Shouldice Hospital - Case Analysis

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Dr. Shouldice established a speciality hospital in 1945 near downtown Toronto, Ontario, for the treatment of hernia with a special focus on primary hernia. Starting as a small six room nursing home in 1945 the hospital grew over the years to become an 89 bed facility by 1982. Dr. Shouldice's seminal contribution was to develop a surgical technique for the treatment of hernia which proved to be far superior to the existing practice and had crystallized from his observations over the years that quick and early ambulation following the operation expedited the trouble free recovery process. This surgical technique, popularly known as the 'Shouldice technique' was based upon incorporating operative and post operative processes such as the "use of local anaesthetics, the nature of surgical process itself, the design of a facility to encourage movement without unnecessarily causing discomfort and the post operative regimen designed and communicated by the medical team", which facilitated early ambulation. The entire process significantly reduced the stay in the hospital for the patients and facilitated their early return to their jobs. It was also the cheapest option available to the patients. Besides, the entire experience of staying in the hospital itself was a pleasant experience for the patients. This constituted a major "value proposition" for the patients who themselves provided "word of mouth" publicity of the benefits and experience undergone by them at the hospital and contributed greatly towards the success of the Shouldice Hospital.


Facts of the case reveal that the Shouldice hospital had acquired a huge reputation of a hospital which offered reliable and quality medical facility for the treatment of hernia at a very cheap cost. This had also led to the expansion of the hospital from a modest beginning into a modern facility which carried out 6850 operations in 1982. We carried out the SWOT analysis for the Shouldice Hospital which reveals the following:


Unique and pioneering surgical technique for Hernia operation which considerably reduced the suffering of the patients and led to much quicker recovery as compared to the existing methods. The Shouldice technique enabled the patients to resume their normal routine and jobs in a much shorter period of time ( one to four weeks) as compared to other hospitals ( two to eight weeks).

Standardisation of operating procedures which led to efficient utilisation of the medical staff and other resources. Doctors could conduct 600 operations in a year as compared to 25 to 50 operations per year in other hospitals.

Experienced doctors and nursing staff through careful recruitment philosophy wherein experience, good education, knowledge about domestic situation, personal interest and habits (consciously avoiding people with drinking and drug problems), and their willingness to adhere to the shouldice technique were evaluated to match their value systems with that of the hospital.

'Un-hospital' like experience for patients through measures such as carpeting the hospital that gave the place smell other than that of disinfectant. And encouraging interaction and recreational activities amongst the patients and also with the hospital staff made the stay of the patients a pleasant experience. Matching of roommates based on similar background and the scheduling of their operation at the same time are examples and care exerted to create a friendly and warm environment which is believed to lead to faster recuperation. They developed feeling of belongingness to the hospital during the stay. These patients also proved to be the main source of 'advertising' for the hospital through 'word of mouth' publicity.

Unique recuperating techniques that stressed upon ambulation led to minimizing the cost by cutting down on various post operative patient care activities such as the reduction...
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