Brigham and Women's Hospital in 1992 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 Brigham and Women's Hospital in 1992 case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Brigham and Women's Hospital in 1992 case study is a Harvard Business School (HBR) case study written by Elizabeth Olmsted Teisberg, Eric J. Vayle. The Brigham and Women's Hospital in 1992 (referred as “Hospital Brigham” from here on) case study provides evaluation & decision scenario in field of Strategy & Execution. It also touches upon business topics such as - Value proposition, Decision making, Health, Managing uncertainty, Risk management, Social enterprise.

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 Brigham and Women's Hospital in 1992 Case Study

Brigham and Women's Hospital is a highly successful teaching hospital in 1992. However, the hospital sector is undergoing a major transition and the hospital faces uncertainty about changing demographic trends, new types of competitors, and technological and scientific change. It's premier OB service is declining, and many of the hospital leaders are nearing retirement. How should it craft its strategy for the 1990s?

Case Authors : Elizabeth Olmsted Teisberg, Eric J. Vayle

Topic : Strategy & Execution

Related Areas : Decision making, Health, Managing uncertainty, Risk management, Social enterprise

Calculating Net Present Value (NPV) at 6% for Brigham and Women's Hospital in 1992 Case Study

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Cash Flows
Year 0 (10000896) -10000896 - -
Year 1 3443702 -6557194 3443702 0.9434 3248775
Year 2 3979095 -2578099 7422797 0.89 3541380
Year 3 3958109 1380010 11380906 0.8396 3323305
Year 4 3249318 4629328 14630224 0.7921 2573764
TOTAL 14630224 12687225

The Net Present Value at 6% discount rate is 2686329

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. Profitability Index
2. Payback Period
3. Internal Rate of Return
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. Hospital Brigham 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 Hospital Brigham 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 Brigham and Women's Hospital in 1992

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 Strategy & Execution 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 Hospital Brigham 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 Hospital Brigham 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 %
Cash Flows
Year 0 (10000896) -10000896 - -
Year 1 3443702 -6557194 3443702 0.8696 2994523
Year 2 3979095 -2578099 7422797 0.7561 3008767
Year 3 3958109 1380010 11380906 0.6575 2602521
Year 4 3249318 4629328 14630224 0.5718 1857808
TOTAL 10463620

The Net NPV after 4 years is 462724

(10463620 - 10000896 )

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 %
Cash Flows
Year 0 (10000896) -10000896 - -
Year 1 3443702 -6557194 3443702 0.8333 2869752
Year 2 3979095 -2578099 7422797 0.6944 2763260
Year 3 3958109 1380010 11380906 0.5787 2290572
Year 4 3249318 4629328 14630224 0.4823 1566994
TOTAL 9490578

The Net NPV after 4 years is -510318

At 20% discount rate the NPV is negative (9490578 - 10000896 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Hospital Brigham 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 Hospital Brigham has a NPV value higher than Zero then finance managers at Hospital Brigham 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 Hospital Brigham, then the stock price of the Hospital Brigham 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 Hospital Brigham 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 –

Understanding of risks involved in the project.

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

What can impact the cash flow of the project.

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

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.

References & Further Readings

Elizabeth Olmsted Teisberg, Eric J. Vayle (2018), "Brigham and Women's Hospital in 1992 Harvard Business Review Case Study. Published by HBR Publications.