THE QUESTION
Why are waits in the emergency department so long?
Propose what to do, then judge whether each action would move each root.
30 at the table (29 simulated) · 3 actions proposed against 6 root causes. Add one, then judge whether each action moves each cause.
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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 cause | feasible | impact | fixes itself | priority |
|---|---|---|---|---|
| We have had four reorganisations and no more beds | – | |||
| A decision to admit waits for a consultant round in the morning | – | |||
| Nobody measures whether the patient got better | – | |||
| Patients come here because they cannot get an appointment | – | |||
| A trolley in a different corridor stops the clock | – | |||
| Managers are judged on the target too, so nobody questions it | – |
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.
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.
| ACTION | ROOT CAUSES · does the action on the left reduce it? | |||||
|---|---|---|---|---|---|---|
| We have had four reorganisations and no more beds | A decision to admit waits for a consultant round in the morning | Nobody measures whether the patient got better | Patients come here because they cannot get an appointment | A trolley in a different corridor stops the clock | Managers are judged on the target too, so nobody questions it | |
| Discharge seven days a week, including evenings in focus ↑ · close ✕ | ✓ yes, it reduces this 23 yes / 6 no · 22 of 29 settles it | ✗ no, it does not 5 yes / 24 no · 22 of 29 settles it | ✗ no, it does not 4 yes / 25 no · 22 of 29 settles it | ✗ no, it does not 7 yes / 22 no · 22 of 29 settles it | ✓ yes, it reduces this 24 yes / 5 no · 22 of 29 settles it | ✗ no, it does not 4 yes / 25 no · 22 of 29 settles it |
| One patient number across both systems discuss | ✗ no, it does not 4 yes / 25 no · 22 of 29 settles it | ✗ no, it does not 4 yes / 25 no · 22 of 29 settles it | ✗ no, it does not 2 yes / 27 no · 22 of 29 settles it | ✓ yes, it reduces this 24 yes / 5 no · 22 of 29 settles it | ✓ yes, it reduces this 27 yes / 2 no · 22 of 29 settles it | ✗ no, it does not 5 yes / 24 no · 22 of 29 settles it |
| Pool the hospital and social care budget for discharge discuss | ✗ no, it does not 6 yes / 23 no · 22 of 29 settles it | ✗ no, it does not 6 yes / 23 no · 22 of 29 settles it | ✓ yes, it reduces this 29 yes / 0 no · 22 of 29 settles it | ✗ no, it does not 2 yes / 27 no · 22 of 29 settles it | ✓ yes, it reduces this 26 yes / 3 no · 22 of 29 settles it | ✓ yes, it reduces this 26 yes / 3 no · 22 of 29 settles it |
Highest leverage so far
Pool the hospital and social care budget for discharge reduces 3 of 6 root causes
Discharge seven days a week, including evenings reduces 2 of 6 root causes
One patient number across both systems reduces 2 of 6 root causes