When One Size Doesn't Fit All: Evolving Directions in the Research and Practice of Enterprise Risk Management

Anette  Mikes; Robert S. Kaplan

Article | Journal of Applied Corporate Finance | Winter 2015

When One Size Doesn't Fit All: Evolving Directions in the Research and Practice of Enterprise Risk Management

Abstract

Enterprise risk management (ERM) has become a crucial component of contemporary corporate governance reforms, with an abundance of principles, guidelines, and standards. This paper portrays ERM as an evolving discipline and presents empirical findings on its current state of maturity, as evidenced by a survey of the academic literature and by our own field research. Academics are increasingly examining the adoption and impact of ERM, but the studies are inconsistent and inconclusive, due, we believe, to an inadequate specification of how ERM is used in practice. Based on a ten-year field project, over 250 interviews with senior risk officers, and three detailed case studies, we put forward a contingency theory of ERM, identifying potential design parameters that can explain observable variation in the "ERM mix" adopted by organizations. We also add a new contingent variable: the type of risk that a specific ERM practice addresses. We outline a "minimum necessary contingency framework" (Otley, 1980) that is sufficiently nuanced, while still empirically observable, that empirical researchers may, in due course, hypothesize about "fit" between contingent variables, such as risk types and the ERM mix, as well as about outcomes such as organizational effectiveness.

Keywords: risk management; contingency theory; grounded research; Risk Management; Customization and Personalization;

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Citation:

Mikes, Anette, and Robert S. Kaplan. "When One Size Doesn't Fit All: Evolving Directions in the Research and Practice of Enterprise Risk Management." Journal of Applied Corporate Finance 27, no. 1 (Winter 2015): 37–40.

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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When One Size Doesn't Fit All: Evolving Directions in the Research and Practice of Enterprise Risk Management

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