The 80/20 Rule as applied to patient safety.
Near the dawn of the 20th century, Italian economist Vilfredo Pareto was evaluating land distribution in his home country when he discovered that 80 percent of the land in Italy was owned by only 20 percent of its citizens. Upon further examination, Pareto found that a mere 20 percent of the entire population of Italy controlled roughly 80 percent of the country’s cumulative wealth. Pareto’s findings fueled in him a curiosity that he further developed by turning his attention to his private garden, where he discovered – as in concurrence with his socioeconomic findings – that 20 percent of his garden’s pea pods contained 80 percent of its peas.
Since his publications, Pareto’s principles have been applied to several industries, resulting in such terms as the champagne glass effect, the law of the vital few, and (most notably) the 80/20 rule. Regardless of the moniker, and though exact percentages vary depending on application, the Pareto principle remains a consistent and trusted tool for evaluating relationships between minority influencers and overall outcomes.
The Vital Few vs. the Trivial Many
The Pareto principle is not necessarily based on percentages, but rather the notion that – in any give situation – a small number of things (people, products, actions) results in a disproportionate number of outcomes. For instance, of the nearly 2 million deaths occurring in the United States each year from the top 10 leading causes, a little more than 62 percent result from heart disease and cancer alone. This accounts for the majority of deaths being directly influenced by only 20 percent of the listed causes. Additionally, of the 56.4 million annual deaths worldwide, 54 percent result from only 10 causes; a paltry number when considering the untold fatal diseases, accidents, murders, and catastrophes plaguing the world each year. In applications of finance, businesses often find that the clear majority of their profits come from a relatively small percentage of their customers.
This is what makes the Pareto principle so appealing for evaluating incidents of patient safety in healthcare. When viewing organizations as a whole, the prospect of discovering root causes can be daunting. But if an organization can focus its attention on a select few areas, problems can be discovered and remedied much quicker, with much less time and energy wasted on fruitless efforts.
The Pareto Principle’s Impact On Patient Safety
If we apply the Pareto principle to an organization experiencing a spike in patient safety incidents, for example, we can project that most of those incidents are likely to be caused by only a few influencers. Perhaps we find that a small percentage of that organization’s clinical departments is responsible for nearly all of its recent patient safety incidents. Or perhaps a new device, among a multitude of others, is having devastating impacts on the health of that organization’s patients. If so, steps can then be made to focus efforts on retraining specific departments or eliminating faulty devices. This understanding can greatly expedite investigations and improve overall processes.
The Pareto principle has made a lasting impact over the past century as a valuable tool for assessing all manner of operations with businesses throughout various industries. Its applications in patient safety incidents can improve the safety culture within a healthcare organization considerably, cutting down on rates of incidents and improving overall quality of life for patients.