Standardizing Operation Technic - The History of Shouldice

8/7/2019 Standardizing Operation Technic - The History of Shouldice

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SHOULDICE HOSPITALSHOULDICE HOSPITALSHOULDICE HOSPITAL


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Deconstruct the problem into its parts Deconstruct the problem into its parts

NoNo ORsORsNo bedsNo beds

No nursesNo nursesNo hospitalNo hospital

Dr.Dr. ShouldiceShouldice ss ProblemProblem

19451945


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CartesianCartesian AnalogicAnalogicDeconstructionDeconstruction SolutionSolution

NoNo ORsORs ERER

No bedsNo beds

Fraternity houseFraternity house

No nursesNo nurses Medical studentsMedical studentsand other patientsand other patients

No hospitalNo hospital ClinicClinic healthy patientshealthy patients

Change your way of thinking


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FOCUSED HOSPITALFOCUSED HOSPITAL

FocusFocus Abdominal herniasAbdominal hernias

OptimizeOptimize Physical environmentPhysical environment --stairs, hills, billiards, showerstairs, hills, billiards, showerLessLess capital in the ORcapital in the OROneOne techniquetechnique

Continuous LearningContinuous Learning Consultation / FollowConsultation / Follow --upup

C onstraints can facilitate solutions


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SHOULDICE MODELSHOULDICE MODEL

Corporate Structure

Medical DivisionPrivate Practice

Hospital DivisionEmployees

Global BudgetSupplies

Corporate DivisionLicense

Assets

Shouldice Hospital Limited


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SHOULDICE HOSPITALSHOULDICE HOSPITAL


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Now multiple stand aloneclinics outside the mothership

Heart Institute


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PRODUCTIVITY from theFOCUSED HEALTH CARE

MODEL

PRODUCTIVITY from thePRODUCTIVITY from theFOCUSED HEALTH CAREFOCUSED HEALTH CARE

MODELMODELCan the Focused Health Care model provide forthe three main tenets of the modern health care

system?

High Quality (Better)

Affordability (Cheaper)

Accessibility (Faster)


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Quality ControlQuality Control


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SCIENTIFIC MANAGEMENTSCIENTIFIC MANAGEMENTSCIENTIFIC MANAGEMENT

Principles developed in 1911

Frederick Taylor - Labourer & Engineer

Midvale Steel Company

Specialization and repetition lead toimproved performance

True for individuals and fororganizations


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THE FOCUSED FACTORYTHE FOCUSED FACTORYTHE FOCUSED FACTORY

Simplicity and Repetition Breed Simplicity and Repetition Breed Competence Competence

Wickham Wickham Skinner 1974 Skinner 1974

An organization totally dedicated to a single, simple An organization totally dedicated to a single, simple process, achieving superior quality through high process, achieving superior quality through high

volumes.volumes.


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SUCCESS FROM DETAILSUCCESS FROM DETAILSUCCESS FROM DETAIL

while the while the focused focused part of the focused factory part of the focused factory is essential, it is the details of the factory is essential, it is the details of the factory s s

operating system that makes the difference operating system that makes the difference between success and failure.between success and failure.

Regina Regina Herzlinger Herzlinger 1997 1997


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SHOULDICE CUMULATIVESHOULDICE CUMULATIVERECURRENCE RATE BYRECURRENCE RATE BYPERCENTAGE (1.05%)PERCENTAGE (1.05%)

0123456789

1011121314151617181920

1945 1953 1961 1969 1977 1985 1993 2001


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OPERATING SYSTEM

DETAILS

OPERATING SYSTEMOPERATING SYSTEM

DETAILSDETAILS1) Direct access :no referralnecessary


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OPERATING SYSTEM

DETAILS


DETAILSDETAILS

1) Direct access :no referralnecessary

2) Screeningsystem : qualifiespatients


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MEDICAL QUESTIONNAIREMEDICAL QUESTIONNAIRE


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MEDICAL QUESTIONNAIREMEDICAL QUESTIONNAIRE


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OPERATING SYSTEM

DETAILS


DETAILSDETAILS



3)Bookingsystem: insuresconsistent flow


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OPERATING SYSTEM

DETAILS


DETAILSDETAILS



3) Bookingsystem: insuresconsistent flow

4) Admittingsystem: individualprocess > funnel


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OPERATING SYSTEM

DETAILS


DETAILSDETAILS





5) Orientation :group process,surgery assigned


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THE SHOULDICE EXPERIENCETHE SHOULDICE EXPERIENCEORIENTATIONORIENTATION

A bonding processA bonding process


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OPERATING SYSTEM

DETAILS


DETAILSDETAILS






6) Pre-op therapy:dinner, buddysystem


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PREPRE --OP / RECOVERYOP / RECOVERY


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OPERATING ROOMOPERATING ROOMPROCESSPROCESS


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OPERATING ROOM SETOPERATING ROOM SET --UPUP


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SURGERYSURGERYLOCAL ANAESTHESIALOCAL ANAESTHESIA


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PORTABLE CRASH CART &PORTABLE CRASH CART &ANAESTHESIA EQUIPMENTANAESTHESIA EQUIPMENT


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PATIENT DRAPEPATIENT DRAPE


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SURGICAL PACKSURGICAL PACK


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SURGICAL BUNDLESSURGICAL BUNDLES


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SURGICAL BUNDLESURGICAL BUNDLECUPBOARDCUPBOARD


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SUTURE MANUNFACTURINGSUTURE MANUNFACTURING


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SUTURE MANUFACTURINGSUTURE MANUFACTURING

WEWE RE LIKE ARE LIKE ALITTLE FACTORYLITTLE FACTORY


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ININ--HOUSE LAUNDRYHOUSE LAUNDRY


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Average General HospitalAverage General Hospital -- $250.00$250.00 -- $850$850

Mesh RepairMesh Repair -- TrelexTrelex -- $ 140.00$ 140.00Mesh RepairMesh Repair -- Composix SComposix S -- $345.00$345.00Mesh RepairMesh Repair -- Composix LComposix L -- $945.00$945.00Standard Shouldice RepairStandard Shouldice Repair -- $17.82$17.82

DISPOSABLE COSTS PERDISPOSABLE COSTS PER

OPERATION Cdn$OPERATION Cdn$


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OPERATING SYSTEM

DETAILS

OPERATING SYSTEMOPERATING SYSTEMDETAILSDETAILS







7) Surgery:assembly lineprocess, 5 ORs

8) Post-op care:routine process,buddy system


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THE ROAD TO RECOVERYTHE ROAD TO RECOVERY

Morning stretches help patientsMorning stretches help patientswith daywith day --toto --day mobilityday mobility


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BASIC ROOMBASIC ROOM


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OPERATING SYSTEM

DETAILS

OPERATING SYSTEMOPERATING SYSTEMDETAILSDETAILS







7) Surgery:assembly lineprocess, 5 ORs

8) Post-op care:routine process,buddy system

9) Follow-up:annual contact forlife of patient


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FOLLOWFOLLOW --UPUP

Annual FollowAnnual Follow --Up With Every PatientUp With Every PatientFor The Rest of Their LifeFor The Rest of Their Life

What is the value of followWhat is the value of follow --up?up?Provides Professional Medical ResearchProvides Professional Medical Research

Helps us to Deliver our ServiceHelps us to Deliver our ServiceAllows us to Touch the Patient RegularlyAllows us to Touch the Patient Regularly

Provides Continuing Confidence in the Service ProductProvides Continuing Confidence in the Service Productfor Both Provider and Clientfor Both Provider and Client


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FOLLOWFOLLOW --UPUP

How Far Do We Go to FollowHow Far Do We Go to Follow --up?up?

Over 130,000 FollowOver 130,000 Follow --up Letters Annuallyup Letters Annually

Five Travelling Clinics AnnuallyFive Travelling Clinics AnnuallyDaily Internet / EDaily Internet / E --mail Servicemail Service

Annual Shouldice Patient Alumni ReunionAnnual Shouldice Patient Alumni ReunionUp to 1500 have attendedUp to 1500 have attended

Annually since 1947Annually since 1947

12,000 Patient Follow12,000 Patient Follow --Up Exams per YearUp Exams per Year

Free Exams for International PatientsFree Exams for International Patients


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RELATIONSHIP TREERELATIONSHIP TREE

Shouldice ApostleShouldice Apostle

Patient referralPatient referral

InitialInitialcontactcontact

InternalInternalcoordinationcoordination

SecondSecondcontactcontact

Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing,Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc..

Booking forBooking forsurgerysurgery

AdmissionAdmission

ShouldiceShouldiceExperienceExperience

FollowFollow --upupReferralReferral


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THE FRUITSTHE FRUITSofof

The RELATIONSHIP TREEThe RELATIONSHIP TREEApostles!Apostles!


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RELATIONSHIP TREERELATIONSHIP TREE

Shouldice ApostleShouldice Apostle

Patient referralPatient referral

InitialInitialcontactcontact

InternalInternalcoordinationcoordination

SecondSecondcontactcontact

Government funding and licensing, Marketing, Private financing,Government funding and licensing, Marketing, Private financing,Management/ownership, Human resources, Suppliers, Lawyers, etc..Management/ownership, Human resources, Suppliers, Lawyers, etc..

Booking forBooking forsurgerysurgery

AdmissionAdmission

ShouldiceShouldiceExperienceExperience

FollowFollow --upup Competitors Competitors

Procrastinators Procrastinators Complications Complications

ReferralReferral


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APPOSTLES !APPOSTLES !


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THIRD PARTY REFERRALSTHIRD PARTY REFERRALS


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Q1 Q3Q2

At Admission2-3 days post

Surgery1-Month post

Surgery

SURGERY

Canadian patients

n = 391n = 445n = 490


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Level of Satisfaction andLevel of Satisfaction andOverall Service QualityOverall Service Quality

9.1 9.2

44.5

55.5

66.5

77.58

8.59

9.510

Level ofSatisfaction

OverallServiceQuality

Delighted

Satisfied

ExtremelyHigh Quality

GoodQuality


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8.68.5

9.39.2

9.6 9.6

7.88

8.28.48.68.8

99.29.49.6

Average Good Excellent

Service Quality Satisfaction


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PATIENTSPATIENTS REUNIONREUNION


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CIHI ComparisonResource Intensity Weighted

CIHI ComparisonCIHI ComparisonResource Intensity WeightedResource Intensity Weighted

Total RIW = .83Total RIW = .83 RIW = .8RIW = .8Avg cost/case = $2,800Avg cost/case = $2,800 Avg cost/case = $1,100Avg cost/case = $1,100Incl. in & out patientIncl. in & out patient 100% in100% in --patientpatientCost/diem = $1000.00Cost/diem = $1000.00 Cost/diem = $350.00Cost/diem = $350.00

Total Savings per case = $1,700.00Total Savings per case = $1,700.00

Potential cost savings in Ontario @ 31,000 casesPotential cost savings in Ontario @ 31,000 casesper year > $50,000,000/yrper year > $50,000,000/yr

General HospitalGeneral Hospital Shouldice HospitalShouldice Hospital


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Results AnalysisResults AnalysisResults Analysis

Consistently higher quality of health careConsistently higher quality of health care10% avg recurrence rate (ten yrs)10% avg recurrence rate (ten yrs)30% average complication rate as30% average complication rate asper NEJM April 2004per NEJM April 2004

Lower CostsLower Costs< 35% of average per diem cost per case< 35% of average per diem cost per case

Employee and Customer LoyaltyEmployee and Customer Loyalty

> 12 yrs. avg. tenure> 12 yrs. avg. tenure> 96% of patients are referrals. Previous> 96% of patients are referrals. Previouspatients (49%), professionals (34%),patients (49%), professionals (34%),acquaintances (13%), web & articles (4%)acquaintances (13%), web & articles (4%)


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ConclusionConclusionConclusion

The Focused Health Care Model canmeet the three main tenets of a

modern health care delivery system.High quality (Better)

Affordability (Cheaper)

Accessibility (Faster)


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THE SHOULDICE EXPERIENCETHE SHOULDICE EXPERIENCE

A manifestation of emotional, physical and interactiveA manifestation of emotional, physical and interactiverelationships, orchestrated in a safe environment, built onrelationships, orchestrated in a safe environment, built onfocus, confidence, trust and success.focus, confidence, trust and success.

Standardizing Operation Technic - The History of Shouldice

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