肖尔代斯医院案例

Shouldice:outlineofcaseanalysis3Cs–Company:Shouldice–Customers–CompetitionProcessaudit–processflowdiagram–processanalysis:capacityatstages,determiningthebottleneck–calculationofrelevantperformancemetricsImprovementopportunities–expandingcapacitybyaddingmorebeds–expandingcapacitybyworkingonSaturdays–opennewfacilities–competitivestrategyLessonslearned3CsCompany-ShouldiceCustomerCompetitionHowSuccessfulisShouldiceHospital?140,000highlysatisfied“Alumni”(pastpatients)2,400backlogofscheduledoperationsDemandappearstoexpandwithsupplySuperiorqualityShouldiceMethodofHerniaoperationimitatedbycompetitorLowrecurrencerate,0.80%vs10%HighdegreeofemployeesatisfactionOperationsCompetenceShouldiceachievesoutstandingresultsasalowpriceandatahighprofitbecause:–Everythingdonebythehospitalisdesignedtomaximizethedifferencebetweenperceivedqualityandthevalueoftheserviceprovidedpatientsononehandand–thecostofprovidingtheserviceontheother.Howdidtheydothat?Patientsarecarefullyscreened–Patientsareactiveparticipantsintheservicedeliveryprocess–Theavoidanceofgeneralanesthesticsallowsawiderangeofinvolvementofpatients–Staffisfreedfrommuchdisagreeablework–Reducingthecostofnursing,housekeepingandlaundry–StructurehospitaljobsthatinvolvesmorecounselingandpositiveinteractionwiththepatientsHowdidtheydothat?TheClinicisafocusedfactoryresultingin:–Highlyproductivesurgeon:300hernia/yrVs.30bylessfocusedsurgeon–Sharingofexpensiveservicessuchasanesthetist–Shortandrelativelyregularhoursforsurgeon–highcompensation(15%higher)–Opportunitiesforsurgeonstoobserveandadviseoneanother–Peergrouppressurethatleadstohigherlevelofself-controlofquality–AconsciouseffortismadetomakeShouldicea“family”experience运作系统（传递系统）医院的突出特点是，病人积极参与整个治疗过程中的各个方面。–病人自己携行李办理入住手续–从手术台走到休息区–鼓励病人在手术的当晚与新来的病人讨论治疗经历以减轻他们手术前的恐惧感。设施设计设施的设计刻意鼓励病人锻炼，以便尽快在四天内恢复，这大约是在传统医院中所需时间的一半医院的房间并不舒适，病人必须走到大厅、洗澡间和餐厅医院的庭院加以美化以便于散步，楼内铺了地毯并进行可装饰，避免人们产生任何与医院有关的“联想”患者要想看电视、打电话、上网只能离开病房，在这间专门用作娱乐的房间里进行。为方便疝患者上下，院内楼梯台阶高度均经过特别的降低处理地点位于空气清新的大都市社区，使得医院能成功跻身世界市场。当地人口数量大也提供了相当的病人来源，可以方便安排病人补充任何临时取消的预约能力规划由于疝气手术程序灵活，可以按批安排病人可能的手术时间因此，医院的服务能力得到最大限度的运用手术安排的灵活性允许医院可以像经营一家客满的饭店一样运作因此，可以提供许多辅助性服务，包括清洁服务和餐饮服务。服务接触所有员工都经过培训，帮助劝说病人并鼓励他们快速康复。通过让病人与员工共同进餐，培育出一种具有浓厚家庭氛围的服务文化院内有很多桌面游戏用来促进患者进行俯身运动质量最重要的质量特征是，所有医生必须坚持Shouldice治疗法，这使病人疝气的复发率降低。此外，病人在遇到困难时可以向他的治疗医生求助。在该医院的经历更像一次短期度假而不是住院，这增强了感知质量。甚至自行研制了专用的手术缝线用的钢针，“专用的钢针是采用了特殊的钢材，能够将手术感染的可能降到最低。能力与需求管理通过邮寄问卷的方式了解病人情况，并且只接收预约病人，从而有效地控制病人需求的时机和数量。非预约病人或在等候名单中的当地居民可以填补因取消预约而产生的空缺。这样，保证了医院能力的完全发挥。信息系统医院服务的独到之处是每年的病友聚会，这会使医院和病人之间能够保持联系。通过保存病人的资料，该医院建立起牢固的顾客基础，构成了有效的口头宣传媒介。通过每年提供的免费检查，该医院建立起了有关服务程序的独特的数据库。Costcomparison1.Costoftypicaloperation2.Transportation3.Valueoftimelosttoemployer($50-500perday)-Timelostfromworkwhileathospital-Timelostfromworkwhilerecovering4.Subtotalbeforeallowanceforrecurrence5.Expectedcostofrecurrence=ProbabilityxSubtotal6.Totalcosttopatient,employee,andinsurerShouldiceOtherHospitalsCostComparison1.Costoftypicaloperation2.Transportation3.Valueoftimelosttoemployer($50-500perday)-Timelostfromworkwhileathospital-Timelostfromworkwhilerecovering4.Subtotalbeforeallowanceforrecurrence5.Expectedcostofrecurrence=ProbabilityxSubtotal6.Totalcosttopatient,employee,andinsurerShouldiceOtherHospitals$1990$5240(seepage7)$650+0.2x$300+4x$320$200-$600-3-4days5days5-8days10days$400-4,500$750-9,000$2,590-7090$5990-14,240$21-57$599-1,424$26,11-7147$6589-156640.8%x[$2590-7090]**seefootnote210%x[$2,750-11,150]ClinicRevenues=($650x7,600)+($300x7,600x20%)Costs(frompage12ofcase)Profit$5,396,000$3,500,000$1,908,000HospitalRevenues=3.5daysaveragestayx$320/dayx7600patients$8,512,000Costs(frompage12ofcase)$8,500,000Profit$12,000PROFITABILITYOFSHOULDICE:2004ToalProfit$1,896,000ProcessAudit:ProcessFlowDiagramAdmissionProcessSH.DoctorP.DoctorPatientOnSiteDiagnosisDiagnosisSelfDiagnosisSH.DoctorDiagnosis&ReviewRejectRejectAd.SystemBookPatientAcceptAcceptToPatient-Brochure-Date-Wt.LossProg.Ad.SystemPhoneConfirmConfirm(card)40%60%ProcessofFirst-DaySLEEPPostOPPatientsAfterDinnerMeetingNursesOrientationPatient/RoommateUnpack,PrepPatientToRoomNurses(2)Blood+UrineAdmitPersonnel(2)AdmitRejectArrive20mins.Doctors(6)Exam15-20mins.5-15mins10mins5-10mins30mins****ProcessofSecond-DayPreOP/NursesSedationWAKEOR/Surgeons,etc.OperationPatientExercisePostOp.PostOPPatient:AfterDinnerCookies**CapacityUtilizationKeyResources7600operations/50weeks=150patients/weekUtilizationCapacity1.Exam2.AdmitProc.3.NursesStation55.5%6roomsx3patients/hrx3hours/day(1-4p.m.)x5days/week=270patients/weeka.82%x1hr+18%x1.5hrs=1.09hrs2peoplex6patients/hrx4hours/day(1-4p.m.)x5days/week=240patients/week2stationsx6patients/hrx4hours/day(1-4p.m.)x5days/week=240patients/week62.5%62.5%4.OperatingRm5.Surgeons6.Room72.9%46.4%109.6%100%5roomsx[8.5hrs/day/1.1hrs/patient]x5days/week=188patients/week(11x4patients/a.m.+5x3patients/p.m.)x5days/week=295patients/week89rooms==125patients/week(assuming3.5daysaveragestay)103rooms==150patients/week(assuming3.5daysaveragestayandtheuseof14hostelrooms)aa.82%x1hr+18%x1.5hrs=1.09hrs