How successful is the Shouldice Hospital ?

Shouldice Hospital Limited is an 89 bed healthcare facility located in the suburbs of Toronto, Canada. The 17,000 square foot facility is housed on a sprawling 130 acre estate and specializes in repairing external abdominal hernias. Currently, 7,600 surgeries are performed each year on patients from all across the United States and Canada. Founded by Dr. Earle Shouldice circa 1940, the organization enjoys a reputation for effectively using a unique surgical technique to repair hernias that is considered superior to all others. The procedure includes early ambulation following surgery for rapid and effective recovery. The organization takes great pride in its patient as boss philosophy of service.

Shouldice Hospital is very successful primarily due to its unique service delivered by motivated and empowered staff in a friendly, comfortable environment. Patients are viewed as the boss, so the patient experience is positive. Staff and physicians are treated well so turnover is low. The demand for the Shouldice technique continues to increase, so the future can bring much opportunity if Shouldice management chooses to expand. Issues of expanding operations & generational differences are manageable. The organization is run well but continued success is hinged on the upcoming change in leadership.

The Shouldice competitive advantage boils down to 4 keys to success, which are the following: Distinctive technique Experienced staff Comprehensive patient experience Thoughtful employee policies

These 4 elements work in unison at Shouldice to promote healthy and happy patients, in addition to content and loyal staff. environment. As the hospital itself states, Shouldice Hospital is a total

How do you count for its performance ?

The Shouldice Method Specializes in external hernias only. Is a 45 minute procedure for first time repairs, And a 90 minute procedure for recurrences of hernias previously repaired elsewhere. Involves separation of muscle layers and six rows of sutures in an overlapping fashion resulting in a reinforced muscular wall. Typically, only requires use of a sleeping pill, a pain killer, and a local anesthetic allowing for immediate post-op ambulation & rapid recovery.

The Patient Experience Appointments are driven by patient referrals. Patients are encouraged to self-diagnose to avoid a visit. The experience requires only one or two visits. A typical length of stay is about 3 days. All rooms are semiprivate, and patients are grouped with someone of like interest. Patients nearing discharge help orient new patients arriving. Surgery occurs on day 2. Patients walk from the operating table to the post-op room (with some help from surgeons), For psychological and physiological reasons And are encouraged to exercise regularly, explore the premises and make new friends. Patients were so fond of their experience that they sometimes asked if they could stay an extra day. The most common after-effect in summer is sunburn!

The Nurse Experience Shouldice employs 34 full-time equivalent (FTE) nurses on staff. The ratio of nurses to patients is 1:15, compared to 1:4 in Canadian acute-care hospitals.

Nurses spend an unusually large amount of time providing counseling services to patients. Due to low nurse turnover, there is a waiting list of nurses wanting to work at Shouldice. Competition is constantly short-staffed.

The Doctor Experience 10 full time surgeons, 8 part-time assistants, 2 anesthetists on site, 30-36 operations per day. Each surgeon performs 3-4 surgeries per day. Salary is $144k + bonus (15% over competition). Surgeons typically work 7:30 4:00 M-F. On call 1 weekday night in 10, 1 weekend in 10 Better quality of life than most surgeon schedules Consequently, turnover is low.

The Facility The facility is designed so patients have to walk in order to do things they need or want to do. Rooms are not equipped with phone or TV. Patients must travel to make a phone call, watch TV, socialize, eat, etc. Small rise stairways make it easier on patients who have just completed surgery. Carpeting makes it feel warm and comfortable. Patients and staff eat together in the cafeteria. Food all fresh ingredients and prepared from scratch.

The Administration No one is fired! Turnover is low. Staff is non-union.

Pay scale is higher than the competition. Profit sharing plans are in place for doctors and staff. Cross-training & teamwork are strong. Managing director stays late one night per week to interact with patients and staff.

The Market 1 million hernia operations in the US in 2000. Most commonly performed on males. Shouldice has a backlog of 2400 & growing. Relies entirely on word-of-mouth advertising. Rates are reasonable. Annual checkups are provided for alumni free of charge. Annual reunion of patients draws about 1000.

What actions to take to expand the hospitals capacity ?

Consider becoming a teaching hospital to provide a new revenue stream and spread the Shouldice technique around the world. Consider performing surgeries on weekends. Provide training for leadership & staff, to overcome the concerns about compromised quality & control of operations with expansion. Develop resilience skills of all staff and leadership skills for administration. Hire new staff with the understanding of the new operating hours.

It

is

highly recommended

to adopt

Saturday

working

option

with

some

minor modifications. The existing procedure needs to be synchronized with the various activities and to be well planned.

How would you implement the changes you propose ? Admission of patients to be made on Sundays with the available administrative staff. During the peak period of operations, use the 14 hostel rooms available in the third floor for accommodating the patients. Incentives to doctors, nurses and other staff for the Saturday working days to be paid twice that of normal days. Successor for Dr. Obney from the existing experienced doctors to be done within six months. A general meeting is going to be scheduled to discuss the expansion. Feedback and suggestions would be gathered from the overall staff. Employees would be allowd to work flexibly.