shouldice presentation outline
DESCRIPTION
Final group presentation for capstone operations class on Shouldice Hernia HospitalTRANSCRIPT
04/13/23
Shouldice Hospital
Anna SwansonPhillip
Dean
Ben Gierok
What is Shouldice Hospital?
•Hospital that specializes in hernia repair
•Small facility (89 beds)
•Built on a 130-acre estate
•Located in Thornhill, Ontario
•Privately owned
How do they compete?
•“Shouldice Method”•Local Anesthetic•Procedure Technique•Facility Layout•Early Ambulation
•Patient relaxation, comfort, and quick recovery
•FTQ of 99.2% for 30 year history
Shouldice Hospital
Shouldice Hospital
Shouldice Hospital
Shouldice Hospital
3 Challenges to Shouldice
•Strategy •Government regulation on healthcare•Leave Canada?
•Ethical•Misuse of the Shouldice name by competitors
•Process and Quantitative•Large backlog of potential patients
Assigning Priority
• Based on a worse case scenario…
• First Priority: Government intervention
• Second Priority: Misuse of “Shouldice”
• Third Priority: Patient backlog
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)
Misuse of Shouldice Name
• Ethical obligation of surgeons
• Oath to help others learn vs. protection of competitive advantage
• Recommendation•Establish a certification for “Shouldice Trained”•Allow other doctors to observe
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
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 throughput
•Shouldice constraints:• Surgeons• Patient Bedrooms• Operating Rooms
• Apply lessons to reduce waste and backlog!
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
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
Analysis Backlog Reduction
Input Data Revenue per
Class Amount LossPatients
Misdiagnosed Week Month Year
33 Average Class Size $68,640.00 $0.00 0 0 0 0
$2,080 Average Revenue per Patient $66,560.00 ($2,080.00) 1 4 16 200
$68,640 Average Revenue per Class $64,480.00 ($4,160.00) 2 8 32 400
4 Classes Per Week $62,400.00 ($6,240.00) 3 12 48 600
200 Classes Per Year $60,320.00 ($8,320.00) 4 16 64 800
$58,240.00 ($10,400.00) 5 20 80 1000
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
Process Flow
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
Value Add Analysis
Classification Time (Minutes) Percent to Total ProcessValue Add 56.25 1.30% Surgery
Unnecessary Valued Add 260.00 6.02% Exam and Exercise Necessary Non Value Add 390.00 9.03% Meals, Check In, and Discharge
Unnecessary Non Value Add 3613.75 83.65% Everything Else
Total Minutes Available 4320.00 100.00%
* 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
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
Additional Tools for Improvement • Perform “5 Why” on bottleneck to ID root cause
• Affinity Diagram in to Fishbone
• Continuous Improvement•Prepare for more bottlenecks to surface!
Backlog Reduction—Last 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
New Weekly Scheduling ProcessWeekly Process Schedule – Shouldice Hospital
Thu
rsda
yF
riday
Sat
urda
yS
unda
yW
edne
sday
Tue
sday
Mon
day
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 1 Checks In
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
Backlog Reduction—Last 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
Thank You!
Any questions?