Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?
At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Xinhua Hospital: Implementation of EMR Project case study is a Harvard Business School (HBR) case study written by F. Warren McFarlan, Ning Jia, Weiqi Liu, Shanshan Cao. The Xinhua Hospital: Implementation of EMR Project (referred as “Xinhua Hospital” from here on) case study provides evaluation & decision scenario in field of Leadership & Managing People. It also touches upon business topics such as - Value proposition, .
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.
Established in 1958, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (hereafter referred to as "Xinhua Hospital") is an integrated modern teaching and research hospital with a comprehensive set of disciplines and a specialization in paediatrics. Xinhua Hospital currently has 1,586 beds, 47 clinical departments and 66 specialties. It has three National Key Disciplines, one Shanghai Key Discipline, five Shanghai Jiao Tong University School of Medicine Key Disciplines, one Ministry of Education Key Laboratory (MOE-Shanghai Key Laboratory of Children's Environmental Health), and two of Shanghai clinical centres, respectively. In 2005, Xinhua Hospital co-founded Shanghai Xinhua Hospital Group with Shanghai Children's Medical Centre Affiliated to Shanghai Jiao Tong University School of Medicine, No.3 People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongmingbao Town People's Hospital, and Xinhua Hospital Chongming Branch. Under the arrangement, members remain as stand-alone legal entities, and are financially and operationally independent. Since 2007, Xinhua Hospital has been importing talent to lead its disciplinary development and enhancing its management through informatization development. In 2011, the hospital had 3,400 employees and its number of accident & emergency unit patients reached 3.3 million, the highest in Shanghai; it treated 69,000 inpatients and undertook 41,000 operations. Xinhua Hospital is a large Class 3A (the highest grade in China) public hospital. The focus of this case study is to understand how was it able to implement an EMR-centered (electronic medical records, also known as electronic patient records or electronic health records) information system within its complicated, traditional organizational structure.
| Years | Cash Flow | Net Cash Flow | Cumulative Cash Flow |
Discount Rate @ 6 % |
Discounted Cash Flows |
|---|---|---|---|---|---|
| Year 0 | (10009755) | -10009755 | - | - | |
| Year 1 | 3446641 | -6563114 | 3446641 | 0.9434 | 3251548 |
| Year 2 | 3973892 | -2589222 | 7420533 | 0.89 | 3536750 |
| Year 3 | 3944744 | 1355522 | 11365277 | 0.8396 | 3312083 |
| Year 4 | 3236589 | 4592111 | 14601866 | 0.7921 | 2563682 |
| TOTAL | 14601866 | 12664063 |
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 -
Capital Budgeting Approaches
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. Timing of the expected cash flows – stockholders of Xinhua Hospital 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. Xinhua Hospital shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.
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
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 Xinhua Hospital 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 Xinhua Hospital 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.
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 | (10009755) | -10009755 | - | - | |
| Year 1 | 3446641 | -6563114 | 3446641 | 0.8696 | 2997079 |
| Year 2 | 3973892 | -2589222 | 7420533 | 0.7561 | 3004833 |
| Year 3 | 3944744 | 1355522 | 11365277 | 0.6575 | 2593733 |
| Year 4 | 3236589 | 4592111 | 14601866 | 0.5718 | 1850530 |
| TOTAL | 10446176 |
(10446176 - 10009755 )
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 | (10009755) | -10009755 | - | - | |
| Year 1 | 3446641 | -6563114 | 3446641 | 0.8333 | 2872201 |
| Year 2 | 3973892 | -2589222 | 7420533 | 0.6944 | 2759647 |
| Year 3 | 3944744 | 1355522 | 11365277 | 0.5787 | 2282838 |
| Year 4 | 3236589 | 4592111 | 14601866 | 0.4823 | 1560855 |
| TOTAL | 9475541 |
At 20% discount rate the NPV is negative (9475541 - 10009755 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Xinhua Hospital to discount cash flow at lower discount rates such as 15%.
Simplest Approach – If the investment project of Xinhua Hospital has a NPV value higher than Zero then finance managers at Xinhua Hospital 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 Xinhua Hospital, then the stock price of the Xinhua Hospital 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.
Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Xinhua Hospital 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.
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.
F. Warren McFarlan, Ning Jia, Weiqi Liu, Shanshan Cao (2018), "Xinhua Hospital: Implementation of EMR Project Harvard Business Review Case Study. Published by HBR Publications.
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