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

30-36
surgeries/day

89 Beds

10 Surgeons

Current Situation
Surgery
Monday
Friday

34 Nurses

6 Exam
Rooms

5 Operating
Rooms

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

Current Pre-Surgery / Pre-Patient

Current Arrival: First Afternoon

Current Surgery: Full Day #1

Current Process
Full Day #2

Full Day #3

Check-out

Key Factors for Success

Culture

Expertise

Unique Patient Experience

Key Issues/Problems
# of Beds
# of operating
rooms
Govt Regulation

Standard
surgeries
Complex
surgeries

Pre-patient
screenings

Capacity

Efficiency

Scheduling

Demand
Growing wait list
Inviting
competition

Performance

Perceived
Quality

Features

Quality
Reliability/
Durability

Aesthetics

Serviceability

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

Goals & Objectives

Increase
the number
of surgeries
by 20%

Decrease
throughput
time

Increase
efficiency of
screening
process

Maintain
current
culture

Recommendations
Screening
Efficiency

Implement online
submission of Medical
Questionnaire
Verification of Dx and
weight loss from PCP

Throughput
Time

Scheduling

Decrease patient
throughput time by
eliminating one nights
stay

Standard hernia
surgeries on Mon, Tues,
Thurs, Fri (40 surgeries)
Complex/Recurrence
surgeries on Wed (9
surgeries)

Current Bed Capacity

Patient Intake and Surgeries Performed (as stated in the case)
Bed Capacity Current

Ops Per Day

# of Beds
Length of Stay/Nights
Saturday Surgery

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Total Number in
Hospital

Inputs
33
89
4
No
Sunday
33

Monday
33
33

33

Tuesday Wednesday Thursday

33
33
33
33
33
23
23
23
0
0
33

Friday

Saturday

23
0
33

0
33

33

66

66

89

89

89

56

Total Number of Surgeries

33

33

23

33

Total

122
surgeries

Improved Bed Capacity

Bed Capacity

Inputs

Ops Per Day

40

# of Beds

89

Length of Stay/Nights
Saturday Surgery
Sunday

3
No
Sunday

Monday

Tuesday

40

40

40

40

40

40

40

40

40

40

40

40

40

Monday
Tuesday
Wednesday

Wednesday

Thursday

Thursday

Friday

Saturday

Friday
Saturday
Total Number in Hospital
Total Number of
Surgeries

40

80

89

89

89

80

40

40

40

40
Total
Surgeries

169

Increase

39%

7:30 AM

7:45 AM

7:45 AM

8:00 AM

8:00 AM

8:15 AM

8:15 AM

8:30 AM

8:30 AM

8:45 AM

8:45 AM

9:00 AM

9:00 AM

9:15 AM

9:15 AM

9:30 AM

9:30 AM

9:45 AM

9:45 AM

10:00 AM

10:00 AM

10:15 AM

10:15 AM

10:30 AM

10:30 AM

10:45 AM

10:45 AM

11:00 AM

11:00 AM

11:15 AM

11:15 AM

11:30 AM

11:30 AM

11:45 AM

11:45 AM

12:00 PM

12:00 PM

12:15 PM

12:15 PM

12:30 PM

12:30 PM

12:45 PM

12:45 PM

1:00 PM

1:00 PM

1:15 PM

1:15 PM

1:30 PM

1:30 PM

1:45 PM

1:45 PM

2:00 PM

2:00 PM

2:15 PM

2:15 PM

2:30 PM

2:30 PM

2:45 PM

2:45 PM

3:00 PM

3:00 PM

3:15 PM

3:15 PM

3:30 PM

3:30 PM

3:45 PM

3:45 PM

4:00 PM

10

14

15

Coffee Break

11

16

12

17

13

18

19

20

Lunch

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

CURRENT:
Daily
Operating
Schedule

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

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

Improved Process Flow Chart

Arrival:
first
afternoon

Surgery:
Full Day 1

Check out
Rest/Rec
overy:
Full Day 2

Improved Pre-Surgery / Pre-Patient

Results / Outcomes
Process
Performance
Metrics

Linear
Programming

Productivity

Capacity
Utilization

METRICS

Forecasting

 Decrease throughput
time by eliminating
one nights stay
Increase number of
surgeries by adjusting
the surgery scheduling
Increase the efficiency
of the screening
process

Outcomes:

Recommendations:

Conclusion

Increase number of
surgeries per week by
39%
Maintain current
culture & core
competencies

Works Cited:

1. Private Hospitals Act (1990, January 1). http://www.canlil.org/en/on/laws/stat/rso-1990-cp24/latest/rso-1990-c-p24.html. Retrieved Month 3, 2012, from www.canlil.org:
http://www.canlil.org/en/on/laws/stat/rso-1990-c-p24/latest/rso-1990-c-p24.html
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 www.Shouldice.com:
www.shouldice.com
6. Inman, R. A. (2012, January 1). Reference for Business. Retrieved March 3, 2012, from Reference
for Business Encyclopedia of Business, 2nd ed.:
http://www.referenceforbusiness.com/management/A-Bud/Aggregate-Planning.html#b
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, 1991-2000. BMC Health Services
Research, 522-10. doi:10.1186/1472-6963-5-22