60/30/10 Rule

60/30/10 Rule

This is an important read. If nothing else, remember the 60/30/10 rule: Work on growing the 60, reducing the 30, and eliminating the 10.

60/30/10 Rule:

  • 60% of care on average is in line with evidence- or consensus-based guidelines
  • 30% is some form of waste or of low-value
  • 10% is harm

The 60-30-10 Challenge has persisted for three decades.

Some memorable quotes:

"Complexity science is making breakthroughs in understanding the dynamic webs of virtually infinite combinations of interactions required to deliver effective care. These complex healthcare ecosystems resist standardization, and inevitably flex and adapt in the face of constant change and shifting pressures."

"As well as beginning to understand the strengths of these kinds of networked collaborative structures, researchers have gradually realized that healthcare systems are non-deterministic and behaviors are emergent—that is, it is not possible to confidently predict the future by generalizing from the past."

"In the end, all this top-down activity is not genuine improvement and just adds up to the same 60-30-10 gridlock."

"The drivers are as follows: being committed to improvement, a readiness and preparedness for change, recognizing the capacities for and barriers to progress, an understanding of the types of implementation strategies available, and building sufficient leverage and allocating resources to the fast-paced learning needed in today’s busy clinical world."

"Our notion of a clinical-microsystem-as-learning-system is one that is adaptable and fluid rather than rigid and static—in other words, its features are much more closely aligned with the complex adaptive system of which it is an integral part. With such characteristics, the learning health system may be able to bring together and manage data from multiple sources, including information on health status, patients’ expectations and preferences, clinical and biological information, genomic data, cost and benefit schedules, and lifestyle and history profiles."

There is a lot to unpack here, but enough to start a conversation. Read on and post your thoughts.

Braithwaite, J., Glasziou, P. & Westbrook, J. The three numbers you need to know about healthcare: the 60-30-10 Challenge. BMC Med 18, 102 (2020). https://doi.org/10.1186/s12916-020-01563-4

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01563-4#Fig2

Leanne Rath

Specialist Sports and Exercise Physiotherapist (FACP), Past Adjunct Research Fellow (University of Queensland) and Clinical Educator

3 周

Great paper

回复
Sinju Thomas

CEO & Founder: THERAPHA, Primary Spine Practitioner, Board Certified Orthopedic Specialist, Cert. McKenzie Clinician, Doctor of Physical Therapy

1 个月

Thanks for sharing this, Alex Bendersky! The title is definitely engaging, but it seems somewhat misaligned with US healthcare standards. I’m curious about where these numbers would stand in our system. It would be interesting to see if any similar studies have examined these proportions within the US healthcare framework.?

Andrew Imrie

Bridging Health Strategy to Delivery - Human-centrically, Clinically, Collaboratively, Empirically and Continuously...

1 个月

Great paper that one. I wonder what the 60/30/10 proportions look like in pain management? Their conclusion is on point; "...All-inall, worldwide, we are investing heavily in biomedical and technological advances that promise safer, affordable, more effective healthcare. But without commensurate attention to fit-for-purpose, responsive, evidence based delivery models that are built to learn and are commensurate with a complex systems view of healthcare rather than an inflexible, top-heavy, hierarchically laden command model, we will remain trapped in an Einsteinian Groundhog Day—doing the same thing over and over to achieve the same unsustainable results."

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