THE QUESTION
Why does A&E make people wait for hours?
Propose what to do, then judge whether each action would move each root.
30 at the table (29 simulated) · 3 actions proposed against 4 root causes. Add one, then judge whether each action moves each cause.
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Some claims influence each other in a circle
↺ Nobody tells you how long the wait will be → Being frightened makes everything take longer → Staff leave faster than we can hire them → I came here because I could not get seen anywh → …
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 cause | feasible | impact | fixes itself | priority |
|---|---|---|---|---|
| Beds are full because nobody can be discharged | – | |||
| Nobody has ever asked me what would have kept me away | – | |||
| The form asks questions I cannot answer about my own body | – | |||
| The GP said six weeks and it has been five months | – |
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.
| ACTION | ROOT CAUSES · does the action on the left reduce it? | |||
|---|---|---|---|---|
| Beds are full because nobody can be discharged | Nobody has ever asked me what would have kept me away | The form asks questions I cannot answer about my own body | The GP said six weeks and it has been five months | |
| Tell people the expected wait, and update it in focus ↑ · close ✕ | ✓ yes, it reduces this 28 yes / 0 worse / 1 no | ✓ yes, it reduces this 27 yes / 0 worse / 2 no | ✗ no, it does not 6 yes / 0 worse / 23 no | not decided yet |
| Let one person who knows the patient stay with them discuss | ✗ no, it does not 4 yes / 0 worse / 25 no | ✗ no, it does not 6 yes / 0 worse / 23 no | ✗ no, it does not 4 yes / 0 worse / 25 no | not decided yet |
| Ask every returning patient what would have kept them away discuss | ✗ no, it does not 4 yes / 0 worse / 25 no | ✓ yes, it reduces this 23 yes / 0 worse / 6 no | ⚑ the group split 8 yes / 0 worse / 21 no | not decided yet |
Highest leverage so far
Tell people the expected wait, and update it reduces 2 of 4 root causes
Ask every returning patient what would have kept them away reduces 1 of 4 root causes
What we expect to follow
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 23 Jan 2027
Tell people the expected wait, and update it
expected: people know what they are waiting for and how long
measured by: % of patients told an expected wait within 30 minutes of arrival
the room: 48 (median of 15, spread 20 to 85)