• Shouldice has expanded their room capacity to 89 beds with 5 specialized operating rooms and a staff of about 150 people (nurses, doctors, administrative) that collaborate together to provide a higher quality health care service to the patient.
• The innovative method used for sedating a patient with a sleeping pill has enabled patients to recover faster and minimizes the patient’s risk of having any complications. Therefore, the patients have received positive results and feedback from the surgery, where it has been shown that the surgeons had a 99% success rate, which is the highest record in the world and this has been used as a benchmark for other hospitals in Canada and other countries.
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In contrast to other hospitals, Shouldice encouraged its patients to walk from the operation table instead of using wheelchair. This method will prove themselves that they are in perfect health conditions, capable of doing exercises and having the opportunity to make friends. With this system, Shouldice Hospital transformed the hernia surgery from a nervous and tension experience to a memorable moment.
• Their commitment to meet the highest standards in the health care industry and providing a more efficient service to the customer has attracted many patients from oversees, especially from the United States because of the high quality service provided at a low cost.
• For the past 55 years, Shouldice Hospital was been a recognized hospital nationwide (Canada) and other countries because of the patients’ memorable experience. A study showed that “49% of the new patients were referred by former patients and 34% by healthcare professionals”.
1) How do you account for its performance?
Shouldice Hospital’s potential growth and success in the health care industry was due to the following strategies that Dr. Shouldice implemented for treating patients more effectively.
• High responsiveness: The Shouldice method based on an anesthetic used for sedating the patients prior to the surgery helped them recover faster and discharge earlier from the hospital, which made this treatment superior to other hospitals in the region because it required only 4 days compared to other hospitals that required 7 or more days. A strategy that the hospital used was to only focus on treating external hernias which required less time to operate (45 minutes) than other hernias. Since these procedures were short, doctors had more time available to attend other patients and this increased the hospital’s capacity. According to the cases study “the surgeons may perform 750 or more operations per year”. Since the anesthetic used for sedating the patient prior to the operation allowed the patient to recover faster and discharged immediately (higher response to the treatment), this reduced the amount of days that the patients needed to be hospitalized at Shouldice.
• Expansion of facilities: Dr. Shouldice built very “unique and innovative” facilities to increase the hospital’s capacity for treating patients with hernia. According to the hospital’s website, “Shouldice started off with just one operating room”. His surgery was so successful that it attracted more patients, especially from overseas (United Stated) to receive this treatment, which pushed him to expand it by adding more buildings and staff.
• Differentiate services provided: Dr. Shouldice enhanced the patient’s experience at the hospital by creating a comfortable environment that no other hospital provided, where patients were able to exercise and socialize with the nurses. Also, parents who were accompanying their children during the surgery were able to stay free at the hospital, which guaranteed a fast recovery.
• Cross-functional organization: Shouldice Hospital was a cross functional organization where staff members helped each other and shared responsibilities. They were not remunerated based on their effort but instead the profits were divided equally among the supportive staff. This ensured that each staff member provided equal quality of services to the patient.
• Low Price Treatment: Based on the case study “Patients were attracted to the hospital, in part, by its reasonable rates”.
At Shouldice Hospital, the cost of staying at the hospital was $320 per day while other hospitals charged $5,240 for treating hernia. Therefore Shouldice had an advantage over other hospital because they provided a low cost treatment that not only affordable to wealth patients, but to also low and middle income patients.
Shouldice Treatment Cost Other Hospitals Cost
$1280 ($320 x 4days ) $5240
• Service level: Shouldice Hospital had an operating team of 34 nurses and 10 full time surgeons who were trained and rotated frequently which guaranteed them to perform better and maintain the quality of service provided.
2) As Dr.Shouldice, what actions, if any, would you take to expand the hospital’s capacity?
• In order to increase the hospital’s capacity in Toronto, we propose to expand the facilities by increasing the number of rooms needed to perform the surgery and for the patients to stay overnight, as well as hiring more nurses and surgeons to meet this
demand.
• Shouldice Hospital could branch off and build more facilities overseas, such as in the United States where according to the case study “An estimated 1,000,000 operations were performed in the United States alone”. This will attract more patients, since there is high demand for this treatment in the United States and it will be more convenient for them because the facilities will be closer to them, which will reduce the travel expenses to Canada.
• Perform operations on Saturdays. Based on the case study, managers consider that the hospital can increase its capacity by 20% if they performed surgeries on Saturday. Although many doctors opposed to this idea, these could be encourage to work on weekends if they were compensated for the extra hours they worked. This will not only benefit the doctors but also the patients who are only available during the weekend.
3) How would you implement changes you propose?
There are many ways that the Shouldice Hospital management can implement changes to improve the quality of health care services delivered.
Problem Solution
The hospital delivers the questionnaire to the patients by mail The hospital should implement an electronic system for delivering the questionnaire to patients. This will ease the process of inserting each person’s information in the database.
It was detected that after a typical wait of about 20 minutes it was discovered that a patient had not corrected his or her weight problem. We suggest a joint program with the Shouldice Clinic that has nutritionists who can work along with the patients to reduce weight and help monitor their conditions prior to the treatment. Doctors can then have access to these results and determine if the patient is ready for the surgery. This would help reduce the waiting time of 15-20 minutes.
Shouldice Hospital collects few systematic data on the patients. We suggest that the hospital should collect more statistical data to have a better knowledge of:
• Status of the patient: high, middle or low income
• How many people in Toronto and overseas suffer from hernia
• Number of patients they receive per year.
Based on this information, managers can predict how many patients to expect in the future and make better decisions on how to expand the hospital.
Shouldice Hospital brochure does not provide some relevant information such as the benefits of the “Shouldice Method” for hernia. Improve the marketing of the Shouldice Hospital by adding more information on the treatment, special services and programs they offer to help patients lose weight before the treatment.
Shouldice Hospital only operates on external hernias. Expand variety of specialties to attract more patients. This may include operations like eye surgery, heart surgery and treating patients with varicose veins and other ailments that are commonly diagnosed in the region.
References
Shouldice Hospital. Retrieved from www.shouldice.com. Consulted on June 28th, 2012
Heskett, J. (2005). Shouldice Hospital Limited. Harvard Business Review , 14.