Medical Errors and Quality of Care: From Control to Commitment 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 Medical Errors and Quality of Care: From Control to Commitment case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Medical Errors and Quality of Care: From Control to Commitment case study is a Harvard Business School (HBR) case study written by Naresh Khatri, Alok Baveja, Suzanne A. Boren, Abate Mammo. The Medical Errors and Quality of Care: From Control to Commitment (referred as “Errors Care” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, Corporate governance, Motivating people, Personnel policies, Risk 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 Medical Errors and Quality of Care: From Control to Commitment Case Study

Ongoing efforts to reduce medical errors and enhance quality of patient care focus primarily on technological innovations. However, important management issues that underlie about two-thirds of adverse events have commanded insufficient attention. Examines two alternative management philosophies--control based and commitment based--premised on opposite sets of assumptions about human motivation, and develops a model linking the overall management philosophy with medical errors and quality of care. The current control-based culture and management systems in health care organizations are inherently inadequate in delivering high-quality patient care and safety. To bring further improvements in clinical outcomes, it is necessary to transform them. Implementing commitment-based management will foster collaboration, communication, coordination, and teamwork--the essential mechanisms for reducing medical errors and rendering high-quality health care.

Case Authors : Naresh Khatri, Alok Baveja, Suzanne A. Boren, Abate Mammo

Topic : Technology & Operations

Related Areas : Corporate governance, Motivating people, Personnel policies, Risk management

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Calculating Net Present Value (NPV) at 6% for Medical Errors and Quality of Care: From Control to Commitment Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10013760)	-10013760	-	-
Year 1	3456186	-6557574	3456186	0.9434	3260553
Year 2	3979515	-2578059	7435701	0.89	3541754
Year 3	3948207	1370148	11383908	0.8396	3314991
Year 4	3245564	4615712	14629472	0.7921	2570791
TOTAL			14629472		12688088

The Net Present Value at 6% discount rate is 2674328

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

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

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Formula and Steps to Calculate Net Present Value (NPV) of Medical Errors and Quality of Care: From Control to Commitment

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 Errors Care 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 Errors Care 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	(10013760)	-10013760	-	-
Year 1	3456186	-6557574	3456186	0.8696	3005379
Year 2	3979515	-2578059	7435701	0.7561	3009085
Year 3	3948207	1370148	11383908	0.6575	2596010
Year 4	3245564	4615712	14629472	0.5718	1855662
TOTAL					10466136

The Net NPV after 4 years is 452376

(10466136 - 10013760 )

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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	(10013760)	-10013760	-	-
Year 1	3456186	-6557574	3456186	0.8333	2880155
Year 2	3979515	-2578059	7435701	0.6944	2763552
Year 3	3948207	1370148	11383908	0.5787	2284842
Year 4	3245564	4615712	14629472	0.4823	1565183
TOTAL					9493732

The Net NPV after 4 years is -520028

At 20% discount rate the NPV is negative (9493732 - 10013760 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Errors Care 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 Errors Care has a NPV value higher than Zero then finance managers at Errors Care 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 Errors Care, then the stock price of the Errors Care 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 Errors Care 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 will be a multi year spillover effect of various taxation regulations.

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.

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 Medical Errors and Quality of Care: From Control to Commitment

References & Further Readings

Naresh Khatri, Alok Baveja, Suzanne A. Boren, Abate Mammo (2018), "Medical Errors and Quality of Care: From Control to Commitment Harvard Business Review Case Study. Published by HBR Publications.