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Presented by: Group No: 10 Kashish Goyal Padia Archin Ramakant Parminder Singh Rohit Goyal Saurabh Arora

Dr. Earle Shouldice was the founder of the Shouldice Hospital By 1940s he began to develop a surgical technique for repairing Hernias He created new facilities by buying a 130-acre estate with a 17000 square foot main house in the Toronto suburb of Tornhill Dr. Shouldice died in 1965


Alen ODell was the managing director Addressing people needs Maintaining the work culture Addressing employee issues Imparting training to secretaries Generating a culture of cross training without the aid of organizational chart

10 Full time surgeons 8 part time assistant surgeons 2 Anesthetists Each operating team required a surgeon, an assistant surgeon, a scrub nurse and a circulating nurse Operating load was 30-36 operations per day


Patient Examination Administering anesthetics Assisting patients Performing Operations Post-operation counseling Examining Patients Consulting other surgeons Chief surgeon assigned surgeons to various operating rooms Senior surgeons imparted training to new recruited doctors

34 full time- equivalent nurses staffed Shouldice for 24 hour period 6 full time equivalent nurses were on premises during non-operating hours Nurses to Patient ratio was 1:15 Low ratio from average ratio in acute-care hospitals Spent large proportion of time in counselling activities


Explaining the incoming patients about What to expect , Need of exercise after the operation and daily routine Emphasizing the importance of attending the dinner and recreation session Encouraging patients for social interaction Taking patients to the pre-operating room Nurses administered analgestics


Administrative Roles Housekeeping services Preparation of food in the kitchen Staff members picked up food from a cafeteria line placed in the center of the kitchen providing opportunity for interaction

Core Competency(Shouldice Method and Program)

Removal of misconceptions about Hernia operations Program devised because of high Recurrence Rate Surgeons at Shouldice Hospital performs 750 operations as compared to 50 by other surgeons.

Level of customer participation

Diagnosed by mail using Medical Information Questionnaire.

Risk and type of hernia decided on the basis of responses.

Weight loosing program prior to operation, if needed.

Examination time dependent on level of anxiety mentioned in questionnaire

Person was sent home after examination, if over weight or no hernia problem

Patients room was allocated on the basis of occupation, background and interests.

Interaction among patients who had their operations earlier the same day at dinner time.

Exercises later on and change in daily routine after the operation.

Exercise immediately after the operation encouraged by nurses.

Patients attitude was most important to take complete advantage of shouldice program.

Learned about hospital from previous shouldice patients.

Succession of Dr. Degani

Grooming has been started

Decision on Saturday operation as hes opposing it.

Improvement on certain successful procedures

Competitors Advertisement
(Pg. 673)

Alternatives available Scope of Improvement in current portfolio

Core Competency being emulated by others

Service Quality
Reliability Extensive research by Dr. Shouldice Highly trained and experienced surgeons (600 Hernia operations) Well aligned patient needs and service offered

Assurance Complication free experience High amount of time for counseling Crash cart at every floor in case of emergencies like heart strokes.

Use of local anesthetics, pre-operative sedatives to minimize any discomfort Sedatives for rapid recovery Nurses/doctors encourage to talk with other patients Carpeting to reduce hospital feeling and fear of fall Prelim-diagnosis by mails for out of town patients Parents of children being operated can stay free

Admission by appointment: scheduled service Easier to estimate the service time Orientation provided for incoming patients. Walk-in patients or local residents on waiting list to make up cancelled reservation

Acres of gardens to encourage exercise & rapid recovery Minimize hospital feeling (carpeting & odorless disinfectant etc) Stairways are designed for patients to use after operations No TVs and Telephones in rooms to encourage walking Patients encouraged to explore premises

Service Encounter
Brochure is sent to interested patients Large lounge area, recreational areas. Employees trained to help / counsel patients Orientation for incoming patients Common dining for doctors, nurses , staff and patients

Gap Model

Gap 1

Nurse orientation to patients regarding need of exercise, routine etc Large time on counseling Operation procedure Short waiting period Discharge period Opportunity to interact

Gap 2

Well specified process time limits for every activity Scheduled dinner time, recreational & tea breaks 34 full time nurses Well defined schedules of surgeons are followed

Gap 3

Adherence to Shouldice technique Average Nurses to Patients ratio is 1:15 Fresh food

Gap 4

Word of mouth advertising Reasonable rates( half of other hospitals) Welcoming, supportive atmosphere(website)

Gap 5

Patients sometimes ask to stay an extra day Expectations shaped from word of mouth are well met by the hospital services

Managing capacity & demand

Admission by appointment: scheduled service

Screening patients: easier to estimate the service time walk-in patients or local residents on waiting list to make up cancelled reservation Medical Information questionnaire

Capacity planning
Hernia operations are elective procedures, patients can be scheduled in batches to fill the operating time available

Capacity can be utilized to its maximum

The facility is intentionally designed to encourage exercise and rapid recovery within four days, which is approximately one-half the time at traditional hospitals.

Yield Calculations

320 * 4 + 650 + 300 = 2230

(Per Day Stay charge*4 + Surgical Fee + Anesthesia Fees)

Total capacity that can be used Operations = 180/week

(36(No of Operations)*5 (NO. of Days))

Total capacity that is being used

Operations = 148/week

89(No. of Beds)*5(No. of Days) /3(No of a days a patient stays)

Yield = Actual Revenue / Potential Revenue

Actual Revenue = Actual Capacity * Price Potential Revenue = Total Capacity * Price

Yield = 148*2230/180*2230 = 82.22 %

Annual Alumni Reunion Leads to

Continuing relationship of the hospital with its patient.

Keep alumni informed

Gather customer feedbacks

Loyal customer base

Effective word-ofmouth

Analysis of Reunion Data

More than 50% of patients came though referral or word of mouth from friend.

More than 78% of patients feel food service to be important

97% said operation procedure is important 65% said nurses care and guidance was very important 89% said the shouldice hardly seemed like a hospital 91% said that friendship and acquaintance with other patients was important.

Analysis of Reunion Data

Hospital should concentrate more on happy customers as major customers come through referrals Hospital should maintain its good quality food as it is valued by patients Nurse care and guidance is important so should be kept at same level or could be increased Friendship with other patients should be continued and encouraged

Failing which

Invite competition Cause Shouldice to loss market share

-ve Impact

Upset the existing work force Lower service quality

Can satisfy more demand

Support of young Doctors

More Revenue for Company

No Additional Investment

Increase Capacity by 20%

Difficult to maintain same working relations

Opposition by the senior doctors

Staff is not pleased

Dr. Degani wont be there to control

6 Surgeons & other staff have to work on Saturday

1 2 3 4. 5 6

Need to hire new surgeons, nurses and staff Improve its competitive position and increase its profits

Existing staff can be helpful in teaching and encouraging new ones

New Opportunities for existing personnel (like promotions) Requires a significant investment and Quality Control difficult to create the same culture and country club atmosphere

Keeping staff happy by profit sharing policy Less working load on staffs weekends off

Happy Employees
enables people to spend time with their family

Less Turnover Employee satisfaction More People wants to join

Internal Marketing (Employees)

keeps customer Happy

Product Surgery Service Expertise of Doctors, dedication of staff, overall feel of place

Target Niche Market to low risk hernia operations USP Good Quality Service at low price

Word of Mouth Publicity Concept of Alumni Meet helps in spread the good word about service

There operating capacity is close to 100% so, they just need to focus on maintaining the Quality of service