Lesson 5: time and copies can be made for the patient

upon request.
Health Informatics  Communication: Provides communication
between multiple doctors or hospitals.
 the application of both technology and systems in a According to Government Health IT, medical
healthcare setting professionals must pay close attention to
confidentiality issues, such as patient privacy
Health Information Technology
and security safeguards to ensure unauthorized
 focuses on tools users cannot access the information.
 A good Health Information Systems delivers
Health Information Systems the accurate information in a timely
manner, enabling decision-makers to make
 cover the records, coding, documentation, and better-informed choices about different aspects
administration of patient and ancillary services of the health institution, from patient care to
Overview of Health Information Systems annual budgets. It also upholds transparency
and accountability due to the easier access to
o Health Information systems information.
 refer to any system that captures, stores,
manages or transmits information related to o Components of Health Information Systems
the health of individuals or the activities of I. Health Information Systems Resources
organizations that work within the health sector  These include the legislative, regulatory
 definition encompasses district level routine and planning frameworks required for a
information systems, disease surveillance fully functioning health information
systems, and also includes laboratory system, and the resources that are required
information systems, hospital patient for such a system to be functional.
administration systems (PAS) and human  Such resources involve: personnel,
resource management information systems financing, logistics support, information
(HRMIS). and communications technology (ICT),
 a well-functioning HIS is an integrated effort and coordinating mechanisms within and
to collect, process, report and use health between the six components
information and knowledge to influence policy II. Indicators
and decision-making, program action,  A core set of indicators and related targets
individual and public health outcomes, and is the basis for a health information
research. system plan and strategy. Indicators need
 policy level - decisions informed by evidence to encompass determinants of health;
contribute to more efficient resource allocation health system inputs, outputs and
 delivery level - information about the quality outcomes; and health status
and effectiveness of services can contribute to
better outcomes.
 employees need feedback on how the routine
data they collect can be utilized, and also need
to understand the significance of good quality III. Data Sources
data for improving health (Pacific Health  divided into two main categories;
Information Network, 2016).  (1) population-based approaches
(censuses, civil registration and
o Role and Function of Health Information Systems population surveys)
 Sheahan (2017) describes health information  (2) institution-based data (individual
systems as a mechanism to keep track of records, service records and resource
everything related to patients, records).
 patient’s medical history, IV. Data Management
 to medication logs,  This covers all aspects of data handling
 contact information, from collection, storage, quality-assurance
 appointment times, and flow, to processing, compilation and
 insurance information analysis
 billing and payment accounts. V. Information Products
 Files Are Easier to Access: systems are  Data must be transformed into
information that will become the basis for
electronic, so the days of hard files and loose
papers are over. evidence and knowledge to shape health
action
 More Controls: Staff must be authorized to
access the health information system. Doctors VI. Dissemination and Use
 The value of health information is
may have permission to update, change and
delete information from the electronic medical enhanced by making it readily accessible
to decision-makers and by providing
record. The receptionist, however, may only
have the authority to update a patient’s incentives for, or otherwise facilitating,
information use
appointments.
 Easy to Update: let doctors create electronic
medical records for their patients. Patient
information can be pulled up for review at any
o In addition to the six components, the Health Metrics although these are likely to be the least commonly
Network (HMN) also further subdivides HIS into inputs, available (Donaldson and Lohr, 1994).
processes, and outputs.
 INPUTS - Health information system
resources.
 PROCESSES - Indicators, Data sources, Data
management
 OUTPUTS - Information products,
Dissemination and use

o Categories of different sources of information in HIS

a. Demographic data consist of facts such as age (or

birth date), gender, race and ethnic origin, marital
status, address of residence, names of and other
information about immediate family members, and Lesson 6:
emergency information. Information about
 Healthcare administrations were managed manually,
employment status (and employer), schooling and
traditionally starting from the patient registration to
education.
consultation. The creation of documents proved to be
b. Administrative data involves facts, with respect to
time consuming and posted a risk of having duplicate
services provided (e.g., diagnostic tests or outpatient
records. There was also a need for proper storage, which,
procedures), and also typically include charges and
if not considered and practiced, could result to difficulty
amounts paid, the kind of practitioner (physician,
in retrieval and high cost maintenance.
pediatrist, psychologist), physician specialty, and
nature of institution (general or specialty The problems faced by hospitals using traditional manual process:
hospital, physician office or clinic, home care
agency, nursing home, and so forth).  No real time data available to monitor the performance of
c. Health risk information reveals lifestyle and the hospital
behavior (e.g., whether an individual uses of  Evidence based program management was a challenge
tobacco products or engages regularly in strenuous  Undue delays in receipt of data
exercise) and facts about family history and genetic  Retrieval of old manual records was ineffective and time
factors to evaluate propensity for different diseases. consuming.
d. Health status (or health-related quality of life), is  Duplication of records
generally reported by individuals themselves,  Monthly reports sent as hard copy which is a real
reflects domains of health such as physical challenge for data analysis/comparison
functioning, mental and emotional well-being,
 Drug inventory/equipment inventory maintenance.
cognitive functioning, social and role functioning,
 Lack of standard names and code
and perceptions of one's health in the past, present,
and future and compared with that of one's peers Health Management Information System (HMIS)
e. Patient medical history considers data on previous
medical encounters such as hospital admissions,  information system specially designed to assist in the
surgical procedures, pregnancies and live births, and management and planning of health programs, as
the like; it also includes information on past medical opposed to delivery of care. (WHO,2004)
problems and possibly family history or events (e.g.,  one of the six building blocks essential for health system
alcoholism or parental divorce). strengthening.
f. Current medical management includes the  It is a data collection system specifically designed to
content of encounter forms or parts of the patient support planning, management, and decision making in
record. Such information might reflect health health facilities and organizations.
screening, current health problems and diagnoses,
allergies (especially those to medications),
diagnostic or therapeutic procedures performed,
laboratory tests carried out, medications prescribed,
and counseling provided
g. Outcomes data comprise a wide array of measures
of the effects of health care and the aftermath of
various health problems; they might reflect health
care events such as re-admission to hospital or
unexpected complications or side effects of care,
and also include measures of satisfaction with care.
Outcomes assessed weeks or months after health
care events, and by means of reports directly from
individuals (or family members), are desirable,
  The system is actually a set of integrated components Eight Elements of the HMIS
and procedures organized with the objective of
generating information which will improve health care I. Data Acquisition
management decisions at all levels of the health system.  This involves both the generation and
 It is a routine-monitoring system that monitors and the collection of accurate, timely, and
evaluates the process with the intention of providing relevant data. In HMIS, this is normally
warning signals through the use of indicators achieved through the input of standard
coded formats (e.g., the use of bar codes)
Roles of the HMIS to facilitate the rapid mechanical reading
and capturing of data.
 The major role of HMIS is to provide quality II. Data Verification
information to support decision-making at all levels  Data verification involves the
of the health care system in any medical institution.
authentication and validation of
 it also aims to aid in the setting of performance targets gathered data. The quality of collected
at all levels of health service delivery and to assist in
data depends largely on the authority,
assessing performance at all levels of the Health validity, and reliability of the data
Sector (Ministry of Health, 2010)
sources.
A Health Management Information System needs to be: III. Data Storage
 The preservation and archival of data
 Complete: It should provide information on all key may be regarded as part of the data
aspects of the health system without duplication storage function. When accumulated data
 Consistent: If similar information is provided by are no longer actively used in the system,
different sources, their definitions need to be consistent. a method to archive the data for a certain
 Clear: It should be very clear on what all the elements period is usually advisable and may
are actually measuring sometimes be mandatory, as when it is
 Simple: It should not be complicated required by legislation.
 Cost Effective: The actual usage of each element should IV. Data Classification
justify the costs of its collection and analysis.  This is also known as Data
 Accessible: Data should be held in a form readily Organization.
accessible to all legitimate users, and it should be clear  It is a critical function for increasing the
who these people are. efficiency of the system when the need
 Confidential: It should ensure that people without arises to conduct a data search.
legitimate access are effectively denied.  Most data classification schemes are
based on the use of certain key
Functions of HMIS parameters.
 For example, data referring to a patient
 The information from the HMIS can be used in planning,
population may be classified and sorted
epidemic prediction and detection, designing according to various diagnostic
interventions, monitoring and resource allocation
classification schemes.
(Ministry of Health, 2010). V. Data Computation
 Historically, all information systems, including HMIS,
 involves various forms of data
are built upon the conceptualization of three fundamental
manipulation and data transformation,
information-processing phases: data input, data
such as the use of mathematical models,
management, and data output
statistical and probabilistic approaches,
linear and nonlinear transformation, and
other data analytic processes.
 It allows further data analysis, synthesis,
and evaluation so that data can be used for
strategic decision-making purposes other
than tactical and/or operational use

VI. Data Update

 New and changing information is
accounted for through the element of data
update. The dynamic nature of such data
modification calls for constant
monitoring. For HMIS to maintain current
Three fundamental information-processing phases: data, mechanisms must be put in place for
updating changes in the face of any
o Data Input - includes data acquisition and data ongoing manual or automated
verification. transactions.
o Data Management - also called processing phase VII. Data Retrieval
includes data storage, data classification, data update,  Data retrieval is concerned with the
and data computation. processes of data transfer and data
o Data Output - includes data retrieval and data distribution.
presentation.  The data transfer process is constrained by
the time it takes to transmit the required
 data from the source to the appropriate  Having a system in place which support data collection,
end-user. analysis and transform it to useful information will help
 One significant criterion to be considered in promoting evidence based on decision making.
in the data retrieval function is the  Thus, all components within the system are ideal in
economics of producing the needed making the RHIS perform better.
information.  The effectiveness of the organizational culture is to
VIII. Data Presentation improve RHIS performance, promoting a culture of
 it has to do with how users interpret the information use, which involves the ability and control to
information produced by the system. promote values and beliefs among members of an
 In situations where only operational or organization by collecting, analyzing and using
even tactical managerial decision making information to accomplish the organization's goals and
is expected, summary tables and statistical mission (Sanga, 2015).
reports may suffice.
Technical determinants
 The use of presentation graphics for
higher-level managerial decision analysis  Technical factors involve the overall design used in the
is particularly encouraged because these collection of the information.
appear to provide a better intuitive feel of  It comprises the complexity of the reporting forms, the
data trend. procedure set forward in the collection of data, the
overall design of the computer software used in the
List of functions of HMIS
collection of information (Sanga, 2015).
o Client data
PRISM Framework (Performance of Routine Information System
o Scheduling Management)
o Authorization tracking
o Billing o this conceptual framework broadens the analysis of
o Accounts receivable management routine health information systems to include the three
o Reporting key factors.
o Medical records
1.Behavioral determinants - knowledge, skills, attitudes, values,
o Compliance
and motivation of the people who collect and use data.
o Financial data
2. Technical determinants - data collection processes, systems,
Determinants of HMIS Performance Area forms, and methods.
o Behavioral 3. Organizational/environmental determinants-Information
o Organizational culture, structure, resources, roles, and responsibilities of the health
o Technical system and key contributors at each level.
Behavioral determinants Determinants of HMIS Performance Area

 The data collector and users of the HMIS need to have o This framework identifies the strengths and
confidence, motivation and competence to perform weaknesses in certain areas, as well as correlations
HMIS tasks in order to improve the Routine Health among areas.
Information System (RHIS) process. The chance of the o This assessment aids in designing and prioritizing
task being performed is affected by the individual interventions to improve RHIS performance which in
perceptions on the outcome of what is being performed turn improves the performance of the health system.
and the complexity of the task being performed (Aqil, o The PRISM Framework defines the various components
Lippeveld, and Hozumi, 2009). of the routine health information system and their
 Lack of enough knowledge on the use of data has been linkages to produce better quality data and continuous
found to be a major drawback on the data quality and use of information, leading to better health system
information use.
 Despite training on data collection and data analysis,
people are still having negative attitude on the data, and
hence a lot needs to be done to change people’s behavior,
in order to increase the performance of the (RHIS)
process (Routine Health Information Network, 2003).

Organizational Determinants

 Health workers and data collectors work in organization's

environments which have value, norms, culture and
practice.
 The most important organizational factor which affects
the RHIS process is related to structure, resource,
procedure, support services and the culture which is
used to develop and improve the RHIS process. (2000,
Design and Implementation of Health Information
Systems. Geneva: Sage.Lippeveld T)
performance and, consequently, better health outcomes.
 other factors which affect the RHIS process which
includes lack of funds, human resource, and
management support.
 o It is founded on performance improvement principles  facilitate the identification of indicators and data sources,
(Aqil, Lippeveld, and Hozumi, 2009). provide tools and guidance for data analysis, and show
how the data can be communicated and used for
decision-making
 bring together the monitoring and evaluation work in
disease-specific programs with cross-cutting efforts such
as tracking human resources, logistics and procurement,
and health service delivery

M and E Framework

 Monitoring and evaluation (M&E) is a core component

of current efforts to scale up for better health. Global
partners and countries have developed a general
framework for M&E of health system strengthening
(HSS)
 The core is the strengthening of a common country
platform for M&E of HSS, which should result in better
alignment of country and global M&E systems and can
be used both for monitoring the health systems funding
platform, as well as for tracking the performance of
specific programs. The framework addresses indicator
selection, related data sources, analysis and synthesis
practices (including quality assessment), performance
review, communication and use (World Health
Organization, 2009).
 For monitoring medical services, indicators should be
tracked to assess processes and results associated with
the various indicator domains. Monitoring these
indicators provides information on the strengths and
weaknesses of implementation, and can help to identify
Lesson 7: “red flags” where further investigation and adjustments
may be needed.
Monitoring and Evaluation
 It should be noted that shifts in outcome and impact
 Monitoring is the systematic collection, analysis and indicators may not be directly attributable to integrated
use of information from programs for three basic service delivery efforts, as there are many other factors
purposes: which influence these indicators.
 (1) Learning from the experiences acquired (learning
function);
 (2) Accounting internally and externally for the resources
used; and
 (3) the results obtained (monitoring function) and taking
decisions (steering function).
 Evaluation is assessing an ongoing or completed
program or policy as systematically and as objectively
as possible. Based on this information, it can be
determined whether any changes need to be made at a
program or policy level, and if so, what they are, what
went well, where is there room for improvement.
 Thus, Evaluation has both a learning function - the
lessons learned need to be incorporated into future
proposals or policy - and a monitoring function - partners
and members review the implementation of policy based
on objectives and resources mobilized. Monitoring and
evaluation
 Progress of any medical institution are monitored and
evaluated through various activities such as monitoring
reports, HMIS, surveys and evaluation studies. The state
has undertaken various activities as a part of established
monitoring and evaluation system. According to the
National Health Mission (2014), strategies for
operationalizing the framework should:
 be primarily country-focused but also offer the basis for
global monitoring;
 address M&E needs for multiple users and purposes,
including monitoring program inputs, processes and
results, tracking health systems performance and
evaluation;
Relationship between M&E with HMIS Indicators Health System Indicators and Data Sources

An indicator can be defined as a variable whose value changes. It is

a measurement that measures the value of the change in
meaningful units that can be compared to past and future units. It
focuses on a single aspect of a program or project – i.e., an input,
output or the overarching objective

Key Performance Areas and Indicators

 There are different HMIS indicators which can be used

for monitoring of key aspects of the health system
performance. These are from among the five broad
categories –
 Reproductive health,
 Immunization,
 Disease prevention and control,
 Resources utilization and
 Data Quality

The Maternal Survival Strategy and HMIS Indicators

 o The Maternal Survival Strategies lays down a framework o Ethiopia is one of those countries who have made great
for achieving the fifth Millennium Development Goal of strides towards reducing the under-5 mortalities based on
reducing maternal mortality. Given the complexity of the Ethiopia Maternal and Child Health Data (2012).
country contexts and the determinants of maternal health, o However, under-5 mortalities still remain high at 106 per
none of the maternal survival intervention alone can 1000 live births (LB) in 2010 and the country faces the
reduce the maternal mortality rate. Rather, evidences challenge of reducing it to 61/1000 LB by 2015.
support packaging of health facility oriented o Diarrhea, pneumonia, measles, malaria, HIV/AIDS, birth
interventions is highly effective and has high coverage of asphyxia, preterm delivery, neonatal tetanus and neonatal
the intended target group. sepsis are the major causes of under-5 deaths in Ethiopia,
o In order to routinely monitor the progress towards with under-nutrition attributing to over one third of these
implementation of a highly effective package of maternal deaths.
survival interventions, the HMIS is designed to provide
albeit some of the core input, process and output Ethiopia is implementing interventions targeting under 5-year-old
indicators. HMIS indicators related to pregnancy care children through:
interventions are:
 Universal Immunization Coverage,
o 1st antenatal care attendances
 Nutrition program,
o 4th antenatal care attendances
 Integrated Management of Childhood Illnesses and the
o Cases of abnormal pregnancies attended at out-patient
Community Case Management of Childhood Illnesses
departments (OPD) of health facilities
 Through Health Development Army to – improve water,
o Institutional cases of maternal morbidity and mortality
sanitation and hygiene– Malaria prevention through
due to Antepartum hemorrhage (APH), hypertension and
Integrated Household Spraying and distribution of
edema reported by In-patient departments (IPD) of health
Insecticide Treated Nets (ITN) (USAID, 2013).
facilities
o Cases of abortion attended at health facilities The related HMIS indicators are:
o Cases of medical (safe) abortions conducted at health
facilities  Number of treatments for children under five provided
by health facility by disease : Diarrhea, dysentery,
HMIS indicators related to intrapartum care: pneumonia, measles, malaria, neonatal tetanus
 Number of infants immunized for measles
o Deliveries by skilled attendance (at health facilities)
 Latrine coverage
o Deliveries by Health Extension Workers (HEW) (at
 Safe water coverage
home of Health Posts)
 Household with ITN
Institutional cases of maternal morbidity and mortality due to
Causes of mortality rate of children in the Philippines
Obstructed labor
 Pneumonia
o HMIS indicators related to post-partum care:
 Diarrhea and gastroenteritis
o 1st postnatal care attendance
 Congenital anomalies
o Institutional cases of maternal morbidity and mortality
 Other diseases of the nervous system
due to Postpartum hemorrhage (PPH) and Puerperal
sepsis  Septicemia
 Accidental drowning and submersion
HMIS indicators related to inter-partum (between  Chronic lower respiratory diseases
pregnancies) period  Dengue fever and dengue hemorrhagic fever
 Meningitis
o Family planning method acceptors (New and Repeat)
 Pulmonary and heart disease
o Family planning methods issued by type of method
The STOP TB Program
Though not a complete set to monitor every facet of maternal
survival strategies, these HMIS indicators duly capture data related o With the vision to have a TB free world, the goal of the
to pregnancy, intra-partum and postpartum care, sufficient to give a STOP TB Program (STP) is to dramatically reduce the
broad indication of the ongoing performance of the package of global burden of TB by 2015, in line with the
maternal survival interventions, and having the ability to instigate Millennium Development Goals and the Stop TB
further investigation if problems/issues are identified using these Partnership targets of the World Health Organization
HMIS indicators. (2006). One of the main objectives of the program is to
achieve universal access to high-quality care (i.e.
The Child Mortality and Child Survival Interventions
universal access to high quality diagnosis and patient
centered treatment) for all people with TB(including
those co-infected with HIV and those with drug-resistant
TB).
o TB case detection and successful completion of the
treatment/cure of the TB remains at the core of the Stop
TB Strategy. Hence one of the targets linked to the
MDGs and endorsed by the Stop TB Partnership is by
2050 to reduce prevalence and deaths due to TB by 50%
compared with a baseline of 1990.The following
flowchart puts the HMIS indicators (in green shaded
boxes) in the context of the STOP TB Program.
Routine Monitoring data on TB program captured through
HMIS

HMIS Indicators to Monitor STOP TB Program

o TB patients on DOTS
o Number of new smear pulmonary TB cases enrolled in
the cohort
o TB Case Detection
o Number of New smear positive pulmonary TB cases
detected
o Number of new smear negative pulmonary TB cases
detected
o Number of new extra pulmonary TB cases detected
o HIV – TB – Co-infection
o Proportion of newly diagnosed TB cases tested to HIV
o HIV+ new TB patients enrolled in DOTS
o TB Treatment outcome
o Treatment completed PTB+
o Cured PTB+, Defaulted PTB+, Deaths PTB+
 adaptation was comprised of designating health facilities,
DHIS monthly reports, sections of monthly reports and
group of data elements as ‘Lots’ to provide
representative samples for data quality assurance of
DHIS.

Routine Data Quality Assessment (RDQA)

o The Routine Data Quality Assessment Tool (RDQA) is a

simplified version of the Data Quality Audit (DQA)
which allows programs and projects to verify and assess
the quality of their reported data. It also aims to
strengthen their data management and reporting systems.
Lesson 8: The objectives of RDQA are as follows:
Data quality is the overall utility of a dataset(s) as a function of its
ability to be processed easily and analyzed for a database, data
warehouse, or data analytics system.

It is a perception of the data's appropriateness to serve its purpose

in a given context. Having quality data means that the data is useful
and consistent. Data cleansing can be done to raise the quality of
available data (Rouse, 2005).

Development Implementation Plan

o An Implementation Plan is a project management tool

that shows how a project will evolve at a high level. An
implementation plan helps ensure that a development

Data Accuracy using Lot Quality Assessment Sampling

(LQAS)

o The Lot Quality Assessment (LQAS) is a tool that

allows the use of small random samples to distinguish
between different groups of data elements (or Lots) with
high and low data quality.
o For health managers and supervisors, using small
samples makes conducting surveys or supervision more
efficient. This technique has a wide application in the
industry for decades and has primarily been used for
quality assurance of products.
o The concept and application of LQAS technique has team is working to deliver and complete tasks on time
been adopted in the context of (District Health (Visual Paradigm, 2009).
Information System) DHIS data quality assurance. The o The development of an Implementation Plan is important
to ensure that the communication between those who are
 involved in the project will not encounter any issues and o What is a Root Cause Analysis?
work will also be delivered on time. The plan validates A root cause analysis is a class of problem solving
the estimation and schedule of the project plan. methods aimed at identifying the root causes of the
problems or events instead of simply addressing the
An Implementation Plan has the following key components: obvious symptoms.
o Define Goals/Objectives: The aim is to improve the quality of the products by
using systematic ways in order to be effective (Bowen,
o Answers the question “What do you want to
2011).
accomplish?”
o Techniques in Root Cause Analysis
o Schedule Milestones:
Root cause analysis is among the core building blocks in
o Outline the high level schedule in the implementation
the continuous improvement efforts of the organization.
phase.
Keep in mind that root cause analysis alone will not
o Allocate Resources:
produce any results. The organization should embrace a
o Determine whether you have sufficient resources, and relentless pursuit of improvement at every level and in
decide how you will procure what’s missing. every department for this to work. The analysis will help
o Designate Team Member Responsibilities: develop protocols and strategies to address underlying
o Create a general team plan with overall roles that issues and reduce future errors.
each team member will play.
o Define Metrics for Success: Techniques involved in a root cause analysis as described by
o How will you determine if you have achieved your Bowen
goal?
o Ask Why 5 Times
Data Quality Tool  This might sound like the technique of a five-
year-old wanting to get out of going to bed, but
o A Data quality tool analyzes information and identifies the five whys analysis can be quite useful for
incomplete or incorrect data. Cleansing such data follows getting to the underlying causes of a problem.
after the completion of the profiling of data concerns, By identifying the problem, and then asking
which could range anywhere from removing "why" five times - getting progressively deeper
abnormalities to merging repeated information. into the problem, the root cause can be
o By maintaining data integrity, the process enhances the strategically identified and tackled.
reliability of the information being used by a business. o Failure Mode and Effects Analysis (FMEA)
Usually these data quality software products can share  The Failure Mode and Effects Analysis
features with master date management, data integration, (FMEA) is a technique which is aimed to find
or big data solutions. various modes for failure within a system.
FMEA requires several steps for execution:
Data quality tools used to address the data quality problem:  All failure modes (the way in which an
observed failure occurs) must be determined. 
Application/Scope of Data Quality tools
How many times does a cause of failure
occur? 
What actions are implemented to prevent this
cause from occurring again? 
Are the actions effective and efficient?
 FMEA is often performed and updated any
time a new product or process is generated,
when changes are made to current conditions,
or to the design, when new regulations occur,
or when there is a problem determined through
customer feedback.
o The Pareto Analysis

o The first generation of data quality tools was

characterized by dedicated data cleansing tools designed
to address normalization and de-duplication.
o But during the last 10 years, it was observed that there is
generalization of Extract, Transform, Load (ETL) tools
which allowed the optimization of the alimentation
process.
o Recently, these tools started to focus on Data Quality
Management (DQM), which generally integrate
profiling, parsing, standardization, cleansing and
matching processes (Goasdue, Nugier, Duquennoy, and
Laboisse, 2007).

Techniques in Root Cause Analysis

  The Pareto analysis operates using Pareto starting with each of those problems using
principle (20% of the work creates 80% of the causal language (if...and...then). The tree will
results. You will want to run Pareto analysis depict each potential cause for a problem.
any time when there are multiple potential Eventually, the tree will show one cause that is
causes to a problem. In order to perform a linked to all four problems.
Pareto analysis, you will want to create a o Fishbone or Ishikawa or Cause-and-Effect Diagrams
Pareto chart using Excel or some other  No matter what term you use for the fishbone
program. To create a Pareto chart, you will list diagram, the truth is, that it is a useful
technique that will help you in your root cause
analysis. A fishbone diagram will group causes
into categories including:
 People
 Measurements
 Methods
 Materials
 Environment
 Machines

potential causes in a bar graph across the

bottom - from the most important cause on the
left to the least important cause on the right.
Then, you will track the cumulative percentage
in a line graph to the top of the table. The
causes reflected on the table should account for
at least eighty percent of those involved in the
problem.
o Fault Tree Analysis
 Fault Tree Analysis uses Boolean logic to
determine the root causes of an undesirable
event. This technique is usually used in risk
analysis and safety analysis. At the top of the
fault tree, the undesirable result is listed. From o Kepner-Tregoe Technique
this event, all potential causes tree down from
 The Kepner-Tregoe technique, also known as
it. Each potential cause is listed on the diagram
rational process is intended to break a problem
in the shape of an upside down tree.
down to its root cause. This process begins
o Current Reality Tree (CRT)
with an appraisal of the situation - what are the
 The current reality tree analyzes a system at priorities and orders for concerns for specific
once. It would be used when many problems issues? Next, the problem analysis is
undertaken to get to the cause of undesired
events. Then, a decision analysis is tackled,
outlining various decisions that must be made.
Finally, a potential problem analysis is made to
ensure that the actions decided upon in step
three are sustainable.
o RPR Problem Diagnosis
 One final technique used in root cause analyses
is the RPR Problem diagnosis. RPR stands for
"Rapid Problem Resolution" and it deals with
diagnosing the causes of recurrent problems.
 This process has three phases
 Discover - team members gather data and
analyze their findings
 Investigate - a diagnostic plan is created and
the root cause is identified through careful
analysis of the diagnostic data
 Fix - the problem is fixed and monitored to
ensure that the proper root cause was
identified.
exist and you want to get to the root causes of
all the problems. The first step in creating a Sustaining culture of information use
current reality tree is listing all of the
o Choo, Bergeron, Detlor, and Heaton (2008) stress that
undesirables or, problems. Then begin a chart
information culture affects the information use outcomes.
o The information culture is determined by the following
variables: mission, history, leadership, employee traits,
industry, national culture. It can also be shaped by
cognitive and epistemic expectations which is influenced
by the way that tasks are performed and decisions are
made.
o The result suggests that in order to have a sense of the
information attitudes and values, the managers should
consider taking the information pulse of their own
organizations. The sets of identified behaviors and values
were able to account for significant proportions of the
variance in information use.
o Thus, the management plays an important part in
sustaining the culture of information and should
continuously work on maintaining and improving the
quality of data and information used in their daily
operations.