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While reading this case study, one problem can obviously been observed- paradox of change. Shouldice is operating at its "best operating level"(as we can see from the case), a specialized work force but it is failing to meet all the demand for its chosen market niche. Adding additional capacity to meet market need may upset the existing work force and lower quality of operations. Failing to meet market requirements may cause competition that would …

…recommend them a combination of staying at present level with existing stuff and hospital, and to meet unmet market demand with external sources of capacity to stop competitors from entering the market. -Some additional measures to be considered: to prevent possibility of stealing techniques I suggest them to patent all theirs unique methodics, so other hospitals and doctors can't use them without permission, also patented methods will inspire and persuade patients to use Shouldice services