To ensure patients get the best care, there is a need to analyse and change nursing practice, demonstrated in the report on the Mid Staffordshire public inquiry. This article, the first in a three-part series on change management tools, examines how using fishbone analysis to identify the cause of problems, leading to solutions and action plans, can assist staff to make changes to their service to benefit both patients and staff. A case study of a team trying to reduce clinic waiting times is discussed.