However, their taking of opposite sides was a reason of concern. It might have led to dissensions between the doctors. The Shouldice hospital is very successful among the persons suffering of hernia problems. This is due to the proficiency of the doctors which work there, the high standards that they respect. The surgeons are employed only after a close interview with Dr. Obney. When selecting them, he takes into consideration the following aspects: they should have experience and a good education. They should develop a pace and a touch; they should be aware of the moments when speed is necessary, or when it is better to go slow. The most important issue is that they repair exactly as told and they ask for help whenever something unusual occurs. On account of their skills, the surgeons perform about 600 hernia operations per year, comparatively with others which complete 25 to 50. Other employees are also important for the service because they establish relationships with the patients, enabling them to communicate and, thus, overcome the situation easier.

The owners know what the patients need and, therefore, they struggle to offer them the best conditions. There is a relationship of friendship between the employees and the patients and even between the owners and patients. They visit them and even have discussions about the way they are treated within the facility.

The customers come because they find out about the exceptional results from former patients. Even though outside doctors do not recommend the facility, many times people have their problem diagnosed by personal physicians and then take the initiative to contact Shouldice. The major difference between Shouldice and its competitors consists of the fact that...

They can return to work within a week after the operation if they have a job involving light exercise (opposed to two weeks after an operation performed in a different facility) or within four weeks for a more strenuous job (compared to eight weeks when going to a different facility).
When making suggestions, we should take into consideration the total capacity of the hospital which is of 89 beds. If another floor was added, then the hospital would reach about 134 beds. However, if the surgeons started operating on Saturdays, the capacity would reach 107 patients. I would recommend both of these two approaches on a short-term basis. Even if some doctors do not agree with Saturdays, they can be put on duty only during the former working days, assigning the Saturdays to the employees who are willing to accept. I believe that this is a good approach because the control over the quality can be maintained (by using the same employees or eventually adding only one or two more).

As for the long-term plans, by franchising, the hospital could lose control over the method of practice. Any person could buy the franchise and perform it in a wrong manner, therefore ruining the fame that it relies on. Many unskilled doctors could franchise, leading to the loss of control over the quality of the services provided. However, I don't believe there is too much risk involved in opening another unit. Dr. Shouldice could supply training programs only to the employees selected under his surveillance. He could supervise their activity and make sure of their appliance of the proper methods and their maintaining of the standards.