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Sholdice Hospital

Sholdice Hospital
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Answer the questions to the case study. I will attach the Grading Rubric For the Case Study, and the Questions. Course Textbook
Jacobs, F. R., & Chase, R. B. (2010). Operations and supply chain management (13th ed.). New York, NY: McGraw-Hill.
C A S E :  S H O U L D I C E  H O S P I T A L — A  C U T  A B O V E
“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, it 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 whom have been attending the event for over 30 years.  A number of notable features in Shouldice’s service delivery system contribute to its success. (1) Shouldice accepts only 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 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 one of the 12 full-time surgeons assisted by one of seven 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 14th night and every 10th weekend.
Each patient undergoes a screening exam prior to setting a date for his or her operation. Patients in the Toronto area are encouraged to walk in for the diagnosis. 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 or otherwise represent an undue medical risk are refused treatment. The remaining patients receive confirmation cards with the scheduled dates for their operations. 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 their surgery. After a short wait, they receive a brief preoperative examination. They are then sent to 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 acquainting themselves with their roommates.
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 their 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 preoperative sedation. The first operations begin at 7:30 A.M. Shortly before an operation starts, the patient is administered a local anesthetic, leaving him or her alert and fully aware of the proceedings. At the conclusion of the operation, the patient is invited to walk from the operating table to a nearby wheelchair, which is waiting to return the patient to his or her room. After a brief period of rest, the patient is encouraged to get up and start exercising. By 9 P.M. that day, he or she is in the lounge having cookies and tea and talking with new, incoming patients.  The skin clips holding the incision together are loosened, and some are removed, the next day. The remainders are removed the following morning just before the patient is discharged.  When Shouldice Hospital started, the average hospital stay for hernia surgery was three weeks. Today, many institutions push “same day surgery” for a variety of reasons. Shouldice Hospital firmly believes that this is not in the best interests of patients, and is committed to its three-day process. Shouldice’s postoperative rehabilitation program is designed to enable the patient to resume normal activities with minimal interruption and discomfort. Shouldice patients frequently return to work in a few days; the average total time off is eight days.  “It is interesting to note that approximately 1 out of every 100 Shouldice patients is a medical doctor.”
The management of Shouldice is thinking of expanding the hospital’s capacity to serve considerable unsatisfied demand. To this effect, the vice president is seriously considering two options. The first involves adding one more day of operations (Saturday) to the existing five-day schedule, which would increase capacity by 20 percent. The second option is to add another floor of rooms to the hospital, increasing the number of beds by 50 percent. This would require more aggressive scheduling of the operating rooms.  The administrator of the hospital, however, is concerned about maintaining control over the quality of the service delivered. He thinks the facility is already getting very good utilization. The doctors and the staff are happy with their jobs, and the patients are satisfied with the service. According to him, further expansion of capacity might make it hard to maintain the same kind of working relationships and attitudes.
Exhibit 4.7 is a room-occupancy table for the existing system. Each row in the table follows the patients that checked in on a given day. The columns indicate the number of patients in the hospital on a given day. For example, the first row of the table shows that 30 people checked in on Monday and were in the hospital for Monday, Tuesday, and Wednesday. By summing the columns of the table for Wednesday, we see that there are 90 patients staying in the hospital that day.
1 How well is the hospital currently utilizing its beds?
2 Develop a similar table to show the effects of adding operations on Saturday. (Assume that 30 operations would still be performed each day.) How would this affect the utilization of the bed capacity? Is this capacity sufficient for the additional patients?
3 Now look at the effect of increasing the number of beds by 50 percent. How many operations could the hospital perform per day before running out of bed capacity? (Assume operations are performed five days per week, with the same number performed on each day.) How well the new resources would be utilized relative to the current operation? Could the hospital really perform this many operations? Why? (Hint: Look at the capacity of the 12 surgeons and the five operating rooms.)
4 Although financial data are sketchy, an estimate from a construction company indicates that adding bed capacity would cost about $100,000 per bed. In addition, the rate charged for the hernia surgery varies between about $900 and $2,000 (U.S. dollars), with an average rate of $1,300 per operation. The surgeons are paid a flat $600 per operation. Due to all the uncertainties in government health care legislation, Shouldice would like to justify any expansion within a five-year time period.
Course Textbook
Jacobs, F. R., & Chase, R. B. (2010). Operations and supply chain management (13th ed.). New York, NY: McGraw-Hill.
Unit II Case Study
The case study for Unit II is “Shouldice Hospital – A Cut Above.” The case is presented on pages 87 and 88 of the textbook. Respond to the questions at the end of the case on page 88. Your responses should be complete but succinct.
Shouldice Hospital (Saturday Operations)
90    = Total Beds
30    = Daily Admissions
Beds Required
Mon    Tues    Wed    Thurs    Fri    Sat    Sun
Check-in day    Monday    30    30    30
Tuesday        30    30    30
Wednesday            30    30    30
Thursday                30    30    30
Sunday    30    30                    30
Total by Day        60    90    90    90    60    30    30
Utilization by Day        66.7%    100.0%    100.0%    100.0%    66.7%    33.3%    33.3%
150    = Total Operations per Week
630    = Available Bed-Days
450    = Used Bed-Days
71.4%    = Bed Utilization
12.5    = Operations per Surgeon
30    = Operations per Operating Room
Name: DBA8475-12C-UnitI_GradingRubricForCaseStudy
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A-level qualities (90-100)     B-level qualities (80-89)     C-level qualities (70-79)     D- or F-level qualities (60-69 or below 60)
Points Range: 22.5 (22.5%) – 25 (25%)
Presents an insightful and thorough analysis with strong arguments and evidence; interpretation is both reasonable and compelling. Course concepts and analytical tools are always appropriately applied.
Points Range: 20 (20%) – 22.25 (22.25%)
Presents a thorough analysis with effective arguments; interpretation is both reasonable and compelling. Course concepts and analytical tools are often appropriately applied.
Points Range: 17.5 (17.5%) – 19.75 (19.75%)
Presents an analysis with relevant arguments; interpretation is not thoroughly supported and not compelling. Course concepts and analytical tools are not always appropriately applied.
Points Range: 0 (0%) – 17.25 (17.25%)
Presents a descriptive account with little analysis or relevant argument; interpretation is not well supported. Course concepts and analytical tools are not appropriately applied.
Points Range: 22.5 (22.5%) – 25 (25%)
Demonstrates application of relevant research findings and/or course content.
Points Range: 20 (20%) – 22.25 (22.25%)
Demonstrates application of adequate research findings and/or course content.
Points Range: 17.5 (17.5%) – 19.75 (19.75%)
Demonstrates limited application of relevant research findings and/or course content.
Points Range: 0 (0%) – 17.25 (17.25%)
Demonstrates no or incomplete application of research findings and/or course content.
Writing Mechanics
Points Range: 22.5 (22.5%) – 25 (25%)
Writing is clear and concise. Sentence structure and grammar are excellent. Correct use of punctuation. No spelling errors.
Points Range: 20 (20%) – 22.25 (22.25%)
Writing is mostly clear and concise. Sentence structure and grammar are strong and mostly correct. Few minor errors in punctuation and/or spelling.
Points Range: 17.5 (17.5%) – 19.75 (19.75%)
Writing lacks clarity or conciseness. Minor problems with sentence structure and some grammatical errors. Several minor errors in punctuation and spelling.
Points Range: 0 (0%) – 17.25 (17.25%)
Writing lacks clarity and conciseness. Serious problems with sentence structure and grammar. Numerous major and/or minor errors in punctuation and spelling.
APA Guidelines
Points Range: 22.5 (22.5%) – 25 (25%)
Documents sources using APA format accurately and consistently.
Points Range: 20 (20%) – 22.25 (22.25%)
Documents sources using APA format with minor errors.
Points Range: 17.5 (17.5%) – 19.75 (19.75%)
Reflects incomplete knowledge of APA format.
Points Range: 0 (0%) – 17.25 (17.25%)
Does not use APA format.

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