Shouldice

Shouldice is an interesting example of how focusing on one clinical procedure and targeting a patient segment results in efficient, high quality care. Patients are carefully screened so there are few risks to the patients who come. The entire set of activities at Shouldice is committed to the surgical repair of external abdominal hernias without complications. All patients stay in semi-private rooms, matched according to age, gender and personal interests. There are putting greens and hiking paths designed to promote activity and ambulation at an appropriate level. Ninety-eight percent of the patients rate their satisfaction with quality at the top of the five-point scale. Ninety-six percent of the 7500 patients treated at Shouldice have “no complaints of any sort.”

Each Shouldice surgeon performs 15-20 repairs a week versus the average hernia surgeon in Ontario who average only one each week. In addition, once a day, these surgeons are challenged with the task of repairing another surgeon’s failed repair. Although repairing a hernia a second time is difficult, Shouldice surgeons find a recurrnce intensely satisfying. The physicians are also extremely satisfied and some stay for as long as 30 years at Shouldice. When interviewed these physicians proudly say that they love their work because they know they are “the best hernia surgeons in the world.”

The outcomes have been documented extensively. For example, Shouldice patients return to work within 8 days on average. The Shouldice method has the lowest ten-year recurrence rate of one half of one percent (.005), and a fifty-year recurrence rate of less than one percent, which are among the lowest in the world. In Boston the average day surgery charge for a simple hernia repair is about $4,000, compared with $997 at Shouldice. Hence it is cheaper for patient from Boston to be flown to Shouldice, stay 4 days, and treated than to go to a local day surgery facility.

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