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					Shouldice Hospital:The Center of Excellence
 for the Repair of Abdominal Wall Hernias




                              Dr. Earle Shouldice
 Why Patients like Shouldice?

w Quality Outcome
     l   Highly developed surgical method, careful training and
         experience of surgeons guarantees high-quality
         procedure.
w Quality of Interaction
     l   Though limited, contact time with surgeons and staff
         delivers maximum value.
     l   First person patient meets is surgeon. Surgeon can interact
         with patient, before during and after procedure.
     l   Staff Time is freed-up to interact with patients.
w Fast Recovery
     l   Self-service aides recovery.
     Why Patients like Shouldice?

w Low Price
     l   $954 vs. $2,000-4,000 elsewhere.
w Facilities/Decor
     l   Investments made in assets such as carpeting, common areas and
         nice grounds that add value to patients experience.
w Socialization/Ambiance
     l   Self-service, large common areas, spartan rooms provides for
         social interaction and helps ensure a more pleasant, non-hospital-
         like atmosphere
                                  Shouldice Hospital Winter scene




Shouldice Hospital Summer scene
                               Front Entrance in the Spring




    Hospital Gardens –
Summer Flower bed at the "Y"
                   Shouldice:
            a great “service factory”
w Standardization of work           w High utilization of surgical
  method                              support
   learning curve effects                 roving nurse, roving
w Highly focused/limited                  anesthesia, defibrillator
  delivery                          w Low capital investment in
   economies of specialization        rooms/equipment
w Minimal direct labor                    no phone, T.V., minimal
                                          medical equipment
   surgeon/staff time, transport,
      housekeeping                  w High utilization of room
w High utilization of                 space
  surgeons time                           even flow of patients, double
                                          occupancy
      kept busy all day, minimal
      idle time
Key to McDonald’s Success

w Speed
w Consistency
w Value for money
          McDonald’s Approach

n   Limited Menu:
       McDonald’s menu is a model of brevity
n   Standardization
    Example: Fries
       w By requiring potato suppliers to meet almost as many
         specifications as missile-makers
       w By demanding that cooks learn to work with high-tech frying
         machines to produce a morsel that is exactly 9/32 of an inch
         thick, crisp on the outside and fluffy on the inside—every
         time.
       w Oh yes, and it must be ready in under a minute.
What works for Hamburgers
    works for Hernias
                   Key Characteristics

w Limited menu
   n   limit what you do, but do a lot of it and do it very well
w Attention to details
   n   emphasis on processes and efficiency
w Strive constantly to simplify procedures
w Replace expensive bits of equipment with cheaper
  ones
w Benefit from better data

Resulting in very high performance on the dimensions
  of cost and quality.
                  Focused Factories

w Customer segmentation and limited focus: cancer
  centers, nursing units, hernia clinic
w Focus on processes
   n   operating system, care path and procedures
   n   dedicated organizational and physical design
w High volume drives low cost and high quality
   n   leverage experience base / perfect preprocesses
   n   eliminate waste of labor and technology
w Potential for franchising
       Successful Focused Factories

w Shouldice (Toronto, Canada): hernia specialists
w Texas Heart Institute
   n   Bypass surgery for $27,000 ($16,000 cheaper than
       national average)
   n   Five-yr survival rate: 92%
w Salick Health Care (11 cancer centers in US)
w Mid America Dental, Hearing and Vision Care
  (Missouri)
w Mayo Clinic (broader focus but very process
  oriented)
           Potential Applications

w Chronic Diseases
  n   Cancer
  n   Diabetes
  n   Congestive heart disease
  n   Infant care
  n   Asthma
  n   Emphysema
          A Universal Solution?

No. Sickness is not always focused.
Examples
  l   Multitude of Ailments
        AIDS sufferers
        Elderly people
  l   Uncertain Ailments
        Emergency room patients

				
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