$$ A family medicine practice, with a history of over two decades at the same location, was running with a full team, including a Doctor, a Physician$$s Assistant $($PA$),$ Medical Assistants $($MA$),$ Office Managers, and Clerks. Though a significant part of the staff had been with the practice for many years, the practice faced challenges. With nearly $8,700$ patient visits the prior year, they had shifted from paper to an electronic health record $($EHR$)$ system due to the Affordable Care Act $($ACA$)$ requirements, which proved to be a major transition. The practice struggled with the accuracy of their EHR system and lacked process$-$oriented operations. A Lean Six Sigma consultant was called in$,$ emphasizing that the practice had issues with data management, process efficiency, and possibly its organizational culture.

$$ Shortage of staff

$$ Doctor was delayed.

$$ A patient without an appointment came and was seen before the scheduled patient.

$$ MA forgot supplies for a room, missed recording vitals, and made an x$-$ray error

$$ The doctor made an incorrect EHR error and nearly prescribed the wrong medication to a patient.

$$ The office manager juggles problems, including wrong deliveries and staff$-$related concerns, alongside criticism from the doctor over the day's disorganization.

$$ Patients were also not very happy at all today with the service they received and the excessive wait times.

Create $6$m fishbone diagram $$unhappy patient