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fCase 5-1 (Algal Shouldice Hospital in Canada is widely known for one thinghernia repair! In fact, that is the only operation it performs, and it

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\fCase 5-1 (Algal Shouldice Hospital in Canada is widely known for one thinghernia repair! In fact, that is the only operation it performs, and it performs a great many of them. Over the past two decades this small 102bed hospital has averaged 7,960 operations annually. Last year, it had a record year and performed nearly 8,460 operations. A hernia repair operation at Shouldice Hospital is performed by one of the 12 fulltime surgeons assisted by one of seven parttime assistant surgeons. The first operations begin at 7:30 AM each day, Monday through Friday. Surgeons generally take about one hour to prepare for and perform each hernia operation, and they operate on an average of at most four patients per day. This four patient per clay limit on the average number of operations performed per surgeon has been found to be the best operating level for the hospital as it take into account time the surgeons need for patient exams and consultations, updating medical charts, writing reports, traveling to professional conferences, vacations, and other times when they are performing other duties or are not available to perform surgeries. A given surgeon may perform more than four surgeries on a given day, but the average cannot exceed four without having adverse effects on overall hospital operations- The surgeons' day ends at4 p.m. Although hernia repair operations are performed only ve days a week, the remainder ofthe hospital is in operation continuously to attend to recovering patients. The table below shows the room occupancy plan for the existing system. Each row in the table follows the patients who checked in on a given day. The columns indicate the number of patients in the hospital on a given night. BEDS REQUIRED CHECK IN DAY MONDAY TUESDAY HEDNE SDAY THU RSDA'Y FRIDAY SATURDAY SUhDAY Monday 34 34 34 Tuesday 34 34 34 Wednesday 34 34 34 Thursday 34 34 34 Friday Saturday Sunday 34 34 34 Total 63 192 162 162 58 34 34 ' For example, the rst row of the table shows that 34 people checked in on Monday and were in the hospital for Monday, Tuesday, and Wednesday nights before being discharged on Thursday. By summing the column of the table for Wednesdav we see that there are 109 patients stavina in the hospital that nidht

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