Causal Diagram

Next, the team participates in brainstorming sessions to analyze the causes of the waiting-time problem using the Causal Table or "Why-Because Technique." The team has two brainstorming sessions: one on the immediate causes of the problem, and another on the root causes of the problem.

After the team is finished with brainstorming, Mrs. Alvarez is left with a list of possible causes for the problem.

Causal Table: Possible Causes of Long Wait Time

Immediate Cause	Root Cause
Staff arrives late to work	staff member has a second job staff member must complete domestic chores before coming to work staff member experiences unexpected delay in getting to work
Too much paperwork	disorganization of the files complicated storage methods complicated procedures
Lack of user cooperation	users don't respect turns users don't bring ID cards users don't keep appointments
Limited space	insufficient capacity for number of users
Procedures take too long	lack of automation of procedures outdated methods

The team is uncomfortable expressing their opinions on the root causes of personnel issues such as staff arriving late to work. They decide that before diagramming these issues, Mrs. Alvarez will formally meet with the rest of the staff to examine why some arrive late to work.

Step 3: Affinity Technique

In preparation for describing the causes graphically, the team decides to group them by relationships, or affinities, using the Affinity Technique, into policy and user issues. Working with a group of between five and eight participants, Mrs. Alvarez asks each participant to write down, individually, on four or five cards, their ideas about the common factors of the causes. After 10 minutes, she posts the cards on the wall and reorders the ideas in groups. Each participant moves any cards to group them by affinity, until all the participants are in general agreement with the grouping of ideas. Mrs. Alvarez lists the personnel issues she has identified in meetings with the rest of the staff.

The causes are grouped under the following headings:

• policy
• personnel
• user
• methods/procedures

Step 4: Create the Cause-and-Effect Diagram

Now the team creates a Cause-and-Effect or Fishbone Diagram using the information they collected from the Affinity Technique.

Cause-and-Effect Diagram for Long Waiting Times

This diagram makes it easy to see the many possible root causes of the issues that can lead to increased user waiting time.