Shouldice Hospital

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Decision Case #13

Shouldice hospital offers an enriched and comfortable experience for patients accepted into the program for hernia operations. As soon as they arrive at the hospital they are interacted with very closely. Administrators and surgeons spend time with their patients prior to the operation to ensure that their needs are met and that their stay at Shouldice is a comfortable and successful one. After a normal hernia operation at a hospital or another institution, patients are encouraged to check out, whereas Shouldice recommends a resting period for up to four days to recover fully, with the help of on-site nurses. This four day period is also a small vacation for patients, which after any surgery is important in the healing process. The hospital encourages patients to exercise and interact with other patients going through the same experience to enforce that this surgery can be a pleasant one. Shouldice offers a more committed involvement with the patient compared to a normal hospital, which is why they excel in their specialty, with the statistics to prove it.

The target group of customers is males and most commonly come from the 41+ age group. Females and younger patients are very rare (Exhibit 3). Most of the patients at Shouldice are from outside the greater Toronto area. The success rate and the patients’ experience at Shouldice have proven that word of mouth is the best advertisement, rather than a recommendation from a personal doctor.

The process in which the benefits of Shouldice are delivered is very standard and reoccurring. The process begins with a patient being diagnosed by mail or in person using a medical information questionnaire. Based on the information in the response, both doctors and surgeons determine whether or not the patient has a hernia, or if there are other factors such as body weight or any underlying medical conditions that may signal risks associated with the surgery. Once all medical history is accounted for, the patient is given a surgery date and a brochure is sent describing the hospital and the Shouldice method. When arriving at the clinic the day before the operation, the patient joins the other patients in the waiting room that will then be examined by the surgeon who is going to being performing their operation. After checking administrative details about an hour after arriving at the hospital, the patient is directed to their room number. Patients with similar jobs, backgrounds, or interests were assigned to the same room to make the experience both familiar and comfortable. Later that same day, patients are required to attend a nurse’s orientation and familiarize themselves with information about what to expect; including the need for exercise after the person undergoes surgery and how to change their daily routine. Dinner is then served following by further recreation. Nurses encourage attendance at this time because it provides an opportunity for pre-operative patients to talk with those whose operations have been completed earlier that same day, for encouragement and to decrease anxiety associated with both the surgery and the recovery. Patients who are to be operated on early are awakened at 5:30am to be given pre-op sedation. Patients were then taken to the pre-operating room where the circulating nurse administrated Demerol, an analgesic, 45minutes before surgery. Upon the completion of the operation, during which a few patients are usually “chatty” and fully aware of what’s going on, patients are invited to get off the operating table and walk to the post operating room with the help of their surgeons. In a normal hospital or clinic, walking after any surgery is not encouraged for the patient, but with Shouldices’ technique, it forces the patient to begin recovery right away and prove to themselves that they can do it. This technique is an important start to a quick recovery with the help of guided exercise routines. The day after the...
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