Why is the emergency department always behind?
a walkthrough with stand-ins — a demonstration, not a finding · 23 certified links · outlined boxes are the roots · tap a claim to read it in full
Showing every action the room judged: it acts directly on 0 of the 6 root causes. It does not act directly on 6.
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
WHAT WAS PREDICTED TO FOLLOW
Each number on the map marks a root cause that action reduces.
① Fund on a ten-year plan, not a winter
no prediction about this action yet
② Pay something for the patient who did not need to come
no prediction about this action yet
③ One budget for discharge, held jointly
we expect: a patient ready to leave is not held by whose budget it is
measured by: median days of delayed discharge per patient
due 24 Mar 2027
guesses: the room: 5 (median of 15, spread 2 to 12)
A map from True Causes: a group’s judgement, not a measurement.