The Emerging Capital Market for Nonprofits

Robert S. Kaplan; Allen S. Grossman

Article | Harvard Business Review | October 2010

The Emerging Capital Market for Nonprofits

by Robert S. Kaplan and Allen S. Grossman

Abstract

Many of our largest and most successful companies today did not exist 50 years ago. During this same time interval, companies that ranked among top in the 1960s have disappeared, been merged out of existence, or become much smaller presences in the U.S. industrial scene. These shifts in fortunes are vivid examples of the private sector's cycle of Schumpeterian creative destruction. In contrast, the list of the largest nonprofit organizations has remained stable over decades. Large nonprofits do not disappear and few new ones—Habitat for Humanity and Teach for America are among the exceptions—scale to national size. Schumpeter's cycle apparently does not operate in the social sector. This paper proposes that the disparity arises from the nonprofit sector's historically immature infrastructure and poor mechanisms for channeling funds from donors and foundations to the most effective nonprofits and away from underperforming ones. We illustrate how innovative information and financial intermediaries, using new measurement approaches tailored for the nonprofit sector, have recently arisen to help direct funds to the most effective nonprofits. These innovations have the potential to enable the sector to become far more responsive, effective, and efficient in creating positive social impact at a national scale.

Keywords: Capital Markets; Investment Funds; Philanthropy and Charitable Giving; Corporate Accountability; Management Practices and Processes; Infrastructure; Corporate Social Responsibility and Impact; Performance Effectiveness; Nonprofit Organizations;

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Kaplan, Robert S., and Allen S. Grossman. "The Emerging Capital Market for Nonprofits." Harvard Business Review 88, no. 10 (October 2010).

Leaders at six hospitals conducted a research study to assess and compare the health outcomes and costs of pediatric aerodigestive care. Four of the hospitals delivered care with an integrated practice unit (IPU) while two delivered care traditionally, with isolated specialists. The study used time-driven activity-based costing as a tool to measure and compare costs across the six sites. The results demonstrate that the four IPU sites improved clinical outcomes and had lower costs of care.

Value-based care models are becoming instrumental in structuring clinical care delivery in our healthcare climate. Our objective was to determine the value associated with implementation of a Family-Centered Care Coordination (FCCC) program for neonates undergoing tracheostomy.

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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