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3. Do you think Shouldice Hospital should expand off-site? If so, where and why? Shouldice Hospital presents several options at the ending of the case which all have pros and cons for expansion concepts. Expanding the current location presents many possible issues which include government interference if the physical size of the building is altered and a lack of staff support if the decision is made to operate on Saturdays. With these alternatives, the hospital would have to be concerned with whether the current staff would be able to handle the capacity of patients above the present workload that is divided among the surgeons, nurses, cleaning staff, and administration. The current executive team is also concerned about how the working environment would change with an internal expansion plan. It is for these reasons that expanding off-site to a new location seems to be the most plausible step toward successful expansion for the Shouldice hospital. Possibly expanding to a location in the United States would allow the current location to continue to operate at its current capacity with little to no interruption, continuously processing patients through registration, orientation, preparation, anesthetics, operation, and post operation. These same tactics would need to be applied to the new location preserving the reputation and atmosphere of the Toronto location expanding the reach of the Shouldice Method. External expansion to the Unites States presents new patient opportunities for the hospital. It would open its services to those individuals who have been interested in seeking the specialization of Shouldice but have been reluctant or unable to travel to the Toronto facility for whatever reason. The same training and scheduling techniques would be applied within this new location to ensure that the new location was able to maintain the aspects of the Shouldice philosophy that have brought about the current success. The Unites States would make an ideal location as

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