Private Healthcare Success: Designing for Growth

Start With the Business Model, Not the Building

One of the strongest themes from the discussion was the risk of designing a facility before defining the business model. Too often, exciting clinical ideas translate into over-designed, under-funded projects. As Shrewsbury noted, clinicians may come with great ideas for new services, “but they don’t really understand how to execute, how to implement, and how to design, and when the real costs surface, eyes glaze over”. Early enthusiasm can lead to growing scope and gold-plated features, but without a solid financial plan these concepts eventually fall flat. Shrewsbury observed that many consultant-led ventures fail because “so many of the consultant groups fall by the wayside because they can’t agree or they won’t support each other”, and they lack a viable commercial model to bind them. Georgina Bishop emphasised the need for early commercial discipline:

“There always has to be that focus on the business model: where are the patients coming from? what’s the market rate for the proposed services? and how do you make the numbers work while still delivering a quality service?”.

In practice, this means starting with a robust business case before anyone touches a floorplan. Every design decision should tie back to how the facility will attract patients and operate sustainably. This approach guards against facilities that are beautiful but nonviable. Projects that ignore the financial model are unlikely to secure funding or ever open their doors. The takeaway is simple – define the service and revenue model first, then design the space to serve it.

Why Commercial Reality Must Inform Every Design Decision

There is an importance on embedding financial leadership at the very beginning of any private healthcare development. Too often, design discussions begin with enthusiasm, ideas and clinical wish-lists long before anyone has pinned down the financial boundaries. As concluded by the participants, this is where the projects start to drift.

During the discussion, an analogy was used that resonated strongly: the idea of a “candy store with no till”. It described what happens when teams keep adding desirable features – more diagnostics, larger suites, premium interiors – without simultaneously accounting for the cost impact. Everything looks attractive in the early sketches, but no one is capturing the cumulative expense as the scope expands. The result is predictable: by the time the cost plan finally catches up with the design, it becomes clear the project is now financially unworkable.

Jonathan Shrewsbury emphasised this risk, explaining that many concepts falter because expectations are allowed to grow unchecked. When finance and commercial voices are involved from day one, the process is fundamentally different. Instead of designing first and costing later, multidisciplinary teams triangulate scope, cost, and programme continuously, ensuring every decision is grounded in the commercial model. This reframes the conversation away from “What would be ideal?” to “What can we sustainably deliver while maintaining quality and viability?”.

This approach is increasingly recognised as best practice across high-performing healthcare developments. By aligning each design iteration with the business case, organisations:

• Prevent costly late-stage redesigns
• Accelerate timelines by avoiding unviable concepts
• Protect operational efficiency and revenue potential
• Ensure that every square metre has a defined purpose and return

In short, when commercial viability leads alongside design – not after it – organisations arrive at a workable, affordable, and strategically coherent facility far more quickly. It allows ambition to remain grounded, protects the long-term sustainability of the service, and ultimately supports better outcomes for patients, teams, and investors.

Build a Design Guide Before You Scale

The discussion made it clear that no organisation should move into detailed planning without first establishing a design guide. This blueprint of capturing lessons learned, design standards, room specifications, patient flow considerations and operational best practices, provides the structure needed before any physical facility is developed. Aspinall described how, in previous projects, early clinics acted as de facto prototypes. The team discovered small but meaningful gaps in layout, workflow and spatial assumptions, and each time they opened a new center, they refined the model further. Over time, these incremental improvements evolved into a highly effective template, demonstrating why codifying insights early makes every subsequent build faster, safer and more efficient.

A well-developed design guide offers multiple benefits:

Importantly, the design guide should be a living document. Each new facility project is an opportunity to refine the standards further. As Aspinall put it, by the later projects “it was so much better” thanks to continuous refinement. This kind of iterative standardisation is increasingly seen as best practice in healthcare development.

Flexi-Space: Designing for a Future You Can’t Yet See

Flexibility was another topic emerging from the roundtable as one of the most urgent priorities in a fast-evolving healthcare landscape. Medical technology is advancing rapidly, care delivery models are shifting, and acuity profiles in private settings are increasing. Providers must assume that the services they deliver today won’t be delivered in the same way five years from now. Therefore, designing rigid, single-purpose spaces is a recipe for future cost and regret.

Bishop illustrated this vividly with a real example: a gorgeous new clinic building that featured wide corridors and a generous waiting area – “beautiful… huge patient waiting space” – but had relatively few consulting rooms. Much of its square footage was in non-revenue-generating areas. Before long, demand outstripped capacity for consult rooms and clinical functions.

Retrofitting those wide corridors into usable clinical space or adding sinks to rooms that lacked them, proved incredibly expensive and disruptive, far more costly than designing the space more efficiently from the start.

Aspinall highlighted how difficult it can be to anticipate future clinical requirements during early planning, but how costly it becomes when facilities cannot adapt. She recalled private hospital rooms originally built with baths that later had to be replaced with walk-in showers as patient care pathways changed – today both patients and insurers demand shorter lengths of stay and more rapid recovery. The message is that design should be done with the expectation that services and patient needs will evolve.

In practice, flexibility means creating a building shell and internal layout that can change function without major reconstruction. This can include modular walls, consistent room sizes, additional infrastructure capacity (plumbing, electrical, digital), and adaptable “soft” spaces that can be converted into clinical areas when needed. As Bishop noted, attractive architecture is no substitute for operational suitability: “The building may be beautiful, but wide corridors and big waiting spaces don’t generate revenue.”

Governance Must Lead Growth, Not Follow It

Perhaps the most passionate theme that emerged was the primacy of clinical governance in any growth endeavour. In the rush to capitalise on rising demand, some new entrants in private healthcare focus narrowly on profit and speed to market, only to realise too late that they have underestimated the operational complexity and regulatory requirements of delivering safe care. Aspinall put it powerfully:

“All too many times I’ve seen commercial profitability is number one and governance second. It absolutely has to be the other way around… you get the safety right, you get the clinical right, the money will follow.”

The panel unanimously agreed that clinical governance – quality assurance, patient safety systems, regulatory compliance, and oversight structures – is not a box-ticking exercise or something to be layered on after opening. It is the foundation of the business model itself.

Why is governance so critical to growth? First, from a values perspective, no healthcare venture can sustain itself if it doesn’t deliver quality care – poor outcomes or safety issues will rightly destroy reputation and invite regulator intervention. But even from a financial lens, investing in robust governance pays dividends.

In other words, quality drives profit, not the other way around. Shrewsbury noted that focusing on patient safety and outcomes “will normally feed through to commercial success”, and advised new providers to “be very, very clear about the safety governance and the quality of care you’re going to provide and really stick to it.” Especially in private healthcare, regulators such as the Care Quality Commission (CQC)  1 have stringent standards. Failing those means you may not be allowed to operate, regardless of market demand. Thus, governance can’t be an afterthought or merely reactive. It must lead the growth strategy, informing decisions on what services to offer (can we do it safely?), what facilities to build (will they meet infection control and emergency standards?), and which partnerships to enter (are partners aligned on quality expectations?).

Partnerships: A Strategic Advantage, Not a Referral Mechanism

The roundtable emphasised that partnerships are now essential to private healthcare growth. Fragmentation across the sector often forces patients to move between multiple providers for diagnostics, treatment and follow-up, creating confusion and disjointed care. Both Bishop and Aspinall highlighted the operational and clinical risks when providers lack clear transfer pathways. When a patient needs escalation from an outpatient setting to a higher-acuity environment, pre-agreed partnerships ensure smooth, safe transitions – without last-minute negotiations overshadowing urgent clinical need.

Partnerships should therefore be viewed as strategic extensions of a provider’s capability, not just referral routes. They can expand service scope, reduce capital requirements, strengthen reputation and create a more coherent patient journey. Encouragingly, Bishop pointed to efforts by the Independent Healthcare Provider Network 2 (IHPN) to foster more coordination among London’s private hospitals as a positive step. Partnerships can reduce capital requirements (through shared facilities), bring in expertise, and make smaller providers look bigger in the eyes of patients. Crucially, a well-chosen partner can help deliver care in a more joined-up way, sparing patients the feeling of being passed around an uncoordinated system

In an increasingly competitive market, collaboration is a differentiator. The organisations that succeed will be those that build integrated networks around patients rather than operating in isolation.