Root Causes

Sometimes, when we first encounter a problem, its cause seems obvious. It’s only later, after a few failed attempts to solve it, that we realize the roots of the problem run much deeper than we thought. 

Before you tackle a problem, it’s useful to ask “why” a few times.  It might look something like this:

“We’re having problems with access for new patients.”  Why?

“Because there are no appointments available.” Why?

“Because providers are booked out several months.” Why?

“Because all the appointments are taken by follow-up visits.” Why?

“Because our providers are managing so many chronic disease patients.” Why?

“Because diabetes and hypertension control are our most important quality metrics.” Why?

“Because under value-based payments, that’s how we get paid.”

If you only ask why a couple of times, you’ll be tempted to address the problem with short term fixes. Open up special new patient slots for every provider. Prioritize new patients over follow-ups. Hire some new providers to see new patients. And all of those measures might help--to a point. But if the root causes of the problem are longer term systemic issues, you have to find solutions that dig down to those roots. 

As any gardener knows, it’s not enough to chop off the part of the weed you can see. It’ll just grow back, twice as strong.