True Causes
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7/7 · Actions
30 people · 34 ideas
walkthrough · not counted
obstacles · anyone with the link · listed publicly · federation on
stewarded by its steward (sealed)
30 people · 34 ideas · 2 groups · 3 rooms federated
Passport → · Logic → · record
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On another site, as a live map:
As a picture: https://truecauses.org/d/4b093a1/map.svg
As data: every judged pair in this room (CSV). Each claim has its own address, /c/4b093a1/<card>, listed under the map.
Credit when you publish: Causal map: True Causes, https://truecauses.org/d/4b093a1
THE QUESTION

Why is the emergency department always behind?

Propose what to do, then judge whether each action would move each root.

Sealed 9 days ago: this room no longer knows who sat in it; only its steward is still named. What it concluded stays.
30 at the table (29 simulated) · 3 actions proposed against 6 root causes. Add one, then judge whether each action moves each cause.
Viewing as guest. Enter a handle to join and take part.
Some claims influence each other in a circle
↺ Winter money arrives in November for a plan ne → Every part of the system optimises its own bud → One-year funding buys agency staff, not perman → A saving in social care is a cost here and nob → …
A circle can be a real finding — a cycle that feeds itself — or a link whose direction was never really settled. The map treats the group as one node, so nothing inside it is a root on its own. If it is the second, the pair is worth putting back to the room.
Score the roots first
why
The method's own practice, before any action is proposed: each root cause is scored 1–5 on how feasible it is to address, how much impact addressing it would have, and how likely it is to resolve by itself with no intervention. Priority goes to roots with high impact, high feasibility and low likelihood of fixing themselves — priority = impact + feasibility − likelihood. Scores are averaged across the group and shown with how many scored.
1 = low, 5 = high. Your own scores; the group's averages beside them.
root causefeasibleimpactfixes itselfpriority
We report to eleven bodies and none of them to each other––––
Beds are full because nobody can be discharged––––
Nobody owns the whole patient journey––––
People wait hours in a corridor before anyone sees them––––
The estate is older than anyone working in it––––
Nobody is paid for the patient who did not need to come––––
Would each action move each root cause?
Down the side: the actions people proposed. Across the top: the root causes the map found. Every square is one vote on one question — would this action significantly reduce that cause? One side has to reach 75% of the votes cast to settle it; short of that the square stays split. Each square shows how its votes fell — yes / worse / no — and a square is settled when one of those reaches three quarters of them.
why
Answered at 75% of votes cast, like every other question here. Split means people voted and neither side reached that bar — it is a result, not a queue, and it stays split until enough people change their minds. A square nobody settles stays undecided; it never turns into a no. Judging each pair on its own is what stops a popular action being credited with fixing things it does not touch.
ACTIONROOT CAUSES · does the action on the left reduce it?
We report to eleven bodies and none of them to each otherBeds are full because nobody can be dischargedNobody owns the whole patient journeyPeople wait hours in a corridor before anyone sees themThe estate is older than anyone working in itNobody is paid for the patient who did not need to come
Fund on a ten-year plan, not a winter discussnot decided yet
not decided yet
not decided yet
not decided yet
not decided yet
not decided yet
Pay something for the patient who did not need to come discussnot decided yet
not decided yet
not decided yet
not decided yet
not decided yet
not decided yet
One budget for discharge, held jointly discussnot decided yet
not decided yet
not decided yet
not decided yet
not decided yet
not decided yet
THE ACTIONS ON THE MAP
Showing every action the room judged: it acts directly on 0 of the 6 root causes. It does not act directly on 6.
Read from the squares the room settled at Actions, nothing else. A root in green is reduced by at least one of the shown actions; in grey, none of them acts on it directly; a red outline means one of them makes it worse.
Share this view: as a picture · as a live map for another site
Winter money arrives in November for a plan needed in June → Every part of the system optimises its own budgetWinter money arrives in November for a plan needed in June → One-year funding buys agency staff, not permanent onesVacancies are counted as savings in the same month they are a crisis → We are measured on activity, so activity is what we producePeople wait hours in a corridor before anyone sees them → The incentive is to treat, never to preventEvery part of the system optimises its own budget → Winter money arrives in November for a plan needed in JuneEvery part of the system optimises its own budget → A saving in social care is a cost here and nobody nets itThe estate is older than anyone working in it → The incentive is to treat, never to preventOne-year funding buys agency staff, not permanent ones → Staff leave faster than we can hire themNobody is paid for the patient who did not need to come → The incentive is to treat, never to preventA saving in social care is a cost here and nobody nets it → Staff leave faster than we can hire themStaff leave faster than we can hire them → Every part of the system optimises its own budgetStaff leave faster than we can hire them → A saving in social care is a cost here and nobody nets itBeds are full because nobody can be discharged → People wait hours in a corridor before anyone sees themThe incentive is to treat, never to prevent → An improvement takes two years and a chief executive lasts eighteen monthsThe incentive is to treat, never to prevent → The same patients come back within a weekThe data we report is a year old by the time it is published → We have never once been asked to plan for ten yearsWe report to eleven bodies and none of them to each other → Politics changes the target every electionWe report to eleven bodies and none of them to each other → Nobody owns the whole patient journeyNobody owns the whole patient journey → People wait hours in a corridor before anyone sees themWinter money arrives in November for a plan needed in JuneWinter money arrives inNovember for a plan neededin Junepart of a feedback loop⟳Vacancies are counted as savings in the same month they are a crisisVacancies are counted assavings in the same monththey are a crisisEvery part of the system optimises its own budgetEvery part of the systemoptimises its own budgetpart of a feedback loop⟳The estate is older than anyone working in itThe estate is older thananyone working in itwhat the shown actions do to this root causeNO ACTION ACTS ON ITDIRECTLYOne-year funding buys agency staff, not permanent onesOne-year funding buysagency staff, not permanentonespart of a feedback loop⟳Nobody is paid for the patient who did not need to comeNobody is paid for thepatient who did not need tocomewhat the shown actions do to this root causeNO ACTION ACTS ON ITDIRECTLYA saving in social care is a cost here and nobody nets itA saving in social care isa cost here and nobody netsitpart of a feedback loop⟳Staff leave faster than we can hire themStaff leave faster than wecan hire thempart of a feedback loop⟳Beds are full because nobody can be dischargedBeds are full becausenobody can be dischargedwhat the shown actions do to this root causeNO ACTION ACTS ON ITDIRECTLYThe data we report is a year old by the time it is publishedThe data we report is ayear old by the time it ispublishedWe report to eleven bodies and none of them to each otherWe report to eleven bodiesand none of them to eachotherwhat the shown actions do to this root causeNO ACTION ACTS ON ITDIRECTLYNobody owns the whole patient journeyNobody owns the wholepatient journeywhat the shown actions do to this root causeNO ACTION ACTS ON ITDIRECTLYPolitics changes the target every electionPolitics changes the targetevery electionWe have never once been asked to plan for ten yearsWe have never once beenasked to plan for ten yearsWe are measured on activity, so activity is what we produceWe are measured onactivity, so activity iswhat we producePeople wait hours in a corridor before anyone sees themPeople wait hours in acorridor before anyone seesthemwhat the shown actions do to this root causeNO ACTION ACTS ON ITDIRECTLYThe incentive is to treat, never to preventThe incentive is to treat,never to preventAn improvement takes two years and a chief executive lasts eighteen monthsAn improvement takes twoyears and a chief executivelasts eighteen monthsThe same patients come back within a weekThe same patients come backwithin a week
Each number on the map marks a root cause that action reduces.
① Fund on a ten-year plan, not a winter
② Pay something for the patient who did not need to come
③ One budget for discharge, held jointly
What we expect to follow
Predictions about the actions: what each should change, how to measure it, and when to check. On the date, someone who was in the room writes what actually happened beside it.
why
A map says which actions move which causes. It does not say whether anyone did them, or whether anything changed. An entry here is a prediction with a date and something to measure, written after the map settled. When the date comes, what actually happened is written beside it and the prediction stays as it was: a wrong one is the useful kind. Nobody voted on any of this and it changes nothing the room found.
due 24 Mar 2027
actionOne budget for discharge, held jointly
we expecta patient ready to leave is not held by whose budget it is
measured bymedian days of delayed discharge per patient
guessesthe room: 5 (median of 15, spread 2 to 12)