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Duke business student wins David Calkins Memorial Scholarship

By IHI Open School | Wednesday, November 7, 2012

It’s not every day that someone jumps up and down in the middle of a Starbucks. Sure, the drinks are good, but good enough to leave your feet?


It turns out that Monica VanBuskirk’s excitement last week had nothing to do with her beverage. She’d just learned she won this year’s David Calkins Memorial Scholarship to fully cover general conference fees for this December’s IHI National Forum plus $1,000 for travel and lodging.


“I was tickled pink,” VanBuskirk said upon hearing the good news. “I’ve been a huge fan of IHI ever since I heard about it.”


David Calkins (May 27, 1948 – April 7, 2006), MD, MPP, was a physician, teacher, IHI Fellow, and health care improvement champion who was a member of IHI’s 100,000 Lives Campaign team. He was also an Associate Professor of Medicine at Harvard Medical School and Associate Physician at Massachusetts General Hospital.


A panel of judges, including Susan Rice, David Calkins’ widow, chose VanBuskirk’s winning essay – about activity-based costing – from dozens of excellent candidates. She is the fifth winner of the annual contest and the first MBA student to win.


“My first response was to email my accounting professor and say, ‘Guess what? I can do more work on that activity-based costing idea we talked about!’” said VanBuskirk, a student in the Health Sector Management Program at Duke University’s Fuqua Schools of Business. “[The opportunity to attend the Forum] makes so many things possible. I’m curious to hear, in the real world, how people make things work.”


Here is VanBuskirk’s scholarship-winning essay:


I came to business school convinced that I could learn skills and tools from the business world that could be applied to health care delivery and yield unrealized returns in improvement. I never thought, however, that I would find that in my accounting class.


Earlier this year, I worked on a case about Owens & Minor and their change to activity-based costing. Activity-based costing (or ABC, as it's known) is a method of allocating costs to the distinct, measureable activities that incur those costs. While it seems an intuitive cost allocation strategy, few health care facilities use ABC for their accounting system, largely because of the time and energy required to trace the cost of every single activity undertaken in a delivery system. It's a huge task. But the current state of the U.S. health care system requires disruptive change, and for that, we need a tool that will disrupt our system. Further, because ABC sheds light on the activities that consume resources, the organizations that benefit most from ABC are those that have large overhead from diverse offerings to consumers whose demands also vary.


Currently, I have begun a literature review of ABC in health care under the guidance of my professor, Shane Dikolli. Through MHA students in my Healthcare Finance class at the neighboring Gillings School, I plan to interview current hospital accountants and identify real-world benefits and barriers. I've partnered with a medical student at Duke who is undertaking an ABC study in one of the departments, but plans to use hand-timing to measure activities. Rather than that method, I believe the inter-clinic GPS tracking research I've seen at MGH can more accurately and effectively gather the activity data and then align it with costs. I'm determined to bring together disparate experiences and collaborators to show proof of concept before the end of my studies in May.


I am convinced that ABC is the single, most important tool to affect change in the U.S. health care system. All of the other activities currently underway: changes in consumer behavior, changes in provider behavior, changes in payment models and integration of information across settings, hinge on a need for transparency of information. We will not have that transparency until our financial systems can be understood. We will not be able to effectively invest in change, until we know which activities consume which resources. And we certainly will not be able to efficiently coordinate payments and care across systems until we know how to allocate those resources. With ABC, we can shine light on the daily activities of care, and improve those activities more efficiently than ever, and as effectively as we need if we are ever to turn the system around.


Editor's note: For more information on this December's National Forum, visit our customized page for students.

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