greater understanding of processes and be more willing to
pursue changes that increase the value and effectiveness of
their organization [6–12].
Although the studies above found ABC providing healthcare
management with a more detailed cost analysis and
important cost- and value-enhancement opportunities, in
practice ABC models are not easy to implement. For example,
to build a traditional ABC model, you would survey
employees to estimate the percentage of time they spend
(or expect to spend) on the different activities and then
assign the department’s resource expenses according to the
average percentage you get from your survey [16]. While
this approach works well in a limited setting, difficulties
arise when you try to roll this approach out on a large scale
for use on an ongoing basis. The time and cost demands of
creating and maintaining an ABC model on this large scale
might then become a major barrier to widespread adaptation
at most organizations [14,16]. And, because of the
high cost of continually updating the ABC model, many ABC
systems will be updated only infrequently, leading to out-of-
date activity cost driver rates, and inaccurate estimates
of process, product, and customer costs [20].
The accuracy of the cost driver rates when they are
derived from individuals’ subjective estimates of their past
or future behavior has also been called into question [16,17].
Apart from the measurement error introduced by employees’
best attempts to recall their time allocations, the people
supplying the data – anticipating how it might be used –
might bias or distort their responses. As a result, healthcare
managers might argue about the accuracy of the model’s
estimated costs and profitability rather than address how
to improve the inefficient processes, unprofitable products,
and considerable excess capacity that the model has
revealed [14,16].