Publications

November–December 2020
Article

The Risks You Can't Foresee: What to Do When There's No Playbook

By: Robert S. Kaplan, Herman B. Leonard and Anette Mikes

No matter how good their risk management systems are, companies can’t plan for everything. Some risks are outside people’s realm of experience or so remote no one could have imagined them. Some result from a perfect storm of coinciding breakdowns, and some materialize... View Details

Keywords: Novel Risks; Risk Management; Crisis Management

October 2020
Teaching Note

Swissgrid: Enterprise Risk Management in a Digital Age

By: Robert S. Kaplan and Anette Mikes

This note was prepared by HBS Professor Robert Kaplan and Professor Anette Mikes (University of Oxford) for the purpose of aiding classroom instructors in the use of “Swissgrid: Enterprise Risk Management in a Digital Age,” HBS No. 119-045. View Details

Purchase

2020
Working Paper

Updating the Balanced Scorecard for Triple Bottom Line Strategies

By: Robert S. Kaplan and David McMillan

Many companies are now attempting to achieve triple bottom line performance on financial, environmental, and societal metrics. Successful strategies for such performance, however, generally require new relationships among multiple players in multiple sectors across a... View Details

Keywords: Balanced Scorecard; Adaptation; Environmental Sustainability; Social Issues; Performance; Strategy

SSRN

Article

Assessing the Training Costs and Work of Diagnostic Radiology Residents Using Key Performance Indicators—An Observational Study

By: Robert S. Kaplan, Marta E. Heilbrun, Brad Poss, Luca Boi, Yoshimi Anzai and Nan Hu

Article

Assessing the Value of Pediatric Aerodigestive Care

By: Robert S. Kaplan, Chris Hartnick, Mahek Shah, Steven M. Coppess, Alisa Yamasaki, Kaalan E. Johnson, Jeremy Prager, Christopher T. Wootten, Thomas Gallagher and Evan Propst

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... View Details

Keywords: Time-Driven Activity-Based Costing; Value-based Health Care; Integrated Practice Unit; Health Care and Treatment; Cost Management; Performance Improvement

Article

Quantifying the Benefits from a Care Coordination Program for Tracheostomy Placement in Neonates

By: Christen Caloway, Alisa Yamasaki, Kevin M. Callans, Mahek Shah, Robert S. Kaplan and Christopher Hartnick

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... View Details

Keywords: Family-centered Care; Value-based Healthcare; Time-Driven Activity-Based Costing; Health Care and Treatment; Value; Activity Based Costing and Management

Article

Are Cost Advantages from a Modern Indian Hospital Transferable to the United States?

By: 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... View Details

Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Cost; Organizational Structure; Performance Efficiency; India; United States

Article

Using the Balanced Scorecard for Successful Health Care M&A Integration

By: Robert S. Kaplan

The failure of merged organizations to achieve stated goals is commonplace. In health care, the challenge is exacerbated by the industry’s third-party payer system and multiple stakeholders, especially the physicians in the merging entities. This article describes how... View Details

Keywords: Health Care and Treatment; Mergers and Acquisitions; Integration; Balanced Scorecard

March 2020 (Revised February 2023)
Case

Performance Management at Afreximbank (A)

By: Robert S. Kaplan, Siko Sikochi and Josh Steimle

Based in Cairo, Afreximbank was founded in October 1993 as a specialized continental financial institution designed to address the low level of intra-African trade, the decline in financial flows to Africa, the worsening external debt situation of many African... View Details

Keywords: Performance Management; Balanced Scorecard; Performance Expectations; Performance Evaluation; Performance Improvement; Organizational Culture; Strategy; Banking Industry; Africa; Egypt

Educators

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2020
Working Paper

Novel Risks

By: Robert S. Kaplan, Herman B. "Dutch" Leonard and Anette Mikes

All organizations practice some form of risk management to identify and assess routine risks in their operations, supply chains, strategy, and external environment. These risk management policies, however, fail in the presence of novelty. Novel risks arise from... View Details

Keywords: Risk Management; Policy; Failure; Organizational Change and Adaptation

Article

Mandate Outcomes Reporting

By: Robert S. Kaplan and Michael E. Porter

Currently, few health care providers measure and report their patient outcomes, which leads to several problems. Attempts to introduce price transparency without outcomes transparency could trigger a “race to the bottom.” Should Medicare coverage be expanded to... View Details

Keywords: Outcomes Reporting; Outcomes Measurement; Medicare; Medicaid; Health Care and Treatment; Outcome or Result; Measurement and Metrics

2019
Working Paper

Intelligent Design of Inclusive Growth Strategies

By: Robert S. Kaplan, George Serafeim and Eduardo Tugendhat

Improving corporate engagement with society, as advocated in the Business Roundtable’s 2019 statement, should not be viewed as a zero-sum proposition where attention to new stakeholders detracts from delivering shareholder value. Corporate programs for sustainable and... View Details

Keywords: Inclusion; Sustainability; Performance Measures; Environmental Sustainability; Social Issues; Strategy; Governance; Corporate Social Responsibility and Impact; Business and Stakeholder Relations

SSRN

Article

Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support

By: Michael Nurok, Jonathan Warsh, Erik Dong, Jeffrey Lopez, Mayumi Kharabi and Robert S. Kaplan

We applied a value (outcomes and cost) analysis to extracorporeal life support (ECLS), a relatively rare but very expensive ICU therapy with highly variable outcomes. To address the outcome component of the value approach, we created guidelines for ECLS delivery; to... View Details

Keywords: Health Care and Treatment; Cost Management; Value; Analysis

Article

Navy Medicine Introduces Value-Based Health Care

By: Alee Hernandez, Robert S. Kaplan, Mary L. Witkowski, C. Forrest Faison III and Michael E. Porter

In 2016 the newly appointed surgeon general of the Navy launched a value-based health care pilot project at Naval Hospital Jacksonville to explore whether multidisciplinary care teams (known as integrated practice units, or IPUs) and measurement of outcomes could... View Details

Keywords: Military Health System; Health Care and Treatment; Cost Management; Projects

July 2019
Article

Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements

By: Derek A. Haas, Xiaoran Zhang, Robert S. Kaplan and Zirui Song

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. The paper analyzed... View Details

Keywords: Medicare; Medicaid; Bundled Payments; Health Care and Treatment; Cost Management; Performance Evaluation; Outcome or Result

Article

Reverse the Curse of the Top-5

By: 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... View Details

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

2019
Article

Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance

By: Robert S. Kaplan, Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell and Derek A. Haas

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... View Details

Keywords: Time-Driven Activity-Based Costing; Activity Based Costing and Management; Health Care and Treatment; Analysis

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March 2019
Article

A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes

By: Robert S. Kaplan, Heather A. Heaton, David M. Nestler, William J. Barry, Richard A. Helmers, Mustafa Y. Sir, Deepi G. Goyal, Derek A. Haas and Annie T. Sadosty

Objectives: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes.

Methods: Two research assistants shadowed attending physicians for a total of 64 hours in the... View Details

Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Analysis

Article

Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach

By: Robert S. Kaplan, Michael Nurok, Jonathan Warsh, Todd Griner, Mayumi Kharabi, Joseph Castongia, Cali Overbeck, Lisa Krueger, Bernice Coleman, Danny Ramzy, Joshua Chung, Alice Chan, Eric Ley, Sindhu Kubendran, Neil Parrish, Zhe Yu, Michael Landberg, Stuart Finder, Bradley T. Rosen, Harry Sax and Francisco Arabia

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... View Details

Keywords: Health Care and Treatment; Quality; Performance Improvement