# Shouldice Hospital Case

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Bottleneck analysis: Also see enclosed Process flow chart (Appendix 1). Hospital is able to perform 42 exams/afternoon and send 38 patients to the operation rooms. But surgery capacity is 33 operations/day only. Bottleneck (number of operations/day) is therefore located between these two processes. Hospital performs 33 operations/day = demand 116 beds/Wed,Thu and 99 beds/Tue. Demand is 116 and current capacity is 89. Bottleneck is the number of beds available. It is necessary to increase capacity by (116-89)/89 = 30% just to meet current schedule of surgeries. Currently there are 30 – 36 operations performed daily = 33 for an average. 4*5 = 20 in the morning and 13 in the afternoon (assuming that time slot will last ca. 50 minutes). Here is an opportunity for improvement. Each of normal operations takes 1 hour and there are 5 hours available during the morning => increase 1 operation / room which represents total of 5 operations across 5 operating rooms per day. During afternoon is no improvement possible. It results in increasing of capacity for a total 38 / day (25 each morning and 13 each afternoon). When scheduled for 5 day week, it requires 133 rooms available for peak days of the week (Wed and Thu). The new need represents 50% increase in capacity compared to the current capacity of 89 rooms. Recommendation: Hospital should invest 4 million dollars in the new space, which will increase bed capacity by 50% and will require perform Saturday surgeries as well. Capacity of beds will increase 89*(1 + 50%) = 133. It exceeds number of beds needed at the time (116), therefore eliminate the bed capacity bottleneck. With 133 beds it is possible to accommodate 38 new patients / day, thus 38 operations can be performed per day. Daily examination capacity, daily operation capacity and number of beds available corresponds without any troubles => no individual bottleneck.

Conclusion: After implementation of new strategy (4 MM investment and schedule which includes

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