Gmp smrm sec_b_group6_shouldice


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Gmp smrm sec_b_group6_shouldice

  1. 1. Shouldic e Hospital Case Section B Group 6 Anshuman Jaiswal G09051 Devendra Gondane G09056 Milind Khadke G09066 Sridhar Thiagarajan G09089
  2. 2. XLRI GMP 2009-10 Section B Group 6 1. What is the core service, funding mechanism, employee management system and customer management system for shouldice? Core service of Shouldice Hospital We think the hospital’s core service is the experience the patient gets during his treatment for a hernia. The Hospital has specialized in treating patients of external hernia using a special technique performed under local anesthesia and sedation. This allowed the patients to be ambulatory immediately after the surgery and reduced the length of stay of the patient in the hospital as well as the cost of surgery and stay at the hospital. The patients were mobilized immediately after the surgery, right from the operation table, which gave them confidence to be active the whole day after that. The patients operated on a particular day interacted with the patients to be operated the other day, thus motivating them and allaying their anxiety about the surgery. The patients were also allowed to interact with the staff members over lunch and constantly kept moving out to have recreation or make calls to their loved ones. The hospital floors were carpeted which not only gave the patients a feeling different from other typical hospitals but also protected them in cases of accidental fall. They were discharged immediately on the morning of the fourth day. Thus the core service provided by the hospital was an experience which the patients of hernia had before, during and after their surgery in the hospital in a highly interactive and motivating environment. Funding Mechanism The hospital performed around 7600 surgeries in a year and would charge the patient just $970 for the surgery and the room rent of $320 for a day. Thus the four day stay of the patient and the surgery would cost the patient just (320*3 + 970) = $1930 and an additional $300 if general anesthesia is required (20% of the total cases). Thus the hospital worked on the principle of attracting volume and giving standardized care to all patients. Every year it made a profit of approximately $3 million- calculations shown below 3 days Stay Number of surgeries 7600 Revenue per patient 1930 additional revenue from anesthesia charges 300 146680 Total revenue from surgeries 00 2
  3. 3. XLRI GMP 2009-10 Section B Group 6 Revenue from anesthesia (20%) 456000 151240 Total revenue 00 850000 Operating cost of hospital 0 350000 Operating cost of clinics 0 120000 Total Cost 00 312400 Profit per year 0 Thus the hospital has self funding and sustainable. Employee management The hospital has maintained the service profit chain by keeping its employees happy and satisfied and gaining the employee engagement. Good work environment and professional satisfaction of the employees guaranteed their professional loyalty which in turn resulted in high quality service. This was valued by the client and thus resulted in patient satisfaction and thus profits to the hospital. Also the word of mouth effect on the hospital popularity was very high. Doctors: There are 10 full time doctors and 8 part-time assistant surgeons with two anesthetists in the hospital. Each doctor performed 3-4 surgeries a day and worked five days a week with very few weekend calls and still getting much more salaries than their counterparts in any other hospital in Toronto. Moreover, they could spend sufficient time with their families as their day at work ended at just 4 pm. They also shared hospital profits in the form of bonus. Surgeons had to follow the same technique for every surgery and could get help of seniors in difficult cases. The cases of recurrences of hernia in operated patients were assigned to the same doctor who operated him previously to allow them to learn from their mistakes. Nurses- Nurses also enjoyed working at Shouldice as their main job was to counsel and motivate the patients rather than providing bed pans. Due to this the hospital is able to manage the operations with only 34 nurses, though there is a big waiting list of nurses wanting to be hired. Housekeeping staff is also required to change the linens once in four days and played a major role in mobilizing the patients. The patients had their 3
  4. 4. XLRI GMP 2009-10 Section B Group 6 meals in the cafeteria and no room service personnel had to be employed. All the administrative and support staff received higher pay scales than other comparable jobs and shared the profit of the hospital. So they were all satisfied and loyal. Also multitasking is encouraged in the hospital so that emergencies can be tackled efficiently. Customer management system Around 10% of the patients came from United States and 60% from outside Toronto. The diagnosis of hernia was done on the basis of questionnaire and the patients are given the date for surgery. In this way the patient need not visit the hospital twice for diagnosis and treatment. After their arrival, the patients were motivated to interact with those who had already been operated on the same day. The anesthesia was limited to local anesthesia and sedation so that the patient can be mobilized right from the operating table after the surgery. The nursing and housekeeping staff kept motivating the patients to move around. The patients could move freely inside the hospital, make new friends and enjoy the recreation facilities inside the hospital. On the fourth day morning the patient could go home. The pricing pattern of the hospital was same for all the patients and allowed the patient to save at least $3000 from the surgery. Thus, the customers were managed in a very different way than other hospitals which made them so happy that the hospital relied entirely on word of mouth advertizing. 2. The Hospital is severely constrained for space. Could you make a throughput analysis? Throughput analysis Patient is first diagnosed of hernia through a questionnaire that is mailed to the patient, following which a date for surgery is given. From the day of his arrival the patient undergoes the following- Day-1 1pm-3pm Arrival at the hospital and check up by surgeons 3pm-4.30pm Occupy their allotted rooms 4.30 pm Nurses' orientation Evening Dinner 9pm Tea and cookies with recreation and interaction with patients operated on same morning Day-2 5.30am Sedation tablet given 7.30am First patient for surgery patient walks to the recovery room straight from the 8.30 am operation table 4
  5. 5. XLRI GMP 2009-10 Section B Group 6 Evening Dinner Tea and cookies and interaction with newly admitted 9pm patients Day-3 Whole day Making new friends and recreation. Day-4 Morning Discharge A patient is released on 4th day morning and hence cycle time is 3 days. In a year 7600 patients are operated. Daily 30-35 patients are operated. Thus daily 30-35 patients are discharged in the morning and another 30-35 patients are admitted in the afternoon. Total capacity of the hospital is 89. In 250 working days in the year (excluding Saturday and Sunday) 30 patients are changed every day. Each patient stays for 3 days so the total turnover of patients per year is 30*250=7500 (app.). There is a total waiting list of 2400 patients and the waiting list is increasing by 100 every six months. If the patient is discharged immediately on the next day after the surgery then the total patients that can be treated by the hospital in a year will be approximately 11000. This will have an effect in decreasing the waiting list as well as increasing the revenues. 3 days 2 day Stay Stay Number of surgeries 7600 11350 Revenue per patient 1930 1610 additional revenue from anesthesia charges 300 300 146680 182735 Total revenue from surgeries 00 00 Revenue from anesthesia (20%) 456000 681000 151240 189545 Total revenue 00 00 850000 935000 Operating cost of hospital 0 0 350000 385000 Operating cost of clinics 0 0 120000 132000 Total Cost 00 00 312400 575450 Profit per year 0 0 5
  6. 6. XLRI GMP 2009-10 Section B Group 6 25.33 Increase in revenues % 84.20 Increase in Profits % 3. The hospital is considering increase in capacity and has 3 options A. addition of a floor b. Make Saturday Working c. Open another Hospital You need to evaluate each of the options from funding mechanism; customer management and employee management a. Addition of Floor – Hospital campus is spread over 130 acres and building is 17000 sq ft big. This is big enough space for operating 89 bed hospital. Addition of another floor would he an easy option as compared to other options as service delivery and culture of Hospital can easily be preserved but there is uncertainty over Government Regulations and it is not clear whether it applies to expansion of existing facility. It would perhaps be cheaper as compared to opening another hospital. b. Make Saturday Working - Making Saturday working is less preferable option as it would increase the capacity by 20% because of divide in opinion among older and younger doctors. Also, current chief Surgeon, Dr Degani is against Saturday working. Although this seems to be a minor issue, but in reality it has a big impact on Doctor’s experience. A doctor repeatedly follows a standard procedure and misses on variety but enjoy better pay and more time for family. Hence, Making Saturday working leads to dissatisfaction among doctors and internal staff, which very crucial in maintaining the excellence in service delivery. c. Open another Hospital - A new hospital could be started in Toronto, any other Canadian city or in US as 10% of customers come from US. There are some regulations which are casting doubts in considering this option. Opening hospital in other Canadian cities or US poses a tremendous challenge in terms of replicating the Doctor-Patient-Nurse –Experience. The unique procedure, staff motivation, doctors dedication is not easily transferrable and hence, chance of brand dilution and service compromise is huge. If we open another 45 bed hospital(50% expansion) we can perform incremental 3800 operations/ year or 315 operations per month and hence would be able to clear backlog in 8 months and would carry surplus capacity thereafter as growth of patients is 2% per year and hence would require extensive marketing and advertising to consume the surplus created. This option is market oriented but sophistication involved in replication of services would make it non preferable choice. Since, Hospital is profitable, 6
  7. 7. XLRI GMP 2009-10 Section B Group 6 it can fund $4mn but creating same customer management levels and employee management would be a challenge. Among the three options, Addition of floor or expansion of existing hospital is preferred but there is another option which could be considered and we think is most optimized solution. Another Option: Currently, the patient stays for 2.5 days and is discharged on the 4th day. If we notice the patient is active the very day of operation and hence extra day of stay could be avoided. Hence if we cut down the stay from 2.5 to 1.5 days and start discharging on 3rd day morning instead of 4th day morning, we can create additional capacity as follows: Current procedure takes 2.5 days and hence 100 units of operations in 250 days (Sat and sun are off) in a year. Hence, if we reduce the unit of operation by one day, we should create extra 30 free beds for patients to occupy on alternate days which means if add doctors and nursing staff and expand capacity to 60 from 30 operations per day, we could boost the capacity by internal productivity Incremental Current System Proposed system operations 1st day admit 30 admit 60 0 2nd operate 30, admit 30, operate 60, admit 30, day free 30 beds free bed =0 30 3rd relax 30, admit 30, admit 60, operate 30, day operate 30 free bed =0 0 4th operate 60, admit 30, day free bed =0 30 This means we will able to operate 30 extra operations on every alternate day translating into 125 days * 30 = 3750 incremental operations per year. This can clear waitlist in 7 months. This is alternative solutions which could be considered. This model is based upon using the internal capacities to fullest and is based on fact that early ambulation and discharge seems to be possible the very next day of operation. 7
  8. 8. XLRI GMP 2009-10 Section B Group 6 4. This is a typical case which discusses "Reach" versus “Richness" concept. Could you draw up a positioning map of the hospitals/ Medical Services/ Doctors you know on these parameters? R I Clinic owned by Doctor(s) and ? C Standalone Hospital like H Hospital N Chains such Doctors as Apollo E practicing Governmen Alternate t Hospitals S S R E A C H Based on concepts of Rich versus Reach, we can position various medical service providers as shown above. Medical service providers 1. Limited Reach, and Highly Rich/custom service a. Clinic Owned by one Doctor b. Clinic Owned by group of Doctors c. Standalone Hospital 2. Medium Reach, and Medium Rich/custom service a. Hospital Chains such as Fortis and Apollo 3. High on Reach, and Low on Rich/custom service a. Government Hospital in Indian Context 4. Low on Reach and Rich/custom service 8
  9. 9. XLRI GMP 2009-10 Section B Group 6 a. Doctors practicing alternate medicines 9