Shouldice Hospital Case Report Essays

Shouldice Hospital Case Report Essays Shouldice Hospital Case Report Essay Shouldice Hospital Case Report Essay Subject: Problems and Plans Operational Assessment of the Shouldice Hospital Thank you for the opportunity to consult on your Shouldice Hospital operational assessment. I understand that you have implemented a well developed focus strategy (market focus and internal focus) successfully and Shouldice achieves outstanding results by maximizing the difference between perceived quality and value to the patient on one hand and the cost of supplying services on the other. The nurses and doctors treat their patients with care and understanding and treat them more like family members. This has led to the high level of praise for this hospital and its treatment. The rising number of satisfied patients and word of mouth referral has led to demand for the facilities services which outstrip the facility’s current capacity. I understand that you are looking for guidance on specific actions in order to increase the hospital’s capacity while at the same time maintaining control over the quality of the service delivered, and the hospital management. I have identified the problems and offered a list of alternate courses of action. Problem Definition: The problem is that Shouldice is facing a paradox of change. Shouldice is operating at its â€Å"best operating level† for a service company with limited flexibility in its facility, a specialized work force but are failing to meet all the demand for its chosen market niche. Adding additional capacity to meet the unmet market need may upset the existing work force and lower service quality. Failing to meet the market demand may invite competition that could eventually cause Shouldice to lose market share and end up with excess capacity. Problem Justification: It is assumed that they are operating at the â€Å"best operating level† because the way the case describes how efficiently the hospital is ran and how the patients appear to be pleased with their treatment. Capacity is nearly 100% full if they do 30 operations a day and the patients stay 3-4 days. This would fill up 89 beds for a 5 day work week. They also have 15% (14 hostel rooms) additional capacity for peak times. This also works out to be about 70% capacity of their full time potential of 7 days. 70% of maximum capacity is the best operating point. To increase it rate of service utilization will decrease the service quality. For capacity analysis, refer to Appendix-B. To increase their output and maintain their quality they would need to increase the size of the hospital. This involves large capital investments and considerable time. Construction would also cause a disruption to the quality and country club atmosphere of the hospital. Due to shift restrictions the current operating rooms are completely un-utilized for 2 days of the week as well as 15. 5 hours of each weekday. Kitchen and common area are designed to accommodate one hundred patients and it is important that these facilities be kept up to ensure patients still receive the high level of satisfaction with the experience at Shouldice. The staff also has limited flexibility. Surgeons and surgeons’ assistants are specialized fields that have limited desire to be cross trained. It is assumed that the staff is happy with the existing work schedule and do not want a change. Increasing the days worked would cause more aggressive scheduling of the operating rooms and may make it hard to maintain the same kind of working relationships and attitudes. Alternative Courses of Action: Alternative courses of action are based on the assumption that the reason for their desired expansion is to meet an unmet market demand. i) They could add an additional day by operating on Saturday. ii) They could do nothing different and continue to do as they are currently doing. iii) They can add a new floor (i. e. 45 i. e. 50% more hospital beds). iv) They can meet the unmet market demand with external capacity (establish a new facility). v) They can utilize the current facilities during some of its present idle time. Evaluate alternatives and make decisions: i) Adding an additional operating day on Saturday is a valid consideration. It would utilize ideal hospital capacity. It could increase the number of patients served by 9% or 800 patient a year. Would this be a sufficient number of patients served to keep competition from entering the same market is unknown. Adding a Saturday is also assumed to have a negative impact on the work force that drive down the quality that gives Shouldice a competitive advantage. It would increase rate of service utilization beyond 70%. This could be offset by hiring addition staff. But one should consider the time it takes the new staff to come up the efficiency curve. For capacity analysis and financial details refer to Appendix-C. ii) Doing nothing is a valid consideration. Their existing system and reputation sets them apart as a market leader and it is assumed to be a profitable setup. If it is working do not try to fix it. We assume that the existing set up is acceptable to management as far as profit and other operating measures. The assumed risk is if they do not do anything then competition will enter the market place and could eventually take patients away from Shouldice. There is insufficient data presented to truly analyze this risk. iii) Increasing the number of bed by 50% would not be advisable unless they added more doctors and surgery rooms because the existing plant capacity and number of doctors could not fill an addition 45 beds. They would be operating the surgery rooms at over capacity. The construction requires large capital investment, time, and would disrupt the country club atmosphere. For capacity analysis and financial details refer to Appendix-D. iv) Meeting the unmet market demand with external demand is a valid consideration. It could be done in several different ways. They could look to other facilities that are similar and team with their doctors to train them in the Shouldice processes and share in the profits. This would help keep the competition out of the market and could be done as a silent partner until the service quality reaches a level that Shouldice would want to associate their name with the other facility. Another option would be to establish a new facility for Hernia. Another option would be to subcontract or franchise the operation. For merits and demerits refer to Appendix-E. v) Relieve the operating room bottleneck by utilizing the current facilities during some of its present idle time. Addition of weekend or evening surgeries will increase throughput without any capital investment. Expand the facility’s kitchen and social area’s to accommodate the increased patient throughput and continue to provide a high quality patient experience for its customers. Recommendations: I would recommend a combination of doing nothing with the existing staff and plant as to maintain the country club atmosphere and gregarious nursing staff that gives it its competitive advantage and meet the unmet market demand with external sources of capacity to keep the competition from entering the market. I would be happy to elaborate on my recommendations in future correspondence. Sincerely, An MBA Student Appendix-A Cost comparison – Shouldice vs. Other Hospitals: Cost Items| Shouldice| Other Hospitals| Remarks| Costs of typical operations| $954*| $2000-4000| * Without general anaesthetic| Transportation(round-trip fares for travel to/from Toronto)| $200-600| $200-600 **| **No data available. Considered the same as Shouldice. | Time Lost from work in Hospital| 04 days| 05 days| | Time lost from work while recovering| 05 days| 10 days| | Value of time lost (ranging from $50 to 500 per day)| $450-4500| $750-7500| | Total before Allowancefor recurrence| $1604-6054| $2950-12100| | Probability of Recurrence| 0. 80%| 10. 00%| | Expected Cost of Recurrence| $13-48| $295-1210| | Total cost to patient, employee and insurer| $1,617-6,102| $3,245-13,310| | Profitability of Shouldice Hospital Clinic: Hospital: Items| Shouldice Hospital| Remarks| Revenues per year(4 days X $111/day x 6,850 patients/year)| $3,041,400| Charges for hospital stay = $111/day. Operations per year = 6,850 (in 1982)| Cost per year| $2,800,000| | | | | Profit per year (A)| $241,400| | Clinic: Items| Shouldice Clinic| Remarks| Revenues per year(($450 + 60 + 75 X 0. 20) X6,850)| $3,596,250| Surgical fee=$450/operation. Fee for the assistant surgeon=$60. Fee for a general anaesthetic =$75. Operations per year=6,850 (in 1982)| Cost per year| $2,000,000| | | | | Profit per year (B)| $1,596,250| | Total (Hospital + Clinic) Profit per year (A+B)| $1,837,650| | Total Depreciated Assets = $5 million Return on Asset = $1,837,650/$5 million = 0. 36753 i. e. 37% Appendix-B Current Capacity Analysis Current Throughput: * 6,850 Operations/50 weeks = average 137 operations/week with a peak of 165/week in September. Capacity Analysis: * Examination Rooms: (6 rooms x 3 hrs (1-4 PM) x 5 days x 60 min/hr) / (20 min / exam) = 270 patients /week = 54 patients/day. * Admitting Procedure: (2 people x 4 hrs (1-5 PM) x 5 days/week x 60 min/hr) / (10min/patient) = 240 patients/week = 48 patients/day. * Nursing Station: (2 stations x 4 hrs (1-5 PM) x 5 days/week x 60min/hr)/ (10 min/patient) =240 patients /week = = 48 patients/day. * Operating Rooms: (5 rooms x 8. 5 hrs/room/day x 5 days/week)/ (1. 1 hrs/patient) = 187 patients /week = 37 patients/day. Average operation time = (82% x 45 min + 18% x 90 min) + 15 min file time = 68. 1 min/operation. * Surgeons: 12 surgeons x 3. 5 operations/day x 5 days = 210 patients/week = 42 patients/day. * Hospital rooms: 89 rooms = 147 patients per week (assuming 3. 5 days average stay, 3 days recovery and Monday – Wednesday admittance, No procedures on Saturday or Sunday only recovery and admittance) – 29 patients/day. 103 rooms (incld. 14 hostel rooms) = 161 patients (assuming 3. 5 days average stay, 3 days recovery and Monday – Wednesday admittance, No procedures on Saturday or Sunday only recovery and admittance and use of 14 â€Å"hostel† rooms for two nights each week) – 32 patients/day. Current: Check-in day| Beds Required| | Monday| Tuesday| Wednesday| Thursday| Friday| Saturday| Sunday| Monday| 30| 30| 30| 0| 0| 0| 0|. Tuesday| 0| 29| 29| 29| 0| 0| 0| Wednesday| 0| 0| 29| 29| 29| 0| 0| Thursday| 0| 0| 0| 29| 29| 29| 0| Friday| 0| 0| 0| 0| 0| 0| 0| Saturday| 0| 0| 0| 0| 0| 0| 0| Sunday| 30| 30| 0| 0| 0| 0| 30| | | | | | | | | Total Number in Hospital| 60| 89| 88| 87| 58| 29| 30| Total number of patients per week| 147| Appendix-C Adding an additional operating day on Saturday Use current 89 beds + 14 hostel rooms. Consider 3. 5 days average stay. Total number of patients per week = 180. Current throughput = 137 operations/week (refer to Appendix-B). Theoretical throughput = 161 patients/week (refer to Appendix-B). So, new throughput = (137/161)*180 = 153 patients/week. Therefore, additional patients per week = 153 – 137 = 16 Additional patients per year = 16*50 = 800 Additional revenue = 800*(450+75*0. 20) = $372,000 Total cost = $124,250 Therefore, Net increase in profit = $372,000 $124,250 = $247,750 for no additional investment. Demerits of this alternate action: * Require to schedule 23-25 operations on Saturday. * Six surgeons and a supervising surgeon have to work on Saturdays. * Additional other personnel (an anesthetic, nurses). * Violates the implied contract that Shouldice has with its surgeons, strong opposition by the senior doctors. * Operating close to the theoretical capacity of the facility. Merits of this alternate action: * No investment is needed. * Can still maintain quality service. Appendix-D Increasing the number of bed by 50% Current number of beds: 89 Add in a new floor (expand the capacity by 50%) at the cost of $2 million: 45 beds Total beds = 89+45 = 134 Total number of patents per week = 210 Current throughput = 137 operations/week (refer to Appendix-B). Theoretical throughput = 161 patients/week (refer to Appendix-B). So, new throughput = (137/161)*210 = 179 patients/week. Therefore, additional patients per week = 179 – 137 = 42 Additional patients per year = 42*50 = 2100 Additional revenue = 2100*(450+75*0. 20) = $ 976,500 Total cost = $176,500 Profit = $ 976,500 $176,500 = $ 800,000 Therefore, Return on investment (ROI) = $800,000/$2,000,000 = 40% Demerits of this alternate action: * Require to schedule doctors to the full capacity of five days per week * Increase work load on admissions, kitchen, laundry, housekeeping and accounting * Further staggering of meal hours for patients (100 seat dining room) * Disruption during construction. * Expensive Merits of this alternate action: * Easy to control and maintain quality * Retain the culture and environment Addition of 45 beds: Check-in day| Bed Required| | Monday| Tuesday| Wednesday| Thursday| Friday| Saturday| Sunday| Monday| 42| 42| 42| 0| 0| 0| 0| Tuesday| 0| 42| 42| 42| 0| 0| 0| Wednesday| 0| 0| 42| 42| 42| 0| 0| Thursday| 0| 0| 0| 42| 42| 42| 0| Friday| 0| 0| 0| 0| 0| 0| 0| Saturday| 0| 0| 0| 0| 0| 0| 0| Sunday| 42| 42| 0| 0| 0| 0| 42| | | | | | | | | Total Number in Hospital| 84| 126| 126| 126| 84| 42| 42| Total number of patients per week| 210| Appendix-E. Meeting the unmet market demand with external demand – Establish a new facility Merits of establishing a new facility: * New location close to current setup, say a major city (New York) in USA * Improve its competitive position and increase its profits * Operate in a less restrictive environment * New Opportunities for existing personnel * Transfer of knowledge and expertise to the new facility. Demerits of establishing a new facility: * Requires a significant investment and time * Difficult to maintain Quality control * Difficult to create the same culture and atmosphere * Potential competition with the existing facility.

Law and Human Immunodeficiency Syndrome Essay Example | Topics and Well Written Essays - 1000 words

Law and Human Immunodeficiency Syndrome - Essay Example Blood transfusion involves two stages diagnosis and therapy. Diagnosis aims to find out whether there is a need for blood transfusion while therapy is the physical process of blood transfusion. Most cases normally arise when a patient claims to have contracted HIV/AIDs because of blood transfusion. When this occurs, it is certain there was no proper blood test or proper screening of the donor. In such circumstances, the plaintiff has to show that the defendant acted negligently and because of this negligence, he was injured. In Roberts v. Subaru Hospital Association, it was held by the Maryland Court of Special Appeals that transfusion of blood was a service rendered and not a seller of the product. The court stated that â€Å"A transfusion is not just a sell of blood which the patient takes home as a package. The transfusion of the blood-the injecting of it into the patient`s bloodstream-is what he really needs and pays for, and that involves the application of a medical skill.â₠¬  There have been developed state laws that protect the confidentiality of HIV/AIDS-related information. Information concerning a patient`s diagnosis of HIV positive must not be disclosed and can only be disclosed to other healthcare professionals if need be. Disclosure of one`s HIV status violates his/her rights to privacy concerning their personal affairs. In Estate of Behringer v. Medical Center at Princeton, the plaintiff, a surgeon was entitled to damages for unauthorized disclosure of his status at the hospital.  

Research Paper Topics For Programming

Research Paper Topics For ProgrammingIn this article, I will share with you some research paper topics for programming. You might be surprised at the list of things that you can do on your computer today to complete some parts of the assignments you will be giving to your students.The first thing that you should know is that computers are now running more than they ever have before. There are many different types of software that have now been created to help make people's lives easier. Computers and software do not belong to just business use. The Internet has become a center for nearly all of our communication today.Many people are getting involved in research paper topics for programming. To some degree, you are the one who is responsible for what goes on with this information that you are gathering.The number of programs that have been created for this purpose have grown over the past few years. There are many areas of software that people use today, so if you are going to use re search paper topics for programming for your school, your students will need to be knowledgeable about many different topics.The software that is available for the general public, like your favorite browser or your favorite word processor, are all commercial products. As long as they are backed by a company and can be used on a personal computer, then they will most likely be accepted.All that you will need to do is run a search on the Internet and take a look at the results that will come up. A good program should be easy to understand and easy to use. Most of the ones that you are going to see are called 'learning environments' because they offer their users the ability to learn at their own pace.Nowadays, it seems like educational software are becoming more popular. There are many different programs that are designed for children to help them learn how to do things for the first time. It is becoming a new way for a child to learn something new and something that they cannot get a nywhere else.

Vital Pieces of College Admissions Short Essay Prompts

Vital Pieces of College Admissions Short Essay Prompts The History of College Admissions Short Essay Prompts Refuted Perhaps right now you're trying to enter the school that you dream about. If you're beginning to feel frustrated or overwhelmed by your essay, take a rest and do something different. Start with writing a list of all of the things you are searching for during your college career. There isn't a prompt to direct you, and that means you must ask yourself the questions that will get at the center of the story you would like to tell. MIT students work to enhance their communities in various ways, from tackling the world's most significant challenges to being a fantastic friend. Seeing students become productive and purposeful is among the most gratifying aspects of being a true teacher. What to Do About College Admissions Short Essay Prompts If you wish to be one of the 6% of students accepted to Stanford, you'll need to have a wonderful GPA. The applications of students who don't select or were not able to take part in the optional alumni interview aren't negatively impacted. Admissions officers want to learn what you desire to do beyondacademics. Is meant to help students develop skills to compose excellent essays at university we now dwell in a post-materialist age, where individuals do not need to be so. Individual schools sometimes need supplemental essays. Colleges are more inclined to admit students who can articulate certain explanations for why the school is an excellent fit about them beyond its reputation or ranking on any list. Personal Achievements Colleges are seeking students who have achieved in some region of their lives. Choosing Good College Admissions Short Essay Prompts Use outlines, word clouds or absolutely free association that will help you come up with material for every one of the different prompts. Colleges are seeking a feeling of maturity and introspectionpinpoint the transformation and demonstrate your private growth. Your solution shouldn't be a book report. If you're working with the Common Application, you've met the quick activity essay. A brief answer essay provides the college a practical window into the applicant's interests. A self introduction essay is in the majority of cases written employing the very first person standpoint. It is essential that you find out more about the essay requirements for each and every college on your application list. So far as content is concerned, all of us have various opinions. Very good grades and test scores aren't enough you want an outstanding college essay too. Templates may also help you get a notion of the way to make a good college admission essay format. Facts, Fiction and College Admissions Short Essay Prompts Writing a terrific college admission essay requires a lot of creativity. Students don't need to write about a significant turning point in their essay, Soule states. You'll observe a similar structure in a lot of the essays. Colleges can tell whenever your essay is merely a form essay. The folks reading essays really dowant to understand what makes you special. This Stanford essay prompt is extremely wide. Facts, Fiction and College Admissions Short Essay Prompts It's very beneficial to take writing apart so as to see just the way that it accomplishes its objectives. Describe some tasks which you have accomplished over the last two years with no connection to academic studies. On the flip side, in the event you made a great choice, focus on what influenced you to make that decision and the way it has changed you. Up to now, your application talks a good deal about academics. So, pay attention and make certain you concentrate on the most suitable assignment. So, there's no need to be concerned about someone requesting a refund. More than anything, you don't need to set your application in jeopardy. Even in the event the deadline is act ually tight, feel free to get hold of our managers. Consider what you love to do in your free time. Students lead busy lives and frequently forget about a coming deadline. Following your initial draft is finished, allow it to sit for no less than a day. Take your time to thoroughly think about each prompt. Therefore, the quick answer essay doesn't highlight any sort of remarkable accomplishment or private talent. So you don't actually wish to get a topic! Pick a distinctive topic that others may not think of, and whatever you select, make sure that you know a lot about it! As you can basically choose almost any topic you prefer, it can be more challenging to pick a topic which you think would showcase you, your ideas, your objectives, or your achievements in some manner.

Compare and Contrast Essay Topics Good and Evil - the Conspiracy

Compare and Contrast Essay Topics Good and Evil - the Conspiracy Conventional classes require students to attend class at a certain time and in a particular site. Enough practice in reading and writing will supply you with an extra advantage. Students who excel in writing about such complex topic can have an opportunity to be enrolled into a number of the ideal Art universities to come up with their abilities and talent. It's additionally wise that if evaluating school assignment that may be purchased, find an organization that can be keen on your employment than its monetary health benefits a thing a significant number of on the web depending publishing providers don't do. To be honest a rising number of scholars need an economical school assignment of top quality to satisfy their school demands. If you aren't prepared to master the art of academic writing alone, there is absolutely no need to go the site of an official writing service for students and purchase a low-cost paper written from scratch to stick out from the remainder of your peers! Both small and big universities can provide students with the opportunities to realize educational targets. Which people compare and offer you to compose decent topic tips that you would be how to remember. You should research your topic to select three claims. The key to opt for a fantastic topic for an argumentative essay is to select a subject where there's a lot of debates on topics or stances. When picking an essay topic, learn more regarding the target audience beforehand. Choosing the right topics might take a while in case you don't have a list of sample topics facing you. Since you may see, the topics are split between multiple categories so it would be simpler that you select one. Before you begin, it is essential to choose topics that you truly know well. Thus, it's vital that you select the ideal topic to write. Now you know how to opt for a compare and contrast essay topic, here's a list of some intriguing topics that can be written on. In the majority of instances, the topics you select should be closely related. The list is really endless. Suggestions for a brief guide to compose an exact worldwide exam essay topic suggestions out. Things You Won't Like About Compare and Contrast Essay Topics Good and Evil and Things You Will In the majority of the scenarios, you should search for items to compare that have some differences but similarities also. It is advised to look for the one which has a great reputation and offers high-quality papers at economical rates. You should have your reasons, and our primary concern is that you wind up getting an excellent grade. Also, be sure to look for distinctive features at various degrees of research. The War Against Compare and Contrast Essay Topics Good and Evil You also know how to discover sources and the very best kind to utilize in your paper to ensure it is relevant and interesting. The first thing you should do before you get started writing is to opt for a suitable topic to write about. Though you're just beginning to compose essays, you shouldn't struggle attempting to develop something to discuss. The very first thing you ought to do is identify the kind of compare and contrast essay which you are handling. Essay writing is a job where a million thoughts cross your head in a moment, therefore it is always beneficial you have another revision. Always have another look at your essay once you have finished. Writing an essay is not ever an easy job. Writing an excellent essay might be a bit of cake if you're feeling inspired. There are similarities irrespective of location, like the company chosen to observe the movie, and the movie itself. Secretly, individuals wish in their minds and thoughts that something bad would happen to some other individual or they would get in trouble or receive a lousy grade. Although they may think they are always doing the right thing they are not. Therefore, without the proper guidance, young women and men wind up destroying their fruitful lives. Most Noticeable Compare and Contrast Essay Topics Good and Evil You also have to be definite that the school assignment will adhere to the set up you have preferred. Students may typically understand the structure with only a quick quantity of instruction.

King Richard 1 Lion Heart Research Paper Example | Topics and Well Written Essays - 1500 words

King Richard 1 Lion Heart - Research Paper Example For this reason, King Richard is suspect of being a bad king. Nevertheless, there are some qualities in him to be appreciated. The label of a ‘bad king’ may not fully suit him. As king, he gave much on the behalf of others. Unfortunately, those ‘others’ were not the people of his kingdom. King Richard should be taken as he is and not quickly judged. The conclusion that he was neither a good or bad king, but a king, most correctly suits him. While not perfect, he was not wholly corrupt. An intelligent man, King Richard had a reason for his actions. Surely, the people of his land desired a better life than what he brought them. However, their suffering served a purpose that was to benefit a greater good. King Richard fought on behalf of what he believed to be right. He fought for that right with all that he had; which happened to include everything that the people of kingdom had. It is not amazing in medieval times for the peoples of a kingdom to lack social m obility. The oppression of his people for the sake of financial gain made such mobility impossible for those under King Richard’s rule. In this paper, the evidences that have been presented to label King Richard as either a good or bad king will be discussed and analyzed. The intent is to demonstrate that neither of these labels can fully describe him. Having some qualities from both categories, King Richard does not fit neatly into either. The actions of King Richard often depict a King that was not very interested in caring for his kingdom. He was obsessed with money. The kingdom was no more than a source of revenue to him. King Richard was able to extract large amounts of wealth from his people and land. This money he used for his own purposes. Therefore, his people did not get to enjoy the best of lives. Instead, King Richard pressured the people to pay taxes. He did not seek to enrich the lives of his own people. Their lives were full of work and yet they languished beca use of poverty. It is because of King Richard that the legend of Robin Hood was born. Robin Hood was a bandit, an outlaw, who sought to promote financial equality. The low distribution of wealth was the result of King Richards rule. He raped the land and the people of riches. Many people resented King Richard’s actions; especially since his father was considered to be a much better king. However, King Richard was hardly interested in following his father’s example. In fact, during his younger years, King Richard had actually engauged in war against his father. As it has been reported â€Å"  In 1173 he, the Young King and a younger brother, Geoffrey, backed by their mother, took up arms against their father in a war that lasted eighteen months† (Cavendish 2007). King Richard came to be despised by many of his people. For his greed of gain he is considered to be a bad king. When the thought of a king is someone who is beloved of the people and seeks their best interests arises, King Richard seems to fall nicely into the category of ‘bad king’. His lack of patriotism also helps him to fit into this category. It has been noted that â€Å"historians have traditionally spoken of him as incompetent and destructive, small-minded and incapable† (Heiser 1997; p.1). It was only about five months out of each year of his reign that the king actually resided in his own land. The rest of this time he spent in France. When King Richard made decisions about his kingdom they were often misguided. Being absent from

Sustainable Land Development

Sustainable Land Development The increasing demand of the land for housing due to different push and pull factors like: rural-urban migration, population growth and natural disaster, expectation of job and urban facilities, most of the cities and the governments are facing many challenges to relocate the urban poor and low income groups in planned and environmentally safe areas (Paudyal, 2006). On the other hand, the people who are living in squatter settlements are deprived from the security of land tenure, land development rights and land use rights (Pugh, 2000). Therefore, they are far from the facilities provided by the government and consequently suffering from the poor environmental conditions such as lack of water, sanitation, health facilities and education (Atterhà ¶g, 1995). However, land is one of the single un renewal natural resource and it is related to basic necessity such as food and shelter for living beings (Palmer et al., 2009). Therefore, sustainable land development to meet the basic need f or shelter in urban area of developing and under developed counties cannot be achieved without change in the land rights and condition of the land ownership such as change in geometry, area, land use, location (Muller, 2004). The government and the private organizations are the main land developing agencies to facilitate developed land plots in the land market through the urban management methods, process and techniques (Larsson, 1997). These methods might be compulsory or voluntary depending upon the legislation of the government (Hebbert, 1994; Turk et al., 2010). One of the non-compulsory or voluntary urban land development method is the Land Readjustment (LR) and LR is based on self-financing project and win –win strategy (Archer, 1986; Muller, 2004). It is used to readjust the irregular boundaries of the land plots with infrastructure and utility facilities (Doebele, 1982; Hong et al., 2007; Lemmen et al., 2012; Muller, 2004). LR projects are introduced by the central government, local governments, municipalities, private organizations and public agency with the participation of land owners and tenants. In 1902, Germany had initiated LR as a method for converting agricultural land to urban lan d with the enactment of land transfer law called Lex Adickes. Later on from 1954, LR technique has been adopted for disaster recovery in Japan under the Land Readjustment Acts 1954 and about 30% of the urban land were developed using this technique. Besides land use conversion and disaster recovery, LR has been used in Europe, Asia and America as urban renewal, development of new urban cities and prevention of spotted settlements (Atterhà ¶g, 1995; Yomralioglu, 1993). In spite of the popularity and advantages of the LR technique, there exist several problems that relates to the principles of land governance such as security, equity and participation (Turk, 2008). Therefore, the assessment of the governance principles in different aspects of the governance such as policy, process and structure is necessary for efficient and sustainable urban LR. Moreover, it is important to review the LR in the case of squatters to find out whether it is possible to relocate the squatters in developed and environmentally safe area based on participatory approach (UN-HABITAT, 2013a). Principally, LR projects are fully dependent on the consent of users (land owners) to use their land for infrastructure development and for cost recovery of the project. For instance, almost 30 % of Japanese urban land has been developed by LR technique but there was considerable disagreement by the small land owners with argument that the LR technique has favoured large landowners. The refore, about half of the municipalities have not used it at all (Atterhà ¶g, 1995). Similarly, the study on consensus among the land owners and multi-sectorial involvement in LR reveals that LR projects are fully dependent on the participation among the land owners, private sector and with the government (Hong et al., 2007). In addition to the participation, equity is other significant principle of the land governance for sustainable LR. Inequity in the distribution of the land resources causes different difficulties in building consensus and finally convert into violence, thus equity is measured by the value of the needs (Yomralioglu, 1993). Equity can be described in terms of input equity, process equity and output equity (Doebele, 1982). Input equity means the involvement of users (stakeholder; landowners are the entire users in LR project) in the policy formulation and planning. Process equity such as land contribution ratio and inclusive participation of users should be fair (Karki, 2004a; Turk, 2008). Output equity can be measured in terms of the benefit returned from the LR project through land value and urban facilities (Turk et al., 2010). Unfortunately, in Nepal, the Lands Act 1963 has made the restriction to maintain minimum parcel size to 80 m2. Because of this the land owner who are unable t o maintain the minimum parcel size as mentioned in the acts are forced to sell their land to the LR project and consequently they lose the sentimental value attached with their land and social relationship. However, good land governance is always supportive against the forced eviction (Karki, 2004a). Besides the equity, land tenure security is another principle to be assessed in LR. Land tenure security strengthens the relation between people and land (Simbizi et al., 2014). Insecurity in land tenure discourages the land owners to participate in land readjustment process. During the LR process temporary land owner is the land developer, who can restrict the transaction of the parcel by subdivision and physical changes on the land. On the other hand due to delay of the LR projects, land owners might be prevented from the land use rights. In Nepal, land ownership certificate and restriction free letter from the Land Revenue office are essential to get the financial credit from the bank but when land ownership certificate are submitted to the LR project it creates the problem to get the credit from the bank. Security of land tenure, in the case of the project handled by the private organizations is another challenge to convince the land owners about security of the land tenure and other use rights (Turk, 2007). To face these problems the network among inter-organizational and multi-sectorial stakeholder is necessary for sustainable LR (Mattingly, 1996). Acc ording to Sorensen (2005), when the governance actors are participated in a horizontal integration to meet common societal goal then such a network is called governance network. In the governance network the power among the governance actors is shared for sustainable urban development. On the other hand, for the case of the squatter settlers who are deprived from land tenure, equitable access to land for shelter; participatory LR with the application of good land governance is essential. Relocation of the squatters into land readjusted area can be possible by constructing social houses by the government, private sector and civil society groups through acquisition of the cost recovery land from LR project. PILaR- Participatory and Inclusive Land Readjustment approach could address many challenges of conventional LR through incorporating participation among the government, internal users (land owners), external users(squatter people), civil society groups, academia and private sector to support the squatters providing secure shelter (UN-HABITAT, 2012, 2013a; World-Bank, 2002). These aforementioned problems are closely related to the land governance. Thus, it is essential to assess the land governance principles such as land tenure security, participation and equity in different aspects of the governance such as policy process and structure for sustainable implementation of LR. It is also important to review the LR for the relocation of squatters into LR area to meet the need of basic shelter.