Two years ago, the COVID-19 pandemic began to spread across the world. One after the other, the countries were being hit by the virus spread. There was one country in particular, however, which suffered heavily from the very beginning: that country was Italy. In less than one month from the recording of the first case (i.e. from February 20th to March 17th), the pandemic spread in Italy reached an average of more than 3,000 cases per week!
Everyone remembers the horrifying TV broadcasts from Bergamo (in particular), where brave hospital doctors were fighting hard to save peoples’ lives, but also the country’s NHS (National Health System) from collapse! There is one question, however: Why Italy was hit earlier and more severely than any other country? What went wrong there? What was the problem?
Problems are sometimes different from problem statements: in the case of pandemic spread in Italy, the problem is the swift pandemic spread in the country, whereas the problem statement is related to the question mentioned earlier: why Italy was hit earlier and more severely in comparison with other countries?
In scientific problem solving, such problems are called complicated: there isn’t one thing that goes wrong; there are many. And some of them go wrong simultaneously! (Or, to put it in problem solving glossary, there isn’t a single ‘root-cause’; there are many and concurrent).
The most useful tool to analyse complicated problems is the so-called ‘fishbone analysis’. The fishbone analysis is nothing but a diagram which helps us find all the possible causes for a particular problem. The diagram looks like a fish skeleton with the problem statement at its head and the causes for the problem feeding into the spine. Its main purpose is to act as a first step in problem solving by generating a comprehensive list of possible causes. Fishbone analysis can either lead to immediate identification of causes and point to the potential remedial actions, or it may indicate the best potential areas for further exploration and analysis.
Let’s use this problem to illustrate the method of fishbone analysis. Bear in mind, however, that the analysis is just for demonstrating purposes only and is by no means complete; there could be some other causes missing, or there may be others which –although included here- were not in fact root causes. The fishbone diagram will look like the one below:
Six different angles have been selected for the analysis: people, processes, technology, environment, information and management (different angles can be used for different problems, the most relevant ones to the ‘nature’ of the problem at hand).
People: It is well documented that the speed of coronavirus transmission had been underestimated in the early days of the pandemic. As a result, people did not deviate from their daily routines and no containment measures were taken. Two examples: in February 19th, nearly forty thousand people in Bergamo went to the city’s stadium to watch the football match between Atalanta and Valencia. There were no prophylactic measures taken, despite the experts’ warnings. Second, many Chinese who live and work in Lombardy travelled to China to celebrate the Chinese New Year. Although it was known that the virus had started its spread in China since November 2019, three months later people were going to and returning from that country without any precaution.
Processes: There was a great delay in applying containment measures, despite the warnings from scientists. Lockdown in Northern Italy, for example, was announced on March 8th, nearly three weeks after the first Covid-19 case was reported in the country. That was too long. Until March 8, warnings from scientists were met by skepticism by the public, as well as by some politicians, who believed that ‘business as usual’ should continue in the country’s industrial North.
Technology: Like everywhere in the world, the country’s NHS was not prepared to face a pandemic. There were not enough ICU or single beds in hospitals, and there were not enough doctors as well. In addition, there were neither medicines, nor vaccines available to fight, or protect from COVID-19 disease. (Here, please note that these two are indeed root-causes for the problem, but not relevant to the problem statement).
Environment: The coronavirus pandemic hit the country in the middle of winter. And it is well known that respiratory infections spread more easily during the winter (again, like in technology, this root cause is not relevant to the problem statement).
Information: WHO has been criticized for declaring the pandemic too late; they did it on March 11th. Had they declared it earlier, Italy could have probably taken the threat more seriously, and measures could have been in place earlier on. Second, China has also been criticized for not providing enough information quickly, and that caused further delay in assessing the magnitude of the problem. And third, since Italy was the first country to face the problem, there was no information, or best-practices available from others to imitate (in problem solving, this is called the ‘first mover’s disadvantage’, where you can’t learn from others, simply because you are the first who encounters the problem!)
Management: Unlike other countries, the political system in Italy gives autonomy to the regions with regards to decision making. Regional governors can deviate from the central government’s recommendations. As a result, Italy failed to adopt a coordinated approach to the emergency. For example, Lombardy and Veneto, two neighboring regions, adopted entirely different policies: Veneto imposed a much broader testing of both symptomatic and asymptomatic cases than Lombardy. They also performed active tracing of possible positives and put a strong emphasis on home diagnosis and care. Lombardy did not follow. In addition, because of the different measures in regions, the closing of Northern Italy (March 8) sparked a massive, frightened exodus to Southern Italy, which resulted in spreading the virus to other regions. And to make things worse, the central government delayed the request for assistance from other countries, believing that they could manage to contain the spread soon, despite the voices from some regional governors who were calling for a quicker and more extensive response.
The above analysis shows that there are many root-causes for a complicated problem (twelve for the problem of the pandemic spread in Italy). Some of them (in black in the diagram) do respond to the problem statement, some others (in gray) do not.
As it is mentioned previously, fishbone diagram is the first step in solving complicated problems. You don’t stop there. Your next task is to discard the non-relevant root causes, focus on the remaining ones, and try to identify what you can avoid, correct, improve, or do differently in case you face a similar problem in the future.
