Map · Why is the emergency department always behind?

Every room on this question built its own map; these are folded into one. The same claim raised in two rooms is one item, and each link shows how many rooms found it. Where rooms found opposite things, each finding stands, with how many of the rooms that judged the link found it.

2 links found by several rooms · 0 contested · 75 links in all.

found by two or more independent rooms one room another room agrees in its own words, or by a path only rooms that do not count rejected by most rooms that judged it a dispute between rooms

In a claim’s corner, one figure for each room that raised it; past five, a group with the number. Where the caption leaves no room for figures, the number alone (×7).

Under a cause: in how many of the rooms that judged actions against it one of their actions reduces it. Green: at least one room found such an action; grey: none did; uncoloured: no room judged actions against it. The numbers are the actions, listed under the map.

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THE ROOMS IN THIS MAP

⚠ All 3 rooms: demo · up to 4 cards word for word the same as in 2 other rooms here

Why is the emergency department always behind?

counts its verdicts weigh on this map — steward trusted by this instance

Why are waits in the emergency department so long?

demo · stands 1 vouch from its source, trusted steward _2e8400ac38

counts its verdicts weigh on this map — vouched for by the steward of “Why does A&E make people wait for hours?”

Why does A&E make people wait for hours?

counts its verdicts weigh on this map — steward trusted by this instance

A room counts once someone accountable stands behind it. ● settled before any map was public; ○ after.

RAISED IN MORE THAN ONE ROOM · 9

Beds are full because nobody can be discharged	3 rooms	on the map
People wait hours in a corridor before anyone sees them	3 rooms	on the map
Staff leave faster than we can hire them	3 rooms	on the map
The same patients come back within a week	3 rooms	on the map
There is no water and no food after ten	2 rooms	on the map
Two systems hold the same patient under different numbers	2 rooms	on the map
I was sent home at midnight with no way to get there	2 rooms	on the map
The staff are not the problem and everyone knows it	2 rooms	not on the map: no link to it was certified
Every winter is treated as a surprise	2 rooms	not on the map: no link to it was certified

WHAT THE ROOMS WOULD DO

Each room judged its own actions against its own root causes, at three quarters of its own votes. Nothing here is a vote across rooms: it counts, cause by cause, what each room found. A room appears once its Actions stage has closed. Each number on the map marks a root cause that action reduces.

Reduced in 1 of 3 rooms:

Beds are full because nobody can be discharged

① Tell people the expected wait, and update it · Why does A&E make people wait for hours?

Reduced in 1 of 1 room:

Managers are judged on the target too, so nobody questions it

② Pool the hospital and social care budget for discharge · Why are waits in the emergency department so long?

Nobody has ever asked me what would have kept me away

① Tell people the expected wait, and update it · Why does A&E make people wait for hours?

③ Ask every returning patient what would have kept them away · Why does A&E make people wait for hours?

Nobody measures whether the patient got better

② Pool the hospital and social care budget for discharge · Why are waits in the emergency department so long?

We have had four reorganisations and no more beds

④ Discharge seven days a week, including evenings · Why are waits in the emergency department so long?

No room found an action that reduces these:

A decision to admit waits for a consultant round in the morning · judged in 1 room
Nobody is paid for the patient who did not need to come · judged in 1 room
Nobody may discharge at night, so a bed is lost for twelve hours · judged in 1 room
Nobody owns the whole patient journey · judged in 1 room
People wait hours in a corridor before anyone sees them · judged in 1 room
The GP said six weeks and it has been five months · judged in 1 room
The estate is older than anyone working in it · judged in 1 room
The form asks questions I cannot answer about my own body · judged in 1 room
We report to eleven bodies and none of them to each other · judged in 1 room

FOUND BY 3 ROOMS · 1

Beds are full because nobody can be discharged

→

People wait hours in a corridor before anyone sees them

FOUND BY 2 ROOMS · 1

People wait hours in a corridor before anyone sees them

→

The same patients come back within a week

FOUND BY 1 ROOM · 73

I did not come sooner because I could not afford the trip	→	I came here because I could not get seen anywhere else
	→	Nobody tells you how long the wait will be
	→	Staff leave faster than we can hire them
The form asks questions I cannot answer about my own body	→	You are moved three times and explain yourself three times
	→	People wait hours in a corridor before anyone sees them
	→	Nobody explained what the test was for
We report to eleven bodies and none of them to each other	→	Nobody owns the whole patient journey
	→	Politics changes the target every election
	→	The same patients come back within a week
A trolley in a different corridor stops the clock	→	Staff leave faster than we can hire them
	→	The same patients come back within a week
Managers are judged on the target too, so nobody questions it	→	An incident report goes into a system nobody reads back
	→	The target changes what we do more than the illness does
Nobody has ever asked me what would have kept me away	→	I have been in this corridor before and nothing changed
	→	Staff leave faster than we can hire them
Nobody is paid for the patient who did not need to come	→	The incentive is to treat, never to prevent
	→	The same patients come back within a week
Patients come here because they cannot get an appointment	→	Experienced staff leave and take the workarounds with them
	→	People wait hours in a corridor before anyone sees them
A decision to admit waits for a consultant round in the morning	→	Beds are full because nobody can be discharged
A pharmacy could have handled a third of today	→	Staff leave faster than we can hire them
Nobody measures whether the patient got better	→	Nobody may discharge at night, so a bed is lost for twelve hours
The data we report is a year old by the time it is published	→	We have never once been asked to plan for ten years
The estate is older than anyone working in it	→	The incentive is to treat, never to prevent
Vacancies are counted as savings in the same month they are a crisis	→	We are measured on activity, so activity is what we produce
We have had four reorganisations and no more beds	→	Beds are full because nobody can be discharged
I have been in this corridor before and nothing changed	→	Being frightened makes everything take longer
	→	I came here because I could not get seen anywhere else
	→	Nobody tells you how long the wait will be
An incident report goes into a system nobody reads back	→	The people who know the fix are never asked
	→	A patient waits for one test that takes ten minutes to run
Nobody may discharge at night, so a bed is lost for twelve hours	→	Beds are full because nobody can be discharged
	→	Social care and the hospital are funded from different budgets
Nobody owns the whole patient journey	→	People wait hours in a corridor before anyone sees them
Beds are full because nobody can be discharged	→	I was sent home at midnight with no way to get there
	→	Social care and the hospital are funded from different budgets
	→	The GP said six weeks and it has been five months
	→	The interpreter was booked for twenty minutes
	→	Nobody explained what the test was for
I did not know a pharmacy could have helped	→	I came here because I could not get seen anywhere else
	→	My mother came home with no one to help her stand up
	→	Staff leave faster than we can hire them
People wait hours in a corridor before anyone sees them	⇄	Experienced staff leave and take the workarounds with them
	→	The incentive is to treat, never to prevent
	→	An improvement takes two years and a chief executive lasts eighteen mo
Staff leave faster than we can hire them	⇄	A saving in social care is a cost here and nobody nets it
	→	Every part of the system optimises its own budget
	→	Nobody tells you how long the wait will be
Every part of the system optimises its own budget	→	A saving in social care is a cost here and nobody nets it
	⇄	Winter money arrives in November for a plan needed in June
Experienced staff leave and take the workarounds with them	⇄	People wait hours in a corridor before anyone sees them
	→	Two systems hold the same patient under different numbers
I came here because I could not get seen anywhere else	→	Being frightened makes everything take longer
	→	My mother came home with no one to help her stand up
My mother came home with no one to help her stand up	→	Nobody tells you how long the wait will be
	→	Staff leave faster than we can hire them
Nobody tells you how long the wait will be	→	Being frightened makes everything take longer
	→	I did not know a pharmacy could have helped
Winter money arrives in November for a plan needed in June	⇄	Every part of the system optimises its own budget
	→	One-year funding buys agency staff, not permanent ones
A saving in social care is a cost here and nobody nets it	⇄	Staff leave faster than we can hire them
Being frightened makes everything take longer	→	I did not know a pharmacy could have helped
One-year funding buys agency staff, not permanent ones	→	Staff leave faster than we can hire them
I was sent home at midnight with no way to get there	→	The same patients come back within a week
	→	There is no water and no food after ten
The incentive is to treat, never to prevent	→	An improvement takes two years and a chief executive lasts eighteen mo
	→	The same patients come back within a week
Social care and the hospital are funded from different budgets	→	Two systems hold the same patient under different numbers
The GP said six weeks and it has been five months	→	The interpreter was booked for twenty minutes
A patient waits for one test that takes ten minutes to run	→	The same patients come back within a week
Imaging closes at six and reopens at eight	→	A patient waits for one test that takes ten minutes to run
The interpreter was booked for twenty minutes	→	Nobody explained what the test was for
The same patients come back within a week	→	Imaging closes at six and reopens at eight

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