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

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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

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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	(10026644)	-10026644	-	-
Year 1	3464983	-6561661	3464983	0.9434	3268852
Year 2	3953695	-2607966	7418678	0.89	3518774
Year 3	3949209	1341243	11367887	0.8396	3315832
Year 4	3231098	4572341	14598985	0.7921	2559332
TOTAL			14598985		12662791

The Net Present Value at 6% discount rate is 2636147

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. Payback Period
2. Net Present Value
3. Internal Rate of Return
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. 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.

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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	(10026644)	-10026644	-	-
Year 1	3464983	-6561661	3464983	0.8696	3013029
Year 2	3953695	-2607966	7418678	0.7561	2989561
Year 3	3949209	1341243	11367887	0.6575	2596669
Year 4	3231098	4572341	14598985	0.5718	1847391
TOTAL					10446650

The Net NPV after 4 years is 420006

(10446650 - 10026644 )

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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	(10026644)	-10026644	-	-
Year 1	3464983	-6561661	3464983	0.8333	2887486
Year 2	3953695	-2607966	7418678	0.6944	2745622
Year 3	3949209	1341243	11367887	0.5787	2285422
Year 4	3231098	4572341	14598985	0.4823	1558207
TOTAL					9476736

The Net NPV after 4 years is -549908

At 20% discount rate the NPV is negative (9476736 - 10026644 ) 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 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.

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.

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Negotiation Strategy of Leading Organisational Change: Improving Hospital Performance

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.