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Leading Organisational Change: Improving Hospital Performance 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 Leading Organisational Change: Improving Hospital Performance case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Leading Organisational Change: Improving Hospital Performance case study is a Harvard Business School (HBR) case study written by Mattia J Gilmartin, D'Aunno Thomas. The Leading Organisational Change: Improving Hospital Performance (referred as “Nurses Tracey” 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, Customer service, Health, 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 Leading Organisational Change: Improving Hospital Performance Case Study


"Tracey Burns, Director of Nursing at the King Edgar NHS Hospital Trust was assigned to head a project to improve the efficiency of patient flows throughout the hospital's system. The case describes how nurses are empowered to play a more proactive role in the process of discharging patients. In addition the Trust was going through a financial crisis, it had difficulties meeting government's waiting list targets and was receiving adverse media coverage. The case looks at how the nurses finally took responsibility for making the final decision to discharge individuals - traditionally the physician's job. The task was difficult as it meant the balance of power between physicians and nurses would alter, but in order for the process to change, there would have to be close cooperation between the two parties."


Case Authors : Mattia J Gilmartin, D'Aunno Thomas

Topic : Leadership & Managing People

Related Areas : Customer service, Health, Leadership, Operations management




Calculating Net Present Value (NPV) at 6% for Leading Organisational Change: Improving Hospital Performance Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10008926) -10008926 - -
Year 1 3459948 -6548978 3459948 0.9434 3264102
Year 2 3972398 -2576580 7432346 0.89 3535420
Year 3 3955930 1379350 11388276 0.8396 3321475
Year 4 3245687 4625037 14633963 0.7921 2570888
TOTAL 14633963 12691885


The Net Present Value at 6% discount rate is 2682959

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. 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 Nurses Tracey 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. Nurses Tracey shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.




Formula and Steps to Calculate Net Present Value (NPV) of Leading Organisational Change: Improving Hospital Performance

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 Nurses Tracey 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 Nurses Tracey 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 (10008926) -10008926 - -
Year 1 3459948 -6548978 3459948 0.8696 3008650
Year 2 3972398 -2576580 7432346 0.7561 3003704
Year 3 3955930 1379350 11388276 0.6575 2601088
Year 4 3245687 4625037 14633963 0.5718 1855732
TOTAL 10469174


The Net NPV after 4 years is 460248

(10469174 - 10008926 )






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 (10008926) -10008926 - -
Year 1 3459948 -6548978 3459948 0.8333 2883290
Year 2 3972398 -2576580 7432346 0.6944 2758610
Year 3 3955930 1379350 11388276 0.5787 2289311
Year 4 3245687 4625037 14633963 0.4823 1565243
TOTAL 9496454


The Net NPV after 4 years is -512472

At 20% discount rate the NPV is negative (9496454 - 10008926 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Nurses Tracey 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 Nurses Tracey has a NPV value higher than Zero then finance managers at Nurses Tracey 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 Nurses Tracey, then the stock price of the Nurses Tracey 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 Nurses Tracey 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 can impact the cash flow of the project.

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.

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

Mattia J Gilmartin, D'Aunno Thomas (2018), "Leading Organisational Change: Improving Hospital Performance Harvard Business Review Case Study. Published by HBR Publications.