S9 EP4: Rebecca Wark, Government Goodies

Rebecca discusses the highest priorities for Health Infrastructure including future work.

If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:00:22] I'm your host, David Cummins and today we're speaking to Rebecca Wark, who is the Chief Executive at Health Infrastructure in New South Wales. I'm excited to learn more about Rebecca today, to hear more about the New South Wales Government and Health Infrastructure and what they're doing now and into the future.

[00:00:38] Welcome, Rebecca. Thank you for your time to be here. 

[00:00:40] Rebecca Wark: Hi, David. Thanks very much for having me today. 

[00:00:43] David Cummins: I'm going to bet that this will probably be our most popular podcast because I would say most people, if not all people in Australia, certainly... if not know you, certainly know of you and I think this will be a very popular podcast for sure.

[00:00:55] Your role at HI (Health Infrastructure) has been so instrumental, what drives you to make sure that HI and New South Wales get the outcomes?

[00:01:03] Rebecca Wark: David, I'm flattered by your opening remarks to say that this is going to be the most popular, but thank you.

[00:01:09] I'd firstly like to acknowledge today that I'm joining from the lands of the Cammeraygal People, and I pay my respects to the Traditional Owners of the land. 

[00:01:18] Your question was around, what's been instrumental in some of this. I think it's a diversity of thinking that we promote in everything that we do and I've been with HI since 2008, with a couple of breaks in the early years but for 16 years I trained as a landscape architect.

[00:01:37] I majored in urban design and then studied project management as well, mostly to validate the work that I was doing. 

[00:01:45] But it's about having a passion for wanting to make change and make people's lives better. So for me, it's about having better facilities and better health services to actually make a real change in people's lives.

[00:01:58] David Cummins: I totally agree. 

[00:01:59] I've got a clinical background myself and that's certainly what drives me, but not everyone in this industry has clinical, not everyone has the same background, but that diversity in thinking, that's drawn together by the common purpose of better care for patients and community, I find throughout these podcasts a very common theme which is why people stay in the industry for so long and people are happy to do a podcast and do research to it.

[00:02:23] But I also find some people that don't have that purpose probably don't stay in the industry as long. 

[00:02:27] Rebecca Wark: And I think, for me, before I did this Chief Executive role, which has been five years, I focused on delivering our rural and regional projects so I had a lot of interaction with the health workforce and communities in that space and have a real passion for healthcare in remote areas.

[00:02:46] I've been around long enough, I think I've been through four election cycles and a pandemic and bushfires and floods and all sorts of different things which have challenged how we deliver health care and how people live and the changes that people make in their life. 

[00:03:02] So in this role, I think you become accustomed to change and I have a reasonable sense of what might come next and how the market reacts to that. 

[00:03:11] David Cummins: Yeah, I agree. 

[00:03:12] Knowing that HI is probably the biggest beast in delivery and planning in Australia at the moment, do you mind just telling some of our listeners what the current state of play is in HI at the moment. What you've got now, what you've got in the future, that's readily available information?

[00:03:27] Rebecca Wark: HI had the benefit over a long time of being... what was it you referred to us as... the beast, the biggest beast. 

[00:03:34] But now Queensland and Victoria both have similar pipelines. 

[00:03:39] I think what that means is we've got an enormous national pipeline at the moment and we need to think through how we deliver that. 

[00:03:47] But our state of play in New South Wales, the current government has been in office for 12 months. The 2023/24 budget confirmed three general priorities; delivering essential services in health, investing in frontline staff and improving access to care.

[00:04:05] So we have a role in that. There's $13.8 billion committed in the health infrastructure capital investment pipeline over the next four years. And the expectation of us as a business is to build about $2 billion of infrastructure every year, so that's significant. 

[00:04:24] And of course, with some of the issues that we have at the moment around escalation, around workforce. 

[00:04:30] That's challenging as to how we do that most efficiently, how we make those dollars go as far as we can without cutting the scope of what we're delivering to the point that it's no longer beneficial to the communities. 

[00:04:44] There's pressures on the system, I think everyone acknowledges that. And we need to be collegiate and work with our industry partners about how we react and respond to deliver what we have to do or what we've been asked by government to do.

[00:04:58] David Cummins: Yeah, it certainly is a balancing act, even just resources alone. Every state and territory, if not the world, is feeling that pain point of lack of resources for an increasing and aging population. So, what do you, or certainly your team consider when releasing work to the market. 

[00:05:14] Is it about the timing, is it about the scope, is it about the needs, is it about the facade and making sure it will be there forever. What are some of the considerations that you as a team consider? 

[00:05:23] Rebecca Wark: We are very intentional on how we release things to the market. We've learnt that through trial and error over a number of years and through continuous dialogue with our delivery partners.

[00:05:34] We believe through that increased consultation, that careful and steady release of work... that has helped cultivate and grow the relationships that we have. And it means that we've got high calibre, highly specialised, highly networked workforce. that we have here in New South Wales. 

[00:05:52] In practice, what does it mean? It means we communicate early and often on our forward pipeline to help industry prepare. It allows industry to respond about which projects they want to be involved with and have very targeted tender submissions and it helps industry shape our procurement process.

[00:06:09] So that's through things like Statements of Participation, which is a form of market sounding to gauge industry interest and preferences around what we're doing, they happen throughout the year, they happen with some of our bigger programs. 

[00:06:23] And then when we're sequencing work, we go back and refer to that to make sure that we get a spread of different industry players across our portfolio and to make sure that we're responding appropriately to the demand for resources that we have.

[00:06:37] Some of our biggest challenges in that space though, are how do we get some of those partners to work in some of the more regional and remote areas, because it's very difficult for them to get trades, subcontract resources into that space, where it's frankly not as attractive nor as profitable and higher risk.

[00:06:57] We're seeing that procurement as a gateway to the partnership and that's where it needs to start, at the beginning. 

[00:07:03] David Cummins: Yeah, I totally agree. I was speaking to a Western Australian team the other day and they were talking about the challenges that they have with diversity of geography in itself.

[00:07:12] So I do think that it is a common problem around Australia. But with HI in particular, a lot of your projects, and full transparency, worked on one or two of them... the pipework does seem to be very consistent and very, very special in many ways. 

[00:07:27] So, what is probably some of your main principles that you focus on as a team to make sure that that pipework is not only consistent but also attractive for a lot of team members?

[00:07:40] Rebecca Wark: It's a very big pipeline. 

[00:07:41] But other states, as we said, also have big pipelines now. As well as the quantity of what we have in New South Wales, I think we are very focused on the quality of the work we do.

[00:07:52] And we have many lessons learned, picked up of over the last 15 or so years.

[00:07:58] So we're prioritising good design where, last year we launched the Design Guide for Health... Spaces, Places and Precincts and that was done in collaboration with the New South Wales Government Architect. And that guide provides clarity to our teams on what we mean by good design on our projects.

[00:08:16] It allows us to balance great design with functionality and whole of life affordability. So we're also focusing on whole of life cycle costs, of different parts of the built structure, on major medical equipment, on other equipment that's in our buildings, so that we get a more considered design life cost in our buildings and that we also consider our workforce issues and sustainability in that workforce space. 

[00:08:44] Not just environmental sustainability, but also touching on workforce sustainability, economic sustainability.

[00:08:52] And in doing that, we've also launched very recently some additional work that we're doing in the design standardisation space to reduce not only design and construction costs through potentially modularity in those spaces, but also to reduce operating costs and in doing that, unlocking innovation.

[00:09:13] David Cummins: Literally that was my next question about innovation because I'm very sure that certainly as a whole, Australia is talking about innovation more in design where what was traditional and he just picked up on as well with operational costs... what was traditionally certainly 20 years ago when I entered the industry, it was very much.. we build the building for now, but it seems very, very common now and almost essential when you're talking about design to talk about innovation, future proofing and not necessarily the design of the project, but the whole life cycle of the hospital, including operations. 

[00:09:45] So it is something that certainly has changed, and I do think HI do lead the way in that as well, which makes it for a designer or a project team more exciting to actually know that the principles of research and the principles of understanding what the needs are would last, 10, 20, 30 years in the future. 

[00:10:01] Is that your understanding as well? 

[00:10:03] Rebecca Wark: Yeah, absolutely. 

[00:10:04] And that whole sustainability piece, it's not just innovation anymore, people are expecting it as business as usual. So it's how do we shift the dynamic into that space? 

[00:10:15] NSW Health is a very high carbon-emitting entity and we need to make sure that we're taking decisive steps to lower carbon emissions. 

[00:10:25] And part of our role in that space is building in climate resilience. So we need to do that with the whole of the health ecosystem. 

[00:10:32] We've raised the minimum sustainability requirements for all of our capital projects last year, and I can talk you through a few ways that we're doing that. We've developed as a first step, a standard approach to measuring, the carbon measurement.

[00:10:48] And we found that embodied carbon was responsible for almost two thirds of the carbon emissions in our buildings. 57 percent embodied, including 29 percent of upfront carbon. And that clarified that for almost all HI projects, the key opportunity is reducing that in the upfront and embodied carbon through changes in our structural design.

[00:11:09] So we're trying to focus on that now and additional opportunities through changes to interiors and building services.

[00:11:17] And we're looking at how do we do our cost benefit analysis in that space and having an evaluation guide for upfront carbon to support all of that decision making.

[00:11:26] So I think if we look back a few years... we didn't know what we didn't know and now it's such a steep learning curve, but there is an absolute commitment in that space. And the climate risks are evolving for us every day. 

[00:11:39] David Cummins: A lot of people think it's purely because of operations, but it's actually not. I mean, a lot of it's got to do with the design or the output or life cycle of that product, so if we can actually start to instill better initiatives now, then that life cycle of 50 plus years or 40 plus years will just help future generations.

[00:11:56] So does that mean that comes into your business case phase as well, sustainability initiatives? 

[00:12:01] Rebecca Wark: It means we certainly need to look at that and it comes into our tender schedules too when we're looking for our design partners and our project partners in this space as well about what our different partners can add in this space.

[00:12:11] It's everything from... there's newly updated flood modelling, and how do we respond to that without just building higher buildings. And some of that is really very challenging about how we solve those problems.

[00:12:23] Extreme heat and fire risks in New South Wales... we've had terrible bushfires in recent years and we have more hot days, we have higher humidity and we are definitely seeing some changes in our building structures and our heating and cooling systems in our buildings need to respond to that. So we have a new Risk Assessment Tool as well which we've launched specifically for our health projects.

[00:12:45] David Cummins: It sounds like a lot of... which I always say 90 percent planning, 10 percent execution.

[00:12:49] It'll be hard for government but all these people who say we have to get it out, we have to get it out, but the honest answer is you have to plan more, and then get it out, because then it will actually be rolled out.

[00:12:58] So that would be quite a challenge, I imagine, getting that balance between all that extra planning to push out for the government, or is that not a consideration? 

[00:13:07] Rebecca Wark: No, it is, and I think... one of the challenges is with our huge levels of investment is working out what we can do in our projects now, recognising that we can't do everything now, but what are the important things that we need to look at and then what are our ambitions for our projects where we're just commencing planning now so that we can pick up additional innovation and savings and be ambitious in that space.

[00:13:31] David Cummins: Yeah, that's fantastic. 

[00:13:34] I know we've got one quick last question. 

[00:13:35] How important is it to include diversity when it does come to design, especially in state -run hospitals. 

[00:13:42] Rebecca Wark: For me, it's hugely important, and it's, if you surround yourself with people who think the same way that you think, you don't come up with new ideas. So a big part of that, that we engender in our teams, is listening. 

[00:13:57] Listening to staff about what's important for workforce and wellbeing in that space. Listening to community patients and patient carers about what's important. Part of that is designing for Country. 

[00:14:10] It's how we weave in our Arts in Health Program, not just to put artwork on walls, but to have programs which are better for people's wellbeing. So, it's about all of that diversity piece, David, it's around how do we promote better mental health and wellbeing for all of the people that we are working for in this.

[00:14:30] So that's about communities, patients, carers and staff.

[00:14:34] And diversity and thinking from my perspective has got to be the key because then you're promoting a good culture and with that good culture, you're getting positive engagement. And when we have positive engagement, we always find we have better outcomes.

[00:14:47] David Cummins: Yeah, I totally agree. I know we're out of time, but I just want to thank you not only HI for all the hard work that you do for New South Wales, but also Australia, but also you particularly, Rebecca, I think you're absolutely amazing. 

[00:14:58] I think your dedication to this industry is phenomenal. 

[00:15:00] Your dedication to this profession is fantastic and your dedication to time with things like this or conferences around Australia is just amazing. So I don't know how you do it, but I'm just so grateful, not only for you, but for your team as well, for everything you do to this industry.

[00:15:14] So thank you so much. 

[00:15:14] Rebecca Wark: Thanks, David. It's been a pleasure chatting with you today. 

[00:15:18] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:15:23] To learn more about the AHDC, please connect with us on our LinkedIn or website. 

[00:15:26] Thank you for listening.