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Frederick Southwick and Reducing Medical Errors 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 Frederick Southwick and Reducing Medical Errors case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Frederick Southwick and Reducing Medical Errors case study is a Harvard Business School (HBR) case study written by Rosabeth Moss Kanter, Ai-Ling Jamila Malone, Jihea Kang. The Frederick Southwick and Reducing Medical Errors (referred as “Southwick Errors” from here on) case study provides evaluation & decision scenario in field of Innovation & Entrepreneurship. It also touches upon business topics such as - Value proposition, Developing employees, Health, Human resource management, Organizational structure.

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 Frederick Southwick and Reducing Medical Errors Case Study


Medical errors both in the U.S. and worldwide occur at alarming rates. In the U.S. medical errors were the third leading cause of death. Southwick experienced the consequences of preventable medical errors firsthand. As a physician and a professor, he researched and wrote about the causes and solutions for medical errors over the years. Southwick also launched pilot programs applying different quality improvement frameworks from other fields to medicine. Although the results were positive, he encountered resistance from many physicians. To build more skills, Southwick became an Advanced Leadership Fellow in 2010 and a Senior Advanced Leadership Fellow in 2011. He used his time at Harvard to develop solutions that would address the root causes of medical errors. The complexities in healthcare and the entrenched cultural norms presented strong barriers to creating change. The case explores Southwick's efforts in getting medical professionals to work collaboratively, communicate effectively, and create a new sustainable culture that improves healthcare outcomes. Southwick's experience raises the question of how one person can best make a difference in a large, complex, entrenched system.


Case Authors : Rosabeth Moss Kanter, Ai-Ling Jamila Malone, Jihea Kang

Topic : Innovation & Entrepreneurship

Related Areas : Developing employees, Health, Human resource management, Organizational structure




Calculating Net Present Value (NPV) at 6% for Frederick Southwick and Reducing Medical Errors Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10005225) -10005225 - -
Year 1 3451326 -6553899 3451326 0.9434 3255968
Year 2 3956341 -2597558 7407667 0.89 3521129
Year 3 3955064 1357506 11362731 0.8396 3320748
Year 4 3244450 4601956 14607181 0.7921 2569908
TOTAL 14607181 12667754




The Net Present Value at 6% discount rate is 2662529

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

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. Southwick Errors 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 Southwick Errors 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 Frederick Southwick and Reducing Medical Errors

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 Innovation & Entrepreneurship 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 Southwick Errors 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 Southwick Errors 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 (10005225) -10005225 - -
Year 1 3451326 -6553899 3451326 0.8696 3001153
Year 2 3956341 -2597558 7407667 0.7561 2991562
Year 3 3955064 1357506 11362731 0.6575 2600519
Year 4 3244450 4601956 14607181 0.5718 1855025
TOTAL 10448259


The Net NPV after 4 years is 443034

(10448259 - 10005225 )








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 (10005225) -10005225 - -
Year 1 3451326 -6553899 3451326 0.8333 2876105
Year 2 3956341 -2597558 7407667 0.6944 2747459
Year 3 3955064 1357506 11362731 0.5787 2288810
Year 4 3244450 4601956 14607181 0.4823 1564646
TOTAL 9477020


The Net NPV after 4 years is -528205

At 20% discount rate the NPV is negative (9477020 - 10005225 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Southwick Errors 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 Southwick Errors has a NPV value higher than Zero then finance managers at Southwick Errors 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 Southwick Errors, then the stock price of the Southwick Errors 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 Southwick Errors 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.

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.

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

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.






Negotiation Strategy of Frederick Southwick and Reducing Medical Errors

References & Further Readings

Rosabeth Moss Kanter, Ai-Ling Jamila Malone, Jihea Kang (2018), "Frederick Southwick and Reducing Medical Errors Harvard Business Review Case Study. Published by HBR Publications.


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