個案總覽

The case describes the application of time-driven activity-based costing (TDABC) at a new tertiary hospital operated by Partners-in-Health in Mirebelais, Haiti. A project team mapped the clinical processes for use in estimating the direct costs of personnel, equipment, and facilities for obstetric and breast cancer care. The accurate cost information revealed opportunities to optimize resource-utilization and reduce costs by establishing more efficient sterilization procedures and task-shifting administrative responsibilities away from high-cost physicians. It would also potentially be used for budgeting and to propose new payment models with Haiti's Ministries of Health and Finance.

Two groups of orthopedic surgeons form a joint venture with a community hospital to establish Hoag Orthopedic Institute, a for-profit hospital and two ambulatory service centers. By controlling and integrating all aspects of the patients' medical treatment, the physicians deliver superior outcomes, which they communicate with an annual public outcomes report. They also introduce bundled payment contracts with three insurers for orthopedic surgeries, and join a multi-hospital study for applying time-driven activity-based costing to identify process improvement and cost reduction opportunities. The case concludes with HOI leaders examining several options for expansion and growth.

Health care providers in much of the world are trying to respond to the tremendous pressure to reduce costs--but evidence suggests that many of their attempts are counterproductive, raising costs and sometimes decreasing the quality of care. Kaplan and Haas reached this conclusion after conducting field research with more than 50 health care provider organizations. Administrators looking for cuts typically work from the line-item expense categories on their P&Ls, they found. This may appear to generate immediate results, but it usually does not reflect the optimal mix of resources needed to efficiently deliver excellent care. The authors describe five common mistakes: (1) Reducing support staff. This often lowers the productivity of clinicians, whose time is far more expensive. (2) Underinvesting in space and equipment. The costs of these are consistently an order of magnitude smaller than personnel costs, so cuts here are short-sighted if they lower people's productivity. (3) Focusing narrowly on procurement prices and neglecting to examine how individual clinicians actually consume supplies. (4) Maximizing patient throughput. Physicians achieve greater overall productivity by spending more time with fewer patients. (5) Failing to benchmark and standardize. Administrators, in collaboration with clinicians, should examine all the costs of treating patients' conditions. This will uncover multiple opportunities to improve processes in ways that lower total costs and deliver better care.

The case describes a pilot project on applying activity-based costing to measure the cost of treating patients. After an overview of Boston Children's Hospital and its local health care market environment, the case presents process maps and financial data relating to patients making office visits to a plastic surgeon for three different diagnoses. Students use the hospital's existing cost system and a proposed new system, based on time-driven activity-based costing, to calculate and compare costs and margins of the three types of office visits.

Spreadsheet supplement to be used in conjunction with Boston Children's Hospital: Measuring Patient Costs, case number 112-086, and Boston Children's Hospital: Measuring Patient Costs, teaching note number 913-419.

The case describes two pilot projects on applying activity-based costing to measuring the cost of treating patients. It presents process maps and financial data relating to the processes used during (1) an office visit to a plastic surgeon for three different diagnoses, and (2) application and removal of three different casts in the orthopedic cast room. Students calculate and compare the costs and margins of the three procedures at the two different sites using the hospital's existing cost system and a proposed new system based on time-driven activity-based costing.

Risk management is too often treated as a compliance issue that can be solved by drawing up lots of rules and making sure that all employees follow them. Many such rules, of course, are sensible and do reduce some risks that could severely damage a company. But rules-based risk management will not diminish either the likelihood or the impact of a disaster such as Deepwater Horizon, just as it did not prevent the failure of many financial institutions during the 2007-2008 credit crisis. In this article, Robert S. Kaplan and Anette Mikes present a categorization of risk that allows executives to understand the qualitative distinctions between the types of risks that organizations face. Preventable risks, arising from within the organization, are controllable and ought to be eliminated or avoided. Examples are the risks from employees' and managers' unauthorized, unethical, or inappropriate actions and the risks from breakdowns in routine operational processes. Strategy risks are those a company voluntarily assumes in order to generate superior returns from its strategy. External risks arise from events outside the company and are beyond its influence or control. Sources of these risks include natural and political disasters and major macroeconomic shifts. Risk events from any category can be fatal to a company's strategy and even to its survival. Companies should tailor their risk management processes to these different risk categories. A rules-based approach is effective for managing preventable risks, whereas strategy risks require a fundamentally different approach based on open and explicit risk discussions. To anticipate and mitigate the impact of major external risks, companies can call on tools such as war-gaming and scenario analysis.

What do you do if one of your largest and oldest customers is now one of your most unprofitable? That's the dilemma faced by Tommy Bamford, director of the fictional UK-based interior fixtures manufacturer Egan & Sons. Activity-based costing analysis reveals that Westmid Builders, a long-standing client of Egan's, has become a big drag on the bottom line. But Jane Oldenburg, a regional sales manager for Egan who has deep ties with the Westmid account, argues against dropping it. After all, Westmid has stuck with Egan through thick and thin, even as many of Egan's other customers turn to Chinese manufacturers. Besides, there's a publicity angle. Case author Robert S. Kaplan, of Harvard Business School, asks whether Egan should sever its 63-year-old relationship with Westmid. Commentary comes from Timothy J. Jahnke, of Elkay Manufacturing; Jacquelyn S. Thomas, of Southern Methodist University; and HBR's online readers.

What do you do if one of your largest and oldest customers is now one of your most unprofitable? That's the dilemma faced by Tommy Bamford, director of the fictional UK-based interior fixtures manufacturer Egan & Sons. Activity-based costing analysis reveals that Westmid Builders, a long-standing client of Egan's, has become a big drag on the bottom line. But Jane Oldenburg, a regional sales manager for Egan who has deep ties with the Westmid account, argues against dropping it. After all, Westmid has stuck with Egan through thick and thin, even as many of Egan's other customers turn to Chinese manufacturers. Besides, there's a publicity angle. Case author Robert S. Kaplan, of Harvard Business School, asks whether Egan should sever its 63-year-old relationship with Westmid. Commentary comes from Timothy J. Jahnke, of Elkay Manufacturing; Jacquelyn S. Thomas, of Southern Methodist University; and HBR's online readers.

What do you do if one of your largest and oldest customers is now one of your most unprofitable? That's the dilemma faced by Tommy Bamford, director of the fictional UK-based interior fixtures manufacturer Egan & Sons. Activity-based costing analysis reveals that Westmid Builders, a long-standing client of Egan's, has become a big drag on the bottom line. But Jane Oldenburg, a regional sales manager for Egan who has deep ties with the Westmid account, argues against dropping it. After all, Westmid has stuck with Egan through thick and thin, even as many of Egan's other customers turn to Chinese manufacturers. Besides, there's a publicity angle. Case author Robert S. Kaplan, of Harvard Business School, asks whether Egan should sever its 63-year-old relationship with Westmid. Commentary comes from Timothy J. Jahnke, of Elkay Manufacturing; Jacquelyn S. Thomas, of Southern Methodist University; and HBR's online readers.

The case describes two pilot projects on applying activity-based costing to measuring the cost of treating patients. It presents process maps and financial data relating to the processes used during (1) an office visit to a plastic surgeon for three different diagnoses, and (2) application and removal of three different casts in the orthopedic cast room. Students calculate and compare the costs and margins of the three procedures at the two different sites using the hospital's existing cost system and a proposed new system based on time-driven activity-based costing.

The case illustrates how a leading German hospital group has invested deeply in the measurement of patient-level outcomes and costs, the foundations of a health care value framework. The company launches a pilot project to use time-driven activity-based costing (TDABC) for measuring the cost of total knee replacements. The costing project complements an existing initiative for comprehensive outcomes measurement. The combination of accurate measurement of outcomes and costs empowers local personnel - physicians, nurses, and administrators - to improve the value of care they deliver. It also permits benchmarking across the group's multiple hospital sites to identify best practices that can be shared. The case concludes with a decision on using outcome and cost measurement to inform the adoption of a new recuperative approach that promises to dramatically lower post-surgical length-of-stays.

U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions-not organizational units or narrow diagnostic treatment groups-as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-based costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson Cancer Center in Houston, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Schon Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.

The financial meltdown made clear that the executives of many major financial institutions were operating with inadequate or distorted information about the values and risks of their firms' assets. It's fair to say that business scholars bear some responsibility for that. Most of them are neither studying nor teaching emerging best practices in asset valuation and risk management. They need to begin exploring the interior of leading-edge companies to provide detailed, qualitative case studies.

A new management team at VW do Brazil develops and deploys a strategy map and Balanced Scorecard to accomplish a turnaround and cultural change after eight consecutive years of financial losses and market share declines. The team uses the strategy map to align financial and project resources to the strategy, and to motivate its more than 20,000 employees by communicating the strategy in multiple ways and installing reward and recognition programs. It also establishes new programs to align the extensive networks of suppliers and dealers to the strategy. But after a sharp decline in sales triggered by the global financial crisis of 2008, the executive team faces a dilemma: should cut back production levels and funding for strategic initiatives until sales recover, or should it continue to invest for the future?

Why is it that effective business start-ups frequently grow into corporate giants, but effective new nonprofits rarely reach national scale? Because, say Harvard Business School's Kaplan and Grossman, the mechanisms and institutions that channel money and information between donors and nonprofits are underdeveloped. They don't provide reliable data on performance and don't hold organizations accountable for producing results. So inefficient nonprofits swallow up dollars that effective ones could use to serve more constituents. The good news is, that's beginning to change: A new generation of charitable foundations and intermediaries is measuring the impact of donations and targeting the highest-performing nonprofits. Taking a page from mutual funds and venture capital firms in the private sector, the new intermediaries conduct extensive due diligence on nonprofits and demand hard data on outcomes achieved. A few pioneers provide ongoing support, helping grantees develop action plans, detailed frameworks to measure impact, and strategic advice. If practices like these spread, we could soon see a social capital market that delivers real returns on donors' dollars.

Spreadsheet supplement for case number 106058.

Spreadsheet supplement for case number 106060.

Speadsheet supplement for case number 195196.

Spreadsheet supplement for case number 190002.