The hospital built by doctors

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The Hospital for Specialist Surgery is a new and unique concept both in hospital ownership and hospital design for Australia. Dr Pritpal Singh, ophthalmic surgeon and Founder talked to us about the design process used for the hospital which opened in June this year.

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Sydney’s Hospital for Specialist Surgery is owned and operated wholly by 46 medical specialists, 43 of whom are specialist surgeons. We have set out from the very beginning to focus on patients and the delivery of quality care. If we get that right, the rest will follow.
Being designed by doctors, we were able to bring to bear many years of accumulated working knowledge of operating theatres and hospital wards. We were able to optimise the design in terms of efficiency, ease-of-use by patients, doctors, nursing staff, allied health professionals and support staff.
It is predominantly a surgical hospital with 10 operating theatres in total. There are six main theatres and four rapid turnover day surgery type operating theatres. From the main operating theatres, the patients can either be discharged home, go immediately to high dependency or surgical wards and from there, to the onsite integrated rehabilitation facility if needed.
Our philosophy is very much “ground-up collaborative effort” to make the best hospital that we can. There is easy interchange between all who work at the HSS. Any issues in patient care or problems with the hospital can be brought directly to the attention of management. This streamlines the efficiency and running of the facility.
The chairman and the directors of the hospital are all surgeons who use the facility. They have a direct understanding of the issues surrounding surgery and patient management. They are not removed from the facility and don’t view it in terms of an intellectual exercise or a spreadsheet. They are often at the HSS many days of the working week operating and using the facility. The users of the hospital are stakeholders and there is free and frank exchange of ideas on how to make the hospital better. They know the staff by name and in many cases, have worked with many of them over many years, building up relationships and friendships.
Forming the Team
The Castle Hill Day Surgery (CHDS) was built in the hills district of Sydney about 14-15 years ago with about 17 owners. The facility was a huge success and expanded to five operating theatres from the original three and over 70 users doing many thousands of procedures a year.
Five years ago, our chairman Dr John Fox learnt that a building was on the market in Norwest Business Park next to the lake. With an inspired leap of faith Dr Fox and a colleague Dr Alf Lewis, felt that a bigger version of the CHDS could be created with the same ethos of community and patient orientation.
They approached their colleagues many of whom worked at CHDS or the Westmead Hospital and 35 original doctors wanted to be part of the collaborative effort. A company was incorporated and the project moved into a design and then construction phase. The project rapidly gained momentum and after a short while we were being approached by doctors wanting to join the team. We were able to select those doctors with a track record of excellence and who we felt would have the same philosophy of collaborative effort.
There are a number of issues that we have faced.
First of all we were converting an office space into a hospital. As a result we had to work within the constraints imposed by the existing structure. In some cases we had to perform major structural work that added cost and complexity. Generally speaking these were technical issues and with a bit of creative thinking they could be surmounted.
The bigger issue was keeping the architects and engineers on track. It is not enough to delegate the work to those that you think have the knowledge, and hope that it will all come out fine in the wash. We were constantly performing surveillance on the quality of the work that was being presented. Fortunately, the board is very handson and a number of our doctors are multiskilled, with an intimate understanding of design and engineering. On multiple occasions we picked up design flaws or engineering errors. As a result, we saved hundreds of thousands of dollars and kept the project moving.
The last major issue we are faced has been getting all the requisite approvals prior to opening. There is a lot of bureaucracy involved but with persistence and considerable support from benefactors such as our local member of Parliament, that hurdle has been surmounted.
Lastly you might think that with such a large group of doctors that there could be difficulty keeping everyone on track on such a large financially demanding project. Somewhat surprisingly that has not been an issue at all. The group has been incredibly cohesive and understanding, allowing the board to progress the design and construction in a timely manner.
Core Principles in Healthcare Design
Our philosophy is “patients first”. For that you need the right people. We have actively sought those with a compassionate and caring nature. People who would see a problem and not leave it to someone else to solve it but would actively fix it themselves. [pull quote]
Because of the long-standing success of the CHDS, when the community became aware that we were building a new hospital, we were inundated by quality applications. A very fortunate position to be in.
Because surgeons are the owners as well as the users, we were able to pick their brains to make sure that we got the best equipment possible. Each craft group selected a wishlist of equipment. Subcommittees were formed to look at what was available, cost-benefit ratios and future directions in technology to ensure that we did not end up with redundant equipment.
The hospital is on an ideal site. It is situated on a large parcel of land close to transport and shopping. The north west of Sydney is experiencing rapid growth ideally placing the hospital in a position to provide services to the local population. Finally, being adjacent to the lake and with views out to the mountains, it provides a restful and comfortable environment for patients to recuperate after their procedures.
We believe greenspace is an integral part of the healing process, and have adopted this principle into our hospital design. The HSS has sculpted grounds. There is a contemplation garden for when patients and family require it. Being adjacent to the lake there are beautiful views out over the water. There is a lot of local wildlife using the lake such as ducks and geese. All the patient rooms have elevated views over the lake and mountains with large windows allowing lots of sunlight. These can all help to make a difference in patient recuperation.
In order to be flexible around permanent needs, we have put a lot of effort into futureproofing the building which could last for 50+ years. We have built in a lot of excess capacity that can be utilised as the demands on the hospital increase. Additionally the day surgery and rehabilitation swimming pool wing were designed with extra-large footings so that the building envelope can be expanded in the future, adding another four floors onto that section. This came at additional building cost but gives us the ability to add a few thousand square metres down the track should we need it. Lastly, the zoning of the site permits another building of the same size!
Environmental impact factor is an important consideration. First of all, just by retrofitting an existing building rather than knock down and construction dramatically reduces the environmental impact. The philosophy was to use as much material from the original building as we could, which has had the added benefit of cutting costs.
We have used double glazing on all windows and high levels of installation in the wall and roof panels. We have installed awnings onto the outside of the building to cut down on solar exposure and reduce air conditioning costs. All the lights had been replaced with high efficiency long use LEDs. The building electronics are all on “Smart Grids” minimising electricity consumption. We have installed our own oxygen generation equipment. This is quite a common technology overseas but is the first in Australia.
From the design of our management team to the filling of our resources for staff and patients, our vision has been to build a hospital where the philosophy of Patients First is instilled from the ground up. HSS realises that vision in ways the corporate and public sectors cannot match.
Infection Control
We have incorporated our infection control strategies are incorporated into the building design through:

• Hospital grade air conditioning with HEPA filtration.


• The operating theatres are extremely large with positive airflow. A lot of effort was put into separating the clean from non-clean areas to avoid cross contamination.


• We have imported the best tunnel washers to sterilise the surgical equipment.


• Handwashing is extremely important and there are sinks or hand wash lotion virtually every few metres.