Shouldice Hospital

In the Shouldice Hospital case, I have identified two primary constraints: 1) The number of beds available to patients and 2) The number of surgeons available to operate on the patients. Since the demand for this type of operation seems to exceed the number of operations Shouldice can perform, as an organization whose goal is to produce profits, the staff at Shouldice Hospital should subordinate all of their processes to ensure that their bottleneck resources are operating at their most effective capacity.

I am proposing two separate improvements that will allow Shouldice Hospital to increase their overall capacity without having to incur the additional costs of building an addition or even a new clinic and also allow them to keep control over their quality of performance. The first improvement to their processes would be to make sure the surgeons spend as much time as possible on the actual operations on the patients and as little time as possible on the other activities on which they currently spend time.

The second improvement would be to make changes to the inflows of patients which could free up additional bed-space without having to add beds. Case Analysis The problem that Shouldice Hospital has is that it does not have enough capacity to meet the demand for their services. While this may seem like a good problem to have, every time they have to turn away a patient due to lack of space, they are losing out on the revenues that patient would be bringing. There are a few options Shouldice Hospital can consider to expand their current capacity; the first option would be to build additional facilities to house the additional patients.

They could either add-on to their existing facilities in Canada or build a new clinic internationally, most likely in the United States. The first option is troublesome due to the regulatory laws in Canada regarding healthcare, and the second option is controversial as a certain amount of control over operations would have to be ceded from the top management to the remote facility. The third option, which I propose, would be to examine their current activities and see if they aren’t wasting additional capacity which they could regain through improved processes.

The surgeons at Shouldice Hospital are one of the biggest bottlenecks, or system constraints, preventing the clinic from taking on additional patients. The problem I see is that surgeons only spend about half of their day actually performing the surgeries, which is the one activity that only they can handle. If we freed up as much of their time from other, more mundane, activities that could be delegated to other employees, the surgeons could use their additional time to take on more patients and add to the throughput for the clinic.

One way to do this is to pass off the duties of the pre-surgery examinations to other personnel. All patients are examined by the surgeons the day before their surgery. If they were examined by nurse practitioner’s or physicians assistants, (personnel who aren’t qualified or licensed to perform surgery but can handle all other tasks doctors perform), the surgeon’s will have much more time to operate than they currently do. Also, I think it is essential that when a surgeon enters the operating room, his or her time is treated as gold.

That is to say that the surgeon is not waiting in the operating room for the nurses to finish preparing the patients or for anesthetists to finish their duties. If the patient was completely ready to be operated on when the doctor entered, the time per operation would decrease, thus increasing the overall capacity of the hospital. The second large constraint at Shouldice Hospital is the limited availability of patient’s beds.

Even if there were an unlimited number of surgeons available to operate on the patients, if there was not enough space to house the patients after the surgery, the number of operations would be limited. The key term here is that patients need to have somewhere to recuperate after the surgery, but they do not need to be occupying valuable space the night before. My proposal would be to lease space at a local hotel (which they could probably get a discounted rate, especially during the non-peak travel months) and put the pre-operations patients up at the hotel.

This would free up more space at the clinic for recovering patients and allow the clinic to operate on more patients. There is one major problem I see with subordinating all activities to the bottleneck resources at Shouldice Hospital. It would be difficult to maintain quality control while subordinating everything in the hospital to getting additional throughput. In a healthcare setting, it only takes one mistake for an entire institution to tarnish its reputation forever. Then the problem will not be gaining extra capacity, but trying to increase the demand.

The Shouldice center employs its own technique, called the Shouldice method for repair of hernias. Only external types of hernias are treated. Approximately 82% of surgeries are primaries, requiring 45 minutes. The rest 18% involve recurrence of hernias repaired elsewhere. …

1. ) How well is the hospital currently utilizing its beds? The hospital stay cycles have been provided: | Mon Beds| Tue Beds| Wed Beds| Thu Beds| Fri Beds| Sat Beds| Sun Beds| Available Beds| 90| 90| 90| 90| 90| …

1. ) How well is the hospital currently utilizing its bed? 90 beds x 7 days/ week = 630 beds available in a week 30 patients x 3 days x 5 days per week = 450 beds utilized 450 beds …

1. How successful is the Shouldice Hospital? Generate a P&L statement using available information from the case. Treat each of the two operations—hospital and the surgery—separately. Hospital: Revenues (4 days X $111/day x 6,850 patients/year)3,041,400 Cost2,800,000 Profit: 241,400 Clinic: Revenues …

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