您好,欢迎访问三七文档
当前位置:首页 > 商业/管理/HR > 质量控制/管理 > Shouldice-Hospital
9-683-068REV:JUNE2,2003________________________________________________________________________________________________________________ProfessorJamesHeskettpreparedthiscase.HBScasesaredevelopedsolelyasthebasisforclassdiscussion.Casesarenotintendedtoserveasendorsements,sourcesofprimarydata,orillustrationsofeffectiveorineffectivemanagement.Copyright©2003PresidentandFellowsofHarvardCollege.Toordercopiesorrequestpermissiontoreproducematerials,call1-800-545-7685,writeHarvardBusinessSchoolPublishing,Boston,MA02163,orgoto—electronic,mechanical,photocopying,recording,orotherwise—withoutthepermissionofHarvardBusinessSchool.JAMESHESKETTShouldiceHospitalLimitedTwoshadowyfigures,enrobedandinslippers,walkedslowlydownthesemidarkenedhalloftheShouldiceHospital.Theydidn'tnoticeAlanO'Dell,thehospitaladministrator,andhisguest,whohadjustemergedfromthebasementboilerroomonatourofthefacility.Oncetheywereoutofearshot,O'Dellremarkedgoodnaturedly,“Bythewaytheyact,you’dthinkourpatientsownthisplace.Andwhilethey’rehere,inawaytheydo.”Followingavisittothefiveoperatingrooms,alsolocatedonthefirstofthreelevels,O’Dellandhisvisitoronceagainencounteredthesamepairofpatientsstillengrossedindiscussingtheirherniaoperations,whichhadbeenperformedthepreviousmorning.HistoryBornonafarminBruceCounty,Ontario,Dr.EarleShouldice,whowastofoundthehospitalbearinghisname,firstdisplayedhisinterestinmedicalresearchattheageof12.Heperformedapostmortemonacalfthat,hediscovered,haddiedfromanintestinalobstruction.Afterayearoffollowingthewishesofhisparentsthathestudyfortheministry,ShouldicepersuadedthemtolethimenrollinmedicineattheUniversityofToronto.Anattractivebrochurethatwasrecentlyprinted,althoughneitherdatednordistributedtoprospectivepatients,describedEarleShouldiceasfollows:WhilecarryingonaprivatemedicalandsurgicalpracticeintheyearsbetweenthetwoWorldWarsandholdingapostaslecturerinanatomyattheUniversityofToronto,Dr.Shouldicecontinuedtopursuehisinterestinresearch.Hedidpioneerworktowardsthecureofperniciousanemia,intestinalobstruction,hydrocephaliccasesandotherareasofadvancingmedicalknowledge.Hisinterestinearlyambulationstemmed,inpart,fromanoperationheperformedin1932toremovetheappendixfromaseven-year-oldgirlandthegirl’ssubsequentrefusaltostayquietlyinbed.Inspiteofheractivity,noharmwasdone,andtheexperiencerecalledtothedoctorthepostoperativeactionsofanimalsuponwhichhehadperformedsurgery.Theyhadallmovedaboutfreelywithnoilleffects.Fouryearslaterhewasremindedofthechildwhenheallowedwashroomprivilegesimmediatelyfollowingtheoperationstofourmenrecoveringfromhernia.Allhadtrouble-freerecovery.683-068ShouldiceHospitalLimited2BytheoutsetoftheSecondWorldWarin1940,Shouldicehadgivenextensivethoughttoseveralfactorsthatcontributedtoearlyambulationfollowingsurgery.Amongthemweretheuseofalocalanesthetic,thenatureofthesurgicalprocedureitself,thedesignofafacilitytoencouragemovementwithoutunnecessarilycausingdiscomfort,andthepostoperativeregimendesignedandcommunicatedbythemedicalteam.Withallofthesethingsinmind,hehadbeguntodevelopasurgicaltechniqueforrepairinghernias1thatwassuperiortoothers.Heofferedhisservicesincorrectingherniasforarmyinducteeswhootherwisewouldnotqualifyforservice.Becausehospitalbedsoftenwerenotavailable,sometimesthesurgerytookplaceintheemergencydepartmentoftheTorontoGeneralHospital,andthepatientsweretransportedlaterinthedaytoamedicalfraternitywheretheywerecaredforbymedicalstudentsfortwoorthreedays.Bythewar’send,wordoftheShouldicetechniquehadspreadsufficientlythat200civilianshadcontactedthedoctorandwereawaitingsurgeryuponhisdischargefromthearmy.Becauseofthescarcityofhospitalbeds,particularlyforanoperationthatwasconsideredelectiveandofrelativelylowpriority,hestartedhisownhospital.Dr.Shouldice’smedicallicensepermittedhimtooperateanywhere,evenonakitchentable,andconsequentlyhereceivedauthorizationfromtheprovincialgovernmenttoopenhisfirsthospitalinasix-roomnursinghomeindowntownTorontoinJuly1945.Asmoreandmorepatientsrequestedoperations,Dr.Shouldiceextendedhisfacilitiesbybuyingarambling130-acreestatewitha17,000-squarefootmainhouseinthesuburbofThornhill,15milesnorthofdowntownToronto.Initially,a36-bedcapacitywascreatedinThornhill,butaftersomeyearsofplanning,alargewingwasaddedtothehousetoprovideatotalcapacityof89beds.Atthetimeofhisdeathin1965,Dr.Shouldice’slong-timeassociate,Dr.NicholasObney,wasnamedsurgeon-in-chiefandchairmanoftheboardofShouldiceHospitalLimited,thecorporationformedtooperateboththehospitalandclinicalfacilities.UnderDr.Obney’sleadership,thevolumeofactivitycontinuedtoincrease,reachingatotalof6,850operationsinthe1982calendaryear.TheShouldiceMethodOnlyexternaltypesofabdominalherniaswererepairedatShouldiceHospital.Internaltypes,suchashiatus(ordiaphragmatic)hernias,werenottreated.Asaresult,mostfirst-timerepairs(calledprimaries)involvedstraightforwardoperatingproceduresthatrequiredabout45minutes.Primariesrepresentedapproximately82%o
本文标题:Shouldice-Hospital
链接地址:https://www.777doc.com/doc-4465351 .html