Deconstructing the Value Proposition of a Service Innovation Exemplar
The value proposition has become one of the terms most widely used in business (Anderson,
Narus & van Rossum, 2006). Webster (2002) suggests that the value proposition “should be
the firm’s single most important organizing principle” (p.61). Research into the identification
and development of value propositions has been highlighted as one of the key research
priorities for the period 2010-2012 by the Marketing Science Institute (MSI, 2010).
However, despite its importance there is surprisingly little academic research on how value
propositions are identified and constructed. A literature review revealed few examples or
illustrations of how value propositions are developed by organizations and little effort aimed
at deconstructing value propositions into their constituent components. The process of
deconstructing an organization’s value proposition is important, as it permits identification of
the key building blocks by which superior value is offered to customers. This gap in the
literature, together with the importance of this topic (Webster, 2002), motivates this study.
The aim of this paper is to (1) develop an approach for deconstructing the value
proposition of a service innovator and (2) identify the key components of this proposition that
constitute value. The paper is structured as follows. First, we provide a brief overview of the
value proposition concept. Second, we discuss the concept of deconstruction and explain how
we selected one service enterprise, Shouldice Hospital, for analysis. Shouldice is an exemplar
enterprise that has revolutionized the service experience of repairing hernias, by offering a
highly innovative value proposition. Third, we outline the data sources and research method.
Fourth, we deconstruct the Shouldice value proposition into its constituent components.
Finally, the research contribution, managerial implications and future research are discussed.
The Value Proposition
It is not our purpose to rehearse a detailed review of the literature on value propositions. For a
review of this literature, see Frow and Payne (2008). Rather, we wish to provide a brief
overview of the concept which was first introduced by Bower and Garda (1985). Some years
later, Lanning and Michaels (1988) described a value proposition as “what precise benefit or
benefits at what price will be offered to what customer group, at what cost” (p. 3).
Despite more than two decades passing, this topic has received relatively little
detailed academic attention. We identify three key themes relating to work in this area. First,
value propositions and the identification of competitive strategies. For example, Treacy and
Wiersema (1995) describe value propositions in the context of three value disciplines and
Kambil, Ginsberg and Blosch (1996) develop a value map aimed at identifying strategies
relating to the benefits and price of different competitive propositions. Second, some limited
work considers the construction of value propositions. For example, Anderson, Narus and
Van Rossum (2006) propose that organizations typically adopt one of three approaches in
developing value propositions: all benefits; favorable points of difference; and resonating
focus. Rintamaki, Kuusela and Mitronen (2007) propose four broad categories of value
propositions including those that reflect: economic value; functional value; emotional value;
and symbolic value. Third, value propositions described in the context of experiential value.
For example, Lanning (1998) emphasizes the co-creation perspective with less emphasis on
‘delivery’ of value propositions. Vargo and Lusch (2004; 2008) extend these ideas in their
foundational premise dealing with value propositions.
Our overview of the value proposition literature and earlier work (Frow & Payne,
2008) suggests that there is limited research on this topic and none that addresses a structured
process for deconstruction of existing value propositions. We contend that an in-depth
analysis of best-in-class exemplar companies through value propositions deconstruction is
important as it can yield new insights for managers seeking to develop their own innovative
value propositions.
1
Deconstruction and Selection of a Best-in-Class Exemplar
Deconstruction is a form of analysis that involves the critical practice of literally taking apart
the meanings of that which is socially-constructed (Goodall, 1991). The purpose of
deconstruction is to question what is ‘taken for granted’ and how things ‘got this way’
(Eisenberg & Phillips, 1991). Within the management marketing literatures there is an
increasing interest in the concept of deconstruction (Ehrensberger et al., 2000) in a number of
industry and managerial contexts.
The business system concept developed by consulting firm McKinsey & Co. (Gluck,
1980; Bauron, 1981; Bales et al., 2000) provides a structure for analyzing and deconstructing
an enterprise’s value proposition. The value chain developed by Porter (1985) draws heavily
on the notion of the business system concept. In this paper we utilize the business system
concept as a framework, rather than the value chain for several reasons. First, we are less
concerned with the value chain’s ‘support activities’ (Porter, 1985). Second, the linkage
between the value proposition and the business system is more explicitly made in the
literature (Coyne, 2009). Third, the business system addresses criticisms of linearity and
unidirectionality (e.g., Normann & Ramírez, 1993), which argue that the value chain
representation does not sufficiently emphasize the value-creating system itself.
We used three criteria in determining a suitable service enterprise. First, to identify a
service enterprise that is a highly regarded best-practice exemplar within its sector. Second,
to select an enterprise recognized as having an outstanding and innovative value proposition.
Finally, given recent emphasis on co-creation of value, to select an enterprise where cocreation makes an important contribution to the value proposition.
The researchers independently compiled a shortlist of alternatives case studies and
using the three selection criteria, they choose Shouldice Hospital. It is described as one of the
world's best service companies and the ‘world’s best hospital’ (e.g., Heskett, Schlesinger &
Sasser, 2003), with an outstanding, innovative value proposition (Hwang, 2009) and cocreation forms an integral part of its service system (Heskett, Sasser & Wheeler, 2008).
Data Collection and Method
In the context of academic research, scholars such as Yardley (2000) emphasize that it is
desirable to employ “triangulation of data collection” in order “to achieve a rounded
multilayered understanding of the research topic” (p. 222) by gathering data from different
sources and by different methods. Our data generation involved triangulation of data
collected from different sources and by different methods, as shown in Appendix 1.
As outlined in Appendix 1 in the ‘research method’ section, using these data sources,
the researchers progressively examined and interpreted the data to: provide an overview of
the operation of Shouldice Hospital; identify Shouldice’s value proposition; determine the
discrete elements of Shouldice’s business system; and, more substantively, identify and
categorize the many components of value adding activity that collectively represent a
deconstruction of Shouldice’s value proposition. Given the scope of Shouldice’s activities,
we purposively selected these multiple data sources to gain a comprehensive, rich
understanding of the organization and to permit triangulation of data.
Shouldice Hospital - a Best-Practice Exemplar
The Shouldice Hospital Hernia Centre is located in a suburb of Toronto, Canada. The hospital
is renowned globally for its innovation and sole specialization in repair of external abdominal
hernias. Dr. E. E. Shouldice founded the Shouldice Hospital focusing on a surgical technique
he developed during World War II. At this time, this form of surgery normally involved three
weeks of hospitalization. Dr Shouldice reduced this time to less than one week. This new
2
innovative method of hernia surgery involved several breakthrough ideas. First, the hernia
operation can be performed with a local anesthetic, rather than a general anesthetic. Second,
early ambulation following surgery contributes to a faster recovery. Third, Dr Shouldice
proposed the design of a totally integrated hospital environment for hernia repair and
recovery that would facilitate patients moving about and exercising to hasten recover.
The Shouldice Method, as practiced at Shouldice Hospital, is recognized as the gold
standard in hernia repair (Hay et al., 1995). It has proved to be an exceptionally reliable, safe
and cost-effective method of external abdominal hernia repair. Because the operation is
carried out under local anesthesia, the risks associated with general anesthesia are avoided.
Shouldice Hospital also benefits from scale and standardization. An average general surgeon
might only perform 25-50 hernia operations in one year. Shouldice Hospital surgeons each
perform up to 700 operations a year. Shouldice has repaired more than 330,000 hernias with a
greater than 99% success rate. As Gummesson (2009) points out, the almost nil recurrence
rate is as close to zero defects, or Six Sigma, that you can possibly get in a hospital.
Shouldice Hospital does not have a formal explicit statement of its value proposition
(Urquart, 2010). This is not surprising. Some implicit value propositions are successful
because an entrepreneur has a clear vision (Lanning & Michaels, 1988), as is the case with
Shouldice. Lanning and Michaels (1988), propose a structure for representing a value
proposition through a formal statement of: the target customers; the key benefits offered; the
price relative to the competition; and a concise summary of the value proposition. Using this
structure and following a subsequent member check (Hirschman, 1986; Wallendorf & Belk,
1989) with Shouldice’s Business Development Director, where minor adjustments were
made, we present a value proposition statement for Shouldice Hospital in Figure 1.
Figure 1: Shouldice Hospital Value Proposition
Ta rg et cu s to m ers :
•
O th e rw is e h e a lth y m a le s w ith e x te rn a l in g u in a l h e rn ia w illin g to tra v e l to O n ta rio C a n a d a
to re ce iv e ‘g o ld s ta n d a rd ’ h e rn ia re p a ir
K ey b en ef its o f f ered :
•
h ig h ly s k ille d a n d s p e cia liz e d s u rg e o n s p e rf o rm in g ju s t o n e f o rm o f o p e ra tio n
•
f a s t s p e e d o f s u rg e ry
•
h ig h s u cce s s ra te
•
e x ce p tio n a lly lo w co m p lica tio n s a n d re cu rre n ce
•
f a s t re co v e ry a n d re tu rn to n o rm a l d u tie s
•
lo w lik e lih o o d o f in f e ctio n
•
a n x ie ty a n d te n s io n re d u ctio n
•
clu b - lik e a tm o s p h e re a n d g ro u p th e ra p y – m o re lik e a re s o rt h o te l th a n a h o s p ita l
•
A f te rca re , ch e ck u p s f o r lif e a n d lo n g - te rm re la tio n s h ip s
P rice rela tiv e to co m p etitio n :
•
Lo w , h ig h ly co m p e titiv e p rice - ty p ica lly a b o u t h a lf co m p a ra b le co s ts f o r h e rn ia s u rg e ry a n d re co v e ry
S u m m a ry o f v a lu e p ro p o s itio n :
•
H ig h ly s u cce s s f u l h e rn ia s u rg e ry u s in g a p ro v e n te ch n iq u e – “T h e S h o u ld ice M e th o d ” - u n d e rta k e n in
a co m f o rta b le a n d s u p p o rtiv e e n v iro n m e n t, w ith f a s t re co v e ry a n d little lik e lih o o d o f f u tu re p ro b le m s
Deconstruction of the Shouldice Value Proposition
We adopted a deconstruction methodology, breaking down the business system into
component parts and analyzing their contribution to the value creation process in terms of
differentiators and cost drivers. The key business system activities for Shouldice identified
during the research process (see Appendix 1) consist of seven elements: facilities design;
3
diagnosis; admission & pre-operation; the operation; patient recovery; post-operative
service; and marketing. The business system concept also provides a structure for
understanding the cost drivers and differentiators that collectively form the key components
of the Shouldice value proposition. As outlined in in Appendix 1, our analysis identified 116
component differentiators and cost drivers through a process of independent coding of the
data by the two researchers. Appendix 2 summarizes these key cost drivers and differentiators
for each part of the business system. Given the page limits, it is not feasible to discuss all
these differentiators [D] and cost drivers [C]. Instead, for each of the seven elements of the
business system, we provide some brief illustrations of them below and we provide a detailed
summary of the full range of differentiators and cost drivers in Appendix 2.
(1) Facilities Design: The facilities have been carefully designed to make the patient’s
experience positive and memorable rather than a traumatic one [D]. The facilities of
Shouldice Hospital have also been configured with low-cost in mind. All the bedrooms in the
hospital are double occupancy and have a high room utilization rate [C].
(2) Diagnosis: Carefully planned procedures have been developed to ensure that only
patients who are healthy, apart from their hernia, are operated on at Shouldice [C&D]. All
aspects of diagnosis carried out before arriving at Shouldice and before admission are aimed
at providing a suitably qualified and screened patient base [D].
(3) Admission and Pre-operation: On arrival at the hospital, patients are examined by
a surgeon to confirm that they are acceptable for admission. Following a check, they are
admitted and undertake a new patient orientation [D]. After dinner and recreation they retire
to bed in preparation for the operation on the next day.
(4) Operation: As outlined above, the development of the Shouldice Method involved
several highly innovative concepts including undertaking hernia operations under a local
anesthetic [C&D], utilizing early ambulation after surgery to facilitate faster recovery [C&D],
and the benefits of a totally integrated hospital environment that involves ‘mental medicine’
and ‘group healing’ [D].
(5) Recovery: Shouldice encourages patients to interact extensively with one another
and build relationships with each other during their recovery [D]. Many aspects of the
recovery process act as both a cost driver and a differentiator.
(6) Post-operative service: Once the patient leaves Shouldice Hospital, considerable
effort is placed on maintaining the patient relationship [D]. In what is possibly the longest
running post-operative follow-up medical research program in the world, Shouldice gathers
post-operative condition and satisfaction reports from all former patients annually [D].
(7) Marketing: Shouldice is in an enviable position in that much of the marketing is
through the word-of-mouth of patients and their relatives, as well as intermediaries such as
referring doctors [C].
The identification of cost drivers and differentiators discussed above and summarized
in Appendix 2 provides a framework for understanding the key components of Shouldice’s
value proposition. Our representation in the central element of Appendix 2 develops the
business system further and, importantly, highlights its systemic nature. It also addresses
criticisms (e.g., Normann & Ramirez, 1993) which argue that a value chain representation is
too linear and unidirectional and does not sufficiently emphasize the value-creating system
itself. Our development of the business system concept in Appendix 2 explicitly recognizes
that value arises from the customer’s processes as well as those of the firm. This is shown in
the central section of Appendix 2. It highlights the value-in-use (e.g., Vargo & Lusch, 2004;
2008) that results from the communication encounter, the service encounter and the usage
encounter. The importance of these three elements has been highlighted both conceptually
and empirically in recent literature (Payne, Storbacka & Frow, 2008; Lemke, Clark &
Wilson, 2010)
4
Conclusions, Managerial Implications and Future Research
A key Marketing Science Institute research priority for 2010-2012 is the identification and
development of value propositions. Our research makes two contributions to the literature on
the identification and development of value propositions. First, we develop a structured
approach to the identification, analysis and deconstruction of the value proposition and we
use this approach to explore the anatomy of a service innovation exemplar. Second, existing
conceptualizations of the business system fail to explicitly acknowledge the value-in-use
(Vargo & Lusch, 2004; 2008) that results from key encounters and to reflect the interactive
and recursive nature of learning processes within the business system. Our extension of the
business system concept, shown in the central section of Appendix 2, explicitly addresses
these aspects of value creation.
This research has important managerial implications for both the health care sector
and industry more generally. Developing improved value propositions through deconstructing
the business system and identifying differentiators and cost drivers as outlined above, should
result in better health outcomes. Hernia repair is the most common operation in general
surgery. In the US alone, some 700,000 patients seek hernia treatment and nearly 800,000
patients seek to avoid hernia surgery, often claiming disability because of the presence of a
hernia – this represents a health care cost of over US$3 billion (Stylopoulos, Gazelle &
Rattner, 2003). Further, there is a cost to the economy incurred by some 15 million per
annum lost working days because of hernias (Memon & Fitgibbons, 1998). A further
important managerial implications is that specialisation in healthcare is likely to create better
outcomes (differentiation) and realize lower costs (cost drivers).
Some more general managerial implications also emerge from our study. Whilst the
focus of this paper has been on the service sector, managers in firms in all industry sectors
need to consider their value propositions. They should consider how their value proposition
might be deconstructed and consider under what conditions value could be reconfigured.
Importantly, the deconstruction of the value proposition outlined in this paper frees
executives from only gaining general learning from best-in-class case studies. As one
executive we exposed this research to commented: “It permits a shift from ‘it’s really
interesting what they have done’ to ‘this is how they did it’. This provides great insight into
how we can develop an improved value proposition for my company”.
Research into value propositions is at an early stage of development, hence the
discovery-oriented approach adopted in this study. This topic has considerable research
potential. There are also limitations relating to the current study which suggest areas for
potential future research. First, more general research into the value proposition concept is
required. There is the need for a definitive review of the value proposition concept, its
adoption in industry and the development of a conceptual framework that integrates different
perspectives, contributions and insights from the literature. Second, this study has focused on
value proposition deconstruction for only one service innovator. Future research could extend
the analysis to other health care exemplars, other organizations in the service sector, and
other industry sectors such as business-to-business and consumer goods. Third, application of
the learning from value proposition deconstruction in other best-in-class companies
represents an area with considerable potential. Finally, the role of co-creation in developing
improved value propositions requires further investigation. Prahalad and Ramaswamy (2004)
highlight the co-creation opportunities resulting from the transformation of customers from
‘passive audiences’ to ‘active players’. The obvious benefits of co-creation in enhancing
Shouldice’s value proposition and the recent heightened interest in co-creation in the
literature suggest this as an area of research opportunity.
5
Appendix 1: Data Collection, Sources and Research Method
Data Sources
Source Details
Interviews, discussion and correspondence
Business Development Director, Shouldice Hospital
Formal Presentation
Business Development Director, Shouldice Hospital
Video documentary and audio transcript
Observation and analysis of transcription of video from Canadian Broadcasting
Commission
Documentation from Shouldice Hospital
Written materials and extensive on-line materials produced by Shouldice
Discussion forum involving 35 former patients on
website
In-depth case studies of Shouldice Hospital
Shouldice Hospital patient surveys
Health forum website (ehealthforum.com, 2010)
Observation of hernia operation
Observation in operating theatre of a hernia clinic during an operation
Review of academic and managerial literature on
Shouldice Hospital
Heskett, Schlesinger & Sasser, 2003; Herzlinger, 2004; Urquhart & O'Dell, 2004;
Christensen, 2007; Ferguson, Paulin & Leiriao, 2007; Frei, 2008; Gummesson,
2009
Review of medical literature on Shouldice Method and
other methods of hernia repair
Bendavid, 1989; 1995; 2003; Froom et al., 2001; Papadakis & Greenburg 2002;
Shouldice, 2003; Welsh and Alexander, 1993; Hay, et al., 1995; Rutkow, 1998;
Bax et al.,, 1999; Schneider et al. 2008
Heskett & Hallowell, 2004; Pope, Stephenson & Haywood, 1997
Ferguson, Paulin & Leiriao, 2007; Ferguson, Paulin & Bergeron, 2010
Research Method
1. This exploratory research used mixed methods and data sources that were selected to provide a rich picture of the organisation, its
business system and value creation. Initially, extant literature was reviewed, with additional literature and data sources purposively
selected to enrich understanding and provide a comprehensive picture of Shoudice, its business system and value proposition.
2. Starting with the most detailed and comprehensive sources, including a transcription of the video documentary, each set of data was
studied in detail to ensure a ‘rich picture’ (Hoskisson, Hitt, Wan & Yiu, 1999) of the organization, including its unique context and
idiosyncrasies.
3. The two researchers independently reviewed the data sources outlined above and made detailed notes on their views of Shouldice’s
value proposition. Using the structure suggested by the originators of the value proposition concept, they iteratively developed a final
draft of a value proposition statement for Shouldice. This draft was subject to a ‘member check’ (Wallendorf & Belk, 1989) by the
Business Development Director of Shouldice and following minor modification, a final value proposition statement was developed.
4. The researchers next considered Shouldice’s business system. A draft of the business system elements was developed
independently by the researchers and then compared. An initial business system representation was then developed. This went
through some minor modification and a member check before finalization. It aimed at providing a framework for value proposition
deconstruction rather than attempting to include mundane day-to-day ‘support activities’ common to other organizations.
5. The researchers then considered cost drivers and differentiators for each element of the business system. In order to achieve
‘triangulation across researchers’ (Belk, Wallendorf & Sherry, 1989), which permits with a check on completeness and interpretation
from different researchers’ viewpoints, the researchers worked independently. The researchers each highlighted relevant sections in
separate copies of the text of the materials and transcript and noted what they observed in the video material. They then coded each
identified component, including where each cost driver or differentiator fitted within the business system. Analysis followed the
constant comparative method (e.g., Glasser & Strauss, 1967), whereby findings from the next piece of data were progressively
compared to previous data. The researchers continued this process until they each felt confident that they had identified key
components of Shouldice’s value proposition.
6. The researchers reviewed and refined their findings during several lengthy review sessions in order to determine the key
components of the deconstructed value proposition. Finally, they developed a joint list of some 116 component differentiators and
cost drivers. These components were then coded in a spreadsheet so their role as a differentiator or cost driver for different parts of
the business system was classified. Overall, there was a very high degree of unanimity amongst the two researchers in their
representation of the deconstruction of the value proposition, although there were some minor differences. A small number of
variances were resolved through discussion, revisiting the data sources and the subsequent ‘member check’ by Shouldice’s
Business Development Director. Thus, the cost driver and differentiation elements, the structure of the business system and the
description are based on research that reflects researcher consensus substantiated by member check.
6
DI FERE NT I ATOR S
Appendix 2: Deconstruction of the Shouldice Hospital Value Proposition
COS T DR I VE RS
BUSINESS
SYSTEM
• Country club, rather than
a hospital
• Operating theatres out of
sight in basement
• Investments in assets
important to patient
comfort and recovery
• Areas where patients can
meet and engage in
social interaction and
group activities
• Beautiful landscaped
grounds
• Club-like atmosphere
• “Guest” not patient
• Low-rise stairs facilitates
mobility.
• A thorough diagnosis is
made before admission
• Very specific target
market.
• “Shouldice is for me”
• Low risk
• Patients receive
assurance
• Communication of the
substantially higher
success rate and lack of
complications
• Branding: “the Shouldice
Method
• Overall cost - benefit for
patient of having their
operation performed at
Shouldice
• Procedure is explained in
detail and sets patient
expectations , patients
are not kept in the dark
• Expectations are set :“you
will survive -- everybody
does”
• Briefing represents the
start of Shouldice’s
“sharing” culture and
aims at reduction of
patient fear and anxiety
• Reassurance and
managing mental state of
patients
• Length of stay.
• Educating the patient
FACILITIES
DESIGN
DIAGNOSIS
ADMISSION
& PREOPERATION
• Suburban rather than an
expensive city centre
location
• Facilities represent low
cost by today's standards
• One type of operation
• Integrated basement
activities
• Rooms in the hospital are
double occupancy
• Rooms have a high
utilization rate
• Bedrooms have "low
capital investment"
• Meals are served in the
dining room rather than
being delivered to
patients’ rooms
• Wide catchment area for
its patients, including
USA, lowers average cost
of diagnosis
• Low cost initial selfdiagnosis using on-line
Medical Information
Questionnaire
• Screen out unhealthy
patients.
• Patients who are
overweight are retained,
they are counseled to lose
weight and be at an
acceptable weight before
Shouldice will admit them
• Low cost lay staff review
questionnaires
• Group briefing is
undertaken by a nurse
with around 30 new
patients
• Meals before operation
taken in a communal
dining room rather than
served in patient
bedrooms.
• Minimal need for trolleys
and orderlies to take and
collect meal trays from
rooms
• Patients teamed up with
roommates who have
experience of operation
and can answer patient
queries them afterwards
• Innovative technique
• Proven technique
• High order reliability
• Very skilled surgeons
• Local anesthetic rather
than general anesthetic
• Patients are awake
during surgery
• Surgeons who are experts
in procedure
• Vast amount of total
accumulated experience
• Short time in the
operating theatre
• Quality control
• High success rate
• Low risk associated with
the operation.
• Fast recovery time
• No recurrence is ever
likely
• Fun atmosphere
• Exercise classes
• Group activities
 golf putting
 pool/billiards
 exercise in extensive
grounds
• Length of stay
• Experience sharing
• Low risk
• Hospital staff encourages
continual engagement
with other patients
• Group therapy
• Self healing
• Low recurrence rate for
hernia repairs undertaken
at Shouldice
• Members of an alumni
club
• Regular newsletter
contact
• Over 130,000 annual
follow-up letters
• Five travelling clinics are
conducted annually
• 12,000 patient follow-up
examinations each year
• Part of a “club”
• Shouldice patient alumni
reunion
• Continuing relationship
• ‘Esprits de corps’
OPERATION
RECOVERY
POSTOPERATIVE
SERVICE
• Only one operation type
• 340,000 operations
• Specialized &
standardized procedure
• High throughput
• No errors/rework
• Experience curve
• ‘Surgeons assisting
surgeons program’
• Relatively low technology
• Limited medical
equipment required
• Local anesthetic
• Specialized anesthetist
not required
• Specialized & inexpensive
surgical pack
• Focused training for
doctors and for nurses
• Patient s are encouraged
to manage their own
recovery
• Group exercise classes
involve around 60
patients and are
conducted by relatively
low cost nurse.
• Group therapy through
patient to patient
interaction makes
contact with the doctors
& nurses less necessary.
• No meals in rooms
(except for first one after
operation)
• Less post-operative
recovery rooms needed
for patients
• Low recurrence leads to
less post-operative
contact with hospital
staff
• Patient follow-up data
helps identify medical
issues that can be
addressed at earlier stage
• Follow-up program uses
low cost e-mail
• Post-operative follow-up
data build support and
endorsement by the
medical community.
• Follow-up program helps
builds patient confidence
and high levels of postoperative satisfaction
• Track record
• Patients confidence
• 65 years of operations
• 340,000 success stories
• High customer advocacy
• Branding “the Shouldice
method”
• Overall cost/benefit
• No-one dies!
• Little chance of problems
• Clergy probono
operations
• Strong alumni bond
• Extensive media exposure
• Reputation: “the best
hospital in the world
• Stay 72 hours vs. 6 days
MARKETING
• High level of referrals
means no sales force is
needed
• Extensive free publicity
including press coverage
and TV coverage
• Clergy act as an referral
source
• Low cost exposure
though academic sources
e.g., over 300,000 copies
of one case study sold
• Check-up keeps Shouldice
“top of mind”
• Reputation of the
hospital is so strong a
very large number of
patients are recruited
from outside Canada
7
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