Why is the emergency department always behind?
The merged map · Folded from 3 rooms · 2 links found by several rooms
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 counted: Why is the emergency department always behind?A decision to admit waits for a consultant round in the morning → Beds are full because nobody can be discharged counted: Why are waits in the emergency department so long?The estate is older than anyone working in it → The incentive is to treat, never to prevent counted: Why is the emergency department always behind?Every part of the system optimises its own budget → Winter money arrives in November for a plan needed in June counted: Why is the emergency department always behind?Every part of the system optimises its own budget → A saving in social care is a cost here and nobody nets it counted: Why is the emergency department always behind?Experienced staff leave and take the workarounds with them → People wait hours in a corridor before anyone sees them counted: Why are waits in the emergency department so long?Experienced staff leave and take the workarounds with them → Two systems hold the same patient under different numbers counted: Why are waits in the emergency department so long?Being frightened makes everything take longer → I did not know a pharmacy could have helped counted: Why does A&E make people wait for hours?The GP said six weeks and it has been five months → The interpreter was booked for twenty minutes counted: Why does A&E make people wait for hours?I did not come sooner because I could not afford the trip → Staff leave faster than we can hire them counted: Why does A&E make people wait for hours?I did not come sooner because I could not afford the trip → I came here because I could not get seen anywhere else counted: Why does A&E make people wait for hours?I did not come sooner because I could not afford the trip → Nobody tells you how long the wait will be counted: Why does A&E make people wait for hours?Imaging closes at six and reopens at eight → A patient waits for one test that takes ten minutes to run counted: Why are waits in the emergency department so long?The interpreter was booked for twenty minutes → Nobody explained what the test was for counted: Why does A&E make people wait for hours?Nobody is paid for the patient who did not need to come → The incentive is to treat, never to prevent counted: Why is the emergency department always behind?A patient waits for one test that takes ten minutes to run → The same patients come back within a week counted: Why are waits in the emergency department so long?People wait hours in a corridor before anyone sees them → Experienced staff leave and take the workarounds with them counted: Why are waits in the emergency department so long?People wait hours in a corridor before anyone sees them → The incentive is to treat, never to prevent counted: Why is the emergency department always behind?A pharmacy could have handled a third of today → Staff leave faster than we can hire them counted: Why are waits in the emergency department so long?The same patients come back within a week → Imaging closes at six and reopens at eight counted: Why are waits in the emergency department so long?Social care and the hospital are funded from different budgets → Two systems hold the same patient under different numbers counted: Why are waits in the emergency department so long?Staff leave faster than we can hire them → Every part of the system optimises its own budget counted: Why is the emergency department always behind?Staff leave faster than we can hire them → Nobody tells you how long the wait will be counted: Why does A&E make people wait for hours?Staff leave faster than we can hire them → A saving in social care is a cost here and nobody nets it counted: Why is the emergency department always behind?A trolley in a different corridor stops the clock → The same patients come back within a week counted: Why are waits in the emergency department so long?A trolley in a different corridor stops the clock → Staff leave faster than we can hire them counted: Why are waits in the emergency department so long?Vacancies are counted as savings in the same month they are a crisis → We are measured on activity, so activity is what we produce counted: Why is the emergency department always behind?Winter money arrives in November for a plan needed in June → Every part of the system optimises its own budget counted: Why is the emergency department always behind?Winter money arrives in November for a plan needed in June → One-year funding buys agency staff, not permanent ones counted: Why is the emergency department always behind?Beds are full because nobody can be discharged → The GP said six weeks and it has been five months counted: Why does A&E make people wait for hours?Beds are full because nobody can be discharged → People wait hours in a corridor before anyone sees them found in most rooms that judged it (3 of 3) counted: Why is the emergency department always behind?, Why are waits in the emergency department so long?, Why does A&E make people wait for hours?Beds are full because nobody can be discharged → Social care and the hospital are funded from different budgets counted: Why are waits in the emergency department so long?Beds are full because nobody can be discharged → I was sent home at midnight with no way to get there counted: Why does A&E make people wait for hours?The form asks questions I cannot answer about my own body → People wait hours in a corridor before anyone sees them counted: Why does A&E make people wait for hours?The form asks questions I cannot answer about my own body → You are moved three times and explain yourself three times counted: Why does A&E make people wait for hours?The form asks questions I cannot answer about my own body → Nobody explained what the test was for counted: Why does A&E make people wait for hours?I came here because I could not get seen anywhere else → Being frightened makes everything take longer counted: Why does A&E make people wait for hours?I came here because I could not get seen anywhere else → My mother came home with no one to help her stand up counted: Why does A&E make people wait for hours?I have been in this corridor before and nothing changed → Being frightened makes everything take longer counted: Why does A&E make people wait for hours?I have been in this corridor before and nothing changed → I came here because I could not get seen anywhere else counted: Why does A&E make people wait for hours?I have been in this corridor before and nothing changed → Nobody tells you how long the wait will be counted: Why does A&E make people wait for hours?I did not know a pharmacy could have helped → Staff leave faster than we can hire them counted: Why does A&E make people wait for hours?I did not know a pharmacy could have helped → I came here because I could not get seen anywhere else counted: Why does A&E make people wait for hours?I did not know a pharmacy could have helped → My mother came home with no one to help her stand up counted: Why does A&E make people wait for hours?I was sent home at midnight with no way to get there → The same patients come back within a week counted: Why does A&E make people wait for hours?I was sent home at midnight with no way to get there → There is no water and no food after ten counted: Why does A&E make people wait for hours?The incentive is to treat, never to prevent → An improvement takes two years and a chief executive lasts eighteen mo counted: Why is the emergency department always behind?The incentive is to treat, never to prevent → The same patients come back within a week counted: Why is the emergency department always behind?An incident report goes into a system nobody reads back → A patient waits for one test that takes ten minutes to run counted: Why are waits in the emergency department so long?An incident report goes into a system nobody reads back → The people who know the fix are never asked counted: Why are waits in the emergency department so long?Managers are judged on the target too, so nobody questions it → The target changes what we do more than the illness does counted: Why are waits in the emergency department so long?Managers are judged on the target too, so nobody questions it → An incident report goes into a system nobody reads back counted: Why are waits in the emergency department so long?My mother came home with no one to help her stand up → Staff leave faster than we can hire them counted: Why does A&E make people wait for hours?My mother came home with no one to help her stand up → Nobody tells you how long the wait will be counted: Why does A&E make people wait for hours?Nobody has ever asked me what would have kept me away → I have been in this corridor before and nothing changed counted: Why does A&E make people wait for hours?Nobody may discharge at night, so a bed is lost for twelve hours → Beds are full because nobody can be discharged counted: Why are waits in the emergency department so long?Nobody measures whether the patient got better → Nobody may discharge at night, so a bed is lost for twelve hours counted: Why are waits in the emergency department so long?Nobody owns the whole patient journey → People wait hours in a corridor before anyone sees them counted: Why is the emergency department always behind?Nobody tells you how long the wait will be → Being frightened makes everything take longer counted: Why does A&E make people wait for hours?Nobody tells you how long the wait will be → I did not know a pharmacy could have helped counted: Why does A&E make people wait for hours?One-year funding buys agency staff, not permanent ones → Staff leave faster than we can hire them counted: Why is the emergency department always behind?Patients come here because they cannot get an appointment → Experienced staff leave and take the workarounds with them counted: Why are waits in the emergency department so long?Patients come here because they cannot get an appointment → People wait hours in a corridor before anyone sees them counted: Why are waits in the emergency department so long?A saving in social care is a cost here and nobody nets it → Staff leave faster than we can hire them counted: Why is the emergency department always behind?We have had four reorganisations and no more beds → Beds are full because nobody can be discharged counted: Why are waits in the emergency department so long?We report to eleven bodies and none of them to each other → Politics changes the target every election counted: Why is the emergency department always behind?We report to eleven bodies and none of them to each other → Nobody owns the whole patient journey counted: Why is the emergency department always behind?The data we report is a year old by the time it is published raised in: Why is the emergency department always behind?The data we report is ayear old by the time it ispublishedhow many rooms raised this claim1 ROOMA decision to admit waits for a consultant round in the morning raised in: Why are waits in the emergency department so long? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0A decision to admit waitsfor a consultant round inthe morningin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMThe estate is older than anyone working in it raised in: Why is the emergency department always behind? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0The estate is older thananyone working in itin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMI did not come sooner because I could not afford the trip raised in: Why does A&E make people wait for hours?I did not come soonerbecause I could not affordthe triphow many rooms raised this claim1 ROOMNobody is paid for the patient who did not need to come raised in: Why is the emergency department always behind? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0Nobody is paid for thepatient who did not need tocomein how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMA pharmacy could have handled a third of today raised in: Why are waits in the emergency department so long?A pharmacy could havehandled a third of todayhow many rooms raised this claim1 ROOMA trolley in a different corridor stops the clock raised in: Why are waits in the emergency department so long?A trolley in a differentcorridor stops the clockhow many rooms raised this claim1 ROOMVacancies are counted as savings in the same month they are a crisis raised in: Why is the emergency department always behind?Vacancies are counted assavings in the same monththey are a crisishow many rooms raised this claim1 ROOMThe form asks questions I cannot answer about my own body raised in: Why does A&E make people wait for hours? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0The form asks questions Icannot answer about my ownbodyin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMManagers are judged on the target too, so nobody questions it raised in: Why are waits in the emergency department so long? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 1 ② Pool the hospital and social care budget for discharge · Why are waits in the emergency department so long?Managers are judged on thetarget too, so nobodyquestions it②in how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 1 OF 1 ROOMNobody has ever asked me what would have kept me away raised in: Why does A&E make people wait for hours? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 1 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 has ever asked mewhat would have kept meaway①③in how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 1 OF 1 ROOMNobody measures whether the patient got better raised in: Why are waits in the emergency department so long? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 1 ② Pool the hospital and social care budget for discharge · Why are waits in the emergency department so long?Nobody measures whether thepatient got better②in how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 1 OF 1 ROOMPatients come here because they cannot get an appointment raised in: Why are waits in the emergency department so long?Patients come here becausethey cannot get anappointmenthow many rooms raised this claim1 ROOMWe have had four reorganisations and no more beds raised in: Why are waits in the emergency department so long? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 1 ④ Discharge seven days a week, including evenings · Why are waits in the emergency department so long?We have had fourreorganisations and no morebeds④in how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 1 OF 1 ROOMWe report to eleven bodies and none of them to each other raised in: Why is the emergency department always behind? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0We report to eleven bodiesand none of them to eachotherin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMNobody owns the whole patient journey raised in: Why is the emergency department always behind? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0Nobody owns the wholepatient journeyin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMPolitics changes the target every election raised in: Why is the emergency department always behind?Politics changes the targetevery electionhow many rooms raised this claim1 ROOMNobody may discharge at night, so a bed is lost for twelve hours raised in: Why are waits in the emergency department so long? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0Nobody may discharge atnight, so a bed is lost fortwelve hoursin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMI have been in this corridor before and nothing changed raised in: Why does A&E make people wait for hours?I have been in thiscorridor before and nothingchangedhow many rooms raised this claim1 ROOMAn incident report goes into a system nobody reads back raised in: Why are waits in the emergency department so long?An incident report goesinto a system nobody readsbackhow many rooms raised this claim1 ROOMThe target changes what we do more than the illness does raised in: Why are waits in the emergency department so long?The target changes what wedo more than the illnessdoeshow many rooms raised this claim1 ROOMYou are moved three times and explain yourself three times raised in: Why does A&E make people wait for hours?You are moved three timesand explain yourself threetimeshow many rooms raised this claim1 ROOMWe are measured on activity, so activity is what we produce raised in: Why is the emergency department always behind?We are measured onactivity, so activity iswhat we producehow many rooms raised this claim1 ROOMWe have never once been asked to plan for ten years raised in: Why is the emergency department always behind?We have never once beenasked to plan for ten yearshow many rooms raised this claim1 ROOMThe people who know the fix are never asked raised in: Why are waits in the emergency department so long?The people who know the fixare never askedhow many rooms raised this claim1 ROOMBeds are full because nobody can be discharged raised in: Why is the emergency department always behind?, Why are waits in the emergency department so long?, Why does A&E make people wait for hours? rooms that raised it: 3 · rooms that judged actions against it: 3 · rooms in which an action reduces it: 1 ① Tell people the expected wait, and update it · Why does A&E make people wait for hours?Beds are full becausenobody can be dischargedraised in 3 rooms①in how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 1 OF 3 ROOMSOne-year funding buys agency staff, not permanent ones raised in: Why is the emergency department always behind?One-year funding buysagency staff, not permanentonespart of a feedback loop⟳how many rooms raised this claim1 ROOMEvery part of the system optimises its own budget raised in: Why is the emergency department always behind?Every part of the systemoptimises its own budgetpart of a feedback loop⟳how many rooms raised this claim1 ROOMMy mother came home with no one to help her stand up raised in: Why does A&E make people wait for hours?My mother came home with noone to help her stand uppart of a feedback loop⟳how many rooms raised this claim1 ROOMI came here because I could not get seen anywhere else raised in: Why does A&E make people wait for hours?I came here because I couldnot get seen anywhere elsepart of a feedback loop⟳how many rooms raised this claim1 ROOMBeing frightened makes everything take longer raised in: Why does A&E make people wait for hours?Being frightened makeseverything take longerpart of a feedback loop⟳how many rooms raised this claim1 ROOMNobody tells you how long the wait will be raised in: Why does A&E make people wait for hours?Nobody tells you how longthe wait will bepart of a feedback loop⟳how many rooms raised this claim1 ROOMI did not know a pharmacy could have helped raised in: Why does A&E make people wait for hours?I did not know a pharmacycould have helpedpart of a feedback loop⟳how many rooms raised this claim1 ROOMStaff leave faster than we can hire them raised in: Why is the emergency department always behind?, Why are waits in the emergency department so long?, Why does A&E make people wait for hours?Staff leave faster than wecan hire thempart of a feedback loop⟳raised in 3 roomshow many rooms raised this claim3 ROOMSA saving in social care is a cost here and nobody nets it raised in: Why is the emergency department always behind?A saving in social care isa cost here and nobody netsitpart of a feedback loop⟳how many rooms raised this claim1 ROOMWinter money arrives in November for a plan needed in June raised in: Why is the emergency department always behind?Winter money arrives inNovember for a plan neededin Junepart of a feedback loop⟳how many rooms raised this claim1 ROOMI was sent home at midnight with no way to get there raised in: Why is the emergency department always behind?, Why does A&E make people wait for hours?I was sent home at midnightwith no way to get thereraised in 2 roomshow many rooms raised this claim2 ROOMSSocial care and the hospital are funded from different budgets raised in: Why are waits in the emergency department so long?Social care and thehospital are funded fromdifferent budgetshow many rooms raised this claim1 ROOMThe GP said six weeks and it has been five months raised in: Why does A&E make people wait for hours? rooms that raised it: 1 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0The GP said six weeks andit has been five monthsin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMExperienced staff leave and take the workarounds with them raised in: Why are waits in the emergency department so long?Experienced staff leave andtake the workarounds withthempart of a feedback loop⟳how many rooms raised this claim1 ROOMPeople wait hours in a corridor before anyone sees them raised in: Why is the emergency department always behind?, Why are waits in the emergency department so long?, Why does A&E make people wait for hours? rooms that raised it: 3 · rooms that judged actions against it: 1 · rooms in which an action reduces it: 0People wait hours in acorridor before anyone seesthempart of a feedback loop⟳raised in 3 roomsin how many of the rooms that judged actions against this cause one of their actions reduces itREDUCED IN 0 OF 1 ROOMThere is no water and no food after ten raised in: Why is the emergency department always behind?, Why does A&E make people wait for hours?There is no water and nofood after tenraised in 2 roomshow many rooms raised this claim2 ROOMSThe interpreter was booked for twenty minutes raised in: Why does A&E make people wait for hours?The interpreter was bookedfor twenty minuteshow many rooms raised this claim1 ROOMTwo systems hold the same patient under different numbers raised in: Why is the emergency department always behind?, Why are waits in the emergency department so long?Two systems hold the samepatient under differentnumbersraised in 2 roomshow many rooms raised this claim2 ROOMSThe incentive is to treat, never to prevent raised in: Why is the emergency department always behind?The incentive is to treat,never to preventhow many rooms raised this claim1 ROOMImaging closes at six and reopens at eight raised in: Why are waits in the emergency department so long?Imaging closes at six andreopens at eightpart of a feedback loop⟳how many rooms raised this claim1 ROOMA patient waits for one test that takes ten minutes to run raised in: Why are waits in the emergency department so long?A patient waits for onetest that takes ten minutesto runpart of a feedback loop⟳how many rooms raised this claim1 ROOMThe same patients come back within a week raised in: Why is the emergency department always behind?, Why are waits in the emergency department so long?, Why does A&E make people wait for hours?The same patients come backwithin a weekpart of a feedback loop⟳raised in 3 roomshow many rooms raised this claim3 ROOMSAn improvement takes two years and a chief executive lasts eighteen mo raised in: Why is the emergency department always behind?An improvement takes twoyears and a chief executivelasts eighteen mohow many rooms raised this claim1 ROOMNobody explained what the test was for raised in: Why does A&E make people wait for hours?Nobody explained what thetest was forhow many rooms raised this claim1 ROOM
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 map from True Causes: a group’s judgement, not a measurement.