Common steps and sub-activities
Cause effect diagrams
One of the techniques used extensively in systems analysis for computer systems is that of the cause effect diagram. It was developed because a computer system is often requested to solve problems which in fact do not have their cause in the lack of automated support for a system.
The technique aims to establish what are the underlying or root causes of problems. Instead of treating each problem separately it then becomes easier to establish an overall picture which may provide a better idea of the ultimate problem [or problems] to be solved. Once these are established, a solution is found which may or may not involve the use of a computer.
This same technique can be used in all sorts of other situations where there is the need to solve problems. It is thus not a technique whose use is solely confined to computer system development, but a very generic problem solving technique that can be used in many different circumstances. One of its uses can be in the medical context.
The technique is extremely simple, although in practise finding causes and effects is not easy. The technique uses a diagram to trace the cause of problems.
Initially all the problems are listed to the right of the page each one in a box. The problems as a whole are then examined and the question asked ‘what caused this’. Any one problem can have more than one cause and a cause can result in many problems.
At a certain point, the cause – the problem - becomes one that has no solution because it is one that has ceased to apply or is a ‘closed event’ – it has gone and finished and is thus something that cannot be acted on. In the example, the ringed causes cannot be ‘solved’, they have no solution as they are over and done with. In some cases the event is a single event like the ‘death of the mother’ in other cases, the cause may cease to exist, so if the person has retired from the job then it can no longer be ‘solved’ even though it has had a long term effect.
But the remaining causes can be isolated and a solution attempted. These are arrowed in the diagram.
The diagram then provides the input for a ‘plan of campaign’, all of which may require different skills and treatments. In the example
- Break up with lover/best friend – a plan of reconciliation
- Emotional distress – osteopathic treatment aimed at balancing emotions
- Poor diet and over eating – a nutritional review and a diet plan
- Not enough exercise – an exercise plan
- Heart failure – medical intervention via surgery
Thus for any situation of co-morbidities, multi-disciplinary treatment may be required
In this simplified example of a child with obesity, there are many cyclical causes. Overweight has meant the child does not get enough exercise, but by not getting enough exercise, the child simply gains more weight. There are a number of causes which can be tackled here…
The plan of campaign then becomes the following
- Problems at home between the parents – requires a plan to help the parents sort out the problems that are affecting the child.
- The emotional problems caused by the child’s poor self image and their lack of friendship require a plan to help the child with both problems and to delve further into the self image and the lack of friends – in other words further examination of why these exist.
- The lack of proper meals - requires a plan to educate the parents on how to provide nutritional meals for the child with the correct balance of nutrients and calorie intake.
- The lack of exercise – requires a plan that helps the child exercise in a way that is suited to the level of fitness he/she has and their level of obesity.
Cause effect diagrams are designed to help identify the root causes of a set of problems which may have their origin way back in time or in activities that have long since passed. By going backwards using the question ‘what caused or is causing this’ a point comes when the primary causes have been found along with a set of ongoing problems that can be treated – solved.
The solution may be multi-disciplinary involving a range of professionals from the osteopath, medical doctors, fitness specialist and coaches, surgeons, psychotherapists, nutrionists, as well as friends and parents. The approach is holistic in that it treats the person and all their problems as a whole.
The technique helps to ensure that it is not the symptoms only that are treated – for example the use of drugs to ‘cure’ obesity, or anti-depressants to treat loneliness, inhalers to treat the shortness of breath, support stockings for the oedema, paracetomol/co-codamol for the headaches and so on, but that a more measured and systematic study is made of the root causes and a plan of campaign proposed based on causes which have some chance of solution.
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