Shouldice Hospital Case

Richard Veller, the new CFO for Union Medical Center, began to change the operations of their management. Richard Veller looked to change UMC to an industrial system, which meant that the hospital would view cases as products. Just like any ordinary business, these products would have cost objects and would require an accounting system. In order to allocate costs appropriately, UMC was required to organize their cases into Diagnosis Related Groups to create a functional management control system. These changes brought certain internal issues into the spotlight. If solutions are not found, the hospital will not be able to implement their plans.

After analyzing this information and reading through the case thoroughly, it would be quite difficult for Shouldice to perform 45 operations a day. They have limitations due to their operating rooms and the number of surgeons at their facility. According to the case, they have 12 full-time surgeons and only 5 operating rooms. Each surgeon operates on 4 patients per day so at most, the 12 surgeons can perform 48 total operations on a daily basis. Additionally, each operation takes 1 hour and since they only have 5 operating rooms, the maximum number of operations they can perform is 5 operations per hour. Operation time

Currently the clinic sees about 45 patients per day and they have capacity to handle 85. If they continue how they are operating the clinic is looking at a loss of $3,173. At this rate the clinic will not be able to make a profit in spite of inflation over the next couple years.

After surgery, Mr. Baker is taken to a room on the medical-surgical floor. He has an IV infusing at 125 ml/hr, a PCA pump, and a nasogastric tube connected to low suction. He is receiving oxygen through a nasal cannula.

Data plays an important role in this research. Collecting adequate and accurate data is paramount. Prior to data collection, requirements have to be established on what statistics are required for research. To build an accurate simulation model, each detail within the process has to be captured. Process maps have been put together to capture the patient flow and understand resource utilization as various types of patients use different resources for statistically variable amount of time.

In this process a particular patient is selected and then the information is gathered about the treatment, care or services the patient has received at the hospital. This is done through interviewing, questionnaires and scrutiny of documents related to the patient (Uselton, Kienle, Murdaugh & Coe, 2010).

Throughout this course I have learned about the various challenges that impede productivity and efficiency at today’s hospitals. These issues facing the modern healthcare organization come in varying forms from technological, staffing, and financial to name a few. There are no limits to what hospitals can face in these modern technologically savvy times. Below are the major issues that today’s hospitals are facing, though there are many facets to these topics it will be described as best as possible to meet overall challenges:

Reassign the number of exam rooms to better optimize utilization and fulfill demand; MD cycle time is 19.4 minutes and NP cycle time is 32.8 minutes. Redirecting exam rooms to MD’s would also reduce the wait time for next available appointment thus improving patient satisfaction with wait time. For example,

.-Evaluate the patient’s progress and change the plan of care to achieve the goal from admission until discharge.

The final standard under communication is the performance of a “time out” before a procedure. There are also elements of performance that must be met to be in compliance for this standard. The first is conducting a “time out” before every procedure. This is met by the Universal Protocol Policy. The Universal Protocol Policy also meets the next bullet point of standardizing “time out” for Nightingale Hospital and having them started by an elected team member with the involvement of team members. The third element of performance is performing a “time out“ between a change of people performing a procedure on a patient. This is unfortunately not met by any protocol in the information provided by Nightingale Hospital. Having team members agree the correct patient identity, the correct site, and the correct procedure to be done on a patient is the next element of performance. The final element of performance is the documentation of “time outs”. Though there are no policies bases on the information given from Nightingale Hospital of “time outs”, there is a graphical analysis of “time outs” hospital wide indicating

This is used to determine the start and finish each hour on time. Does decrease patient waiting time. Avoids issues of who should be seen first.

Department Organization: This 358 hospital bed acute care facility. The HIM department is staffed with twenty one individuals who hold various positions. There is one with a RHIA credential, and two with RHIT credential. The other members of the department include Certified Coding Specialists (4), Certified Coding Associates (1), Birth Recorders (1.5), Clerks (2.2), Technicians (6), System Technician (1), Registry (.8) and Document Specialists (2.2) with many tasks shared among the entire team. The information flow begins with the patient discharge. A new chart is created for each discharge. The chart is assembled, coded and then analyzed by senior HIM Specialist for deficiencies. If the chart is complete the chart goes to the main file. If not, complete MD is notified.

* Minor procedures take about one hour or less, major procedures take two or more hours

Their existing system and reputation have already set them apart as a market leader and has proven to be a profitable setup. However, there is still an unmet demand. Option 1 to add 50% more beds may not be beneficial if we don't also increase operation. Increasing the number of bed by 50% would not be advisable unless they would add more surgeons and operating rooms because the existing operating

A Canadian hospital specializing in hernia operations is considering whether and how to expand the reach of its seraices,