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Ron Ventura at Mitchell Memorial Hospital Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Ron Ventura at Mitchell Memorial Hospital case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Ron Ventura at Mitchell Memorial Hospital case study is a Harvard Business School (HBR) case study written by Frank V. Cespedes, Heide Abelli. The Ron Ventura at Mitchell Memorial Hospital (referred as “Ventura Prescott” from here on) case study provides evaluation & decision scenario in field of Organizational Development. It also touches upon business topics such as - Value proposition, Conflict, Customers, Human resource management, Organizational culture.

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment






Case Description of Ron Ventura at Mitchell Memorial Hospital Case Study


Mitchell Memorial Hospital is a 750-bed regional academic medical center in Ohio. Andy Prescott, Chief of the Cardiovascular Center, is reviewing the performance evaluations of his star vascular surgeon Ron Ventura. The evaluations, the result of a 360-degree performance review cycle the hospital had recently put in place, were much more critical than he had anticipated. Ventura, with a national reputation as an accomplished vascular surgeon, had improved the vascular surgery practice enormously in his short tenure at Mitchell Memorial and generated much new case flow for the hospital. Ventura is also, as the evaluation packet made clear, sharp-tongued, impatient, and abrasive. Prescott knows that the Cardiovascular Center needs team players, but he also has a responsibility to improve the performance of the vascular surgery practice, and Ventura is critical to that effort. Now Ventura's contract is up for renewal. Although Prescott recruited Ventura and gave strong support in his first months, other surgeons are now considering leaving the hospital, HR is getting complaints from the nursing staff and the residency programs, and many point to Ventura's behavior as the cause. Prescott wonders whether Ventura's actions violate Mitchell Memorial's cultural norms focused on teamwork and collaboration and whether or not his contract with the hospital should be renewed. Students must consider approaches to the upcoming performance feedback interview between Prescott and Ventura.


Case Authors : Frank V. Cespedes, Heide Abelli

Topic : Organizational Development

Related Areas : Conflict, Customers, Human resource management, Organizational culture




Calculating Net Present Value (NPV) at 6% for Ron Ventura at Mitchell Memorial Hospital Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10027882) -10027882 - -
Year 1 3468250 -6559632 3468250 0.9434 3271934
Year 2 3953997 -2605635 7422247 0.89 3519043
Year 3 3954878 1349243 11377125 0.8396 3320592
Year 4 3244900 4594143 14622025 0.7921 2570265
TOTAL 14622025 12681834




The Net Present Value at 6% discount rate is 2653952

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting


What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.




Capital Budgeting Approaches

Methods of Capital Budgeting


There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Internal Rate of Return
2. Profitability Index
3. Payback Period
4. Net Present Value

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Ventura Prescott shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.
2. Timing of the expected cash flows – stockholders of Ventura Prescott have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.






Formula and Steps to Calculate Net Present Value (NPV) of Ron Ventura at Mitchell Memorial Hospital

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Organizational Development Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Ventura Prescott often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Ventura Prescott needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.



Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 15 %
Discounted
Cash Flows
Year 0 (10027882) -10027882 - -
Year 1 3468250 -6559632 3468250 0.8696 3015870
Year 2 3953997 -2605635 7422247 0.7561 2989790
Year 3 3954878 1349243 11377125 0.6575 2600396
Year 4 3244900 4594143 14622025 0.5718 1855282
TOTAL 10461338


The Net NPV after 4 years is 433456

(10461338 - 10027882 )








Calculating Net Present Value (NPV) at 20%


If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 20 %
Discounted
Cash Flows
Year 0 (10027882) -10027882 - -
Year 1 3468250 -6559632 3468250 0.8333 2890208
Year 2 3953997 -2605635 7422247 0.6944 2745831
Year 3 3954878 1349243 11377125 0.5787 2288703
Year 4 3244900 4594143 14622025 0.4823 1564863
TOTAL 9489605


The Net NPV after 4 years is -538277

At 20% discount rate the NPV is negative (9489605 - 10027882 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Ventura Prescott to discount cash flow at lower discount rates such as 15%.





Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Ventura Prescott has a NPV value higher than Zero then finance managers at Ventura Prescott can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Ventura Prescott, then the stock price of the Ventura Prescott should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Ventura Prescott should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

What can impact the cash flow of the project.

What will be a multi year spillover effect of various taxation regulations.

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

Understanding of risks involved in the project.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.






Negotiation Strategy of Ron Ventura at Mitchell Memorial Hospital

References & Further Readings

Frank V. Cespedes, Heide Abelli (2018), "Ron Ventura at Mitchell Memorial Hospital Harvard Business Review Case Study. Published by HBR Publications.


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