Six Sigma at Academic Medical Hospital (A) 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 Six Sigma at Academic Medical Hospital (A) case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Six Sigma at Academic Medical Hospital (A) case study is a Harvard Business School (HBR) case study written by Robert D. Landel, Dee C. San, Debra Altschuler. The Six Sigma at Academic Medical Hospital (A) (referred as “Sigma Belt” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, Operations management, Project management.

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

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Case Description of Six Sigma at Academic Medical Hospital (A) Case Study

For 10 years, Academic Medical Hospital's chief of staff had struggled to decrease the amount of time patients spend waiting in the emergency department. Moving patients through the department is a complex task and therefore long wait times had always been excused. But now, the hospital has adopted Six Sigma, a highly disciplined and data-intensive method for streamlining the emergency-care activities and reducing patient wait time. This case traces the design and implementation of a Black Belt improvement project. The various phases of Six Sigma methodology (Define, Measure, Analyze, Improve, Control) are described in the setting of the patient wait-time study and several statistical tools are demonstrated with operating- performance data. The case ends with the Black Belt being concerned about the statistical significance of the results of the recently completed pilot study as well as deep-rooted implementation resistance from several key stakeholders in the hospital and in the medical school. Having led her team through the various phases of Six Sigma and having completed the pilot study, the Black Belt wonders how to focus the next team meeting. The case can be used to teach Six Sigma methodology, to critique effectiveness of application of the phases and tools, and to deal with the statistical significance issues and the implementation concerns. See also the B and C cases.

Case Authors : Robert D. Landel, Dee C. San, Debra Altschuler

Topic : Technology & Operations

Related Areas : Operations management, Project management

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Calculating Net Present Value (NPV) at 6% for Six Sigma at Academic Medical Hospital (A) Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10013313)	-10013313	-	-
Year 1	3463690	-6549623	3463690	0.9434	3267632
Year 2	3978478	-2571145	7442168	0.89	3540831
Year 3	3939511	1368366	11381679	0.8396	3307689
Year 4	3232175	4600541	14613854	0.7921	2560185
TOTAL			14613854		12676338

The Net Present Value at 6% discount rate is 2663025

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.

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Capital Budgeting Approaches

Methods of Capital Budgeting

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

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

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. Sigma Belt 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 Sigma Belt have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.

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Formula and Steps to Calculate Net Present Value (NPV) of Six Sigma at Academic Medical Hospital (A)

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 Technology & Operations 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 Sigma Belt 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 Sigma Belt 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	(10013313)	-10013313	-	-
Year 1	3463690	-6549623	3463690	0.8696	3011904
Year 2	3978478	-2571145	7442168	0.7561	3008301
Year 3	3939511	1368366	11381679	0.6575	2590292
Year 4	3232175	4600541	14613854	0.5718	1848007
TOTAL					10458504

The Net NPV after 4 years is 445191

(10458504 - 10013313 )

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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	(10013313)	-10013313	-	-
Year 1	3463690	-6549623	3463690	0.8333	2886408
Year 2	3978478	-2571145	7442168	0.6944	2762832
Year 3	3939511	1368366	11381679	0.5787	2279810
Year 4	3232175	4600541	14613854	0.4823	1558726
TOTAL					9487776

The Net NPV after 4 years is -525537

At 20% discount rate the NPV is negative (9487776 - 10013313 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Sigma Belt 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 Sigma Belt has a NPV value higher than Zero then finance managers at Sigma Belt 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 Sigma Belt, then the stock price of the Sigma Belt 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 Sigma Belt 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 will be a multi year spillover effect of various taxation regulations.

What can impact the cash flow of the project.

Understanding of risks involved in the project.

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

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.

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Negotiation Strategy of Six Sigma at Academic Medical Hospital (A)

References & Further Readings

Robert D. Landel, Dee C. San, Debra Altschuler (2018), "Six Sigma at Academic Medical Hospital (A) Harvard Business Review Case Study. Published by HBR Publications.