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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
OPERATING SYSTEMOPERATING SYSTEM
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
OPERATING SYSTEMOPERATING SYSTEM
DETAILSDETAILS
1) Direct access :no referralnecessary
2) Screeningsystem : qualifiespatients
3)Bookingsystem: insuresconsistent flow
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OPERATING SYSTEM
DETAILS
OPERATING SYSTEMOPERATING SYSTEM
DETAILSDETAILS
1) Direct access :no referralnecessary
2) Screeningsystem : qualifiespatients
3) Bookingsystem: insuresconsistent flow
4) Admittingsystem: individualprocess > funnel
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OPERATING SYSTEM
DETAILS
OPERATING SYSTEMOPERATING SYSTEM
DETAILSDETAILS
1) Direct access :no referralnecessary
2) Screeningsystem : qualifiespatients
3) Bookingsystem: insuresconsistent flow
4) Admittingsystem: individualprocess > funnel
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
OPERATING SYSTEMOPERATING SYSTEM
DETAILSDETAILS
1) Direct access :no referralnecessary
2) Screeningsystem : qualifiespatients
3) Bookingsystem: insuresconsistent flow
4) Admittingsystem: individualprocess > funnel
5) Orientation :group process,surgery assigned
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
1) Direct access :no referralnecessary
2) Screeningsystem : qualifiespatients
3) Bookingsystem: insuresconsistent flow
4) Admittingsystem: individualprocess > funnel
5) Orientation :group process,surgery assigned
6) Pre-op therapy:dinner, buddysystem
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
1) Direct access :no referralnecessary
2) Screeningsystem : qualifiespatients
3) Bookingsystem: insuresconsistent flow
4) Admittingsystem: individualprocess > funnel
5) Orientation :group process,surgery assigned
6) Pre-op therapy:dinner, buddysystem
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.