Find leverage points, target the vital few, and don’t make ROI the only judge

Not all problems are created equal. In most systems, a small number of people drive a large share of cost or harm, and a small number of conditions make trouble more likely. That’s good news. It means you can pull a few handles and get outsized results, if you know where to look and if you don’t let money be the only judge.

Start by listing risk factors (what increases odds of trouble) and protective factors (what lowers them). If teens drink more when they have lots of unstructured time with peers, add structured options after school. If customers churn when they don’t use a product in the first 30 days, call in week one and help them get a win. The point is to push on what matters most, not everything at once.

Then find the vital few. One housing team realized 15% of addresses generated most eviction filings. They started calling those landlords early, offering flexible payment plans and mediation. Filings dropped in those buildings, and so did homeless system inflow. In a small clinic, two dozen patients accounted for a stream of preventable ER visits. The clinic paired each with a nurse and a social worker, scheduled same‑day appointments, and gave a number to call before dialing 911. The visits fell, the patients felt known, and costs followed.

Be careful with ROI. Of course we should spend money wisely. But using “it must save money” as the only gatekeeper for prevention is a trap. We fix broken hips without asking for payback; we can prevent harm because it’s right. The science here is simple: distributions are often skewed, risk clusters, and intensive support can change trajectories. Ethics matter too. Write your principle now so you’re ready when a spreadsheet says “no” and your gut says “do it.”

Grab a page and split it into risk and protective factors for your problem, then circle one factor you can act on quickly. Run the numbers to spot the vital few people or places driving most of the harm and design a high‑touch offer for them, even if it feels uneven. Finally, decide your moral threshold in writing so ROI isn’t the only voice in the room. Start with one handle this month and learn fast.