Shouldice Hospital

18.08.2010

To : Dr Byrnes Shouldice

From : ABC

Subject : Report on the visit to Shouldice Hospital to propose options to increase

hospital capacity

With re ferenc e to our meeting at Shouldice hospital and discussion with your

department heads, I could understand the operation of your hospital and the

challenges faced. Based on the me eting please find attached the r eport with

rec ommendations.

Executive Summary

Dr. Earl Shouldice pioneered hernia repair technique what is known as the Shouldice

method that a llows for immediate patient activity following the procedure. By 1982,

the procedure was so popular that it led to a 1200 patient wait-list. The challenges

faced by the hospital were, first, to find ways to increase capa city while mainta ining

the same level of care and second, determining the location of the bottle neck

responsible for the wait list. After c areful analysis of the case keeping in mind the

investment required, government regulation and quality of service, possible

recommendations that emerge with the first being recommended.

1. Opera tions on Saturday

2. Adding a new floor

(

Number of words – 109

)

Contents

1. Executive Summary

2. Situation Analysis

3. The Problem

4. Objective

5. The Options

6. Criteria for Evaluation

7. Evaluation of Options

8. The Recommendation

9. Action Plan

Situation Analysis

Shouldice Hospital was e stablished in 1945 b y Dr. Earle Shouldice, inventor of the

Shouldice repair, developed this innovative tec hnique to help young men who were

unable to enlist in the military because of their hernias. His unique repair method

improved surgical results and reduced recovery time.

After his discharge from army, he started his small hospital and as more & more

patients requested operations, he expanded his facilities in Thornbill. The e xpanded

facility was started with 36 bed capacity and later extended to 89 beds. Dr Earle

Shouldice passed a way in 1965 but the hospital continued to operate under the

leadership of Dr Obney with 6850 operations b y 1982.

Dr Shouldice’s unique technique allowed surgery to be performed under local

anesthesia and pain killers. It also encouraged the patients to walk upto post operative

room from the operating table. It also allowed the patients to move a round freely in

the hospital and share the ir expe riences with other patients. The patients as a part of

the daily routine had to come to dining area(with a capacity of only 100 seats) for

their meals, whic h helps them to mix with other patie nts due for surgery next day a nd

boost their confidence. Patients get discharged from hospital on 4

day from the da y

th

of surgery. In the process the hospital created about 1,40,000 satisfied customers.

Also the recurrence rate of Shouldice hospital was 0.8%, far lower than their

competitors with about 10%.

The hospital was popular amongst patients on following c ounts

Great experience

Faster recovery

Less cha nce of reoccurrence

The hospital was popular amongst surgeons on following counts

It gave them time see their childre n grow

Routine activity, not too demanding

Higher salaries

The hospital was popular amongst nurse’s on following counts

Higher pa y scales than other comparable jobs

Their major time was spent in counse ling activities

The success came with some additional c hallenges of having a backlog of about 1200

patients.

Why the backlog?

The hospital employed 12 fulltime surgeons, 7 part time assistant, 30 nursing staff and

other staff to take care of administrative work. The patients can come to hospital as

walk in or with prior appointments. The typical admission proce ss for about 30 to 34

patients started with arriving to hospital, examination by surgeon, health insurance

cover check, pathology tests and allotment of room.

The surgerie s in 5 opera ting rooms start by around 7.30 am and take about 45min for

a routine case and about 60 to 90 min for a case involving recurrence, on an average

1.1hr per surgery

(Exhibit 1)

. The number of operation varied from 30-36 per day a nd

on average each surgeon performed 3-4 surgeries per day. From 1.00 to 3.00pm some

of the surgeons after the ir surgery examined patients at the clinic.

The load on the hospital varied with lull during January & late summer time a nd

contrasted with peak activity in September. With 89 beds and 14 hostel rooms

hospital is able to manage peak load of 165 surgeries per week. However with the

gaining popularity of the hospital, the number patient’s wa iting for surgery is

increasing and is about 1200 nos in January 1983 i.e a wa it time of minimum 7

½

weeks

. T he process flow of the hospital is shown in

Exhibit 2

to indentify the bottle

neck.

As a proposal to incre ase the capacity it was debated whether to go for Saturda y

working which was not liked by four senior doctors and also some of

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