Robert S. Kaplan

Harvard University | Harvard · Harvard Business School

The US fee-for-service payment system under-reimburses clinics offering access to comprehensive treatments for opioid use disorder (OUD). The funding shortfall limits a clinic’s ability to expand and improve access, especially for socially marginalized patients with OUD. New payment models, however, should reflect the high variation in cost for usi...

Objective Measuring the cost of performing breast imaging is difficult in healthcare systems. The purpose of our study was to evaluate this cost using time-driven activity-based costing (TDABC) and to evaluate cost drivers for different exams. Methods An IRB-approved, single center prospective study was performed on 80 female patients presenting f...

Billing and insurance-related costs are a significant source of wasteful health care spending in Organization for Economic Cooperation and Development nations, but these administrative burdens vary across national systems. We executed a microlevel accounting of these costs in different national settings at six provider locations in five nations (Au...

The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of veno-venous extracorporeal membrane oxygenation (VV ECMO) for respiratory failure to estimate how much of the higher ICU costs at 1 US site can be attributed to...

Background Accurate measurement of healthcare costs is required to assess and improve the value of oncology care.Objectives We aimed to determine the cost of breast cancer care provision across collaborating health care organizations.Methods We used time-driven activity-based costing (TDABC) to calculate the complete cost of breast cancer care—init...

INTRODUCTION Integrated quality improvement (QI) and cost reduction strategies can help increase value in cancer care. Time-driven activity-based costing (TDABC) is a bottom-up costing tool that measures resource use over the full care cycle. We applied standard QI and TDABC methods to improve workflow efficiency and reduce costs for MRI-guided pro...

Objective To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. Methods We defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct obser...

Background There remains no tool to quantify the total value of comparative processes in health care. Hospital administrative data sets are emerging as valuable sources to evaluate performance. Thus, we use a framework to simultaneously assess multiple domains of value associated with an enhanced recovery initiative using national administrative da...

Purpose In value-based health care delivery, radiation oncologists need to compare empiric costs of care delivery with advanced technologies, such as intensity-modulated proton therapy (IMPT) and intensity-modulated radiation therapy (IMRT). We used time-driven activity-based costing (TDABC) to compare the costs of delivering IMPT and IMRT in a cas...

Background Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals’ cost advantages to US peers remains unc...

Rationale and objectives: To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure. Materials and methods: In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost all...

Importance In 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model. Objective To evaluate changes in key economic and clinical outcomes associated with the C...

Objective To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes. Methods This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experience in physician–scribe interactions and ED workflow...

Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in academic primary care clin...

Las organizaciones que emplean a los directivos rara vez se implican en su formación más allá del proceso de contratación y, a veces, de subvencionarlos como estudiantes. Lo que sí hacen, en cambio, es tomar las riendas de su desarrollo. Esto ha dado como resultado mayor variedad y también mayor experimentación, también más practicidad y, por lo ta...

Purpose To perform a cost analysis comparison for managing common ocular disorders in an eye emergency department (ED) versus an urgent care setting using a time-driven activity-based cost model (TDABC) to assist physicians and staff in appropriate allocation of resources at their own institution. Design Retrospective analysis. Setting Massachusett...

Purpose: To determine whether residency training represents a net positive or negative cost to academic medical centers, we analyzed the cost of a residency program and clinical productivity of residents and faculty in outpatient primary care practice with or without residents. Method: Patient volume and revenue data (Current Procedural Terminol...

The balanced scorecard, originally designed as a measurement system, has evolved into a comprehensive process to manage the execution of an organization’s strategy. The framework uses measures to translate the strategic objectives into targets and initiatives while the management system creates focus, alignment and leadership. It is estimated that...

Objective To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Methods Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient’s medical dossier. We trained one data colle...

Objective Endoscopic/colonoscopic procedures are either done with gastroenterologist-administered conscious sedation or with anesthesia-administered sedation with propofol. There are potential benefits to anesthesia-administered sedation, but the concern has been the associated increased cost. Methods To perform this study, we used the time-derive...

We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient's minimally acceptable outcome, maximally acceptable bur...

This chapter discusses how to measure and improve spine care outcomes and costs. Today′s commonly used outcome metrics, , such as readmission and complication rates, are actually process and quality metrics. They are not the outcomes, such as improvement in pain and mobility, that patients expect to enjoy from being treated for spine pain. Similarl...

Objectives/hypothesis: Providing high-value healthcare to patients is increasingly becoming an objective for providers including those at multidisciplinary aerodigestive centers. Measuring value has two components: 1) identify relevant health outcomes and 2) determine relevant treatment costs. Via their inherent structure, multidisciplinary care u...

Rationale and objectives: The lack of understanding of the real costs (not charge) of delivering healthcare services poses tremendous challenges in the containment of healthcare costs. In this study, we applied an established cost accounting method, the time-driven activity-based costing (TDABC), to assess the costs of performing an abdomen and pe...

In many situations, having physicians and other clinical personnel talk more with patients and each other can be the least expensive and most effective approach for delivering better patient care, and new payment models provide incentives for such discussions.

Health care costs related to surgical care account for 40% of all hospital and physician spending.¹ Payers attempting to contain costs are replacing fee-for-service with value-based payment schemes that can encompass entire episodes of care, including physician services and postacute costs. Bundled payments, for example, will provide strong incenti...

Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare deliver...

Background The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission a...

Purpose: The transformation from volume to value will require communication of outcomes and costs of therapies; however, outcomes are usually nonstandardized, and cost of therapy differs among stakeholders. We developed a standardized value framework by using radar charts to visualize and communicate a wide range of patient outcomes and cost for t...

Background: Previous studies have documented wide variation in health care spending and prices; however, the causes for the variation in supply purchase prices across providers are not well understood. The purpose of this study was to determine the drivers of variation in prosthetic implant purchase prices for primary total knee and hip arthroplas...

The balanced scorecard, originally designed as a measurement system, has evolved into a comprehensive process to manage the execution of an organization’s strategy. The framework uses measures to translate the strategic objectives into targets and initiatives while the management system creates focus, alignment and leadership. It is estimated that...

Many believe that the recent emphasis on enterprise risk management function is misguided, especially after the failure of sophisticated quantitative risk models during the global financial crisis. The concern is that top-down risk management will inhibit innovation and entrepreneurial activities. We disagree and argue that risk management should f...

Many believe that the recent emphasis on enterprise risk management function is misguided, especially after the failure of sophisticated quantitative risk models during the global financial crisis. The concern is that top-down risk management will inhibit innovation and entrepreneurial activities. We advocate, however, that risk management done wel...

Many believe that the recent emphasis on enterprise risk management function is misguided, especially after the failure of sophisticated quantitative risk models during the global financial crisis. One concern is that top‐down risk management will inhibit innovation and entrepreneurial activities. The authors disagree and argue that risk management...

Value in emergency medicine is determined by both patient-important outcomes and the costs associated with achieving them. However, measuring true costs is challenging. Without an understanding of costs, emergency department (ED) leaders will be unable to determine which interventions might improve value for their patients. Although ongoing researc...

Introduction: Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed 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 $32 201±$23 059. The same ope...

Purpose: Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. Methods and materials: Patients with low-risk PCa treated with low-dose-rate PB...

The American College of Obstetricians and Gynecologists has called for safely reducing cesarean delivery rates and policymakers have proposed linking cesarean delivery rates to value-based insurance designs. Predicting the effect of reducing cesarean delivery on institutional margins is complex because the costs are rooted in the clinical processes...

We extend traditional agency theory by exploring the roles for formal measures when managerial behavior is not governed by rules, formulas, or contracts. Part I describes relational incentive contracts with informal weights on formal performance measures. More importantly, it also explores how formal measures could be used in models of informal man...

In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditiona...

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 and over 250 interviews with senior risk officers, we put forward a contingency theory of ERM, identifying potential...

Purpose: Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. Methods and materials: Patients with low-risk PCa treated with low-dose-rate PBT b...

Object: To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors...

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 provid...

As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This...

Time-driven activity-based costing: Traces the path of a patient throughout the continuum of care for a specific medical condition. Identifies the actual cost of each resource used, such as personnel, space, consumables, and equipment, in both inpatient and outpatient settings. Documents the amount of time the patient spends with each resource. Sup...

SYNOPSIS The paper describes the theory and preliminary results for an action research program that explores the implications from better measurements of health care outcomes and costs. After summarizing Porter's outcome taxonomy (Porter 2010), we illustrate how to use process mapping and time-driven activity-based costing to measure the costs of t...

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 o...

Las organizaciones que emplean a los directivos rara vez se implican en su formación más allá del proceso de contratación y, a veces, de subvencionarlos como estudiantes. Lo que sí hacen, en cambio, es tomar las riendas de su desarrollo. Esto ha dado como resultado mayor variedad y también mayor experimentación, también más practicidad y, por lo ta...

La gestión de clientes refleja buena parte de todo lo que es nuevo en la estrategia empresarial moderna (figura 1). En la era industrial, las estrategias se basaban en el producto: " Si lo fabricamos, vendrán " era la filosofía fundamental. Las empresas tenían éxito aplicando procesos de gestión operativa eficientes e innovación de productos. Los p...

Purpose The purpose of this paper is to provide the author's insights about five papers written in this volume about his published work on the balanced scorecard (BSC). Design/methodology/approach The author's comments are based on his personal writing, teaching, speaking about, and implementing the BSC during the past 20 years. Findings The auth...

Professor of Management Studies Las organizaciones que emplean a los directivos rara vez se implican en su formación más allá del proceso de contratación y, a veces, de subvencionarlos como estudiantes. Lo que sí hacen, en cambio, es tomar las riendas de su desarrollo. Esto ha dado como resultado mayor variedad y también mayor experimentación, tamb...

This book of the collection this time dedicated to what is learned in the best MBA programs worldwide and the contributions of academics of the major schools of Europe, the US and the world, totally new material and adapted to changing current scenario. The chosen group includes academics representing reputed MBA and graduate programs, from Harvard...

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 d...

Recent accounting scholarship has used statistical analyses on asset prices, financial reports and disclosures, laboratory experiments, and surveys of practice. The research has studied the interface among accounting information, capital markets, standard-setters, and financial analysts and how managers make accounting choices. But as accounting sc...

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 emp...

The case, in a non-profit project-oriented setting, introduces fundamental risk management principles and processes that are easily applicable to private sector settings. Gentry Lee, senior systems engineer and de-facto chief risk officer, is applying a new comprehensive risk management system to a $600 million high-profile Mars landing mission. Th...

David Norton and I introduced the balanced scorecard in a 1992 Harvard Business Review article (Kaplan & Norton, 1992). The article was based on a multi-company research project that studied performance measurement in companies whose intangible assets played a central role in value creation (Nolan & Norton, 1991). Our interest in measurement for dr...

The division has just finished a project to install a time-driven activity-based cost system that traces costs directly to the processes used to produce, sell and deliver a wide variety of stainless steel sinks. The division sells to customers in multiple channels (retail, distributors, contractors, and wholesalers). The VP of sales wanted a much m...

Traducción de: The Balanced Scorecard. Translating Strategy into Action.

Too often, long-term strategic programs fall victim to slash-and-burn cutbacks in response to short-term economic woes. To sustain your competitive advantage, segregate and protect your strategic expenditures from traditional capital and operational expenditures, and root out operational inefficiencies.

The case “Infosys’ Relationship Scorecard: Measuring Transformational Partnerships” analyzes the relationship scorecard (RSC), an innovative application of the balanced scorecard (BSC) developed by Infosys, an Indian IT services firm. The tool was created in response to the information needs of the firm’s strategic outsourcing relationships, which...

Companies have always found it hard to balance pressing operational concerns with long-term strategic priorities. The tension is critical: World-class processes won't lead to success without the right strategic direction, and the best strategy in the world will get nowhere without strong operations to execute it. In this article, Kaplan, of Harvard...

01 La estrategia del océano azul (W. Chan Kim y Renée Mauborgne)$backslash$n10 Propósito estratégico (Gary Hamel y C. K. Prahalad)$backslash$n25 Estrategias regionales para el liderazgo global (Pankaj Ghemawat)$backslash$n37 Usar el Balanced Scorecard como un sistema de gestión estratégica (Robert S. Kaplan y David P. Norton)$backslash$n48 La venta...

The balanced scorecard revolutionized conventional thinking about performance metrics. When Kaplan and Norton first introduced the concept, in 1992, companies were busy transforming themselves to compete in the world of information; their ability to exploit intangible assets was becoming more decisive than their ability to manage physical assets. T...

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Purpose – The purpose of this response is to refute Voelpel et al.'s five proposed explanations about why the Balanced Scorecard fails to support innovation and employee empowerment. Design/methodology/approach – Provides quotes from published articles and books by Kaplan‐Norton that directly contradict the positions taken by Voelpel et al. Findi...

Throughout most of modern busi ness history, corporations have attempted to unlock value by matching their structures to their strategies: Centralization by function. Decentralization by product category or geographic region. Matrix organizations that attempt both at once. Virtual organizations. Networked organizations. Velcro organizations. But no...

There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years,...

Passive-aggressive organizations are friendly places to work: People are congenial, conflict is rare, and consensus is easy to reach. But, at the end of the day, even the best proposals fail to gain traction, and a company can go nowhere so imperturbably that it's easy to pretend everything is fine. Such companies are not necessarily saddled with m...

There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years,...

Executives know that a company's measurement systems strongly affect employee behaviors. But the traditional financial performance measures that worked for the industrial era are out of sync with the skills organizations are trying to master. Frustrated by these inadequacies, some managers have abandoned financial measures like return on equity and...

Purpose This article shows how the McKinsey 7‐S model and the balanced scorecard (BSC) model complement each other. Design/methodology/approach The developer of the widely used BSC model analyzes and compares the features and functions of the two models. Findings One can view the BSC as the contemporary manifestation of the 7‐S model, helping to...