Harvard Business Case Case Study

Excerpt from Case Study :

Harvard Case

Shouldice Hospital: A Case Study in Expansion

The Shouldice Hospital, as it is described in the case analysis serving this discussion, is a highly progressive hernia treatment facility which not only specialized in this particular surgical procedure but which also provides a unique setting for convalescence. Through the promotion of ambulatory recovery and the creation of a context which is both clinically excellent and highly social, Shouldice offers a positive healing environment. The hospital experiences good results, positive patient feedback and a successful business model. Indeed, as confirmed by the Navjeevan Hospital (2011) sponsored Hernia Help Center, "Ambulatory Hernia surgery allows patients to walk as much as possible, which helps in faster recovery." (Navjeevan Hospital, p. 1) The positive outcomes and glowing reputation associated with the mode of surgery and the Shouldice Hospital respectively are central to this discussion. As the account hereafter will demonstrate, the greatest challenges before Shouldice largely involve finding ways to better sieze on and build upon its successes.

Major Issues:

Many of the most pressing organizational issues facing Shouldice involve the hospital's continuing growth. For the hospital's chief administrator, Alan O'Dell and for Dr. Shouldice (son of the founding Dr. Shouldice), most of the challenges facing the healthcare facility involve handling an constantly growing backlog of prospective patients. In response to this and several other growth-related needs, Dr. Shouldice indicated the need to increase "the hospital's capacity while at the same time maintaining control over the quality of the service delivered, the future role of government in the operations of the hospital [and] the use of the Shouldice name by potential competitors." (Heskett, p. 11)

Essentially, this denotes that the area in which Shouldice most needs to improve is in remaining abreast of market opportunities as they continue to emerge. This is especially true given both the commonality of the procedure and the increased popularity of the minimally invasive procedure in which the Shouldice facility specializes. According to the article by Landro (2012), more than one million patients a year undergo a hernia repair procedure. Landro goes on to indicate that "studies show that patients undergoing minimally invasive surgery have a quicker recovery and less short-term pain than with open repair." (Landro, p. 1)

This denotes the healthy marketplace within which Shouldice operates, as does the hospital's own difficulty in keeping up with prospective patient backlogs even as it has taken steps for modest expansion of its capacity. Though it certainly can be argued that this is a good problem to have, there is reason to suggest that the accommodation of market demands is necessary for the long-term survival of the hospital's unique treatment and recovery model. Long patient backlogs and growing wait times for threaten to undermine the characteristic efficiency and accommodation that are part of the Shouldice approach.

Research also confirms that patients and healthcare researchers are increasingly finding cause to support the ambulatory care philosophy in which the Shouldice Hospital's treatment regiment is rooted. For instance, a study by Dhumale et al. (2010), finds of the ambulatory hernia procedure that in the scope of its study, "complication rates were low and similar to those obtained in other specialist hernia units. More than 90% of patients were satisfied with the service and would recommend it to a friend." (p. 127)

This denotes that Shouldice hospital can anticipate continued expansion in its market niche. This, in turn, should suggest that its patient backlog will only continue to grow. There is not only a need to address the growing demand for its services but there is likely to be a continuing need for Shouldice to address constantly advancing market demand for its particular area of specialization.

Another issue noted by the case study is that while Shouldice has been innovative in its approach to patient recovery and socialization, it has also become somewhat complacent as a consequence of its success. Consistently positive treatment outcomes have prevented Shouldice from otherwise pursuing improvements in either its procedural approach or the orientation of its personnel. The demand to expand its treatment capacity should also be seen as an opportunity for changes in its medical proceduralism. The fact that, according to Dr. Shouldice, the hospital must bring onboard a new chief surgeon denotes a particular opportunity for this change.


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