Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol

F.  Erhun; B.  Mistry; T.  Platcheck; A.  Milstein; V.G.   Narayanan; R. S. Kaplan

Article | BMJ Open

Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol

by F. Erhun, B. Mistry, T. Platcheck, A. Milstein, V.G. Narayanan and R. S. Kaplan

Abstract

Coronary artery bypass graft (CABG) surgery is a common treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32,000. The same operation reportedly costs less than $2000 to produce in India. The proposed study will (1) identify the difference in the costs incurred to perform CABG surgery at three Joint Commission accredited hospitals, two in U.S. and one in India, and (2) characterize the opportunity to reduce the cost of performing CABG surgery. We use time-driven activity-based costing (TDABC) to quantify the hospitals' costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labor and non-labor resources utilized to perform each activity) with the unit cost of each resource used to provide the care. We will conduct a variance analysis of labor costs to separate out price and quantity effects across the three hospitals to reveal opportunities to bend the cost curve for CABG production in the USA.

Keywords: Activity Based Costing and Management; Health Disorders; Health Care and Treatment; United States; India;

Format: Electronic

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Citation:

Erhun, F., B. Mistry, T. Platcheck, A. Milstein, V.G. Narayanan, and R. S. Kaplan. "Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol." BMJ Open 5, no. 8 (2015).

Kurt Meyer, chief risk officer of Swissgrid, the Swiss national electricity transmission system operator, reflects on the risk management system he installed after the deregulation and liberalization of the European energy market. With 41 connections to other European networks, a failure in Swissgrid’s network could interrupt the supply of electricity in Switzerland and much of Europe. Meyer describes the periodic interactive risk workshops conducted at each business unit to identify, assess, and mitigate risks. Executive Risk Workshops of the CEO and the company’s leadership team discuss the business units’ risk profiles and risks that cut across the units, such as safety, weather, and regulatory changes. New and emerging risks are discussed at Extraordinary Risk Workshops. Meyer recently deployed an app on employees’ smartphones for them to easily report anomalies or concerns. Reports from the app are embedded in a new real-time crisis management platform used by several Swiss companies, federal authorities, and the Swiss Army. Despite a full array of risk management tools and processes, Meyer remains concerned about risks yet to be identified.

Working Paper | HBS Working Paper Series | 2018

Reverse the Curse of the Top-5

Robert S. Kaplan

The past 40 years has seen a large increase in the number of articles submitted to journals ranked in the top-5 of their discipline. This increase is the rational response, by faculty, to the overweighting of publications in these journals by university promotions and tenure committees. The ranking factors for academic journals, however, arose for a completely different purpose, to guide the journal acquisition decisions by budget-constrained university librarians. Using journal impact factors to infer the quality of an faculty members’ publications incurs a high incidence of both Type 1 errors, when we conclude incorrectly that a paper published in a top-5 journal is a high-impact paper, and Type 2 errors, when we conclude that papers (and books) not published in top-5 journals have low impact. In addition, a third type of error gets introduced as faculty pursue the research they perceive is favored by editors of top-5 journals, at the potential expense of more innovative and relevant research, perceived to be unpublishable in a top-tier journal. Accounting scholarship, in particular, has underinvested in research about innovative practices or the emerging accounting issues faced by contemporary organizations (Kaplan, 2011), likely because such research is viewed as unpublishable in top-5 journals. This gap persists despite recent scholarship that has documented how important, fundamental ideas can emerge from “use-inspired” research (see Pasteur’s Quadrant (Stokes, 1997)). The paper concludes by suggesting reforms to overcome the dysfunctional fixation on publication in top-5 journals.

Keywords: Information Publishing; Journals and Magazines; Power and Influence; Research;

Citation:

Kaplan, Robert S. "Reverse the Curse of the Top-5." Harvard Business School Working Paper, No. 19-052, October 2018. View Details

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This note was written to provide students with fundamental concepts and methods for the analysis of cost variances. It focuses on the decomposition of cost variances into price, quantity, and mix variance components, an approach that allows students to identify the root causes of differences between expected and actual costs.

Faculty & Research

Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol

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