Implementing Time Driven Activity Based Costing (TDABC) at MD Anderson

MD Anderson TDABC


The University of Texas MD Anderson Cancer Center is one of the world’s most respected centers devoted exclusively to cancer patient care, research, education and prevention.

Medical imaging is a significant component of MD Anderson’s care, both in terms of cost and the human resources required. 

MD Anderson engaged Agency 39A as an innovation partner to implement a new Time Driven Activity Based Costing (TDABC) approach to managing hours and human resources within their imaging practice. 

Design research provided the data our teams leveraged to develop technical, business, and user requirements


 The TDABC approach required sophisticated software and know-how to scale across all levels of the organization. The program needed strong support from all levels, particularly in areas impacted by TDABC, and an understanding that process mapping and education on how to use TDABC takes time, and capacity cost rates and capacity can be controversial subjects.

MD Anderson’s goal was to have all multidisciplinary care centers adopt the TDABC tool for costing and decision-making within 5 years. Success was dependent on finding answers to how costs trend over time, how each center compares to other centers for this process, and which resources are over/under utilized. They also needed to figure out how to reduce process costs while maintaining quality, ensure practitioners were practicing to the full extent of their licenses, and assess their costliest processes and the reason behind the cost.

The TDABC had to provide relevant and timely information for the user, rewarding their time investment with the outputs they expect. It was critical that this service was neither perceived nor used as a surveillance device in the workplace, but rather as an activity tracker that enhances agency and boosts productivity through increased visibility.

A side-by-side evolution of a complex wireframe evolving into a data-intensive, detailed interface


Our teams leveraged design thinking, research, strategic planning, user experience design, product design, and front-end development to reveal opportunities for optimizing workflows, improve decision making, and ultimately develop software to visualize and manage resources across MD Anderson.  

Agency 39A identified needs across the organization through design research, mapping roles to requirements, defining and prioritizing features for the future-state application through design sprints, and developing new workflows and information architecture through user experience design and planning.

We partnered with MD Anderson IT and innovation technology teams to implement and deploy a platform that translated cost-engines, process maps, and event triggers into scalable software, user experiences, and user interfaces used across departments by a wide range of clinical and non-clinical users.

Visualization-rich user interfaces surface key data and assist in decision making processes


Agency 39A designed and implemented a practice-wide platform to capture direct cost of care for all treatment modalities. Our web-based costing tool calculates total direct labor costs for specific treatment plans based on modality, complexity, and fractionation.

In just months, we identified 1,000 administrative hours, 250 physician hours, 250 clinical staff hours, and 100 medical physics hours associated with the costs of radiation therapy. Our work saved MD Anderson $2.25M in annual salaries and continues to provide savings as new team members are added across all departments. We also identified an additional $12M of annually recurring unidentified patient fees.

Resulting in a simple, easy to use interface for system-wide use

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