Shouldice Hospital Case Summary
➢ Company Overview:
Shouldice Hospital is a privately owned surgical hospital which specializes in external abdominal wall hernia repair with holistic recovery services. The Shouldice facility located near Toronto, Canada, was founded by Dr. Earle Shouldice in 1945 and is the world’s leading center of excellence in abdominal hernia repair. Shouldice Hospital employs nearly 160 employees with an average tenure of 10 years. Shouldice Hospital, with an 80% referral rate, conducts more than 7,000 hernia surgical repairs annually with a 99.5% lifetime success rate. According to the company website, the 89 bed hospital “offers its patients a complete and holistic recovery program that promotes health and a rapid return to normal activities” (Shouldice, …show more content…
2014).
The following is a compilation of Group 4’s team collaboration of key operations management concepts identified within the Shouldice Hospital Case Study along with our alternative recommendations for improvement.
Concept #1 Defining Services: Include page numbers where the concepts may be found, a brief description of major issues needing attention or things that the firm could do to improve and a brief description of possible solutions to each situation needing attention or improvement, based on concepts covered in the course and outside research.
➢ Concept # 2: New Service Development:
Quality service is imperative when working with the public. Quality service, especially in a hospital, is equally important. William J. Stevenson defines service as, “something that is done to or for a customer” (Stevenson, 2012, p.160). Patients that are going to the hospital for treatment, such as surgery, desire to receive quality service. That may ease the nerves of patients that have never gone under before. The Shouldice Hospital is a well-known hospital in Canada that performs hernia surgery with excellence. With providing quality services, the hospital has a service delivery system. Stevenson defines it as “the facilities, processes, and skills needed to provide a service” (Stevenson, 2012, p.160).
James Heskett describes the patient experience in the study. There are routine processes that each patient must go through before the procedure. Patients were to complete a questionnaire that was given to them prior to their arrival. Once he or she arrives at the hospital, a brief examination is done by one of the surgeons, health insurance is checked by personnel, and nurses check the patient’s blood and urine. “At this point, about an hour after arriving at the hospital, a patient was directed to the room number shown on his or her wristband. Throughout the process, patients were asked to keep their luggage (usually light and containing only a few items suggested by the hospital) with them” (Heskett, 2003, p.4). Afterwards, an orientation was given to let the patients know what to expect, and what needed to be done after the surgery. Heskett then goes into detail about moments prior to the surgery, and moments after. “Upon the completion of the operation, during which a few patients were ‘chatty’ and fully aware of what was going on, patients were invited to get off the operating table and walk to the post-operating room with the help of their surgeons” (Heskett, 2003, p.4). The surgeons created a great personal experience with their patients by interacting with them. The nurses encourage the patients to walk around, get a little exercise, and make friends. The whole experience that the patients have is so positive that some do not want to leave. Heskett provided in great detail the service delivery system. He goes into depth the processes in the facility, and the skills that were utilized to create a great patient experience.
To provide great service and to ensure incredible patient experience, “always, always, make sure patients are treated with courtesy and respect. Treating patients has become simply a job for many healthcare professionals. They manifest boredom with their jobs by treating patients indifferently. That 's not professional and it 's bad business (Lauer, 2010). The quality of service that the staff at the Shouldice Hospital demonstrates towards their patients is impeccable. That staff makes sure that the patients feel like they are at home away from home. The environment that has been created there creates a positive atmosphere not only for the patients, but even the staff. “Always make sure your explanations are not clouded with excessive and complicated verbiage. Be brief and to the point. True professionals go out of their way to explain things in simple, declarative sentences” (Lauer, 2010). Patients that are going into surgery may be extremely nervous. When communicating with a patient, it is important to let them know everything that will take place, and what is expected. In the Shouldice case, that is exactly what the nurses did. “ At 5:00 P.M. a nurse’s orientation provided the group of incoming patients with information about what to expect, the drugs to be administered, and the need for exercise after the operation, the facility, and the daily routine” (Heskett, 2010). The patients know exactly what to expect, and what is expected of them. The professionalism in the hospital is exceptional, and that type of service should be given to every patient in hospitals.
➢ Concept #3: Service Facilities - Decision-Making
Product and service choices, process selection and layout of facilities are among the most basic decisions operations managers make (Stevenson, 2012 p. 235). Shouldice Hospital Limited is a good example of a service facility faced with making tough decisions on seeking new and better ways of operating to sustain a competitive advantage amongst their competitors.
The Shouldice Hospital case study identified five major quandaries that require the Shouldice board member’s decisive decision-making: 1) how best to increase the hospital’s capacity while at the same time maintaining control over the quality of the service delivered, 2) how will the future role of government impact Shouldice Hospital, 3) how to respond to the external threat of potential competitors using the Shouldice name, 4) how best to market Shouldice services, how best to upgrade hospital technology and 5) how best to select the next chief surgeon for Shouldice Hospital” (Heskett, 2003 p. 11). In health care the array of treatment options, hospital administration and medical costs makes tools such as decision trees particularly valuable in diagnosing and prescribing treatment plans. A decision tree is a schematic representation of the alternatives available to a decision maker and their possible consequences (Stevenson, 2012 p. 217). Generally speaking important decisions take a long time to make. In its simplest form, experts suggest to think of the decision-making process like a funnel. When you start the process, fill it with all of your options as the funnel narrows down the options only one comes out the other end, the choice you will act on in the next link (Hajek, 2009 p. 133).
Implementation of a flexible lean process system which is based on a philosophy and methodology that focuses on eliminating waste and streamlining operations by closely coordinating all activates (Stevenson, 2012 p. 619), is a recommended alternative strategy to aid the Shouldice Hospital in their decision-making and improvement of areas that would have the greatest impact on increasing the hospital’s capacity while at the same time maintaining control over the quality of the service delivered. “Lean operation systems tend to achieve greater productivity, lower costs, shorter cycle/ wait times, and higher quality than non-lean systems/competitors” (Stevenson, 2012 p. 619). The elimination of paper waste could assist the Shouldice Hospital in “going green” which would align with the hospital’s holistic and earth friendly facility layout/environment/culture. Shouldice patients currently manually complete intake paper forms/questionnaires/card prior to scheduled operations, converting to an online or tablet patient intake process would lower costs, reduce errors, decrease wait times, and improve the overall patient intake process and experience. Eliminating barriers to delivering cost effective services is just one of many benefits Shouldice Hospital can receive when implementing a Lean operation system/process.
➢ Concept #4: Process Improvement
Shouldice Hospital Limited showed many examples of using the concept process improvement. Process improvement is a systematic approach to improving a process (Stevenson, 2012 p. 398). Process improvement involves documentation, measurement, and analysis for the purpose of improving the functioning of a process. There are several major goals of process improvements. These goals include increasing customer satisfaction, achieving higher quality, reducing waste, reducing cost, increasing productivity, and reducing processing time. One of the biggest problems confronting the hospital is Dr. Shouldice’s desire to increase the capacity of the hospital while at the same time having control over the quality of services delivered, the future role of government in the operations of the hospital, the use of Shouldice name by potential competitors, and the choice of a new chief of surgery (Heskett, 2012 p 11). It is clear that Shouldice Hospital may have started from using some forms of process management. One of the ways that it is clear that Shouldice Hospital used process management is because it was well revered by its patients. Shouldice Hospital was recommended by over 1000 doctors and the hospital became known for its simplicity and was often considered a “bread and Butter” operation (Heskett 2003). When confronting the problems ahead for the organization process management is one way that Dr. Shouldice could use to work through the problems at hand. The three main components of process management are mapping the process, analyzing the process, and redesigning the process (Stevenson, 2012 p. 398).
The first step in problem solving with process management is mapping out the process. One of the ways that Dr. Shouldice has begun this process was by determining what the inputs and outputs are, the decisions that need to be made, and the people involved. One of the decisions that Dr. Shouldice chose to make was not allowing other doctors into the facility. Dr. Shouldice realized that they could refuse permission to other doctors who wanted to visit the hospital because they may copy the techniques and misapply it or misinform their patients about the use of it. One way that this process could be improved is by Dr. Shouldice creating a flow chard that accurately depicts the process. The second step in process management is analyzing the process.
When analyzing the process the first step is acting questions about the process. Some of the questions asked during this step are: is the flow logical?, Are any steps or activities missing?, and are there any duplications? (Stevenson, 2012 p. 398). When planning the increasing capacity of the current hospital or expanding the hospital Dr. Shouldice will want to include these questions in the planning. During the second part of analyzing the process Dr. Shouldice will want to ask several more questions. The questions asked should be; Could the time be shortened?, Could the cost to perform the step be reduced?, and could two or more steps be combined?. Dr. Shouldice used this process when determining how the hospital could increase its capacity. Dr. Shouldice said “We could go to Saturday operations and increase our capacity by 20% or, with an investment of perhaps $2 million and permission from the provincial government, we could add another floor of rooms to the hospital, expand our number of beds by 50%, and schedule the operating rooms more heavily” (Heskett, 2012 p. 11). This process outlined by Dr. Shouldice would translate very well to a flow chart to visually see the process in
planning. The last part of process improvement is the redesign the process. During this part of planning Dr. Shouldice needs to focus on using the results of the analysis in order to redesign the process. If Dr. Shouldice maps out the process and analyzes the process the hospital will be able to redesign is structure and increase its capacity and efficiency like it strives to.
➢ Concept #5: Continuous Improvement & Capacity Management
One concept Shouldice Hospital Limited kept in the forefront of their minds is continuous improvement. Continuous improvement is “the philosophy that seeks to improve all factors related to the process of converting inputs to outputs on an ongoing basis” (Stevenson, 2012, p.392). Numerous examples are seen throughout the study and including regular consultations with other surgeons during unusual procedures (Heskett, 2003, p. 6), assigning recurring cases to the original surgeon to learn from their mistakes (Heskett, 2003, p. 7), and questionaries’ for patients to fill out during reunions (Heskett, 2003, p. 17). All of these activities are designed to enhance the knowledge of all employees of the Hospital. Given the relative “newness” of the simple basic external abdominal hernia operation as Shouldice performed it, sharing knowledge to all surgeons was in all patients’ best interest. Dr. Shouldice continually strived to provide quality affordable care to his patients. Dr. David Precious (2011), an oral surgeon, stated about continuous improvement, “We should strive to create innovative improvement methodologies, share best practices, and inspire all health care workers to put the interests of the patients above all else” (p. 413). Dr. Shouldice agreed with this statement while explaining why he allowed other surgeons to tour his facility stating, “But we’re doctors, and it is our obligation to help other surgeons learn” (Heskett, 2003, p. 11). The primary focus of their continuous improvement strategy lay within the procedure itself. This helped the surgical staff perform the best procedure possible, but the same meticulous care was not necessarily brought to all other aspects of the hospital. When patients were brought in for the operations they were moved through stations, much like cattle in preparation. While this process was effective for the hospital, it did little for the patients nerves (Heskett, 2003, p. 4). Making this process more personal for the patient would have helped improve the overall experience for the patients. The next concepts Shouldice Hospital Limited should focus on go hand and hand; design capacity and effective capacity. Design capacity is “the maximum output rate or service capacity an operation, process, or facility is designed for” and effective capacity is “design capacity minus allowances such as personal time, and maintenance” (Stevenson, 2012, p. 186). Dr. Byrnes Shouldice created the plans for the new facility in Toronto “for years and made many changes in the plan before the first concrete was poured” (Heskett, 2003, p. 8) with design capacity in mind. This 17,000 square foot facility was a must, given the increasing volume of patients the hospital saw annually. Dr. Shouldice also kept the amount of staff he employed to a minimum to save on costs especially in the housekeeping and administrative departments. The hospital administrator, Alan O’Dell, describes a situation where all staff “pitched in to help each other” and he insisted “each secretary is trained to do another’s work” (Heskett, 2003, p. 9). He understood that by working together on multiple jobs that less staff would be required and therefore saving costs. “In any period where demand is less than capacity, the unused capacity at the end of that period cannot be carried over to the next period” (Elimam, Interaminense, & Ozluk, 2010, p. 316). While hiring more staff may make the hospital more effective during peak times, the overall loss during slower times would not make up for the additional cost of hiring more full time employees. Shouldice Hospital should consider hiring part-time of seasonal staff to help during busier times though. These added hands could help with simple secretarial duties or in housekeeping and therefore would require little training. This would help the hospital to run more smoothly and help the full time staff stay on top of their duties. In terms of effective capacity, O’Dell also stated, “We don’t have an organizational chart. A chart tends to make people think they’re boxed into jobs” (Heskett, 2003, p. 9). This way of thinking can lead to time where staff is struggling to figure out the next step in there day. This can lead to wasted time and also lead to tasks being over looked. Even if everyone is helping on most tasks setting up an organizational chart for duties can help prevent ineffectiveness within the hospitals administrative staff. Lastly, towards the end of the case study Dr. Shouldice focuses discussing increasing the capacity of his facility to allow for more surgeries due to the increased demand. In 1982 the Hospital performed 6,850 surgeries (Heskett, 2003, p. 2). This is average of 131 surgeries a week if the Hospital stayed open year round and an average 570 surgeries per full time surgeon. The hospital also carried a backlog in 1979 of an average of 1,200 surgeries (Heskett, 2003, p. 10). Based on the averages, it would have taken 10 weeks for the hospital to get caught up. The hospital would need to increase its capacity and create a capacity cushion in order to remain ahead of demand. A capacity cushion is “extra capacity used to offset demand uncertainty” (Stevenson, 2012, p. 190). The best strategy for this would be to expand the amount of beds offered in the hospital by a great deal. Dr. Shouldice states that by adding an addition floor the hospital can increase bed space by 50% (Heskett, 2003, p. 11). This in conjunction with performing surgeries on one Saturday a month for two months could help the hospital rid itself of its backlog and create a capacity cushion for their busier times of year.
References
Elimam, A., A., Interaminense, E., & Ozluk, O. (2010). Optimum service capacity and demand management with price incentives. European Journal of Operational Research (204)2, 316. Retrieved from http://www.sciencedirect.com.ezproxy.liberty.edu:2048/science/article/pii/S0377221709007498
Hajek, J. (2009). Whaddaya Mean I Gotta Be Lean? Mill Creek, WA: Velaction Continuous Improvement, LLC.
Heskett, J. (2003). Shouldice Hospital Limited. Boston MA: Harvard Business School Publishing
Lauer, C. (2010, December 20). 10 Strategies to Provide Patients with Superior Customer Service. Retrieved from: http://www.beckershospitalreview.com/hospital-management-administration/10-strategies-to-provide-patients-with-superior-customer-service.html
Precious, D. S. (2011). Continuous quality improvement. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (112)4, 413. Retrieved from http://www.sciencedirect.com.ezproxy.liberty.edu:2048/science/article/pii/S1079210411004288
Shouldice, (2014). Shouldice at a Glance. Retrieved on 2/25/14 from: http://www.shouldice.com/at-a-glance.htm
Stevenson, W.J. (2012). Operations Management (11th ed.). New York, New York: McGraw-Hill Companies.
Shouldice Hospital is a privately owned surgical hospital which specializes in external abdominal wall hernia repair with holistic recovery services. The Shouldice facility located near Toronto, Canada, was founded by Dr. Earle Shouldice in 1945 and is the world’s leading center of excellence in abdominal hernia repair. Shouldice Hospital employs nearly 160 employees with an average tenure of 10 years. Shouldice Hospital, with an 80% referral rate, conducts more than 7,000 hernia surgical repairs annually with a 99.5% lifetime success rate. According to the company website, the 89 bed hospital “offers its patients a complete and holistic recovery program that promotes health and a rapid return to normal activities” (Shouldice, …show more content…
2014).
The following is a compilation of Group 4’s team collaboration of key operations management concepts identified within the Shouldice Hospital Case Study along with our alternative recommendations for improvement.
Concept #1 Defining Services: Include page numbers where the concepts may be found, a brief description of major issues needing attention or things that the firm could do to improve and a brief description of possible solutions to each situation needing attention or improvement, based on concepts covered in the course and outside research.
➢ Concept # 2: New Service Development:
Quality service is imperative when working with the public. Quality service, especially in a hospital, is equally important. William J. Stevenson defines service as, “something that is done to or for a customer” (Stevenson, 2012, p.160). Patients that are going to the hospital for treatment, such as surgery, desire to receive quality service. That may ease the nerves of patients that have never gone under before. The Shouldice Hospital is a well-known hospital in Canada that performs hernia surgery with excellence. With providing quality services, the hospital has a service delivery system. Stevenson defines it as “the facilities, processes, and skills needed to provide a service” (Stevenson, 2012, p.160).
James Heskett describes the patient experience in the study. There are routine processes that each patient must go through before the procedure. Patients were to complete a questionnaire that was given to them prior to their arrival. Once he or she arrives at the hospital, a brief examination is done by one of the surgeons, health insurance is checked by personnel, and nurses check the patient’s blood and urine. “At this point, about an hour after arriving at the hospital, a patient was directed to the room number shown on his or her wristband. Throughout the process, patients were asked to keep their luggage (usually light and containing only a few items suggested by the hospital) with them” (Heskett, 2003, p.4). Afterwards, an orientation was given to let the patients know what to expect, and what needed to be done after the surgery. Heskett then goes into detail about moments prior to the surgery, and moments after. “Upon the completion of the operation, during which a few patients were ‘chatty’ and fully aware of what was going on, patients were invited to get off the operating table and walk to the post-operating room with the help of their surgeons” (Heskett, 2003, p.4). The surgeons created a great personal experience with their patients by interacting with them. The nurses encourage the patients to walk around, get a little exercise, and make friends. The whole experience that the patients have is so positive that some do not want to leave. Heskett provided in great detail the service delivery system. He goes into depth the processes in the facility, and the skills that were utilized to create a great patient experience.
To provide great service and to ensure incredible patient experience, “always, always, make sure patients are treated with courtesy and respect. Treating patients has become simply a job for many healthcare professionals. They manifest boredom with their jobs by treating patients indifferently. That 's not professional and it 's bad business (Lauer, 2010). The quality of service that the staff at the Shouldice Hospital demonstrates towards their patients is impeccable. That staff makes sure that the patients feel like they are at home away from home. The environment that has been created there creates a positive atmosphere not only for the patients, but even the staff. “Always make sure your explanations are not clouded with excessive and complicated verbiage. Be brief and to the point. True professionals go out of their way to explain things in simple, declarative sentences” (Lauer, 2010). Patients that are going into surgery may be extremely nervous. When communicating with a patient, it is important to let them know everything that will take place, and what is expected. In the Shouldice case, that is exactly what the nurses did. “ At 5:00 P.M. a nurse’s orientation provided the group of incoming patients with information about what to expect, the drugs to be administered, and the need for exercise after the operation, the facility, and the daily routine” (Heskett, 2010). The patients know exactly what to expect, and what is expected of them. The professionalism in the hospital is exceptional, and that type of service should be given to every patient in hospitals.
➢ Concept #3: Service Facilities - Decision-Making
Product and service choices, process selection and layout of facilities are among the most basic decisions operations managers make (Stevenson, 2012 p. 235). Shouldice Hospital Limited is a good example of a service facility faced with making tough decisions on seeking new and better ways of operating to sustain a competitive advantage amongst their competitors.
The Shouldice Hospital case study identified five major quandaries that require the Shouldice board member’s decisive decision-making: 1) how best to increase the hospital’s capacity while at the same time maintaining control over the quality of the service delivered, 2) how will the future role of government impact Shouldice Hospital, 3) how to respond to the external threat of potential competitors using the Shouldice name, 4) how best to market Shouldice services, how best to upgrade hospital technology and 5) how best to select the next chief surgeon for Shouldice Hospital” (Heskett, 2003 p. 11). In health care the array of treatment options, hospital administration and medical costs makes tools such as decision trees particularly valuable in diagnosing and prescribing treatment plans. A decision tree is a schematic representation of the alternatives available to a decision maker and their possible consequences (Stevenson, 2012 p. 217). Generally speaking important decisions take a long time to make. In its simplest form, experts suggest to think of the decision-making process like a funnel. When you start the process, fill it with all of your options as the funnel narrows down the options only one comes out the other end, the choice you will act on in the next link (Hajek, 2009 p. 133).
Implementation of a flexible lean process system which is based on a philosophy and methodology that focuses on eliminating waste and streamlining operations by closely coordinating all activates (Stevenson, 2012 p. 619), is a recommended alternative strategy to aid the Shouldice Hospital in their decision-making and improvement of areas that would have the greatest impact on increasing the hospital’s capacity while at the same time maintaining control over the quality of the service delivered. “Lean operation systems tend to achieve greater productivity, lower costs, shorter cycle/ wait times, and higher quality than non-lean systems/competitors” (Stevenson, 2012 p. 619). The elimination of paper waste could assist the Shouldice Hospital in “going green” which would align with the hospital’s holistic and earth friendly facility layout/environment/culture. Shouldice patients currently manually complete intake paper forms/questionnaires/card prior to scheduled operations, converting to an online or tablet patient intake process would lower costs, reduce errors, decrease wait times, and improve the overall patient intake process and experience. Eliminating barriers to delivering cost effective services is just one of many benefits Shouldice Hospital can receive when implementing a Lean operation system/process.
➢ Concept #4: Process Improvement
Shouldice Hospital Limited showed many examples of using the concept process improvement. Process improvement is a systematic approach to improving a process (Stevenson, 2012 p. 398). Process improvement involves documentation, measurement, and analysis for the purpose of improving the functioning of a process. There are several major goals of process improvements. These goals include increasing customer satisfaction, achieving higher quality, reducing waste, reducing cost, increasing productivity, and reducing processing time. One of the biggest problems confronting the hospital is Dr. Shouldice’s desire to increase the capacity of the hospital while at the same time having control over the quality of services delivered, the future role of government in the operations of the hospital, the use of Shouldice name by potential competitors, and the choice of a new chief of surgery (Heskett, 2012 p 11). It is clear that Shouldice Hospital may have started from using some forms of process management. One of the ways that it is clear that Shouldice Hospital used process management is because it was well revered by its patients. Shouldice Hospital was recommended by over 1000 doctors and the hospital became known for its simplicity and was often considered a “bread and Butter” operation (Heskett 2003). When confronting the problems ahead for the organization process management is one way that Dr. Shouldice could use to work through the problems at hand. The three main components of process management are mapping the process, analyzing the process, and redesigning the process (Stevenson, 2012 p. 398).
The first step in problem solving with process management is mapping out the process. One of the ways that Dr. Shouldice has begun this process was by determining what the inputs and outputs are, the decisions that need to be made, and the people involved. One of the decisions that Dr. Shouldice chose to make was not allowing other doctors into the facility. Dr. Shouldice realized that they could refuse permission to other doctors who wanted to visit the hospital because they may copy the techniques and misapply it or misinform their patients about the use of it. One way that this process could be improved is by Dr. Shouldice creating a flow chard that accurately depicts the process. The second step in process management is analyzing the process.
When analyzing the process the first step is acting questions about the process. Some of the questions asked during this step are: is the flow logical?, Are any steps or activities missing?, and are there any duplications? (Stevenson, 2012 p. 398). When planning the increasing capacity of the current hospital or expanding the hospital Dr. Shouldice will want to include these questions in the planning. During the second part of analyzing the process Dr. Shouldice will want to ask several more questions. The questions asked should be; Could the time be shortened?, Could the cost to perform the step be reduced?, and could two or more steps be combined?. Dr. Shouldice used this process when determining how the hospital could increase its capacity. Dr. Shouldice said “We could go to Saturday operations and increase our capacity by 20% or, with an investment of perhaps $2 million and permission from the provincial government, we could add another floor of rooms to the hospital, expand our number of beds by 50%, and schedule the operating rooms more heavily” (Heskett, 2012 p. 11). This process outlined by Dr. Shouldice would translate very well to a flow chart to visually see the process in
planning. The last part of process improvement is the redesign the process. During this part of planning Dr. Shouldice needs to focus on using the results of the analysis in order to redesign the process. If Dr. Shouldice maps out the process and analyzes the process the hospital will be able to redesign is structure and increase its capacity and efficiency like it strives to.
➢ Concept #5: Continuous Improvement & Capacity Management
One concept Shouldice Hospital Limited kept in the forefront of their minds is continuous improvement. Continuous improvement is “the philosophy that seeks to improve all factors related to the process of converting inputs to outputs on an ongoing basis” (Stevenson, 2012, p.392). Numerous examples are seen throughout the study and including regular consultations with other surgeons during unusual procedures (Heskett, 2003, p. 6), assigning recurring cases to the original surgeon to learn from their mistakes (Heskett, 2003, p. 7), and questionaries’ for patients to fill out during reunions (Heskett, 2003, p. 17). All of these activities are designed to enhance the knowledge of all employees of the Hospital. Given the relative “newness” of the simple basic external abdominal hernia operation as Shouldice performed it, sharing knowledge to all surgeons was in all patients’ best interest. Dr. Shouldice continually strived to provide quality affordable care to his patients. Dr. David Precious (2011), an oral surgeon, stated about continuous improvement, “We should strive to create innovative improvement methodologies, share best practices, and inspire all health care workers to put the interests of the patients above all else” (p. 413). Dr. Shouldice agreed with this statement while explaining why he allowed other surgeons to tour his facility stating, “But we’re doctors, and it is our obligation to help other surgeons learn” (Heskett, 2003, p. 11). The primary focus of their continuous improvement strategy lay within the procedure itself. This helped the surgical staff perform the best procedure possible, but the same meticulous care was not necessarily brought to all other aspects of the hospital. When patients were brought in for the operations they were moved through stations, much like cattle in preparation. While this process was effective for the hospital, it did little for the patients nerves (Heskett, 2003, p. 4). Making this process more personal for the patient would have helped improve the overall experience for the patients. The next concepts Shouldice Hospital Limited should focus on go hand and hand; design capacity and effective capacity. Design capacity is “the maximum output rate or service capacity an operation, process, or facility is designed for” and effective capacity is “design capacity minus allowances such as personal time, and maintenance” (Stevenson, 2012, p. 186). Dr. Byrnes Shouldice created the plans for the new facility in Toronto “for years and made many changes in the plan before the first concrete was poured” (Heskett, 2003, p. 8) with design capacity in mind. This 17,000 square foot facility was a must, given the increasing volume of patients the hospital saw annually. Dr. Shouldice also kept the amount of staff he employed to a minimum to save on costs especially in the housekeeping and administrative departments. The hospital administrator, Alan O’Dell, describes a situation where all staff “pitched in to help each other” and he insisted “each secretary is trained to do another’s work” (Heskett, 2003, p. 9). He understood that by working together on multiple jobs that less staff would be required and therefore saving costs. “In any period where demand is less than capacity, the unused capacity at the end of that period cannot be carried over to the next period” (Elimam, Interaminense, & Ozluk, 2010, p. 316). While hiring more staff may make the hospital more effective during peak times, the overall loss during slower times would not make up for the additional cost of hiring more full time employees. Shouldice Hospital should consider hiring part-time of seasonal staff to help during busier times though. These added hands could help with simple secretarial duties or in housekeeping and therefore would require little training. This would help the hospital to run more smoothly and help the full time staff stay on top of their duties. In terms of effective capacity, O’Dell also stated, “We don’t have an organizational chart. A chart tends to make people think they’re boxed into jobs” (Heskett, 2003, p. 9). This way of thinking can lead to time where staff is struggling to figure out the next step in there day. This can lead to wasted time and also lead to tasks being over looked. Even if everyone is helping on most tasks setting up an organizational chart for duties can help prevent ineffectiveness within the hospitals administrative staff. Lastly, towards the end of the case study Dr. Shouldice focuses discussing increasing the capacity of his facility to allow for more surgeries due to the increased demand. In 1982 the Hospital performed 6,850 surgeries (Heskett, 2003, p. 2). This is average of 131 surgeries a week if the Hospital stayed open year round and an average 570 surgeries per full time surgeon. The hospital also carried a backlog in 1979 of an average of 1,200 surgeries (Heskett, 2003, p. 10). Based on the averages, it would have taken 10 weeks for the hospital to get caught up. The hospital would need to increase its capacity and create a capacity cushion in order to remain ahead of demand. A capacity cushion is “extra capacity used to offset demand uncertainty” (Stevenson, 2012, p. 190). The best strategy for this would be to expand the amount of beds offered in the hospital by a great deal. Dr. Shouldice states that by adding an addition floor the hospital can increase bed space by 50% (Heskett, 2003, p. 11). This in conjunction with performing surgeries on one Saturday a month for two months could help the hospital rid itself of its backlog and create a capacity cushion for their busier times of year.
References
Elimam, A., A., Interaminense, E., & Ozluk, O. (2010). Optimum service capacity and demand management with price incentives. European Journal of Operational Research (204)2, 316. Retrieved from http://www.sciencedirect.com.ezproxy.liberty.edu:2048/science/article/pii/S0377221709007498
Hajek, J. (2009). Whaddaya Mean I Gotta Be Lean? Mill Creek, WA: Velaction Continuous Improvement, LLC.
Heskett, J. (2003). Shouldice Hospital Limited. Boston MA: Harvard Business School Publishing
Lauer, C. (2010, December 20). 10 Strategies to Provide Patients with Superior Customer Service. Retrieved from: http://www.beckershospitalreview.com/hospital-management-administration/10-strategies-to-provide-patients-with-superior-customer-service.html
Precious, D. S. (2011). Continuous quality improvement. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (112)4, 413. Retrieved from http://www.sciencedirect.com.ezproxy.liberty.edu:2048/science/article/pii/S1079210411004288
Shouldice, (2014). Shouldice at a Glance. Retrieved on 2/25/14 from: http://www.shouldice.com/at-a-glance.htm
Stevenson, W.J. (2012). Operations Management (11th ed.). New York, New York: McGraw-Hill Companies.