Shouldicepresentationoutline 1305913421988 Phpapp01 110520124431 Phpapp01

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Shouldice

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  • *Shouldice Hospital Anna SwansonPhillip Dean Ben Gierok

  • What is Shouldice Hospital?Hospital that specializes in hernia repairSmall facility (89 beds)Built on a 130-acre estate Located in Thornhill, OntarioPrivately owned

  • How do they compete?Shouldice MethodLocal AnestheticProcedure TechniqueFacility LayoutEarly Ambulation Patient relaxation, comfort, and quick recoveryFTQ of 99.2% for 30 year history

  • Shouldice Hospital

  • Shouldice Hospital

  • Shouldice Hospital

  • Shouldice Hospital

  • 3 Challenges to ShouldiceStrategy Government regulation on healthcareLeave Canada?EthicalMisuse of the Shouldice name by competitors Process and QuantitativeLarge backlog of potential patients

  • Assigning PriorityBased on a worse case scenarioFirst Priority: Government interventionSecond Priority: Misuse of ShouldiceThird Priority: Patient backlog

  • Government Intervention Threat of legislation against private healthcare Ruling could support public-only coverage under OHIP Intervention actually not a threat New Democratic Party leader Jack Layton Grandfather clause (founded in 1945)

  • Misuse of Shouldice Name Ethical obligation of surgeons Oath to help others learn vs. protection of competitive advantage RecommendationEstablish a certification for Shouldice TrainedAllow other doctors to observe

  • The Final Challenge 2400 patients on backlog and growing How can Shouldice reduce backlog without impacting the quality of service? Consider the Theory of Constraints

  • The Goal by Eli Goldratt Novel about a wasteful production process Lessons about constraints from bottlenecks The Goal Reduce operational expense Reduce inventory (Muda) Increasing throughputShouldice constraints: Surgeons Patient Bedrooms Operating Rooms Apply lessons to reduce waste and backlog!

  • Quality Control Location Quality control in front of process bottleneck Shouldice QC is pre-screening and diagnosis Current practice allows for misdiagnosis Medical Information Questionnaire Self diagnosis Surgeons, Rooms, and ORs are then scheduled for patients who end up being sent home

  • Backlog Impact Also consider financial impact! 200 classes per year Even if there is only one misdiagnosis per class: -$416,000/year If there is consistently five misdiagnosis per class: -$2,080,000/year Recommend all patients receive physician pre-screen

    AnalysisBacklog Reduction Input Data Revenue per ClassAmount LossPatients Misdiagnosed WeekMonthYear33Average Class Size $68,640.00$0.00 0000$2,080Average Revenue per Patient$66,560.00($2,080.00)1416200$68,640Average Revenue per Class$64,480.00($4,160.00)28324004Classes Per Week$62,400.00($6,240.00)31248600200Classes Per Year$60,320.00($8,320.00)41664800$58,240.00($10,400.00)520801000

  • Do All Patients Need Day 1 Processes? To help ID what patients need:Refer to Process Flow Map What percent of the time is: Necessary Value-Add Unnecessary Value-Add Necessary Non Value-Add Unnecessary Non Value-Add

  • Process Flow

  • Do All Patients Need Day 1 Processes? To help ID what patients need:Refer to Process Flow Map What percent of the time is: Necessary Value-Add Unnecessary Value-Add Necessary Non Value-Add Unnecessary Non Value-Add

  • Value Add Analysis* Exercise assumes awake for 12 hours on day 3 (180 min exercise on day 3 and 60 min on day 2) ** Assumes 1 hour/meal and three meals on day three*** Assumes 45 min for check in and discharge

    Classification Time (Minutes)Percent to Total ProcessValue Add56.251.30%SurgeryUnnecessary Valued Add260.006.02%Exam and Exercise Necessary Non Value Add390.009.03%Meals, Check In, and Discharge Unnecessary Non Value Add3613.7583.65%Everything Else Total Minutes Available 4320.00100.00%

  • Recommendations and Impact Allow up to 10 patients option of attending Unnecessary Non Value-Add: Predetermined amount helps control variability If patients opt out: Decrease Cycle Time Increased Capacity on all process bottlenecks Reduced Operating Cost

  • Additional Tools for Improvement Perform 5 Why on bottleneck to ID root cause Affinity Diagram in to Fishbone Continuous ImprovementPrepare for more bottlenecks to surface!

  • Backlog ReductionLast Resort Go forward with $4 million expansion Significant cost Only addresses one bottleneck New weekly scheduling process Fits in a 5th class Requires more Bed rooms Requires more staff Increase Prices

  • New Weekly Scheduling Process

    Weekly Process Schedule Shouldice Hospital

    Monday

    Tuesday

    Wednesday

    Sunday

    Saturday

    Friday

    Thursday

    Class 1 Checks In

    Class 1 Operations

    Class 1 Rooms/Orientation

    Class 1 Examinations

    MORNING ACTIVITIES

    AFTERNOON ACTIVITIES

    Class 2Examinations

    Class 2 Checks In

    Class 2 Rooms/Orientation

    Class 1Exercise/Post Op

    Class 1Exercise/Post Op

    Class 2 Operations

    Class 3 Checks In

    Class 3Examinations

    Class 2Exercise/Post Op

    Class 3 Rooms/Orientation

    Class 1 Discharged

    Class 3 Operations

    Class 2Exercise/Post Op

    Class 3Exercise/Post Op

    Class 4 Checks In

    Class 4Examinations

    Class 4 Rooms/Orientation

    Class 2 Discharged

    Class 3Exercise/Post Op

    Class 4 Operations

    Class 4Exercise/Post Op

    Class 5 Checks In

    Class 5 Operations

    Class 4 Exercise/Post Op

    Class 3 Discharged

    Class 5 Rooms/Orientation

    Class 5 Examinations

    Class 4 Discharged

    Class 5 Exercise/Post Op

    Class 5 Exercise/Post Op

    Class 5 Discharged

  • Backlog ReductionLast Resort Go forward with $4 million expansion Significant cost Only addresses one bottleneck New weekly scheduling process Fits in a 5th class Requires more Bed rooms Requires more staff Increase Prices

  • Thank You! Any questions?

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