Post on 05-Mar-2016
description
*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?