Fun and Profit With Pareto Charts

1. Fun and Profit With Pareto Charts Michael J. Cleary, Ph. D. Wright State University PQ Systems, Inc. Dayton, Ohio Byron Murray, MBA Corporate Transformation Concepts Eugene, Oregon

2. Origins • Italian Economist Alfredo Pareto

3. PARETO ANALYSIS: What Is It? • Bar chart • Bars in rank order of occurrence from highest to lowest • Each bar about different problem/variable • Separates “Vital Few” from “Useful Many” • 80/20 Rule • 80% of gain from 20% of categories • Used to focus improvement on leveraged problems or variables TQT For Healthcare,Pg. 136

4. Types of Data

5. Types of Data • Nominal Data- You can differentiate between items.

6. Types of Data • Ordinal Data – You can order your items

7. Types of Data • Interval Data- allows you to measure distance between items.

8. Types of Data • Ratio Data-Has a defined origin o% and allows to compare variables

12. To Make Pareto Chart • Determine question being asked • Determine data needed to answer it and collect • Summarize data by making a frequency table (how often did things happen in each of your categories?)

13. To Make Pareto Chart • Determine question being asked • Determine data needed to answer it and collect • Summarize data by making a frequency table (how often did things happen in each of your categories?) • Draw and scale the horizontal and vertical axis • Draw and label the bars for each category (from most to least)

16. When Is It Used? • When data can be arranged into categories • When the rank of each category is important • When we need to focus on the most important problems or causes of variation

17. The Questions? • Pareto: • Which are the vital few areas we should concentrate on? • Which variables out of many are occurring most?

19. Frequency Table: Where Are Needlesticks Occurring? Variable Wk1 Wk2 Wk3 Wk4 Tot % 3W 17 14 16 12 59 ED 4 3 4 6 17 Allergy/Imm. 6 2 3 3 14 2S 10 13 12 13 48 Lab 3 2 3 4 12 Other 3 3 3 0 9 Grand Total159

20. 60 40 20 0

21. To Make Pareto Chart • Determine question being asked • Determine data needed to answer it and collect • Summarize data by making a frequency table (how often did things happen in each of your categories?) • Draw and scale the horizontal and vertical axis • Draw and label the bars for each category (from most to least) • Calculate % for each category and annotate on top the respective bar (total for that category divided by grand total X 100) • Study the results

22. Where Are Needlesticks Occurring? Variable Wk1 Wk2 Wk3 Wk4 Tot % 3W 17 14 16 12 59 37.1 ED 4 3 4 6 17 10.7 Allergy/Imm. 6 2 3 3 14 8.8 2S 10 13 12 13 48 30.2 Lab 3 2 3 4 12 7.5 Other 3 3 3 0 9 5.7 Grand Total159 100

23. 60 40 20 0

24. How Is It Interpreted? • Look for the Pareto effect • We won’t always find it! • Is entire chart speaking to us? • Can we re-stratify? • Last choice is selecting a column and tackling it!

26. Adding a Histogram to the Quest for Learning!

28. Profitable and Fun Ways To Use Pareto • Using to drill down

29. Pareto Readmissions By MDCWhich MDCs are greatest sources of unplanned readmissions? MDC 4-Respiratory system MDC 5-Circulatory System MDC 1-Nervous System MDC 7-Hepatobiliary System and Pancreas MDC 18-Infectious and Parasitic MDC 6-Digestive System MDC 17-Myleoproliferative and Poorly Dif Neoplasms

30. Pareto: High Volume DRGs Related to MDCQUESTION: Which DRGs account for the greatest volume of unplanned readmissions in MDC 4? Readmissions by DRG in MDC 4 Percent Total = 1004 48.7% 50 40 30 # readmits 21.6% 20 13.4% 10 4.9% 3.5% 2.9% 2.8% 2.2% 0 89 71 367 309 245 211 Other 189 DRGs

31. Profitable and Fun Ways To Use Pareto • Using to drill down • Using family of Pareto charts to look at different aspects of problem useful

33. Which Med Errors Should We Focus On? Which Contributing Factors Should We Focus On? Counts Counts Counts Total = 434 Percent Counts Total = 167 Percent 100 100 400 150 80 80 300 First chart we saw 60 100 60 # Times This Factor Reported 89 # Errors in Each Category 53.3% 70 200 166 41.9% 38.2% 40 40 50 93 21.4% 100 20 20 46 45 10.6% 10.4% 20 8 19 13 12 11 9 4.6% 4.8% 4.4% 3.0% 2.8% 2.5% 2.1% 0 0 0 0 Trans Pharm Presc. Omit Time Dose Unor Med Route Disc. Oth IV Flow IV Sol Pt Factors Types of Errors Med Errors-Which Day of Week Should We Focus On? Med Errors- Which Locations Should We Focus On? Counts Counts Counts Total = 316 Percent Counts Total = 450 Percent 100 100 300 400 346 80 250 80 76.9% 300 200 60 60 # Errors # Errors 150 200 40 40 100 62 19.6% 52 48 20 16.5% 42 15.2% 38 37 37 100 50 13.3% 20 12.0% 11.7% 11.7% 49 10.9% 32 7.1% 9 7 4 3 0 0 2.0% 1.6% 0.9% 0.7% Tue Mon Fri Thu Wed Sat Sun 0 0 Categories: Day of The Week Med/Surg ICU Other SNF OB/GYN ER Nursery Not Doc.

34. Profitable and Fun Ways To Use Pareto • Using to drill down • Using family of Pareto charts to look at different aspects of problem useful • Stratified Pareto

35. Stratified Pareto: Hospital C Compared to A, B, D Percent Hosp A, B, D Hosp C 56.4% 50 40 28.5% 30 % Unplanned Readmits 23.8% 19.4% 20 16.7% 11.8% 10 6.9% 4.8% 4.2% 3.8% 3.0% 2.9% 2.6% 1.9% 1.9% 1.7% 1.5% 1.1% 1.2% 1.2% 1.0% 0.8% 0.7% 0.6% 0.5% 0.5% 0.5% 0.2% 0 MDC 4 MDC 5 MDC 1 MDC 7 MDC 18 MDC 6 MDC 17 MDC 11 MDC 8 Others MDC 10 MDC 9 MDC 16 MDC 25 MDCs

38. Profitable and Fun Ways To Use Pareto • Using to drill down • Using family of Pareto charts to look at different aspects of problem useful • Stratified Pareto • Repeat Pareto

39. Employee Exposure to Bloodborne Pathogens Employee Exp. to Bloodborne Pathogens-After Counts Counts Counts Percent Counts Percent Total = 64 Total = 32 Scale set 0-60 for both 100 60 60 80 50 50 Color coding makes it easier to see that needle sticks are no longer the Pareto effect 37 40 40 60 57.8% # Exposures # Exposures 100 30 30 80 40 15 20 20 15 46.9% 60 23.4% 20 7 7 10 10 21.9% 10.9% 5 40 3 15.6% 2 3 4.7% 2 3.1% 9.4% 6.3% 0 0 0 0 N-sticks PB Need. Splash Other G-meter PB Need. Splash N-Sticks Other Gl-meter Source of Exposure Source of Exposure

41. What Have Others Used Pareto For? • Sources of referrals to home care? • Hospitals with most unplanned C-sections? • Reasons for same day surgery cancellations? • What customers called most about in Managed Care Org (what benefits)? • Causes of re-admission? • Reasons for patients switching to new physician? • Causes of mortality for individual physician practice? • Patient satisfaction & dissatisfaction, what were biggest satisfiers, dissatisfiers? • Where are falls happening? • Reasons for Monday phone calls? • Causes of Med errors/adverse drugs? • Reasons for delays? (Discharge, etc.)

44. Profitable and Fun Ways To Use Pareto • Using to drill down • Using family of Pareto charts to look at different aspects of problem useful • Stratified Pareto • Repeat Pareto

45. Pareto Chart • Bar chart with bars in rank order • Each bar represents a different variable or problem • Looking for 20% of bars representing 80% of problem • Want to know where to focus our efforts