1 Model Shouldice Hospital as a processing operation with products, attributes and resources.
2 What are its competitive priorities?
3 What kind of market has it chosen to focus on?
Shouldice Hospital follows the business model of focus on a single standardized service for a narrow target of consumers, rather than to provide customized solution (as in a general clinic or hospital). It focuses on providing quick, convenient, and reliable cure for external types of abdominal hernias. The Hospital uses its own technique, called the Shouldice Method and claims to provide relatively short post-operative recovery period.
Shouldice Hospital focus on hernia repair surgery which is mostly performed on males. Shouldice operation strategy involves early ambulation following hernia repair surgery that was superior to others. Only external kind of abdominal hernias were repaired at Shouldice Hospital. Internal types, such as hiatus (or diaphragmatic) hernias were not treated. First time repairs (primaries) of hernias involved straightforward operating procedures that required about 45 minutes. Such cases represent 82% of all operations and remaining were patients suffering recurrences of hernias previously repaired elsewhere. The market was targeted by providing following services
1) The hospital promised early ambulation following hernia surgery. The hospital facility was designed to encourage movement without unnecessarily causing discomfort. Postoperative regimen designed and communicated by the medical team to patients
2) The Hospital provides free services to the clergy and parents of hospitalized children. Hospital provides annual checkups free of charge to its alumni mostly occurred at the time of the annual reunion.
3) The pa...
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...o the patient been examined by surgeon for 15-20 minutes.
3) After examination, patient wait for another 5-15 minutes so see one of two admitting personnel.
4) Health insurance coverage checked and various details are discussed for 10 minutes.
5) Patient sent to nurse's station for blood and urine test (5-10 minutes) with little wait.
6) At 5:00 PM, nurse orientation provided to patients
7) Dinner server from 5:00-6:30 PM.
8) Recreation and then cookies served at 9:00 PM and tucked in bed between 9:30-10:00 PM.
9) Patient to be operated on early in the day were awakened at 5:30 AM.
10) Patients taken to pre-operating room 45 minutes prior surgery
11) A few minutes prior to first operation at 7:30 AM, the surgeon assigned to patient administer local anesthesia.
12) Arrange for the administration of Demerol to the patient scheduled next on the operating table.
Pre-Op begins momentarily, where the patient meets with nurses, surgical technicians, Dr. Todd, and the anesthesiologist to discuss the operation and go over any new concerns or questions the patient may have. They will be hooked up to an IV where the anesthesiologist with administer the local anesthesia before Dr. Todd begins to operate.
Goldman, M. A. (2008). Pocket Guide to the Operating Room. Philadelphia, PA: F.A. Davis Company.
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Saint John’s One Day Surgery (ODS) offers patients a convenient and efficient same day surgical procedure that allows most patients to return home on the same day to recover. The objectives of this paper is to describe the physical environment of the ODS unit and explain the unit’s criteria so that the patient’s surgery may proceed as planned. It will also discuss some of the many roles of the ODS nurse and list one actual diagnosis and two potential nursing diagnoses, with associated supporting evidence, for a patient in the ODS on this particular day. This paper will conclude with my personal experience, both positive and negative, during
appropriate time to examine and note if there is any open wound or pressure ulcers or any other lesions on the patient. As well to note the type of dressing applied and the time and the date the dressing was changed. This allows the oncoming nurse to manage her workload during her shift. For instance, if one of her patients has any type of pressure ulcer that requires treatment, then she can assign her assistance to turn this patient every two hours to prevent further skin breakdown.
Later in 2002 American academy of pediatrics extended this model to include 37 specialties and in 2007 different physician associations collaboratively proposed the principles of patient centered medical homes. [2] Based on this model in 2006, American society of anesthesiologist proposed similar model, perioperative surgical home model in the field of surgery for achieving triple aims; improving patient health care and providing quality health care at low costs. [2]However these concepts have evolved two decades earlier their popularity has increased only after the implementation of affordable care act in 2010 as it introduced the concept of Accountable care organizations which requires different healthcare providers to work collaboratively to provide quality healthcare services at low costs. Similar to perioperative surgical homes, enhanced recovery after surgery model (ERAS) is popular outside United States.
After surgery, they monitor the patient to see if there are any problems while they are coming off an anesthesia (Nurse Anesthetists, Nurse Midwives…) If there are no problems the surgery will be deemed as successful, and the nurse anesthetist will report all findings to the
Billiann replied, “An average day is started by getting a report from the previous nurse on the health status of the patient, any new orders that need to be completed, and overall health care plan. I then assess each patient and give medications as needed. If there are any new health concerns during the assessment or throughout the day I notify the physician. I always have my stethoscope, pulse ox, normal saline flushes, tape and scissors on me. Most needed equipment is already in the patient’s room.”
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
6) mentions some critics argue that treating patients should not be considered a business. These critics argue that these initiatives have the chance of negatively affecting patient treatment and “care as the quest for achieving enhanced operational performance may dictate procedures” (Kudyba, 2010, p. 6). I do see where these critics are coming from however, look how far medicine has come and how much has improved. These new protocols and business models are extremely beneficial to not only the hospitals but to the patients, as well. Most nurses and doctors came into this business to help people. Just because they have to follow a specific business model doesn’t change their heart. These protocols have the ability to improve patient weight time, improve care protocols, which saves time and money for both parties, and save lives. There really is no other way to go about this besides treating it as a
Case Management Case management has become the standard method of managing health care delivery systems today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States. It has been extended to a wide range of clients (Park & Huber, 2009). The primary goal of case management is to deliver quality care to patients in the most cost effective approach by managing human and material resources. The focus of this paper is on the concept of case management and how it developed historically, the definition of case management, the components of case management, and how it relates to other nursing care delivery models.
Historically (before 1880s), only few hospitals were originated in some big cities of U.S. Initially, the hospital system mainly run by religious organization and it served a primary purpose of palliation. According to Shi and Singh (2010), the function of hospitals at that time was more of “social welfare” (such as taking care of homeless people and helping those without families) than practicing medicine (p.56). Over the years, the functionality and the services offered by the hospitals has changed dramatically. However, it’s primary function to treat sick individuals has remained the same. Nowadays, hospitals also function as a research center, a medical educational institution, and is a major source of employment in the community (Sultz
1.I currently work in the surgical unit and one of the major recovery enhancements is early ambulation after any surgery, especially orthopedic and abdominal. Early ambulation will accelerate the return of bowel function (as evidenced by passage of stool and flatus) reduce the rate of overall complications and decrease the length of hospital stays. Evidence-based practices have shown that early post-operative ambulation contributes to decreased pulmonary complications. “When exploring postoperative activity in the general and orthopedic nursing literature, there is sparse evidence outlining nursing's critical thinking skills associated with decreasing the first postoperative activity from the historical 14-day mark to the most current model of day 1 or 2 for the joint replacement population. Also, there were no recently published reports describing a contemporary
I went to the operating room on March 23, 2016 for the Wilkes Community College Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 7:30am-2:00pm. When we got their we changed into the operating room scrubs, placed a bonnet on our heads and placed booties over our shoes. I got to observe three different surgeries, two laparoscopic shoulder surgeries and one ankle surgery. While cleaning the surgical room for the next surgery, I got to communicate with the nurses and surgical team they explained the flow and equipment that was used in the operating room.
One of the many categories would be that of the circulating nurse. Ensuring that the operating room is set up correctly based on the preference of the surgeon, the circulating nurse makes sure all the necessary equipment’s are in place, functioning appropriately, likewise ready to go. In addition, the circulating nurse also verifies the patient identity, surgical site, and consent with the surgeon upon entering the operating room to make sure that they are all the same page, before proceeding with the schedule procedure. Yet another function of the circulating nurse is to make sure that the patient is positioned correctly on the surgical table, hooking up the basic suctions needed, and assisting the anesthesiologist or anesthetist during intubation. Moreover, monitoring the overall condition of the