Deborah Jamieson and the University College London Hospitals 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 Deborah Jamieson and the University College London Hospitals case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Deborah Jamieson and the University College London Hospitals case study is a Harvard Business School (HBR) case study written by D'Aunno Thomas, Anne-Marie Carrick, Mattia J Gilmartin, Paula Caligiuri. The Deborah Jamieson and the University College London Hospitals (referred as “Jamieson Clinics” 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, Economic development, Leadership, Organizational culture.

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 Deborah Jamieson and the University College London Hospitals Case Study

Deborah Jamieson, Advanced Practitioner at the University College London Hospital (UCLH) National Health Service (NHS) Trust, had been employed to set up nurse-led pre-admissions clinics within the Trust and to improve the existing day surgery clinics. The case describes how she manages to recruit and train nurses to run these clinics. She draws on her experience in the US to encourage the nursing staff to take on more clinical responsibilities. The case examines how nurses' roles are developing within the NHS as they take on more tasks that have traditionally been the responsibility of doctors and consultants (attending physicians). The case describes how Jamieson changes the mindset of the key players (managers, consultants and anaesthetists), and how she implements the pre-assessment clinics and improves the existing day surgery pre-admission process. Patient satisfaction is increased and fewer operations are cancelled, thus reducing costs for the Trust.

Case Authors : D'Aunno Thomas, Anne-Marie Carrick, Mattia J Gilmartin, Paula Caligiuri

Topic : Leadership & Managing People

Related Areas : Economic development, Leadership, Organizational culture

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Calculating Net Present Value (NPV) at 6% for Deborah Jamieson and the University College London Hospitals Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10003176)	-10003176	-	-
Year 1	3443204	-6559972	3443204	0.9434	3248306
Year 2	3975875	-2584097	7419079	0.89	3538515
Year 3	3941057	1356960	11360136	0.8396	3308987
Year 4	3250467	4607427	14610603	0.7921	2574674
TOTAL			14610603		12670482

The Net Present Value at 6% discount rate is 2667306

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. Internal Rate of Return
2. Payback Period
3. Profitability Index
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 Jamieson Clinics 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. Jamieson Clinics 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 Deborah Jamieson and the University College London Hospitals

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 Jamieson Clinics 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 Jamieson Clinics 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	(10003176)	-10003176	-	-
Year 1	3443204	-6559972	3443204	0.8696	2994090
Year 2	3975875	-2584097	7419079	0.7561	3006333
Year 3	3941057	1356960	11360136	0.6575	2591309
Year 4	3250467	4607427	14610603	0.5718	1858465
TOTAL					10450197

The Net NPV after 4 years is 447021

(10450197 - 10003176 )

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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	(10003176)	-10003176	-	-
Year 1	3443204	-6559972	3443204	0.8333	2869337
Year 2	3975875	-2584097	7419079	0.6944	2761024
Year 3	3941057	1356960	11360136	0.5787	2280704
Year 4	3250467	4607427	14610603	0.4823	1567548
TOTAL					9478613

The Net NPV after 4 years is -524563

At 20% discount rate the NPV is negative (9478613 - 10003176 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Jamieson Clinics 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 Jamieson Clinics has a NPV value higher than Zero then finance managers at Jamieson Clinics 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 Jamieson Clinics, then the stock price of the Jamieson Clinics 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 Jamieson Clinics 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 can impact the cash flow of 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 Deborah Jamieson and the University College London Hospitals

References & Further Readings

D'Aunno Thomas, Anne-Marie Carrick, Mattia J Gilmartin, Paula Caligiuri (2018), "Deborah Jamieson and the University College London Hospitals Harvard Business Review Case Study. Published by HBR Publications.