Shouldice Hospital Limited (ABRIDGED)

Transcription

1 Shouldice Hospital Limited (ABRIDGED) Shouldice was established in 1945 by Dr. Edward Earle Shouldice ( ), inventor of the Shouldice repair. Dr. Shouldice developed his innovative technique during World War II, to help young men who were unable to enlist in the military because of their hernias. His unique repair method improved surgical results and reduced recovery time, quickly restoring the young recruits to physical fitness for military training. As news of Dr. Shouldice s success spread, there was a growing demand for hernia surgery. But doctors and hospital space were scarce after the war and wait times for surgery were long. Dr. Shouldice responded to the problem by founding his own hospital. A world-class institution Today, two generations later, Shouldice Hospital has grown far beyond its early beginnings to become the world s leading centre of excellence for hernia repair. Dr. Shouldice s son, Dr. Byrnes Shouldice, and daughter, Mrs. W.H. Urquhart continued their father s legacy. Dr. Byrnes Shouldice followed in his father s footsteps as a surgeon at Shouldice in 1961 and is currently President and Chairman of the Board. Mrs. W.H. Urquhart has been involved in management as Vice President and director on the board since the hospital was founded, along with her husband, the late William Urquhart, President and Chairman of the board until his demise in With the support and guidance of the founder s son and daughter and their respective families, Shouldice has developed into a modern, 89-bed facility, with five specialized operating suites, an expert team of hernia surgeons and nurses, and a dedicated staff of about 150 people, all working to meet the needs of patients with hernias. Looking to the future Ideally suited to deliver exceptional results for hernia patients, Shouldice continues to reflect the progressive outlook and traditional values of its founder. A 99% success rate in hernia surgery has long been the benchmark for medical professionals internationally. Shouldice s reputation has been built on a holistic approach to patient care and its philosophy continues to emphasize the well-being of mind and body as the key to a healthy recovery. Over the years,

2 skilled and innovative surgeons have refined the Shouldice repair, ensuring that at Shouldice Hospital, surgical procedures meet the highest standards in medical care. For well over half a century, the Shouldice name has been synonymous with excellence in hernia repair and we are committed to maintaining that tradition of quality and service in the years ahead. What is a Hernia? Hernias are quite common, particularly in men. Anyone can develop a hernia at any age in fact, people are often surprised to learn that babies can actually be born with hernias. A hernia may develop when there is a weak spot or opening in the wall of muscle and connective tissue that supports your abdomen. Once you have a weakness in your abdominal wall, anything that increases the pressure in your abdomen may push fat or part of an organ through the opening. When the tissues or organs inside your abdomen bulge through a weakness in your abdominal wall, it is called a hernia. The Shouldice Hernia Repair The Shouldice repair is internationally recognized as one of the safest and most effective techniques for repairing hernias. When performed by a specially trained and well-experienced Shouldice surgeon, this pure, natural tissue repair virtually eliminates complications or repeat hernias (recurrences). For over 65 years, they have maintained a success rate of 99.5% on primary inguinal hernias an accomplishment that sets us apart from any other medical facility.

3 Pre-surgery Shouldice requires patients to be at an acceptable weight appropriate to their height. Prospective patients who are overweight must bring down their weight to a level appropriate for the surgery. Shouldice states that it improves outcomes and has a full-time dietician on staff to help patients achieve their weight goals with guidance and special diets. Patients enter the hospital the day before surgery and are given a briefing about the procedures to be followed the next day. The night before the operation is also intended as an opportunity for patients to come to know each other: Shouldice encourages patients to work together to promote recovery. Doctors from other institutes constitute a disproportionately higher percentage of patients (doctors from the US needing surgery disproportionately go to Shouldice). Surgery Shouldice operations normally take min. Local anesthesia is used in most surgeries, instead of general anesthesia, as the latter is unnecessary in most types of hernia surgeries, and the former is both safer and less expensive. General anesthesia is used when necessary in certain specially scheduled cases. The procedure most commonly used at Shouldice is a natural tissue, repair of the abdominal wall anatomy and uses no artificial, surgical mesh. Most surgeries at Shouldice involve reestablishing natural anatomic integrity by sewing muscle layers together in an overlapping fashion to repair the hernia defect. This specific technique is often referred to as the Shouldice operation or the Canadian operation Shouldice states that their complication rates (0.5%) are lower than rates achieved in general hospitals. Recovery Unlike many hospitals, Shouldice does not have a "fleet of wheelchairs and gurneys, armies of aides to push them, and banks of wide elevators. Instead, carpeted floors, low-rise stairs and beautiful grounds are available, encouraging activity. The Shouldice property comprises 23 acres (93,000 m 2 ), with a greenhouse, putting green, sunrooms, pool table and dining hall. The hospital focuses on patient care, without compromising on speedy recovery.

4 The landscaped grounds, pool table, and putting green are all intended to encourage patients to be mobile following surgery: to take walks in the grounds and to stretch and bend while playing pool or practicing. Similarly, there are no television sets or telephones in patients' rooms and beds have to be adjusted manually. A daily exercise program is also provided. Patient participation in their own recovery program is a corner stone of the Shouldice philosophy. Patients are scheduled to stay in the hospital for two days and three nights following surgery, although those who live locally and recover faster may leave earlier, if discharged by a surgeon after examination. In other hospitals the sort of low-risk patients that Shouldice operates on are sent home the same day without overnight hospitalization. All rooms are double occupancy, and regularly flow through patients. The patient rooms have "low capital investment" with no phone, television, and minimal medical equipment. Patients are essentially healthy people with a physical defect, which Shouldice cures. Therefore they are not treated as "sick" people but more as clean surgical patients who benefit from professional post-operative and specialized care. The double occupancy rooms also provide income to cover costs not covered by the ministry of health in the global hospital budget. These essential charges are not covered by public health insurance. Shouldice is not; however, an example of the upper tier of two-tier health care as no patient is turned away because of inability to pay.

5 Shouldice Advantage Distinctive Technique Comprehensive Patient Experience Thoughtful Employee Policies Experienced Staff What makes Shouldice different from other Hospitals? Shouldice offers an orientation programme before operation which few hospitals do because according to Alan O Dell, half are so nervous they do not remember much. In the orientation nurses emphasize the importance of attendance, exercise and about the expectation of the operation. They are offered with breakfast, lunch and dinner. During their stay, patients were encouraged to take advantage of the opportunity to explore the premises and make new friends. Some members of the staff felt that the patients and their attitudes were the most important element of the Shouldice programme. Sometimes patients ask for some extra day staying at hospital which is quite interesting that a patient wants to stay at hospital for some more days. Because they arrive here with a certain amount of nervousness, tension and anxiety about their surgery. But when they get to know the Shouldice environment they are happy to stay away of work with no sense of guilty. Nurses at shouldice spent unusually large proportion of time in the hospital. Shouldice even follow a different kind of teaching methods to its junior. They say, We teach each other and try to encourage a group effort and not to take risk to achieve absolute perfection. Excellence is the enemy of good. Training in the Shouldice

6 technique was important because the procedure could not be varied. Where possible, former Shouldice patients suffering recurrences were assigned to the doctor who performed the first operation to allow the doctor to learn from his mistakes. Even at the Shouldice you can see Patients are visiting other patient s rooms, lounging in the sunroom etc. One of the most unique policies Shouldice follows is parents who accompany children here for an operation stay free. Because they say, We learned that we save more in nursing costs than we spend for the parent s room and board. Patients and staff were served food prepared in the same kitchen provided an opportunity to chat with the kitchen staff. Administration follows a profit-sharing plan. They do not even follow an organizational chart because they think that they are boxed in jobs. No one fired! Turnover is low. The hospital also provided annual checkups to alumni, free of charge. Many occurred at the time of the patient reunion.

7 Shouldice Service Model 4 Day Lead Time If not OK Day 1 30/36 Arrivals 1 3 pm Check by MD (15 mins) If OK: Check-in & admin Blood Blood test test Explain process steps Dinner Dinner at 9 at 6 pm Day 2 Local anaesthesia (-20mins) Surgery (40 mins) Rest in room (2-3hrs) Start eating & moving Dinner at 6 pm Tea & cookies at 9 pm Day 3 Loosen stitches Walk, play, & eat with your buddies Dinner at 6 pm Tea & cookies at 9 pm Day 4: Remove stitches, walk, play, eat, check out

8 Problem analysis Shouldice Hospital has been dedicated to the repair of hernia for over 55 years with a greater than 99% success rate. Beside this they are charging a very reasonable rate approximately $2230 which is very low compared to $5240 elsewhere. Right now they are not engaged in any kind of advertising or promotional activities because of their excessive demand. This is due to the reliability of their core service and word of mouth that worked more than any other form of paid advertisement. The amount of credibility Shouldice has on the market forces them to expand their service. But due to the fear of losing its core competency, protest of the personnel and the market condition makes it difficult to expand its service. Fear about expansion Management was afraid to send out new broachers due to huge demand about their service. They though if they advertise they will not be able to give their 100 % to their core competency.on the other hand Management believed that they should improve their services rather than expansion. Scheduling Saturday as an Operating Day They require scheduling operations on Saturday which means six surgeons and a supervising surgeon have to work on Saturdays. This violates the implied contract that Shouldice has with its surgeons and strong opposition was made by the senior doctors. They also had a fear that if they expand their service it will increase its capacity by 20% in that case the service may not be like it was before. Misuse of Shouldice Name Due to this excessive demand their competitors can take the advantage using their name. In this way the hospital may lose its reputation in the market. One of their competitors came up with a print advertisement where it was indirectly stated that they are using the same method

9 as Shouldice hospital. It is very obvious that if something goes wrong with the operation the whole process will be blamed. Recommendation: From our research about cased name Shouldice Hospital Limited finally we come up with some suggestion thus Shouldice Hospital Limited can move to further advance. These are: Add another floor to the existing hospital facility: Though three floor of clinic contain admission, accounts, waiting room, examination room, clinic and hostel room, hospital need to add another floor, because it always crowed and as a hernia specialized hospital it need to keep clam and quite for patients. Operating on Saturday: Shouldice hospital limited faced difficulty on operation on Saturday. As a hospital it will be very helpful for patients, though four older doctors opposed it. But as occupations like doctor, they should more concern on provide service to patients. Not to Expand in US: It will be good for Shouldice hospital limited not to expand in United State. Because operation like Shouldice Hospital do in Canada is often common in majority hospital in USA. Another important issue is government regulation to establish Hospital in other country. If Shouldice expand their business in USA it can be risk for administration for running their hospital in USA. Patent the Shouldice method: Shouldice Hospital limited should patent their method, which is only external types of abdominal hernias should repaired in hospital. Internal types of hernias shouldn t be treated. Proper succession planning of doctors: Yet when it comes to succession and retirement planning for doctors, many lack plans to continue the business post-retirement. Although retirement, death, and disability may not be

10 pleasant topics, the reality cannot be ignored. Succession or pre-sale planning is in the best interest of a medical practice seller and his or her family. Shouldice hospital limited had also succession plan but it was not in proper way. They gave bonus to doctors as seniorities and vote basis by director, which is not proper way of succession for doctor. Bonus should be on performance basis. Better not to diversify from its core competency (Hernia): As we know Shouldice Hospital is Hernia specialized hospital, the authority try to expand their field in Eye surgery, varicose veins or hemorrhoids even in outside in Canada. But it will be better not to diversify from Hernia specialized for Shouldice Hospital Limited, for maintain core competency. Higher more nurses: At Shouldice Hospital there have forty nurses, including both part time and full time. It shows that Shouldice allowed lower nurse to patient ratio than other typical hospital for serving patient. From that point of view Shouldice hospital need to higher more nurses for look after patient.