The 'Pareto principle' may improve radiology workflow
Radiologists could improve workflow efficiency—a factor key to improving quality and care in the imaging environment—by prioritizing overarching issues within their practices and focusing on simple solutions, a pair of Boston-based clinicians wrote in the Journal of the American College of Radiology.
The Pareto principle—or the 80-20 rule—suggests 80 percent of impact stems from just 20 percent of potential causes, H. Benjamin Harvey, MD, JD, and Susan T. Sotardi, MD, wrote in JACR. This concept might be more applicable to radiology than some might think.
“The Pareto principle is of particular importance in quality improvement because it reminds us that addressing a small number of contributory factors can result in a large improvement impact,” the authors wrote. “If you can simply address these vital few contributing factors, then you know that you can make a significant dent in the problem.”
Identifying the “vital few” can seem daunting, Harvey and Sotardi wrote, but Pareto charts can help guide the process. The method urges clinicians to think through factors that could potentially be contributing to a problem, collecting data to identify which of those factors is actually feeding the problem and plotting contributing factors on a Pareto chart as absolute amounts.
“By simply drawing a line on the Pareto chart at 80 percent of the cumulative errors, you have identified the vital few factors contributing to the problem,” Harvey and Sotardi said. “Targeting these few factors is likely to pay significant dividends.”
The pair said they applied the Pareto approach to an issue within their own practice—time to PACS, or the time it takes a completed study to move from an acquisition device to PACS. They wrote the problem became apparent in 2014, when as many as 9 percent of CT cases were taking nearly an hour to make it to the PACS.
A group identified what they believed were the biggest contributors to the issue, and simple human error emerged as the most influential contributor from a pool of factors, including technical problems, contrast reactions and the need for delayed imaging.
Harvey and Sotardi said that seeing the data mapped out made it easy to identify the root cause of PACS delays and helped shed light on just how busy and preoccupied technologists can be. The team implemented an automatic alert-based intervention program to remedy the problem, which led to a 78 percent decrease in the issue at hand.
“The Pareto principle and 80-20 rule do not describe immutable, predestined failures inherent to our workplace,” the authors wrote. “Instead, they describe opportunities. By leveraging these concepts, we can identify high-impact targets for quality improvement interventions and in doing so bring strategy and efficiency to our quality and safety missions.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.