SHOULDICE HOSPITAL LIMITED (ABRIDGED) Shouldice is a private hospital founded by Dr. Earle Shouldice in Toronto in July 1945. The hospital started out as a six-room nursing home in downtown Toronto. As demand

increased for hernia operations, he expanded the facilities to a capacity of 36-beds, which turned into a 89-bed facility after adding a large wing. Dr. Shouldice devised a method called the

Shouldice method to increase the efficiency and the overall experience of the surgery and the post surgery recovery period. The hospital specializes on external hernia cases and will not treat internal hernia patients. The method proved to be a big success.

Dr. Earle Shouldice is a famous operator for his private method of hernia surgery. Unlike normal methods, his way allowed the patient to walk around right after the end of surgery, and move freely at the end of the day. When the number of patients he had increased, he decided to exploit this by founding his own hospital. He died in 1965, but his hospital continued to grow, and at the end of 1982, his hospital had 6850 operations per year.

Initially, the hospital sends out a medical questionnaire to figure out whether the patient has hernia. If the patient requires the operation, they were sent a confirmation card for the surgery. However, after initial examination at the hospital, some of the patients were found healthy, so they were also sent back. After the examination, administrative personnel check the insurance of the patient. Then, a nurse takes blood and urine samples from the patient, and sends the patient to his room. All this is done by 5PM, after which there is an information session regarding the operation. The patients are sent to bed at 9:30PM, and waken up at 5:30AM. The operation takes 1 hour. A few patient were "chatty" and fully aware of what was going on,

patient were invited to get off the operating table and walk to the post-operating room with the help of their surgeons. Ninety nine percent accept the surgeon's invitation. Patients are asked to stay an extra day. During their stay, patient were encouraged to take advantage of the opportunity to explore the premises and make new friend.34 full-time-equivalent nurses staffed Shouldice each 24 hour period. Shouldice ratio of nurses is 1:15. The hospital employed 10 fulltime surgeons and 8 part-time assistant surgeons. Two anesthetists were also on site. A typical surgeon's day started with a scrubbing shortly before the first scheduled operation at 7:30 a.m. A surgeon could expect to be on call on weekday night in ten and one weekend in ten. The 10 full surgeons were paid a straight salary, typically $1, 44,000. Bonuses to doctors were distributed monthly. These depended on profit, individual productivity and performance. Training in the Shouldice techniques was important because the procedure could not be varied. It was accomplished through direct supervision by one or more of the senior surgeons. The shouldice hospital contained two facilities in one building - the hospital and the clinic. In the first level hospital contains the kitchen and dining rooms. Second level contains a large open lounge area, the administrations offices, patient rooms, and a spacious glass-covered Florida room. The third level contains additional patient rooms and recreational areas. The clinic housed 5 operating rooms, a laboratory, and the patient-recovery room. The complex had 1 " crash cart" per floor for use if a patient should suffer a heart attract or stroke. In this hospital there are no organizational chart, so that there is no hierarchy. The hospital relied entirely on word-of-mouth advertising. Patients were attracted to the hospital, in part, by its reasonable rates. They are facing some problem in operating in a special method. A Canadian Hospital is coping their method of operating, so the management of the hospital keeps care on its quality of service delivered, the future role of government in the operations of the hospital and the use of the Shouldice name by

potential competitors. They now fear to provide the brochure to their patient and don't give it unless they request for it. It simply figure outs their popularity.