Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The 80-20 rule: Apply Pareto’s principle to hospital medicine

Suneel Dhand, MD
Physician
December 9, 2014
Share
Tweet
Share

There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but also your personal life.

Pareto’s principle also has become a popular area of focus in the world of business and management. Named after the 19th century Italian economist Vilfredo Pareto, in a nutshell the principle is as follows: 80 percent of effects always come from 20 percent of the causes. Pareto first observed this ratio when he realized that 80 percent of land and wealth in Italy was owned by 20 percent of the population. He then went on to observe the same phenomenon in his garden: 80 percent of peas came from 20 percent of pea pods.

Since he published these findings, the magical ratio of 80:20 (or the “80-20 rule”) has been found to be scattered throughout society and nature. 80 percent of any company’s profits come from 20 percent of their best products. 80 percent of traffic comes from 20 percent of roads. 80 percent of food production comes from 20 percent of the best crops. The ratio is everywhere — frequently even tipped to a 90-10 or 95-5 division. However the 80-20 phenomenon is the distribution most often cited as a universal baseline. That being the case, I thought I would apply Pareto’s principle to the practice of hospital medicine:

  • 80 percent of the clinical and problematic issues on any given day will arise from 20 percent of your patients
  • 80 percent of telephone calls and pages will always come from 20 percent of nurses
  • 80 percent of valuable medical information that you receive will come from only 20 percent of what’s communicated to you
  • 80 percent of your job satisfaction will come from 20 percent of your daily interactions
  • 80 percent of compliments that your group receives will be about the good work of 20 percent of your physicians, and conversely 80 percent of complaints will be about 20 percent of your physicians

How are these statistics even relevant to the daily grind? Well, by recognizing Pareto’s principle we can set realistic expectations and focus on the most important areas to make our jobs more productive and satisfying. We can reverse the 80-20 equation to ask questions such as:

  • Which 20 percent of patients are going to take up 80 percent of my effort?
  • Which 20 percent of colleagues are responsible for 80 percent of what makes my work environment enjoyable?
  • Which 20 percent of my time is giving me 80 percent of my job satisfaction?
  • Which 20 percent of work-related issues are responsible for 80 percent of my job dissatisfaction?

Of course the 80-20 percentage is not absolute, but it can act as a broad starting point of awareness in order to stand a better chance of improving things. Furthermore, remembering Pareto’s principle can also save us from what I call “casting the net too wide syndrome.”

For example, when I have sat on committees addressing problems such as readmissions, solutions are proposed which are all encompassing and don’t adequately target who we should be.

If 80 percent of readmissions come from 20 percent or less of the same congestive heart failure patients, then we should understand the characteristics of these 20 percent before we put excess effort into stopping readmissions among the 80 percent of patients who are very unlikely to be readmitted in the first place.

Another example: If we want to reduce unnecessary daily laboratory testing — who are the 20 percent of patients that this applies to the most? It will usually be those patients with longer lengths of stay who may have multiple transitions and handoffs within the hospital. If we target all patients, we will expend too much energy addressing a problem that may not have existed in 80 percent of patients.

Applying the principle to our daily interactions in hospital medicine, if there are complaints about “specialist communication” or “soft admissions” from the emergency room, who are the 20 percent of physicians responsible for 80 percent of this? Let’s shift the focus on them instead of making blanket statements about how bad the situation may be.

Acknowledging the value of and employing Pareto’s principle can help guide us through our days and even our careers. Only when we hone in on this natural distribution can we then do our best to skew it in our favor, and have an impact on better systems and practices.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

Prev

Analyzing the new treatment recommendations for bronchiolitis

December 9, 2014 Kevin 0
…
Next

Can connected health improve the lifestyle challenges patients face?

December 9, 2014 Kevin 5
…

Tagged as: Hospital-Based Medicine, Hospitalist

Post navigation

< Previous Post
Analyzing the new treatment recommendations for bronchiolitis
Next Post >
Can connected health improve the lifestyle challenges patients face?

ADVERTISEMENT

More by Suneel Dhand, MD

  • The dream patient that makes a doctor very happy

    Suneel Dhand, MD
  • When the family wants to speak to the doctor

    Suneel Dhand, MD
  • 3 reasons why patients are unhappy

    Suneel Dhand, MD

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...