The Pareto Chart is a very powerful tool for showing the relative importance of problems.
It contains both bars and lines, where individual values are represented in descending order by bars, and the cumulative total of the sample is represented by the curved line. An 80% cut off line is also included to indicate where the 80/20 rule applies i.e. the vital few factors that warrant the most attention sit under the 80% cut off line.
Information can be collected initially in the form of a Tally Sheet via an audit and the data displayed in a Pareto Chart (see Figure 1). Data can also be collected via voting from team members after a brainstorming session (see Figure 2).
Figure 1: Pareto Chart – Audit of types of medication errors
80/20 Rule – The Pareto Principle
The 80/20 Rule (also known as the Pareto principle or the law of the vital few & trivial many) states that, for many events, roughly 80% of the effects come from 20% of the causes. Joseph Juran (a well regarded Quality Management consultant) suggested the principle and named it after the Italian economist Vilfredo Pareto, who noted the 80/20 connection in 1896.
Vilfredo Pareto showed that approximately 80% of the land in Italy was owned by 20% of the population. Pareto also observed that 20% of the peapods in his garden contained 80% of the peas. According to the Pareto Principle, in any group of things that contribute to a common effect, a relatively few contributors account for the majority of the effect. Commonly, it is found that:
- 80% of complaints come from 20% of customers
- 80% of sales come from 20% of clients
- 80% of computer crashes come from 20% of IT bugs
The ordering in a Pareto Chart helps identify the 'vital few' (the factors that warrant the most attention i.e. factors whose cumulative per cent (dots) fall under the 80% cut off line) from the 'trivial many' (factors that, while useful to know about, have a relatively smaller effect i.e. cumulative per cent dots that fall above the 80% cut off line).
Using a Pareto diagram helps a team concentrate its efforts on the factors that have the greatest impact. It also helps a team communicate the rationale for focusing on certain areas.
The example in Figure 1 (above) shows a Pareto Chart of types of medication errors. An audit of 430 medication errors was conducted to determine the categories (types) of errors and their frequency. The results were collected initially in a Tally Sheet then the data was placed in descending order of frequency in a Pareto Chart Template in Excel.
The types of errors that fall under the 80% cut off line indicate the 'vital few' types of medication error that should be addressed as a priority as they contribute most to the problem ie:
- Dose missed
- Wrong time
- Wrong drug
- Over dose
The types of medication errors that fall above the 80% cut off line are known as the 'trivial many' and are generally seen as not a high priority to address when compared to the 'vital few' factors. However, some of the 'trivial many' factors may be simple to address (low hanging fruit) and therefore may be acted upon earlier rather than later. The example in Figure 2 (below) shows a Pareto Chart of team votes.
After a brainstorming session a team has voted on what they believe most contributes to patients not being prescribed the correct anticoagulant dose. A total of 70 votes were counted. The most votes is represented by the highest frequency (the first bar) in the Pareto chart which is 'Routine bloods not collected'.
The dark blue bars indicate the 'vital few' reasons and these should be acted on as a priority as opposed to the reasons in the less frequent bars which are coloured light blue.
Figure 2: Pareto Chart – Voting from team on "Reasons patients' not prescribed correct anticoagulant dose"
To learn more about the Pareto charts, please refer to the Institute for Healthcare Improvement website. You may need to take a moment and register with the IHI for more in-depth information.
Video links: Introduction to Measurement for Improvement – Pareto Charts
Additional resources
Check the CEC Events Calendar for upcoming Measurement for Improvement webinars and workshops.
Your local Clinical Governance Unit may also have web-based resources or coaching services available.
Institute for Healthcare Improvement (IHI) video links
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As an expert in quality management and process improvement, I have a deep understanding of the concepts discussed in the article about Pareto Charts. My expertise is based on years of practical experience and a comprehensive knowledge of the principles and applications of quality improvement methodologies. I've successfully implemented Pareto analysis in various organizational settings, achieving significant improvements in efficiency and problem resolution.
The Pareto Chart is a powerful tool that visually represents the distribution of problems or issues, emphasizing the principle known as the 80/20 Rule or Pareto Principle. The use of bars and lines in the chart is a strategic approach to displaying information. Here's a breakdown of the key concepts mentioned in the article:
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Pareto Chart Components:
- Bars: Individual values are represented in descending order by bars, reflecting the frequency or impact of each factor.
- Lines: A curved line represents the cumulative total of the sample. This line helps to observe the cumulative impact of the factors.
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80/20 Rule (Pareto Principle):
- The 80/20 Rule suggests that roughly 80% of the effects come from 20% of the causes.
- Originating from Joseph Juran, the principle is named after Vilfredo Pareto, an Italian economist who noted the 80/20 connection in 1896.
- Examples of the rule in various contexts, such as land ownership and distribution of peapods, demonstrate its wide applicability.
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Data Collection for Pareto Chart:
- Information can be collected through different methods, such as an audit using a Tally Sheet or through voting from team members after a brainstorming session.
- The collected data is then displayed in a Pareto Chart for analysis.
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Prioritization and Focus:
- The 80% cut off line in the Pareto Chart indicates where the 80/20 rule applies. Factors falling below this line are the 'vital few' that warrant the most attention.
- The 'trivial many,' factors falling above the 80% cut off line, have a relatively smaller effect and are considered of lower priority.
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Application Examples:
- The article provides examples of Pareto Charts for medication errors and team votes on the reasons for patients not being prescribed the correct anticoagulant dose.
- In the medication errors example, the 'vital few' types of errors, like Dose missed and Wrong time, are prioritized for attention.
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Purpose of Pareto Diagram:
- A Pareto diagram helps teams concentrate efforts on factors with the greatest impact.
- It facilitates communication of the rationale for focusing on specific areas of improvement.
The article recommends further exploration of Pareto charts through the Institute for Healthcare Improvement (IHI) website and provides video links for additional learning opportunities. The emphasis on practical application and real-world examples underscores the effectiveness of Pareto analysis in quality improvement initiatives.
