Service Marketing Assignment

Shouldice Hospital Case

Presented to: Dr. Omneya Mokhtar

Presented by: Lobna Ashraf

1. What is the market for this service? How successful is Shouldice Hospital?

The target market:

 Patients with external abdominal hernia
 Patients suffering recurrences of hernias previously repaired elsewhere

Shouldice Hospital is really successful, because:

The Shouldice Technique is used
 Using pre-operative sedation and analgesic and only local anesthesia can complete a typical first time repair.
 This technique allowed postoperative patient ambulation and facilitated rapid recovery.

Doctors are very experienced

 They learn the Shouldice technique over a period of several months.
 Doctors teach each other and encourage group effort.
 Doctors perform 750 hernia surgeries per year, as opposed to 25 to 50 hernia operations per year.
 One or more of the senior surgeons directly supervises operations.
 Doctors not scheduled to operate in the afternoon examined incoming patients.
 Surgeons are required to perform the repair exactly as he’s told. This hospital is not a place for prima donnas.
 Surgeons examine the patients that they are to operate on.
 More complex procedures were assigned to more senior and experienced member of staff.
 Surgeons are paid a straight salary of $144,000.
 Bonuses to doctors were distributed monthly.
 Total surgeon compensation is 15% more than the average income for a surgeon in Ontario.
 Recurring patients are assigned to the doctor who performed the first operation, to allow the doctor to “learn from his
mistake”.


Patient Satisfaction
 Patients sometimes ask to stay an extra day.
 They share experiences with other patients, make friends easily and have a run of the hospital.
  Patients were chatty during the surgery, which made them less nervous.

Nurses are proficient

 Nurses provided information about what to expect, including the need for exercise and the daily routine.
 They walk the patients directly from the operating table to their rooms, instead of using wheelchairs.
 Nurses encourage patients to exercise throughout the day after their operation.
 They spend a large proportion of their time in counseling activities.
 Shouldice has a waiting list of nurses wanting to be hired, while other Toronto hospitals are understaffed and currently
recruiting.

2. Define the service model for Shouldice. How does each of its elements contribute to its success?
Patient Arrives Patient in waiting Examination by
room surgeon

Patient waiting for Check Insurance Check up with Nurse Patient arrives at Nurse Orientation Dinner Recreation/ Bedtime
admittance room

Patients Wake/Get Pre-Surgery Prep Demerol Given Novocain Given Operation Begins
Dressed

Patient Recovery Patient Recovery Patient Recovery Discharge (Day 4)

Day day / Loosen skin day/ Removal of skin
(Day 1) Elements clips clips
(Day 2) (Day 3)
1. Customers

 Potential Shouldice patients learn about the hospital from previous Shouldice patients.
 Out of town patients cooperated in the mail diagnosis.
 Patients have to arrive at the clinic between 1pm and 3pm.
 Patients have to bring light luggage between them.
 Patients have to shave themselves in the place of the operation.
 Patients have to wake early on the day of the operation, at 5:30 am.
 99% of patients accept the invitation of the doctor, to walk out of the operating room and back to their room.
 Patients have to exercise on the afternoon after the operation
 During their stay, patients are encouraged to explore the premises and make new friends.
 They share their experiences with other patients.

2. Employees

 Surgeons perform hernia operations with the Shouldice Technique.

 Shouldice technique is accomplished through direct supervision by one or more of the senior surgeons.
 Former Shouldice patients suffering recurrences were assigned to the same doctor who performed the first operation.
 The Shouldice surgeon looks at the questionnaire and determines whether the patient needs the operation or not.
 The surgeons examine the arrived patients in the examination room
 Nurses provide the new patients with orientation and information about what to expect and exercise advice.
 Nurses empathized the importance of new patients to talk to postoperative patients
 Nurses administer Demerol and an analgesic.
 The surgeon administers Novocain.
 Doctors advice postoperative patients to walk to their rooms directly after surgery.
 Nurses walk the patients to their room instead of using the wheelchair
 Nurses and housekeepers encourage postoperative patients to exercise on the afternoon of the surgery
 Nurses staff Shouldice Hospital each 24-hour period
 Anesthetists float among cases
 Each surgeon typically perform three or four operations each day
  Surgeons not scheduled to operate in the afternoon examined incoming patients.
 A surgeon could expect to be on call one weekday night in ten and one weekend in 10.
 Dr. Obney looks for experience and a good education while hiring new surgeons.
 Surgeons and assistants were rotated every few days.
 The typical general surgeon performs 750 hernia operations per year.
 Housekeeping uses fresh ingredients and prepares the food from scratch.
 Nobody is hired, hence turnover is low.
 Each secretary is trained to do another’s job, so that if work needs to be done, they could pitch in.

3. Facility

 Shouldice hospital contains 2 facilities in one building, the hospital and the clinic.
 The hospital contains dining rooms, the kitchen, lounge, patient’s rooms and a glass covered Florida room.
 Every square foot of the hospital is carpeted to reduce the hospital feeling and the possibility of a fall.
 Carpeting also gives the place a smell other than that of the disinfectant.
 Parents accompanying children for an operation, stay for free.
 The clinic houses five operating rooms, a laboratory, and the patient recovery room.
 The anesthetists when needed use two mobile units.
 The complex has one crash cart per floor for use if a patient suffers a heart attack or a stroke.
 The hospital has reasonable rates.
 The hospital provides annual checkups for alumni, free of charge.
3. As Dr. Shouldice, what actions, if any, would you like to take to expand the hospital’s capacity, and how would you implement
such changes?

 I would add another floor in the hospital facility, to accommodate more rooms for patients.
 I would hire part time surgeons to work on the weekends (Saturday and Sunday). This will enable new surgeons to
work weekends without driving a wedge between the old staff.
 I would add an extra clinic facility, to accommodate more operating theatres and thus more patients.
 I would open another Shouldice Hospital in the United States, in North America, since most of the patients come the
United States, and North America will be the perfect place, close to Canada, in order not to lose management control.