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Standard: Should a provincial health ministry fund a hip and knee surgery centre?

You run the case. Read the prompt, answer questions from the notes below, and share data only when the candidate asks for it or gets stuck. Score at the end.

Case timer

00:00

Target length:

1. Read the prompt aloud

Read it slowly, then pause. Let the candidate ask questions before they structure.

A provincial health ministry in Canada has a growing waiting list for hip and knee replacements. It is considering a public day surgery centre that would do only these operations. The exhibit shows the numbers. Should it fund the centre, and what must be true for it to work?

Format note: Difficulty: Standard. Format: interviewer-led, with an exhibit. Industry: Public sector and healthcare. Region: Canada. Interview length: about 30 minutes. The company is fictional and all figures are illustrative.

2. Answers to clarifying questions

Give these answers only if the candidate asks. If they ask something not listed, give a sensible answer or say it does not matter here.

If asked: Would the centre be public or private?
Answer: Public. A regional health authority would run it, the province would pay for it, and patients would pay nothing.
If asked: What target matters?
Answer: The ministry wants the list down to about 3,000 people, which it expects would mean most patients wait under six months (illustrative).
If asked: What limits how many operations the centre can do?
Answer: Mainly staff: surgeons, anaesthesia staff and nurses. I will tell you more later.

3. The hypothesis a strong candidate states

Listen for an early, testable guess like this one. It does not need to match word for word.

The list grows because referrals outpace operations, so my hypothesis is that a dedicated centre can shrink it at a lower cost per operation, if it can be staffed.

4. A model structure

Compare the candidate's structure with this one. A different split can be just as good if it is clean and fits the problem.

Change in the waiting list = new referrals - operations done, then the cost of adding operations
- Key: Waiting list flow: referrals in, operations out
- Extra operations from the centre, and years to reach the target
- Cost per operation in the centre and in main hospitals
- Staffing: surgeons, anaesthesia staff and nurses

Exhibit 1

Reveal to candidate: when they ask for this data, say "Open Exhibit 1" (they press "Show exhibit 1" on their screen).

Hip and knee replacements in the province (illustrative)

Hip and knee replacements in the province (illustrative)
Measure	Value
People waiting today	9,000
New referrals a year	13,000
Operations in hospitals a year	12,000
Operations the centre could do a year	2,500
Cost per operation in a main hospital (CAD)	18,000
Cost per operation in the centre (CAD)	14,000
One-time setup cost of the centre (CAD millions)	20

So-what

Referrals exceed operations by 1,000 a year, so the list keeps growing until capacity is added.

5. The working, step by step

Each step shows how a strong candidate works it out. Share a new fact from it only when the candidate asks or is stuck, and let them do the math: the result in the dark box is what they should reach.

Step 1: How fast the list grows
What a strong candidate does: New referrals minus operations done in hospitals each year.
Growth of the waiting list (people a year): 13,000 - 12,000 = 1,000
Step 2: With the centre
What a strong candidate does: Hospitals plus 2,500 centre operations, minus new referrals.
Fall in the waiting list with the centre (people a year): 12,000 + 2,500 - 13,000 = 1,500
Step 3: Years to reach the target
What a strong candidate does: From 9,000 people waiting down to 3,000.
Years to reach the target: (9,000 - 3,000) ÷ (12,000 + 2,500 - 13,000) = 4
Step 4: Yearly cost of the centre's operations
What a strong candidate does: 2,500 operations at CAD 14,000.
Cost of centre operations (CAD a year): 2,500 × 14,000 = 35,000,000
Step 5: Saving against buying them from hospitals
What a strong candidate does: If the ministry paid main hospitals for the same 2,500 extra operations, each would cost CAD 18,000.
Yearly saving against hospitals (CAD): 2,500 × (18,000 - 14,000) = 10,000,000
Step 6: Setup cost recovered
What a strong candidate does: The CAD 20 million setup cost divided by the yearly saving.
Years to recover the setup cost: 20,000,000 ÷ (2,500 × (18,000 - 14,000)) = 2
Step 7: Curveball: not enough anaesthesia staff
What a strong candidate does: Interviewer: "The health authority can only hire enough anaesthesia staff to run the centre at 80 percent of its capacity." The list then falls by:
Fall in the waiting list at 80 percent (people a year): 12,000 + 2,500 × 0.8 - 13,000 = 1,000
Step 8: Years to the target at 80 percent
What a strong candidate does: The same 6,000 people to clear, at the slower rate.
Years to reach the target at 80 percent: (9,000 - 3,000) ÷ (12,000 + 2,500 × 0.8 - 13,000) = 6

The recommendation to listen for

At the end, say: "The CEO walks in. What is your recommendation?"

The ministry should fund the centre, and secure its staff before it opens. First, the list grows by 1,000 people a year today, so waits will keep getting longer without new capacity. Second, 2,500 extra operations a year make the list fall by 1,500 a year, reaching the 3,000 target in 4 years. Third, each operation costs CAD 4,000 less than in a main hospital. So the centre saves CAD 10 million a year against buying the same operations from hospitals, and recovers its setup cost in 2 years. Staffing is the main risk: at 80 percent capacity the target takes 6 years. Recruit anaesthesia staff now, without drawing them from hospital operating rooms.

Risks a strong answer names: Hiring staff away from hospitals would cut hospital operations and cancel out the gain; Referrals may grow faster as the population ages.

Next steps: Agree a staffing plan with the health authority before approving the build; Track the list size and waiting times every month after opening.

Strong versus weak

A strong answer

Treated the waiting list as a flow, found the yearly gap, timed the target, and tested the plan against the real limit, which is staff.

A weak answer

Said the centre is cheaper per operation and stopped, without checking whether it shrinks the list or can be staffed.

Score the candidate

Score each criterion from 1 to 5. A 2 or a 4 sits between the descriptions.

Structuring

1: No clear structure, or a memorized framework that does not fit the problem.
3: A sensible structure, but with some overlap, a gap, or no clear priority.
5: A structure built for this problem, with no overlap and no gaps, a stated hypothesis, and a clear first step.

Math

1: Frequent errors, no units, or needed heavy help to finish.
3: Right answers but slow or messy working, or one error caught late.
5: Accurate and clearly narrated, with units, a sense check, and what the number means.

Exhibit reading

1: Read the chart aloud without finding the number that matters.
3: Found the key number but gave only part of the so-what.
5: Pulled the right number quickly and said what it means for the case.

Synthesis

1: Summarized what was done, with no clear answer.
3: Gave an answer, but with weak reasons or no next step.
5: Answer first, then two or three reasons with numbers, the main risk, and next steps.

Communication

1: Hard to follow: long silences, no signposting.
3: Clear most of the time, with some rambling.
5: Calm and concise, signposted each step, and checked in with the interviewer.

Total

0 out of 25

Score all five criteria to see the band and the feedback template.

Next: another case in Partner mode

Swap roles and run the next case, so you both practise answering and scoring.

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