The Accumulation of Marginal Gains

British Cycling

British Cycling

The phenomenal success of the British cycling team in the 2012 Olympics as well as Bradley Wiggins and team Sky in the 2012 Tour de France has been put down to the term “the accumulation of marginal gains”.

Dave Brailsford, the performance director, explains “The whole principle came from the idea that if you broke down everything you could think of that goes into riding a bike, and then improved it by 1%, you will get a significant increase when you put them all together. There’s fitness and conditioning, of course, but there are other things that might seem on the periphery, like sleeping in the right position, having the same pillow when you are away and training in different places. They’re tiny things but if you clump them together it makes a big difference.” []

Of course this can’t turn the individual athletes into world beaters they have to be amazing themselves but the accumulated gains together with a great athlete is a powerful combination.

Effect of small changes

The point of using this example in this book is to think about how effective making relatively small changes in our system can be. Let’s look at a simple example. Imagine we have a service with a Core Partnership average of 10 appointments and a Choice to Core Partnership transfer rate of 85%.

Then say they have 10 full time equivalents.

What if they could exert some effort and focus on reducing the completed treatment average (“Letting Go” as well as using goals and routine outcome monitoring) and reducing the transfer to Core Partnership percentage? How much capacity will this gain?


Let’s try out the effect of reducing treatment averages by just 1 appointment and the transfer percentage from 85% to 70%. How many extra staff is this worth?

Over 2 and half whole time clinicians!

Just from 1 appointment less and 15% less transfer.


Maths: The initial service received 10 referrals per week and was in balance. 8.5 referrals went to Core Partnership and so the 10 staff saw and could see 0.85 service users each (i.e. delivering 8.5 Core Partnership appointments each). In the new service now only 7 service users transfer and they need 9 appointments each. These 63 appointments can be done by 7.4 of the staff (63 [number needed]/ 8.5 [number each clinician can do]). Over 2.5 staff now free.