1. Shouldice Hospital
Group Case Analysis – Spring 2012 Management of Business Processes & Operations Wednesday, March 21, 2012
Fallan Faulkner - Krystle Grogan - Mia Hughes - Jeanie Neumeyer - Amie Sistad - Paul Thompson

2. Surgery Monday – Friday
30-36 surgeries/day
10 Surgeons
34 Nurses
5 Operating Rooms
6 Exam Rooms
Surgery Monday – Friday
89 Beds
Current Situation

3. Current Process Flow Chart
Check-in on first afternoon
Surgery and first full day at Shouldice
day #2:
Rest & Recovery
day #4:
Checkout
day #3:
Rest & Recovery

4. Current Pre-Surgery / Pre-Patient

5. Current Arrival: First Afternoon

6. Current Surgery: Full Day #1

7. Current Process
Full Day #2
Full Day #3
Check-out

8. Key Factors for Success
Culture
Expertise
Unique Patient Experience

9. Key Issues/Problems Capacity # of Beds # of operating rooms
Gov’t Regulation
Efficiency
Pre-patient screenings
Demand
Growing wait list
Inviting competition
Scheduling
Standard surgeries
Complex surgeries

10. Reliability/ Durability
Performance
Features
Reliability/ Durability
Serviceability
Aesthetics
Perceived Quality
Quality

11. Quality Quality Costs Appraisal Costs
Medical Information Questionnaire
Patients turned away
Prevention Costs
Scheduling by Dr. Degani
Poka-yokes
Mandatory follow-up Pre-Operation Exam
Purchase and Implementation of Sophisticated Scheduling Software

12. Goals & Objectives Increase the number of surgeries by 20%
Decrease throughput time
Increase efficiency of screening process
Maintain current culture
Efficiency: (measured by the decrease in number of people turned away from surgery…the 10% turned away or no-show each day)
Culture: (measured by retention of employees and patient satisfaction)

13. Recommendations Screening Efficiency
Implement online submission of Medical Questionnaire
Verification of Dx and weight loss from PCP
Throughput Time
Decrease patient throughput time by eliminating one night’s stay
Scheduling
Standard hernia surgeries on Mon, Tues, Thurs, Fri (40 surgeries)
Complex/Recurrence surgeries on Wed (9 surgeries)
Screening: (confirm dx and ensure weight loss/no medical conditions)

14. Patient Intake and Surgeries Performed (as stated in the case)
Current Bed Capacity
Patient Intake and Surgeries Performed (as stated in the case)
Bed Capacity - Current
Inputs
Ops Per Day 33
# of Beds 89
Length of Stay/Nights 4
Saturday Surgery No
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday 23
Total Number in Hospital 66 56
Total Number of Surgeries
Total
122 surgeries

15. Improved Bed Capacity Bed Capacity Inputs Ops Per Day 40 # of Beds 89
Length of Stay/Nights 3
Saturday Surgery No
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday 9
Total Number in Hospital 80
Total Number of Surgeries
Total Surgeries
169
Increase
39%

16. CURRENT: Daily Operating Schedule
7:30 AM
7:45 AM
8:00 AM 1 2 3 4 5
8:15 AM
8:30 AM
8:45 AM
9:00 AM 6 7 8 9 10
9:15 AM
9:30 AM
9:45 AM
Coffee Break
10:00 AM
10:15 AM
10:30 AM 11 12 13 14 15
10:45 AM
11:00 AM
11:15 AM
11:30 AM 16 17 18 19 20
11:45 AM
12:00 PM
12:15 PM
12:30 PM
Lunch
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM 21 22 23 24 25
2:00 PM
2:15 PM
2:30 PM
2:45 PM 26 27 28 29 30
3:00 PM
3:15 PM
3:30 PM
3:45 PM 31 32 33 34 35
4:00 PM
CURRENT: Daily Operating Schedule

17. IMPROVED: Mon, Tues, Thurs, Fri Operating Schedule (standard hernia surgeries)

18. IMPROVED: Wednesday Operating Schedule (Recurrence/Complex hernia surgeries)

19. Improved Process Flow Chart
Arrival: first afternoon
Surgery: Full Day 1
Check out
Rest/Recovery: Full Day 2

20. Improved Pre-Surgery / Pre-Patient

21. Process Performance Metrics
Results / Outcomes
METRICS
Productivity
Linear Programming
Process Performance Metrics
Capacity Utilization
Forecasting

22. Conclusion Recommendations:
Decrease throughput time by eliminating one night’s stay
Increase number of surgeries by adjusting the surgery scheduling
Increase the efficiency of the screening process
Outcomes:
Increase number of surgeries per week by 39%
Maintain current culture & core competencies

23. Questions?

24. Works Cited:
1. Private Hospitals Act (1990, January 1). Retrieved Month 3, 2012, from
2. Eckhert, D. (2012, March 1). Shouldice Hospital Administrator. (K. Groga, Interviewer)
3. F. Robert Jacobs, R. B. (2011). Operations and Supply Chain Management (Vol. 13th). New York, New York: McGraw-Hill/Irwin.
4. Hallowell, J. H. (2005, January 21). Shouldice Hospital Limited (Abridged). Harvard Business School Case . Ontario, Ontario, Canada: Harvard Business Reveiw Publishing.
5. Hospital, S. (1996, January 1). Retrieved March 10, 2012, from
6. Inman, R. A. (2012, January 1). Reference for Business. Retrieved March 3, 2012, from Reference for Business Encyclopedia of Business, 2nd ed.:
7. Jones, D. W. (2011, September 29). Hernia Surgery Not Always Needed. Windsor Star, Body and Health; Doctor Game , p. C5.
8. Levy, A., Sobolev, B., Hayden, R., Kiely, M., FitzGerald, J., & Schechter, M. (2005). Time on wait lists for coronary bypass surgery in British Columbia, Canada, BMC Health Services Research, doi: /