Smkt Shouldice Hospital

8/4/2019 Smkt Shouldice Hospital

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Presented by:

Group No: 10

Kashish Goyal

Padia Archin Ramakant

Parminder Singh

Rohit Goyal

Saurabh Arora


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CASE BACKGROUND

Dr. Earle Shouldice was the

founder of the Shouldice Hospital

By 1940s he began to develop a

surgical technique for repairing

Hernias

He created new facilities by

buying a 130-acre estate with a

17000 square foot main house in

the Toronto suburb of Tornhill

Dr. Shouldice died in 1965


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ROLE OF MANAGING DIRECTOR

Alen ODell was the managing director

Addressing people needs

Maintaining the work culture Addressing employee issues

Imparting training to secretaries

Generating a culture of cross training withoutthe aid of organizational chart


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TEAM OF DOCTORS

10 Full time surgeons

8 part time assistant surgeons

2 Anesthetists Each operating team required a surgeon, an

assistant surgeon, a scrub nurse and a

circulating nurse Operating load was 30-36 operations per day


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TASKS PERFORMED BY DOCTORS

Patient Examination

Administering anesthetics

Assisting patients

Performing Operations

Post-operation counseling

Examining Patients

Consulting other surgeons

Chief surgeon assigned surgeons to various operatingrooms

Senior surgeons imparted training to new recruiteddoctors


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TEAM OF NURSES

34 full time- equivalent nurses staffedShouldice for 24 hour period

6 full time equivalent nurses were on premises

during non-operating hours Nurses to Patient ratio was 1:15

Low ratio from average ratio in acute-care

hospitals Spent large proportion of time in counselling

activities


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TASKS PERFORMED BY NURSES

Explaining the incoming patients about What

to expect , Need of exercise after the

operation and daily routine

Emphasizing the importance of attending the

dinner and recreation session

Encouraging patients for social interaction

Taking patients to the pre-operating room

Nurses administered analgestics


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ROLE OF OTHER STAFF

Administrative Roles

Housekeeping services

Preparation of food in the kitchen Staff members picked up food from a cafeteria

line placed in the center of the kitchen

providing opportunity for interaction


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Core Competency(Shouldice Method

and Program)

Removal of misconceptions about Herniaoperations

Program devised because of high RecurrenceRate

Surgeons at Shouldice Hospital performs 750operations as compared to 50 by other surgeons.


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High

Level of customer participation

Diagnosed by mail using Medical Information Questionnaire.

Risk and type of hernia decided on the basis of responses.

Weight loosing program prior to operation, if needed.


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Examination time dependent on level of anxiety mentioned inquestionnaire

Person was sent home after examination, if over weight orno hernia problem

Patients room was allocated on the basis of occupation,background and interests.

Interaction among patients who had their operations

earlier the same day at dinner time.

Exercises later on and change in daily routine after the operation.


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Exercise immediately after the operation

encouraged by nurses.

Patients attitude was most important to take

complete advantage of shouldice program.

Learned about hospital from previous shouldicepatients.


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Succession of Dr. Degani

Grooming has been started

Decision on Saturday operation as hes opposing it.

Improvement on certain successful procedures


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Competitors Advertisement(Pg. 673)

Alternatives available

Scope of Improvement in current portfolio

Core Competency being emulated by others


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Service Quality

Reliability Extensive research by Dr. Shouldice

Highly trained and experienced surgeons (600 Hernia operations)

Well aligned patient needs and service offered

Assurance

Complicationfree experience

High amount of time for counseling Crash cart at every floor in case of emergencies like

heart strokes.


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Empathy Use of local anesthetics, pre-operative sedatives to

minimize any discomfort

Sedatives for rapid recovery Nurses/doctors encourage to talk with other patients

Carpeting to reduce hospital feeling and fear of fall

Prelim-diagnosis by mails for out of town patients

Parents of children being operated can stay freeResponsiveness

Admission by appointment: scheduled service

Easier to estimate the service time

Orientation provided for incoming patients. Walk-in patients or local residents on waiting list to make

up cancelled reservation


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Tangibles

Acres of gardens to encourage exercise & rapid recovery

Minimize hospital feeling (carpeting & odorless

disinfectant etc)

Stairways are designed for patients to use after operations

No TVs and Telephones in rooms to encourage walking

Patients encouraged to explore premises


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G M d l


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Gap Model


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Gap 1

Nurse orientation to patients regarding need of exercise, routine etc

Large time on counseling

Operation procedure

Short waiting period

Discharge period

Opportunity to interact


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Gap 2

Well specified process time limits for every

activity

Scheduled dinner time, recreational & tea breaks

34 full time nurses

Well defined schedules of surgeons are followed


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Gap 3

Adherence to Shouldice technique

Average Nurses to Patients ratio is 1:15

Fresh food


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Gap 4

Word of mouth advertising

Reasonable rates( half of other hospitals)

Welcoming, supportive atmosphere(website)


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Gap 5

Patients sometimes ask to stay an extra day

Expectations shaped from word of mouth are

well met by the hospital services


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Managing capacity & demand

Admission by appointment: scheduled service

Screening patients: easier to estimate theservice time

walk-in patients or local residents on waitinglist to make up cancelled reservation

Medical Information questionnaire


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Capacity planning

Hernia operations are elective procedures, patients can bescheduled in batches to fill the operating time available

Capacity can be utilized to its maximum

The facility is intentionally designed to encourage exerciseand rapid recovery within four days, which isapproximately one-half the time at traditional hospitals.


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320 * 4 + 650 +300 = 2230

(Per Day Stay

charge*4 +Surgical Fee +

AnesthesiaFees)

Total capacity

that can beused

Operations =180/week

(36(No ofOperations)*5(NO. of Days))

Total capacity

that is beingused

Operations =148/week

89(No. of

Beds)*5(No. ofDays) /3(No of

a days apatient stays)

Yield

Calculations


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Actual Revenue = Actual Capacity *Price

Potential Revenue = Total Capacity *

Price

Yield = ActualRevenue /Potential

Revenue

Yield = 148*2230/180*2230 = 82.22 %


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Annual Alumni Reunion Leads to

Continuingrelationship

of thehospital with

its patient.

Keep alumniinformed

Gathercustomerfeedbacks

Loyalcustomer

base

Effectiveword-of-mouth


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Analysis of Reunion Data

More than 50% of patients came though referral or word of mouth fromfriend.

More than 78% of patients feel food service to be important

97% said operation procedure is important

65% said nurses care and guidance was very important

89% said the shouldice hardly seemed like a hospital

91% said that friendship and acquaintance with other patients was

important.


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Analysis of Reunion Data

Hospital should concentrate more on happy customers as majorcustomers come through referrals

Hospital should maintain its good quality food as it is valuedby patients

Nurse care and guidance is important so should be kept atsame level or could be increased

Friendship with other patients should be continued andencouraged


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Invitecompetition

CauseShouldice toloss market

share

Failingwhich Upset the

existingwork force

Lowerservicequality

-veImpact


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Can satisfymore

demand

MoreRevenue for

Company

IncreaseCapacity by

20%

No AdditionalInvestment

Support ofyoung

Doctors


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Difficult tomaintain same

working relations

Staff is notpleased

6 Surgeons & otherstaff have to work

on Saturday

Dr. Degani wontbe there to

control

Opposition bythe senior

doctors


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1 Need to hire new surgeons, nurses and staff

2 Improve its competitive position and increase its profits

3 Existing staff can be helpful in teaching and encouraging new ones

4. New Opportunities for existing personnel (like promotions)

5 Requires a significant investment and Quality Control

6 difficult to create the same culture and country club atmosphere


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Keeping staff happy by

profit sharing policy Less working load on

staffs

weekends off

Internal Marketing

(Employees)

enables people tospend time with theirfamily

Happy Employees Less Turnover

Employee satisfaction More People wants to

join

keeps customerHappy


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Product Surgery

Service Expertise of Doctors, dedication of staff, overall feel of place

Target Niche Market to low risk hernia operations

USP Good Quality Service at low price

Word of Mouth Publicity

Concept of Alumni Meet helps in spread the good word about service

There operating capacity is close to 100% so, they just need to focus onmaintaining the Quality of service

Date post:	07-Apr-2018
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Smkt Shouldice Hospital

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