Shouldice's Service Delivery System

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

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

Moreover, the office visit length will be shortened due to the high demand of customers making it harder to provide good quality of care to patients as well . On the other hand, from the physician point of view it is predictable that doctors will change practice patterns from private offices to hospital services because the facilities pay salaries with less expectations in the number of patients seen per day. Furthermore, due to the elevated number of patients, time left for clinical documentation and record keeping will be nulle.

In HCA facility, the infectious disease nurse (ID), wound care nurse and the operating room (OR) manager have collaborated to find an effort to reduce the rate of surgical site

In the table below, surgery has been added on Saturday and the number of operations performed per day is 30, this implies the number of beds added will not be utilized, this is because the number of beds available on Saturday are still under the operating policies.

First and foremost, if a hospital is suddenly lost all of its cardiovascular surgeons...heads will roll. However, if there are a major lost of service such as the cardiovascular surgeon...there will be a decrease in the volume due to the lost of services. Thus when the hospital have a reduce in the total volume it will also have a reduce in total cost. If the hospital is operating under statistics budget...in the long run, through the development or discontinuation of certain programs volume may be

Employee satisfaction is very high as they are paid more than union scale for comparable jobs. Through flexible and regular working hours surgeons are able to maintain work life balance.

Shouldice Hospital had an excellent well-developed, focused service delivery system. The business strategy was to not only provide its patients with a quick, quality and low cost surgery but also providing an unforgettable experience and comfortable environment in the facility.

In today’s day and age, health care is constantly changing. Improving society’s health and reducing the cost of health care is very important in the expansion of health care in the United States. The Perioperative Surgical Home is an innovative model that is patient centered to focus on this perspective. The PSH model focuses on the entire surgical experience of a patient. This model focuses on the experience from the decision made to have surgery to up to 90 days. In the end the ultimate goal of the PSH model is to expand access and aim to improve and increase quality of health while reducing the health delivery costs. This can come through improved communication and management through various means. In the end the PSH model will aim to improve and increase quality of health while reducing the health delivery costs.

The biggest problem the Australian Hospital faced was a lack of beds despite the federal government 's $600 million elective surgery ' 'blitz ' ' in 2009 and 2010 (Wallace, 2011). The NSW planned an additional 400 beds, which still would not be adequate for the estimated 9,000 patients that would have their surgeries canceled. According to Owler, ' 'It comes down to beds … we do need to have a certain number of beds, particularly in places like Westmead and Nepean, where demand is high. It 's unusual for us to cancel patients because we 've run out of time. Another 1450 beds were needed to address the problem” (Wallace, 2011). While adding more beds would help it will not solve the cancellation problems unless the other major factors were addressed.

The same concept is applicable in complex surgical procedures. The first application of volume-outcome relationships in the hospital care was reported by Luft in 1979 19.(503167) Still then, numerous publications show a consistent trend toward hospital case volume predicting superior outcome in neurosurgery. Amin-Hanjani S et al 3 (PMID:16304982) reported the national trends and in hospital mortality in their study. They pointed out that high-volume hospitals had less frequent adverse discharge disposition (odds ratio 0.54, p = 0.03). Barker FG 2nd et al 4 (PMID:12699540) published a population study on surgical management of un -ruptured aneurysm and showed surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality. Starke et al23 (22418580) also reported that the outcomes of EC-IC bypass in Moya Moya disease were better in high volume care where turnover of bypass procedures was more. The skill and experience of the individual surgeon, better organized postoperative care, intensive care ,more resources for managing the postoperative complications are the several factors either alone or in combination controls outcome and the differences between high- and low-volume hospital. 5,6(11948273, 14645640

The hospital is currently utilizing 71.43% of their beds, this is actually an ideal operating point. To increase its rate of utilization might decrease the service quality.

Available infrastructure - the hospital should be sufficiently equipped to handle the complicated intra and post- operative course.

As you may have heard, the organization is beginning to transition into a self-service delivery model. This implementation will happen in two phases. During Phase 1, as employees, you will be responsible for you own specific and personal transactions. These actions include a name change, address/phone change, a tax withholding (W-4) change, dependent/beneficiary and emergency contact updates. This will cancel out the process we have been using which includes completing a web-based form, submitting your change to the HR electronic mailbox. From there, HR receives the form, enters the information into the system and in the end

The study was conducted to find the utilization time of minor operation theatre in Aakash healthcare, Dwarka . The objectives were to analyse the time utilization of minor OT and to suggest remedial measures for effective utilization. The study was conducted for a period of 4 weeks and data was collected for 174 patients. Time taken for various procedures performed in the theatre are noted. The data collected were analysed by statistical methods and the utilization time per day was calculated as the total mins of OT used in a day/ total mins of OT available in a day. It was observed that in spite of the organization’s effort to increase the utilization time of the minor operation theatre by also using it as a procedure room ,it is still under-utilized in Aakash health care. It identified the bottle neck as the shortage of surgical patients.