Shouldice Case questions

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Out staff of freelance writers includes over 120 experts proficient in Shouldice Case questions, therefore you can rest assured that your assignment will be handled by only top rated specialists. Order your Shouldice Case questions paper at affordable prices with cheap essay writing service! 1. Draw a process map of how a typical patient is processed at Shouldice, including

if applicable) how much time each step takes, and its cost.

Shouldice Method Process Map (See Attached)

Help with essay on Shouldice Case questions

. Using the information in the case, compute the total cost to Shouldice to treat an

average patient, and compare it to the total cost at a typical hospital. Be sure to

include costs for time lost to employers, and for the risk of recurrence.

Total Cost of an Average Shouldice Patient

Hospital Stay…………………………………………...$ 444.00

$111/day

4 days

Surgical Fee…………………………………………… $ 450.00

(Assume General Anesthetic Not Required)

Assistant Surgeon Fee…………………………………. $ 60.00

Time Loss……………………………………………… $ 400.00

(Assume average wage $ 80.00/day 18)

(Assume average length of unpaid recuperation

Is 1 week)

Risk of Recurrence (Recurrence Cost X 0.8% Risk)...... $ 1.0

Hospital Stay $ 444.00

Surgical Fee $ 585.00

4 weeks unpaid recuperation $ 1600.00

(assume strenuous recup.)

Recurrence Cost $ 6.00

Total…………... $175.0

Total Cost of an Average Patient at a Typical Hospital

Hospital Costs………………………………………… $ 000.00

Range $000-4000

Hospital Stay 7 days

Time Loss…………………………………………….. $ 800.00

(Assume average wage $ 80.00/day 18)

(Assume average length of unpaid recuperation

weeks)

Risk of Recurrence (Recurrence Cost X 10.0% Risk)…$ 67.50

Hospital Cost $ 075.00

(Assume GA $75)

8 weeks unpaid recuperation $ 00.00

(assume strenuous recup.)

Recurrence Cost $ 675.00

Total…………..$ 447.50

. In what respects is Shouldice Hospital a successful service organization? Is its

performance along these dimensions typical of other hospitals?

Shouldice Other Hospitals

(1) Low average production ($ 54.00) High average production costs

($ 000.00)

() Low Cycle Times (4 days) High Cycle Times (7 days)

() High Fill Rate Unable to determine, likely low

(Only small % refuses or sent home)

(4) Low Lead Times likely high many job shops result

(Surgeons are assigned only 1 day in approximately 0-6% idle time

in advance)

(5) Low average inventory High inventory

(OR's furnished) (Bank of equipment)

(6) Low Wait Time to Slate for Surgery Unable to Determine, likely high

(15-0 minutes physical/info ques.)

(7) High Customer Service Not Likely

(Parents of children stay free, (High Nurse-Patient Ratio

annual check-ups, low Nurse-patient due to less counseling)

ratio)

(8) Standardization of work method

(learning curve effects)

() Highly focused/limited delivery

(economies of specialization)

(10) Minimal direct labor Higher Nurse/patient ratios and staff

(surgeon/staff time, transport, housekeeping)

(11) High utilization of surgeons time

(kept busy all day, minimal idle time)

(1) High utilization of surgical support

(roving nurse, roving anesthesia, defibrillator

(1) Low capital investment in rooms/equipment

(no phone, t.v., medical equipment)

(14) High utilization of room space

(even flow of patients, double occupancy)

(15) Facilities/Dcor

(Investments made in assets such as carpeting,

common areas and nice grounds that add value

to patients experience)

(16) Socialization/Ambiance

(Self-service, large common areas, Spartan rooms

provides for social interaction and helps ensure a

pleasant, non-hospital-like atmosphere)

In many respects Shouldice Hospital is a successful service organization and performance along these respects is not typical of other hospitals.

4. How do you account for the success of Shouldice?

(1) Culture the importance is realized by administration of preserving culture in a service delivery system has resulted in high customer satisfaction (as per Exhibit )

Also, Shouldice is operating ahead of its time in a "knowledge-based" environment where they treat their staff as an asset (Regular hours, minimal on-call hours, avoid staff burnout, strong concern for employees, nobody is fired, high comparative pay, nurses have higher quality workplace environment (more counseling vs. bedpans)

Staff satisfaction is evidenced by the low turnover.

() No Functional Silos No organizational chart, secretaries are cross trained. Executive committee directs only one administrator versus separate departments

() Standardization/low customization operate on only external hernias which resulted in largely (8%) primary operations which involved straightforward procedures. Thus, this standardization allows for regular logistics/procurement. Further, a Shouldice Surgeon develops a pace and touch (600 hernia operations/year vs. 5-50 hernia operations/year) and surgeons are encouraged to learn from each other in groups "Excellence is the enemy of good". The benefit of this standardization is seen in the low recurrence rate (0.8%) of Shouldice surgeries versus a high recurrence (10.0%) rate of typical hospital surgeries, as well as lower per-unit cost.

(4) Key to Success Aggregated operations (External hernias only) results in low coefficient of variation. Thus, minimal variation is much easier to manage. Further, a highly developed surgical method, careful training and experience of surgeons guarantees high quality procedure.

(5) Low Supply Chain Uncertainty - Aggregated operations (External hernias only) results in low supply chain uncertainty since the hernia operation acts as a functional product Supply Chain is tailored to product.

(6) Quality of Interaction Though limited, contact time with surgeons and staff delivers maximum value. First person patient meets is surgeon. Surgeon can interact with patient, before during and after procedure.

(7) Focus on processes operating system, care path and procedures

(8) Fast Recovery - Self-service aides recovery.

How does the Shouldice Hospital physical facility and layout contribute?

Shouldice Hospital is an example of an excellent product-process match, such that, Shouldice is on the bottom right corner of the diagonal of the matrix (Large batches, small variety, assembly or continuous flow capacity). Shouldice puts all of its activities necessary for a routine surgery in a single place, tightly coupled, so it acts somewhat like a service assembly line process. Specifically, a dedicated facility and layout focuses on processess

- Shouldice sedates in pre-OR vs. Other hospitals in rooms

- general layout has all departments departments spread out

in close proximity

- patients and staff served food from separate kitchens/cafeteria

same kitchen

- = Product Cell or focused factory = Job Shops

5. Determine the capacity (in patients/week) at Shouldice Hospital taking into

the capabilities of the different areas the patients pass on their way through the

hospital.

(1) Operating Capacity ………………………………………150-180 patients/week

Operating Load 0-6 patients/day

Assume cannot alter staff complement

Note actual ranged from 145-165 between lulls and peak in September.

() Examine Incoming Patient Capacity…………..………….180 patients/week

Between 100-00 ( hours)

Assume 0 minute examinations

6 surgeons

() Bed Capacity………………………………………………161 patients/week

("Bottleneck")

8 beds available

4 days is the average length of stay

No operations performed on weekends but stay OK.

Note Did not consider increased staff complements as the overarching capacity blocker is dependence on government funding.

6. As Dr. Shouldice, what actions, if any, would you take to expand the hospital's

capacity? Why?

Specifically, what decisions would you take concerning the following

The addition of another floor to the hospital.

Reject currently with 8 beds patient capacity is 180 patients/week which exceeds the operating load. Thus, the bottleneck ("OR load") would not allow for this increase.

The addition of a Saturday operating schedule to the clinic.

Accept Adding a Saturday OR schedule would increase capacity by 17 patients/week and reduce the bottleneck in the process. An addition of a Saturday OR schedule is the best way to leverage an increase in capacity. 850 surgeries per year could be increased. Also, would try in increase local bookings for mid-January and late summer lull and could consider opening during two weeks off.

The development of a new self-contained "branch" of Shouldice either in

Toronto or elsewhere.

Reject High capital costs, dependence of government funding

High uncertainty to maintain similar culture. Currently, Shouldice has the ability to increase capacity without incurring additional capital costs. Increased variability will result in increase cost/unit and difficulty managing.

The development of a new specialty medical service either in Toronto or

elsewhere.

Secondary Consideration diversifying into other specialties would likely result in favorable results due to aggregated operations. Only consider after continuous improvement of an addition of a Saturday operating schedule.

7. How would you implement the changes you propose?

(1) Buy-In from Senior Management Dr. Shouldice needs to relate the action to increase capacity to the Executive Committee and Board.

() Executive needs to arrange single person to champion the process. Recommend Mr. Alan O'Dell. O'Dell should start small by increasing capacity in phases (Phase I increase capacity during lulls and closures). In this way, O'Dell will sustain small wins to gain trust and support (success and profit share increase).

() O'Dell should meet with front-line staff to analyze the capacity problem to ensure they understand and see the problem.

(4) Make preliminary implementation plan and run it buy front-line staff, managers of department, executive and board.

(5) Re-do plan based on feedback until everyone agrees.

(6) Start first phase of implementation. Modify plans to fix bugs which may arise.

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