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*Shouldice Hospital Anna SwansonPhillip Dean Ben Gierok
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What is Shouldice Hospital?Hospital that specializes in hernia repairSmall facility (89 beds)Built on a 130-acre estate Located in Thornhill, OntarioPrivately owned
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How do they compete?Shouldice MethodLocal AnestheticProcedure TechniqueFacility LayoutEarly Ambulation Patient relaxation, comfort, and quick recoveryFTQ of 99.2% for 30 year history
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Shouldice Hospital
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Shouldice Hospital
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Shouldice Hospital
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Shouldice Hospital
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3 Challenges to ShouldiceStrategy Government regulation on healthcareLeave Canada?EthicalMisuse of the Shouldice name by competitors Process and QuantitativeLarge backlog of potential patients
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Assigning PriorityBased on a worse case scenarioFirst Priority: Government interventionSecond Priority: Misuse of ShouldiceThird Priority: Patient backlog
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Government Intervention Threat of legislation against private healthcare Ruling could support public-only coverage under OHIP Intervention actually not a threat New Democratic Party leader Jack Layton Grandfather clause (founded in 1945)
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Misuse of Shouldice Name Ethical obligation of surgeons Oath to help others learn vs. protection of competitive advantage RecommendationEstablish a certification for Shouldice TrainedAllow other doctors to observe
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The Final Challenge 2400 patients on backlog and growing How can Shouldice reduce backlog without impacting the quality of service? Consider the Theory of Constraints
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The Goal by Eli Goldratt Novel about a wasteful production process Lessons about constraints from bottlenecks The Goal Reduce operational expense Reduce inventory (Muda) Increasing throughputShouldice constraints: Surgeons Patient Bedrooms Operating Rooms Apply lessons to reduce waste and backlog!
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Quality Control Location Quality control in front of process bottleneck Shouldice QC is pre-screening and diagnosis Current practice allows for misdiagnosis Medical Information Questionnaire Self diagnosis Surgeons, Rooms, and ORs are then scheduled for patients who end up being sent home
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Backlog Impact Also consider financial impact! 200 classes per year Even if there is only one misdiagnosis per class: -$416,000/year If there is consistently five misdiagnosis per class: -$2,080,000/year Recommend all patients receive physician pre-screen
AnalysisBacklog Reduction Input Data Revenue per ClassAmount LossPatients Misdiagnosed WeekMonthYear33Average Class Size $68,640.00$0.00 0000$2,080Average Revenue per Patient$66,560.00($2,080.00)1416200$68,640Average Revenue per Class$64,480.00($4,160.00)28324004Classes Per Week$62,400.00($6,240.00)31248600200Classes Per Year$60,320.00($8,320.00)41664800$58,240.00($10,400.00)520801000
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Do All Patients Need Day 1 Processes? To help ID what patients need:Refer to Process Flow Map What percent of the time is: Necessary Value-Add Unnecessary Value-Add Necessary Non Value-Add Unnecessary Non Value-Add
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Process Flow
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Do All Patients Need Day 1 Processes? To help ID what patients need:Refer to Process Flow Map What percent of the time is: Necessary Value-Add Unnecessary Value-Add Necessary Non Value-Add Unnecessary Non Value-Add
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Value Add Analysis* Exercise assumes awake for 12 hours on day 3 (180 min exercise on day 3 and 60 min on day 2) ** Assumes 1 hour/meal and three meals on day three*** Assumes 45 min for check in and discharge
Classification Time (Minutes)Percent to Total ProcessValue Add56.251.30%SurgeryUnnecessary Valued Add260.006.02%Exam and Exercise Necessary Non Value Add390.009.03%Meals, Check In, and Discharge Unnecessary Non Value Add3613.7583.65%Everything Else Total Minutes Available 4320.00100.00%
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Recommendations and Impact Allow up to 10 patients option of attending Unnecessary Non Value-Add: Predetermined amount helps control variability If patients opt out: Decrease Cycle Time Increased Capacity on all process bottlenecks Reduced Operating Cost
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Additional Tools for Improvement Perform 5 Why on bottleneck to ID root cause Affinity Diagram in to Fishbone Continuous ImprovementPrepare for more bottlenecks to surface!
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Backlog ReductionLast Resort Go forward with $4 million expansion Significant cost Only addresses one bottleneck New weekly scheduling process Fits in a 5th class Requires more Bed rooms Requires more staff Increase Prices
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New Weekly Scheduling Process
Weekly Process Schedule Shouldice Hospital
Monday
Tuesday
Wednesday
Sunday
Saturday
Friday
Thursday
Class 1 Checks In
Class 1 Operations
Class 1 Rooms/Orientation
Class 1 Examinations
MORNING ACTIVITIES
AFTERNOON ACTIVITIES
Class 2Examinations
Class 2 Checks In
Class 2 Rooms/Orientation
Class 1Exercise/Post Op
Class 1Exercise/Post Op
Class 2 Operations
Class 3 Checks In
Class 3Examinations
Class 2Exercise/Post Op
Class 3 Rooms/Orientation
Class 1 Discharged
Class 3 Operations
Class 2Exercise/Post Op
Class 3Exercise/Post Op
Class 4 Checks In
Class 4Examinations
Class 4 Rooms/Orientation
Class 2 Discharged
Class 3Exercise/Post Op
Class 4 Operations
Class 4Exercise/Post Op
Class 5 Checks In
Class 5 Operations
Class 4 Exercise/Post Op
Class 3 Discharged
Class 5 Rooms/Orientation
Class 5 Examinations
Class 4 Discharged
Class 5 Exercise/Post Op
Class 5 Exercise/Post Op
Class 5 Discharged
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Backlog ReductionLast Resort Go forward with $4 million expansion Significant cost Only addresses one bottleneck New weekly scheduling process Fits in a 5th class Requires more Bed rooms Requires more staff Increase Prices
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Thank You! Any questions?
