Shouldice Hospital Case Study Calvin Barron Liberty University March 2, 2010 Respectfully submitted to Prof. Scott McLaughlin Overview The Shouldice Hospital serves as a glaring example of extraordinary service and care for the impaired and needy. From carpeting and soft lighting to doting personal care from the staff, the Shouldice experience sets a standard of excellence for the industry. Dr. Earl Shouldice displayed an early desire for medical understanding with an age 12 exploratory of a farm animal.
Medical training at the University of Toronto led to a private practice after World War One. An appendectomy of an obstinate young child led to questioning of his medical training concerning surgical recovery. The child’s refusal to remain still and bedfast after surgery led to the present “Shouldice method”. The consideration of immediate ambulation promoting quicker recoveries was proven by the observation and inspection of numerous cases following the stubborn child who refused to sit still. Dr. Shouldice used the following years to study and improve on these observations.
The Shouldice Hospital was founded to use these observations to promote and capitalize on his proven method of hernia repair. In something of an assembly line method, Dr. Shouldice designed and developed his current factory type facility. Textual Concepts Competitive Service Strategies from pages 38-41 of the text offers strategies to further the expansion of the Shouldice hospital service methodology. Service and Design Elements from pages 68-69 highlight Shouldice Hospital in the text specifically.
Deming’s Plan-Do-Check-Act system of continuous improvement on page 146 of the text seems the basis of Shouldice’s methodology. Deming’s 14 Point program from page 154 of the text offers some important steps which could be used to softly promote progress within the Shouldice program. Franchising from page 343 of the text offers an answer to immediate inexpensive expansion to the current model. Strengths The Shouldice Hospital has an easily identifiable surgical procedure, recovery practice and service known by the Name of Shouldice worldwide.
The hospital experiences a backload of patients for the better part of the year due to simply word-of-mouth advertisement. The hospital has an “Alumni” of 140,000 clients assumed to be satisfied with the procedures. Out of the 140,000 just . 8% is reported as be reoccurring hernias. Compared to the United States alone, noted as having the best health care in the world, the report indicates a 10% U. S. reoccurrence problem. The relatively low cost of services provided including the operation and travel is small to say the least and serves only to increase demand for the experience.
The increase in patient applications prompted an expansion in productivity which only served to increase the demand the more. Shouldice is as supportive to their staff as they are to their patients. Above average pay, benefits, and profit sharing serve to entice a dedicated performance out of the staff. Doctors are said to find the Hospital desirous due to the light workload and the ability to live a full home life with their families. Weaknesses Only external hernias are repaired by the program.
The inclusion of internal hernias has been discouraged due to the increased amount of time needed to deal with the more extensive procedures in such a fast paced environment. The chances of extenuating circumstances create an unpredictable outcome as well as increased recovery time. The only site offering these unique services is located in Canada. Cases such as that of the author of this report are found to be excluded from such a procedure due to the need for international travel, governmental barriers, and monetary relations with foreign entities.
Dr. Obney has resisted changes based on his inability to be on hand in case of an emergency or on his personal preferences. The ability to add another surgical day or an additional floor to the Hospital and take on more patients is as well off-set by the age and availability of Dr. Obney to be there at an increased rate. Only healthy average weight individuals are accepted as patients. The hernias are chosen as quick and easy repairs to maximize the ability for a greater quantity of patients and a quicker turnaround time.
Doctors are taught and expected to adhere to the Shouldice method barring any deviation from the routine. Any deviation from the norm is required to demand a conference with other surgeons before continuance. Free thinking is frowned upon and the motto of “Excellence is the enemy of Good” is taught and adhered to there. Suggestions From page 39 of the text, Standardizing_ a Custom Service_ offers an ideal prospect for the Shouldice Hospitals’ expansion of services. “…family health care centers are attractive means of delivering routine professional services at low cost. (Fitzsimmons and Fitzsimmons, 2008, p. 39) Considering the profile listed in the text concerning Shouldice Hospital and the service design element of the Facility being highlighted as the discussion topic from pages 68-69 any further discussion of the facilities design would be counterproductive. The ability to reproduce the factory type facility in Canada should be simple enough due to the strict discipline followed and the highly controlled and co-productive nature of the clientele, the operation techniques and procedures, and the strict recovery process.
The relocation to different countries would be the obvious next step since patients worldwide seem to flock to their present location. The garden acres typesetting would indicate a rural setting for additional locations which would allow the lesser expense of non commercial and non prime real estate for typical settings. The feasibility of offering franchises with the demand to strictly duplicate the Canadian model would allow a swifter expansion to a global market. The franchiser retains the right to dictate conditions.
Standard operating must be followed. Materials must be purchased from either the franchiser or an approved supplier. No deviation from the product line is permitted, training sessions must be attended, and continuing royalty fees must be paid. (Fitzsimmons and Fitzsimmons, 2008, p. 343) The Harvard business case of Shouldice Hospital includes a reproduction of a Boca Raton Florida advertisement for a knock-off Shouldice experience; “The Canadian Hernia Clinic” featuring “no overnight stay””. (Heskett, 2003, pg. 8) This could be avoided with simple advertisement and a franchise offering to the popular and lucrative Canadian model. The Plan-Do-Check-Act prospect introduced by Deming in the text appears to be the process indicated in the case study that Dr Shouldice employed in the facilities development, or at least some variation thereof. To use W. Edwards Deming’s 14-point program as a model for the implementation of progressing the service model implemented by Dr. Shouldice would only be appropriate.
On point Ten with the “Excellence is the Enemy of Good” Shouldice employs serves to allow and promote mediocrity as opposed the Deming’s point of striving toward excellence. From Deming we find statements such as; Create constancy of purpose toward improvement of product and service, with the aim to become competitive and to stay in business, and to provide jobs…Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs…Institute leadership. The aim of supervision should be to help people and machines and gadgets to do a better job.
Supervision of management is in need of an overhaul, as well as supervision of production workers…Eliminate slogans…Remove barriers that rob the hourly paid worker of his right to pride in workmanship. (Fitzsimmons and Fitzsimmons, 2008, p. 154) The leadership and allow worker pride in their workmanship all seem to go against the Shouldice model. Followers and automated pre programmed automatons are seemingly encouraged at The Shouldice Hospital. The situation seems to discourage the exact kind of innovation which was responsible for the Hospital and the method and the experience developed by Dr.
Shouldice through innovation and improvement on the status quo of his day. Deming said “Innovation in all business of should be expected” (Fitzsimmons and Fitzsimmons, 2008, p. 154) this is not the practice of Shouldice. Instead they repeat a proven function and disallow any deviation or improvement. It is suggested that Dr. Obney step aside and allow the Facility to be globalized as well as the process. Expanding upon the process as well as the facility should open up new avenues of improvement and innovation such as that which Dr.
Shouldice noticed, explored, developed, and expanded upon so many years ago. The Shouldice Hospital serves as a glaring example of extraordinary service and innovation and should be reproduced and made available to the rest of the world. References Fitzsimmons, J. A. & Fitzsimmons, M. J. (2008). _Service Management: Operations, Strategy, and Information Technology_ (6th ed. ). New York: McGraw-Hill Irwin. Heskett, James (2003) MBS-Harvard Business Case, Shouldice Hospital Ltd. , Harvard Business Cases MBS Direct, Harvard Business School Publishing, Boston, MA 02163
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