Our own project · Meridian Hospital Group is a constructed operator; the instrument and its figures are real
Case study 01
Meridian Hospital Group
A private hospital company that builds, operates and sells, holding one hospital and the proceeds of the rest, deciding where to build next.
Meridian Hospital Group builds hospitals, operates them, and sells them once they are fully mature and best in class. It has done it several times. Today it holds one, a general hospital in London, having disposed of the others, and it is sitting on the proceeds.
This page is the entity itself: what kind of business it is, what it says it is for, and how it is structured. The problem statements hang off it, each one a decision the company actually has to take, with its solution laid out and graded separately.
Chapter 1 · Entity attributes
What kind of business this is
The attributes below do more work than they look like doing. Two of them decide most of what follows: the business model, and the gap between how long Meridian holds a hospital and how long that hospital lasts.
Two further pages describe this entity: what it says it is for, on its brand and values page, and how it is structured, on its people and hierarchy page. Both are written to the same rule as everything else here, which is that a claim has to state what would make it false.
- Legal form
- Private companyEquity held by the founders and a small group of institutional investors.
- Business model
- Build, operate, sellDisposal only once a hospital is fully mature and best in class, never timed to the market.
- Footprint today
- One hospitalA general hospital in London. The rest of the group has been sold.
- Capital position
- Cash richHolding the proceeds of the disposals, uncommitted.
- Stage
- Choosing the next siteThe first of a planned series rather than a one off.
- Sector
- Acute healthcareGeneral hospitals, with specialist centres considered per site.
- Asset life
- 60 yearsAgainst a holding period measured in years. The gap is the subject of problem statement 01.
- Working hypothesis
- NigeriaOn a health tourism argument. Tested, and substantially revised, in problem statement 01.
Chapter 2 · The model
How it makes money, and why that matters here
Build, operate, sell. The usual version of that model is treated with suspicion, and deserves to be: a five year horizon against a sixty year building means every consequence that surfaces after the handover is free to the seller.
Meridian adds one rule that changes the arithmetic. A hospital goes to market only once it is fully mature and best in class against published criteria. Never when the market is warm, never when the capital is wanted elsewhere. That single condition turns the usual shortcuts into the reason a sale cannot happen, because each of them is visible in exactly the numbers a buyer’s adviser will pull first. Quality stops being a cost set against the return and becomes the route to liquidity.
It also means the company is not really producing buildings. It produces demonstrated, transferable operating performance, and the proof is the product. Which is why every figure in these pages carries its basis: at exit, all of it has to survive a room full of people being paid to doubt it.
Chapter 3 · The decision in front of it
Where it stands today
One hospital, in London. Cash from the disposals, uncommitted. A plan to keep building rather than to stop. And a board leaning toward Nigeria on a health tourism argument.
That is the first problem statement, and it is a genuine one, because the answer that comes out is not the answer that went in. The honest version turns out to have almost nothing to do with tourism and almost everything to do with who is going to staff the building.
Chapter 4 · Where the work is
The problem statements
Each statement below is a decision Meridian has to take, examined before any solution is offered. The solution to each one is written separately and graded against published criteria, including the places it falls short.