Operations Management

Question

As Dr. Shouldice, what actions, if any, would you take to expand the hospital's capacity?

Answer

Currently, Shouldice Hospital is operating at its “best operating level”. However, according to Dr.
Shouldice, “Every time we have expanded our capacity, the backlog has declined briefly, only to
climb once again.” Also, the inclusion of additional doctors and staff may lead to lower service
quality since at Shouldice hospital, a surgeon learns the Shouldice technique over a period of several
months developing a pace, a touch and learning to achieve absolute perfection minus any risks.

In light of the above facts, the following actions may be taken by Dr. Shouldice to expand the
hospital’s capacity:

1. Establish a new facility for Hernia

2. Add Saturday operations
3. Add a new floor increasing capacity by 45 beds, and schedule the operating rooms more
heavily
4. Diversify into other specialties

Question

How would you implement changes you propose?

Answer

Case 1: Establish a new facility for Hernia

The total duration of a patient’s stay is 4 days including the postoperative time. However, local
residents or children could be released a day early. This would allow for admission of additional
patients. If the number of operations performed per day can be increased further, the capacity of
the hospital can be expanded. The selection of the location of the new facility must be ascertained
after analysing the cities on the North American continent that the current patients’ hail from.
However, this course of action requires additional investment and a thorough feasibility analysis
must be conducted before adopting it.

Case 2: Add Saturday operations

Operating on Saturdays will enable scheduling of more surgeries, and also releasing patients who
were arriving late in the week and had to stay the weekend. However, this action would increase the
workload on operating doctors and assisting nurses. It also violates the understanding that Shouldice
had with its surgeons about no surgeries on weekends.

But, scheduling Saturday operations needs no additional investment and the hospital can maintain
control over the quality of operations

Case 3: Add a new floor increasing capacity by 45 beds, and schedule the operating rooms more
heavily
The addition of new floor in the Toronto facility would cater to the increasing demand maintaining
control and quality, and at the same time retaining the culture of the hospital. This action would
increase workload on admissions, kitchen, laundry, housekeeping and accounting staff. The
scheduling of operating rooms more heavily can increase the no. of operations per day to 40
(working mentioned below):

Total duration of an operating doctor’s working day = 9 hours

Assuming the ratio of routine hernia operation (operating time 60 minutes) and recurrence hernia
operation (operating time 90 minutes) = 3:1 (as given in the case)

Now, total available operating time per room = 540 minutes

Therefore, total hernia operations that can be scheduled within a day = (6 routine operations * 60
minutes) + (2 recurrence operations * 90 minutes) = 540 minutes

Thus, optimal rotation of surgeons can allow 40 operations to be performed within a day with
sufficient suggested breaks.

Case 4: Diversify into other specialties

Shouldice Hospital is known for expertise in Hernia operations, and patients choose it ahead of
others for this very reason even though Shouldice Hospital does not market and advertise.
Therefore, considering the current change of leadership (the selection of someone to succeed Dr.
Obney) that the hospital might face, it would be best for the hospital to increase capacity in their
field of expertise, and not diversify into other specialties.

Therefore, considering the options, adopting either addition of Saturday operations or addition of a
new floor increasing capacity by 45 beds, and scheduling the operating rooms more heavily would
be the best course of action for Shouldice Hospital