The last time I blogged, I was talking about improving your journey to work by making decisions based on data, but I also wanted to look at how to prioritise which changes are of the biggest benefit and which are the most easily achieved. After all, we only have a finite amount of time and resources within work. How do we choose what improvement area to work on next?

In IQT Silver we use Pareto charts to see where opportunity for improvement lies within work.

A Pareto chart,based on the Pareto principle, states that, for many events, roughly 80% of the effects come from 20% of the causes. Possible examples of this in healthcare are:

80% of referrals coming from 20% of the population, or

80% of hospital bed days come from 20% of inpatients.

A Pareto chart is a type of chart that contains both an ordered bar chart and a line graph, where the bars are ordered from highest to lowest and the line shows the cumulative percentage of the bars across the chart. The ordered bars show how often something happens, the costs of something or another important unit of measure.

This format makes it easy to see at a glance where the biggest areas for improvement lie and how much of the whole picture they represent. This is done by looking up from a bar within the chart to the cumulative line, then across to the right to read the percentage that the chosen bar and those to the left of it represent out of the whole percentage.

That may not be the easiest to understand written down, but if we look at an example using the Pareto chart below, it should make a lot more sense. Below, the Pareto chart shows that if we solved the top two reasons for late arrivals to work (child care and traffic), we would resolve 60% of the issue, illustrated here by the green dotted line.

If we remedied the top three (adding the Public Transportation bar) we would resolve 79% of the issue, because the cumulative total percentage of the three bars is equal to 79%, again illustrated by the green dotted line.

Once an area of improvement is chosen (for example to reduce the number of late arrivals caused by traffic) then the numbers captured could be viewed using a run chart, which I spoke about in my previous blog, to see if the changes to our practice are having the desired effect of reducing the number of late arrivals due to traffic over time.

**So what’s the problem with Pareto charts?**

Pareto charts are a great way of summarising where opportunity lies, but they do have limitations. It is easy to forget when looking at a Pareto chart that all problems are (unfortunately) not equally simple to resolve.

A tool also used within IQT Silver that allows for this to be explored is the Ease/Benefit matrix. The vertical axis can be populated using the figures from a Pareto Chart i.e. what is the “Benefit” of doing something?

The horizontal axis is typically a number from 0 to 10 for how difficult we think implementing the solution to a problem is likely to be (with 0 being very easy and 10 being practically impossible). This “Ease” number should take into account the perspectives of all those that will help make the improvement a success.

Once the matrix is populated, first focus on the ideas in the box labelled 1. Then deal with all those in the both boxes labelled 2, and so on.

Using both the Pareto chart and the Ease/Benefit matrix should help you define what changes are of most benefit to your work, and which can be most easily achieved.

**David Williams is the Information & Improvement Lead in 1000 Lives Improvement.**

**You can follow David on Twitter @daillewill**

What are the biggest challenges facing you? Have you thought about using a Pareto chart to see where the majority of your work comes from? Could you use an Ease/Benefit matrix to choose your next person centred improvement?

**Tell us in the comments below, or tweet us @1000LivesPlus.**

Excel templates for creating Pareto Charts and Ease/Benefit Matrix are available from iqt@wales.nhs.uk