Shouldice Hospital Limited

I- The need for an “All Hernia Hospital”!!!

Dr. Edward Earle Shouldice graduated from the University of Toronto in 1916. By 1940, Dr. Shouldice was operating a private medical and surgical practice, lecturing at the University of Toronto, and pursuing research work in areas of advancing medical knowledge.

During World War II, he was called to serve on the Medical Examining Board. Dr. Shouldice, a major in the army, found that many young men willing to serve their country had to be denied enlistment. These men needed surgical treatment to repair their hernias before they could be pronounced physically fit for military training.

In 1940, hospital space and doctors were scarce, especially for this non-emergency surgery that normally took three weeks of hospitalization. Dr. Shouldice resolved to do what he could to alleviate the problem. Contributing his services at no fee, he performed an innovative method of surgery on seventy of these men, hastening their induction into the army.

The delighted recruits soon made known their success stories and by the war's end, more than 200 civilians had contacted the doctor and were awaiting surgery. The scarcity of hospitals beds however, created a major problem. There was only one solution, Dr. Shouldice decided to open his own hospital.

(Source: Shouldice Hospital official website �www.shouldice.com’)

II- Background and History on Shouldice Hospital

In 1945, the dream came true and the Shouldice hospital opened its doors for the first time welcoming incoming patients. It started with one nurse, one secretary, one cook, one operating room and Dr. Shouldice performing two operations a day.

As result of his success, Dr. Shouldice was forced to expand. In 1953, he purchased a beautiful country estate in Thornhill, where all surgery now takes place.

III- The Shouldice Method “The Secret Formula”

The Shouldice method “secret” is not only in the innovative medical technique followed through operating Hernias but it lies in the whole experience. The experience of patients, nurses, doctors and alumni (previous patients)

a) The medical technique:

The Shouldice technique is mainly based on facilitating early ambulation after the surgery is performed. There are several factors that contribute to the success of the procedure. Among them were the use of local anesthetic, the nature of the surgical procedure itself, the design of the facility to encourage movement without unnecessarily causing discomfort, and the postoperative regimen.

b) The experience:

Being at Shouldice does not resemble the experience of being at any other hospital. Some patients actually consider it an authorized getaway from the hassles of work and their busy life.

Just walking into a place like Shouldice in the beautiful country estate of Thornhill surrounded with greenery everywhere makes you feel relaxed and immediately spot the difference of what is coming ahead.

Through their stay at Shouldice patients get to meet other fellow patients and have the opportunity to bond and ease each other’s fears and worries. The system at Shouldice makes sure to put patients with similar backgrounds together to ensure that this bonding process goes smoothly. Patients get to meet the doctors who are going to perform the surgery and ask them all sort of questions. This goes for the nurses too who are present through the whole process.

To maintain such a lively atmosphere, Shouldice management tries to keep the nurses and the doctors happy and satisfied all the time.

Unlike nurses at other hospitals who spend of most of their time using bed pans, nurses at Shouldice spend most of their time counseling.

A typical day for a doctor at Shouldice starts at 7:30 a.m. and ends at 4:00 p.m. which contradicts the hectic schedules for any other typical surgeons Doctors at Shouldice not only have fixed and relaxed office hours but they are also paid 15% more than the average income for a surgeon in Ontario.

IV- Some facts and figures

• Shouldice contains 2 facilities: a hospital and a clinic. The clinic has 5 operating rooms, a laboratory, and a patient recovery room.

• The hospital’s total capacity is 89 beds and it has 6 examination rooms.

• The Hospital is staffed with 34 full-time nurses. The ratio of nurses to patients at Shouldice was 1:15.

• There are 10 full-time surgeons, 8 part-time assistant surgeons, and 2 anesthetists.

• By 2004, 7600 operations were performed per year.

• An average of 30-36 operations was conducted per day, and each surgeon usually performed 3-4 operations per day.

• A typical operation with a 4-day stay would cost $320/day, plus a surgical fee of $650. An additional fee of $300 was charged if general anesthesia was needed. Thus, an average of $2080 was charged in Shouldice, as compared to $5240 for operations performed elsewhere.

Shouldice applied a focused-factory/ assembly line approach. This was approached was successfully applied through minimizing both diversification and cost:

1. Low diversification:

- The standardization of work procedures.

- Highly focused and specialized, which led to better experience in hernia operations.

2. Low cost:

- Low capital investments in rooms and equipment.

- High utilization of room space, through double occupancy and even flow of patients.

- This led to low cost incurred on the patients.

V- Process flow

VI- Challenges Facing Shouldice

• Expanding the hospital’s capacity, while maintaining the quality of services provided and the friendly attitude.

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