A hospital emergency service department was analyzing the factors that were contributing to failing performance against response time targets set for urgent care response calls. It listed the main issues that prevented the ambulance from bringing the patient back to the hospital on time.

a. Use a Pareto chart to identify the "vital few" patient transport problems. Comment on potential root causes of these problems and identify any especially egregious quality failures.

b. To understand the root cause of the problem, the hospital management requested the ambulance crew to maintain a log of specific difficulties. After a week, the log included the following entries: drunk patient, caller unaware of the location, incorrect address provided, vehicle had mechanical issues, unable to fit patient on a stretcher due to body size, and map system does not have real-time traffic updates. Organize these causes into a cause-and-effect diagram.

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Problem Ambulance driver unable to locate the patient Road traffic Ambulance performance issues Staff availability Equipment issues Uncooperative patient Delayed support from other agencies such as fire and police Total Frequency 22 30 8 8 12 14 6 100