There are several reasons behind the success of Shouldice :-The hospital is particularly designed to treat external hernia. With a limited scope, it is easier for them to provide successful treatment. The recurrence rate for all the operations performed at Shouldice was 0.8% in comparison to U.S where the recurrence rate is 10%.They have a very smooth process for patients movement. First the time is saved through the assessment of patients in advance and scheduling the operations accordingly. All these steps helps in optimising the doctor’s time. After the operation, the patients are encouraged to walk on their own from operation room to their own room. Although it is being done for psychological as well as physiological reasons but 99% of the patients accept this offer. This reduces the resources needed to transport them. All of this helped them in reducing their operating cost as well. In addition to this, hospital was also constructed in a very strategic manner. Operating rooms were relatively cheap as they have mobile units for the anesthesia instead of a proper setup of equipments. In addition to this, special consideration was kept in mind to encourage patient self-care and socialization and thus it supported design features like installation of carpet, low rise stairs, common TV and telephone areas. Patients walking and talking is also a good strategy to keep an open and warm atmosphere in the hospital. The operated patients socialise with the newly admitted and it builds new friendship and a level of trust. It also reduces the need for encouragement from staff to walk and exercise.Shouldice has good quality in every aspect. Surgeons were carefully selected and were effectively trained on the shouldice method of operation. In addition to this, rotation of staff every few days and sending patients with recurrences to their initial doctor were some other steps. The quality of food is controlled by preparing meals from fresh ingredients and in the hospital kitchen. Shouldice also has strong concern for its employees. Nobody is fired and the people pitch in to help each other. They also have high salaries than the market for surgeons and administrative staff.In addition to this, Shouldice allowed allowed parents to stay with their children. Although it was an added cost but they saved in nursing requirements. This also played an important marketing role All these strategies helped them in successfully establishing and running the hospital for a long period of time.