Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners 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 Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners case study is a Harvard Business School (HBR) case study written by Claus Rerup, Jim Tuan. The Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners (referred as “Umbra Branch” 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, Leadership, Operations 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

Case Description of Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners Case Study

This case explores the transformation of Umbra Health Partners (Umbra), a privately owned Canadian healthcare organization, as it undergoes an extensive restructuring, through the perspective of the branch manager, who is a recent graduate of a master of business administration program in health services administration. The first part of the case examines the branch manager's role and the last part of the case examines his new role in the corporate office. When he is first hired at Umbra, he assesses the organizational problems inherent in the branch office and in the organization as a whole. As branch manager, he attempts to find solutions to those problems and improve the reliability of his branch. Later, he is promoted to a position in the corporate office, where he addresses the organizational problems at the corporate level (some of which mirror those at the branch office), such as a lack of interdependence and a vague sense of the direction in which the organization is headed. Taken together, the case offers a host of material to discuss the complexities of organizational change.

Case Authors : Claus Rerup, Jim Tuan

Topic : Leadership & Managing People

Related Areas : Leadership, Operations management

Calculating Net Present Value (NPV) at 6% for Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners Case Study

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Cash Flows
Year 0 (10001097) -10001097 - -
Year 1 3466115 -6534982 3466115 0.9434 3269920
Year 2 3973291 -2561691 7439406 0.89 3536215
Year 3 3942452 1380761 11381858 0.8396 3310159
Year 4 3240305 4621066 14622163 0.7921 2566625
TOTAL 14622163 12682918

The Net Present Value at 6% discount rate is 2681821

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. Payback Period
2. Internal Rate of Return
3. Net Present Value
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. Umbra Branch 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 Umbra Branch 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 Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners

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 Leadership & Managing People 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 Umbra Branch 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 Umbra Branch 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 (10001097) -10001097 - -
Year 1 3466115 -6534982 3466115 0.8696 3014013
Year 2 3973291 -2561691 7439406 0.7561 3004379
Year 3 3942452 1380761 11381858 0.6575 2592226
Year 4 3240305 4621066 14622163 0.5718 1852655
TOTAL 10463273

The Net NPV after 4 years is 462176

(10463273 - 10001097 )

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 (10001097) -10001097 - -
Year 1 3466115 -6534982 3466115 0.8333 2888429
Year 2 3973291 -2561691 7439406 0.6944 2759230
Year 3 3942452 1380761 11381858 0.5787 2281512
Year 4 3240305 4621066 14622163 0.4823 1562647
TOTAL 9491818

The Net NPV after 4 years is -509279

At 20% discount rate the NPV is negative (9491818 - 10001097 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Umbra Branch 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 Umbra Branch has a NPV value higher than Zero then finance managers at Umbra Branch 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 Umbra Branch, then the stock price of the Umbra Branch 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 Umbra Branch 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 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.

Understanding of risks involved in 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.

References & Further Readings

Claus Rerup, Jim Tuan (2018), "Surgery With Blunt Tools: Restructuring and Ambiguity at Umbra Health Partners Harvard Business Review Case Study. Published by HBR Publications.