Shouldice Case

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“Shouldice Hospital, the house that hernias built, is a converted country estate which gives the hospital a ‘country club’ appeal.”

A quote from American Medical News

Shouldice Hospital in Canada is widely known for one thing – hernia repair! In fact, that is the only operation it performs, and it performs a great many of them. Over the past two decades this small 90-bed hospital has averaged 7,000 operations annually. Last year, they had a record year and performed nearly 7,500 operations. Patients’ ties to Shouldice do not end when they leave the hospital. Every year the gala Hernia Reunion dinner (with complimentary hernia inspection) draws in excess of 1,000 former patients. Some of who have been attending the event for over 30 years.

A number of notable features in Shourldice’s service delivery system contribute to its success. (1) Shouldice only accepts patients with the uncomplicated external hernias, and it uses a superior technique developed for this type of hernia by Dr. Shouldice during World War II. (2) Patients are subject to early ambulation, which promotes healing. (Patients literally walk off the operating table and engage in light exercise throughout their stay, which lasts only three days. (3) Its country club atmosphere. Gregarious nursing staff, and built-in socializing make a surprisingly pleasant experience out of an inherently unpleasant medical problem. Regular times are set aside for tea, cookies, and socializing. All patients are paired up with a roommate with similar background and interests.

The Production System

The medical facilities at Shouldice consist of five operating rooms, a patient recovery room, a laboratory, and six examination rooms. Shouldice performs, on average, 150 operations per week, with Patients generally staying at the hospital for three days. Although operations are performed only five days a week, the remainder of the hospital is in operation continuously to attend to recovering patients.

An operation at Shouldice Hospital is performed by 1 of the 12 full-time surgeons assisted by one of 7 part time assistant surgeons. Surgeons generally take about one hour to prepare for and perform each hernia operation, and they operate on four patients per day. The surgeons’ day ends at 4 P.M., although they can expect to be on call every fourteenth night and every tenth weekend.

The Shouldice Experience

All patients undergo a screening exam prior to setting a date for their operation. Patients in the Toronto area are encouraged to walk in to have the diagnosis done. Examinations are done between 9 A.M. and 3:30 P.M. Monday through Friday, and between 10 A.M. and 2 P.M. on Saturday. Out-of-town patients are mailed a medical information questionnaire (also available over the Internet), which is used for the diagnosis. A small percentage of the patients who are overweight of otherwise represent an undue medical risk are refused treatment. The remaining patients receive a confirmation card with the scheduled date for their operation. A patient’s folder is transferred to the reception desk once an arrival date is confirmed.

Patients arrive at the clinic between 1 and 3 P.M. the day before then surgery. After a short wait, they receive a brief preoperative examination. They are then sent to see an admissions clerk to complete any necessary paperwork. Patients are next directed to one of the two nurses’ stations for blood and urine tests and then are shown to their rooms. They spend the remaining time before orientation getting settled and aquainting themselves with their roommate.

Orientation begins at 5 P.M., followed by dinner in the common dining room. Later in the evening, at 9 P.M., patients gather in the lounge area for tea and cookies. Here, new patients can talk with patients who have already had surgery. Bedtime is between 9:30 and 10 P.M.

On the day of the operation, patients with early operations are awakened at 5:30 A.M. for...
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