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• Article | American Heart Journal

  Are Cost Advantages from a Modern Indian Hospital Transferable to the United States?

  R. S. Kaplan, F. Erhun, V.G. Narayanan, B. Mistry and K. Brayton, et al

  We use time-driven activity-based costing to estimate the cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two U.S. hospitals, Intermountain and Baylor Heart, and Narayana Health (NH), in India. All three hospitals use modern management methods to achieve excellent patient outcomes. We use variance analysis to remove the effect of differential prices paid for personnel and space at the three hospitals. NH, even at U.S. price levels, retains a cost advantage over the two U.S. hospitals by shifting tasks to less-credentialed and/or less-experienced personnel, supervised by highly-skilled personnel, a practice facilitated by NH’s high annual CABG volume. NH offsets some of its task downshifting cost savings by having lower-skilled employees spend more time counseling patients and their families for in-hospital and home recovery. NH’s cost-saving practices could be captured by U.S. hospitals by relaxing hospital and health professional licensing regulations, encouraging greater family participation in inpatient care, and performing complex surgeries in high-volume regional centers of excellence.

  Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Cost; Organizational Structure; Performance Efficiency; India; United States;

  Citation:

  Kaplan, R. S., F. Erhun, V.G. Narayanan, B. Mistry, and K. Brayton, et al. "Are Cost Advantages from a Modern Indian Hospital Transferable to the United States?" American Heart Journal 224 (June 2020): 148–155.  View Details

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• Article | NEJM Catalyst | May 21, 2020

  Using the Balanced Scorecard for Successful Health Care M&A Integration

  Robert S. Kaplan

  The failure of merged organizations to achieve stated goals is commonplace. In health care, the challenge is exacerbated by the industry’s third-party payer system and multiple stakeholders, especially the physicians in the merging entities. This article describes how the Balanced Scorecard helps health care leaders overcome cultural misalignment across previously independent providers, enabling them to become better aligned to a new strategy for delivering higher value for patients, physicians, payers, and communities.

  Keywords: Health Care and Treatment; Mergers and Acquisitions; Integration; Balanced Scorecard;

  Citation:

  Kaplan, Robert S. "Using the Balanced Scorecard for Successful Health Care M&A Integration." NEJM Catalyst (May 21, 2020).  View Details

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• Case | HBS Case Collection | March 2020 (Revised May 2020)

  Performance Management at Afreximbank

  Robert S. Kaplan, Siko Sikochi and Josh Steimle

  Based in Cairo, Afreximbank was founded in October 1993 as a specialized continental financial institution designed to address the low level of intra-African trade, the decline in financial flows to Africa, the worsening external debt situation of many African countries, and the sharp reduction in lending to Africa by international commercial banks. This case study explores how the Bank introduced the Balanced Scorecard (BSC) to improve the Bank’s performance management system. The goal was to transform the Bank’s bureaucratic culture and processes into one more attuned to the fast-paced and dramatic changes happening in Africa. The case examines how the BSC is being used to implement the Bank’s strategy and the issues arising from its implementation. The case facilitates a discussion on whether the Bank had become entrepreneurial enough to keep pace with the continent’s thriving, emerging markets.

  Keywords: performance management; Balanced Scorecard; Performance Expectations; Performance Evaluation; Performance Improvement; Organizational Culture; Strategy; Banking Industry; Africa; Egypt;

  Citation:

  Kaplan, Robert S., Siko Sikochi, and Josh Steimle. "Performance Management at Afreximbank." Harvard Business School Case 120-029, March 2020. (Revised May 2020.)  View Details

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