The fishbone diagram, also known as the Ishikawa or cause-and-effect diagram, is a classic quality management tool used to identify root causes of problems [1, 2]. Standard practice often organizes causes under categories such as Process, Data, Human, and Infrastructure/Technology [3].

In system analysis and design, having a structured method is essential to avoid vague or reactive fixes [4]. The fishbone diagram reveals what is wrong, but by itself does not ensure what to do next. To close this gap, causes identified through the fishbone should be translated into clear objectives.

A useful method for this translation is the SMART framework—objectives that are Specific, Measurable, Attainable, Resource-based, and Time-bound [5]. For example, instead of writing “fix reminders” as a solution, the objective becomes: Implement automated LINE reminders within four weeks to ensure 100% of patients receive notifications 24 hours before appointments.

This systematic progression—from problem analysis (Fishbone) to structured action (SMART Objectives)—bridges analysis and execution. At Xystematic, we use this approach by combining principles from systems analysis and design [4], established quality tools [3, 5], and academic practices [2] to ensure every problem leads to clear, measurable objectives.

References:

[1] Ishikawa, K. Introduction to quality control. 3A Corporation, 1990.

[2] Bullington, K. “Learning to fish.” Quality Progress, 45(7), 17–21, 2012. https://www.qualityprogress.com

[3] American Society for Quality. Fishbone diagram (cause and effect diagram, Ishikawa diagram). https://asq.org/quality-resources/fishbone

[4] Kendall, K. E., & Kendall, J. E. Systems analysis and design. 10th ed., Pearson, 2019.

[5] American Society for Quality. SMART matrix. https://asq.org/quality-resources/smart-matrix