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Triage at Rouge Valley Health System 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 Triage at Rouge Valley Health System case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Triage at Rouge Valley Health System case study is a Harvard Business School (HBR) case study written by Gerard Seijts, Robert Way. The Triage at Rouge Valley Health System (referred as “Rouge Triage” 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, Mergers & acquisitions.

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 Triage at Rouge Valley Health System Case Study


In late 2006, the Rouge Valley Health System's board of directors began to grasp the gravity of the leadership challenge set before them: rescue the amalgamated Scarborough Centenary Hospital and the Ajax and Pickering General Hospital, which was financially a "basket case," or face an imposed government takeover. A recently completed independent peer review conducted from June through November 2007 came down hard on the former senior leadership team for poor performance and lack of accountability. To reverse the hospital's grave prognosis, the board needed to perform triage: work with their new chief executive officer to stop the financial bleed, restore faith among the hospital's senior management and work towards a new organizational culture.


Case Authors : Gerard Seijts, Robert Way

Topic : Leadership & Managing People

Related Areas : Leadership, Mergers & acquisitions




Calculating Net Present Value (NPV) at 6% for Triage at Rouge Valley Health System Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10021635) -10021635 - -
Year 1 3456551 -6565084 3456551 0.9434 3260897
Year 2 3973957 -2591127 7430508 0.89 3536808
Year 3 3945356 1354229 11375864 0.8396 3312597
Year 4 3223799 4578028 14599663 0.7921 2553551
TOTAL 14599663 12663852




The Net Present Value at 6% discount rate is 2642217

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. Internal Rate of Return
2. Net Present Value
3. Profitability Index
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. Rouge Triage 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 Rouge Triage 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 Triage at Rouge Valley Health System

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 Rouge Triage 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 Rouge Triage 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 (10021635) -10021635 - -
Year 1 3456551 -6565084 3456551 0.8696 3005697
Year 2 3973957 -2591127 7430508 0.7561 3004882
Year 3 3945356 1354229 11375864 0.6575 2594136
Year 4 3223799 4578028 14599663 0.5718 1843218
TOTAL 10447932


The Net NPV after 4 years is 426297

(10447932 - 10021635 )








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 (10021635) -10021635 - -
Year 1 3456551 -6565084 3456551 0.8333 2880459
Year 2 3973957 -2591127 7430508 0.6944 2759692
Year 3 3945356 1354229 11375864 0.5787 2283192
Year 4 3223799 4578028 14599663 0.4823 1554687
TOTAL 9478031


The Net NPV after 4 years is -543604

At 20% discount rate the NPV is negative (9478031 - 10021635 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Rouge Triage 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 Rouge Triage has a NPV value higher than Zero then finance managers at Rouge Triage 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 Rouge Triage, then the stock price of the Rouge Triage 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 Rouge Triage 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.

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 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.






Negotiation Strategy of Triage at Rouge Valley Health System

References & Further Readings

Gerard Seijts, Robert Way (2018), "Triage at Rouge Valley Health System Harvard Business Review Case Study. Published by HBR Publications.


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