a similar issue occurring.
- Place a possible solution above the cause that it controls.
- Evaluate the different possible solutions.
- Create a plan for actions or a combination of actions that will
be implemented.

Basic

Propose
Possible Solutions
Based on causes identified in the analysis
step
Use: Convention, Industry Standards and
Creative Ideas

Detailed

Evaluate
Solution Options
Consider the Effort IN to the Solution
versus the Result OUT
The impact and
risk to each Goal
should be
reduced to an
acceptable level

Create
Action Plan

Each action item is a project.

Follow-up should evaluate effectiveness.

Step 1. Define the Problem

What
When

Problem(s)
Date
Time
Different, unusual, unique

Where

Facility, site
Unit, area, equipment
Task being performed

Impact to the Goals

Patient Safety
Employee
Compliance
Patient Services
Organization
Schedule, Operations
Property, Equipment
Labor, Time
Labor, Time

This incident

$0

Annualized Cost

$0

Frequency

Possible solution:

Incident title

Effect

Evidence:

Why ?

Patient Safety
Goal Impacted

Employee Goal
Impacted

Compliance
Goal Impacted

Patient
Services
Goal Impacted

Organization
Goal Impacted

Schedule,
Operations
Goal Impacted

Property,
Equipment
Goal Impacted

Labor, Time
Goal Impacted

Cause

OR

Cause Map

Goal Impacted

Why?

AND

Step 2. Analysis

Why ?

Why ?

Why ?

AND/OR

Why ?

Basic Cause-and-Effect Relationship

Step 3. Solutions

Corrective Actions to be implemented

Since solutions control specific causes, every action item (solution) should correspond to a cause from the Cause Map. This provides continuity from the analysis to the action items. Only those
causes with action items (solutions) are listed in this table.

No.
1
2
3
4
5
6
7
8
9
10

Action Item

Cause

Owner(s)
(Names)

Date Due

StatusCompleted

Notes

Verification
(Check of
effectiveness)

Timeline
Date

Time

Description

Diagram
Example objects
(industrial)
Drum

Cylinder

Pump

Use the drawing tools to add any diagram to this worksheet.

Delete these objects if they are not needed.

Valve

Exchanger

Exp
and
er,
Turb
ine

Compr
essor

Photos
Insert any pictures on this worksheet.

Use this box as a picture label

Process Map

Decision point
Copy and use as needed

Steps within a Task

YES

Process
NO

Notes

Investigation Action List

This tab is used to track specific information gathering or support tasks for the investigation.
The 'Solutions' tab will capture the action items that are selected by the investigation team.

No.
1
2
3
4
5
6

311892675.xlsx

Action Item

Owner

Info To Get

Date Created

Due Date

Status

Completed

Page 13 of 15

Click here for Excel video tips on the web site

Quick Access Toolbar

The Quick Access Toolbar, found along the top of the screen, is the only toolbar that you are able to customize. Add any
command to the Quick Access Toolbar by right clicking on the icon and then click Add to Quick Access Toolbar.

Arrow Cursor - Select Objects

The arrow cursor allows you to select drawing objects. The arrow cursor is located by clicking on Home from the menu
bar. The last group on the ribbon is called Editing. Inside of Editing is a Find & Select icon with a drop down. Click on
Select Objects (the arrow) to select it.

Drawing Tools
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Notice when you select an object a new tab, Drawing Tools: Format, is immediately added to the end of the menu bar.
When you click on either Format or Drawing Tools the ribbon changes to a drawing tools ribbon. Remember you must
have an object selected on the worksheet to access the Drawing Tools tab.

Working with Text Boxes

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Copying Boxes
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Using Connectors
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Connect two objects by clicking and holding the left mouse button at the beginning connection point and then moving
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To insert multiple connectors, right click on the Elbow Arrow Connector icon from the Shapes drop-down menu and
select Lock Drawing Mode. Left click on the connector icon or press "Esc" to unlock.
Add to the Quick Access Toolbar The Elbow Arrow Connector can be added to the Quick Access Toolbar by right clicking
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window.

Selecting Multiple Objects

Hold down the shift key and left click on the each object you wish to add to the selection. This multiple selection using
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Moving Boxes in a Straight Line

When moving a box hold down the shift key to move the box only at 90-degree angles: left, right, up or down. The shift
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window that opens. The first section inside of Advanced is called Editing Options. The eighth choice down is Zoom on
roll with IntelliMouse. Check this box and hit OK at the bottom of the window.

Cause Map Examples

Stress applied

Heat

3-Whys
Why ?

Impact to
Safety
Goal

Why ?

Strained muscle
in back

AND

Why ?

Lifted box from

floor to table

Fire

Sorting old
records

Fracture

Stress exceeds
strength

AND

Strength

Fuel

AND

Oxygen

COULD
Cause Map

Paper jam ?

5-Whys

Parallel Causes (a split)

Printer is not
functioning

This Cause Map shows how one effect

can require more than one cause.
Lifted box from
floor to table
Impact to
Safety
Goal

Strained muscle
in back

Force on muscle
in back

Sorting old
records

Out of paper ?
X was added to
tank

AND

Overfilled tank
Lifted with back
(not legs)

OR

AND

Tank had a
available
capacity of Y

Failure Modes

OR

Toner cartridge
empty ?

OR

No power ?