Building pressure: what’s straining Australia’s hospitals and how to build resilience

Wayne Jones stood on crutches for 5 hours in a Perth emergency department while a brain tumour pressed against his skull. In Victoria, Rhiannon Coombs waited nearly 3 years for a colonoscopy that (by then) revealed stage 3 bowel cancer. Queenslander Jane Granger waited 3 years for hip surgery.

Across the country, patients like these embody the pressure building inside Australia’s hospitals. Ambulance ramping, bed blocking and long surgical backlogs collide with chronic workforce shortages and a $42-billion pipeline of hospital projects facing cost blowouts and delays.

For hospital executives, these are pressing issues that affect community health, financial stability, staff satisfaction and institutional reputation.

To understand where the pressure points are, and what can be done, Veri Health spoke with Peter Spryszynski, Country Manager of Q-bital Healthcare Solutions.

Q-bital delivers mobile and modular clinical facilities that can be deployed within weeks, and its vantage point across multiple jurisdictions provides a clear-eyed view of what’s happening in Australia.

Surgeries delayed, beds blocked, ambulances stuck

Queensland alone has more than 65,000 people waiting for elective surgery.

As Spryszynski notes, “Elective surgery still means necessary surgery. When you’re in daily pain due to a bad knee or hip, you really need that surgery to happen.”

Elective backlogs or difficulties accessing primary care can spill directly into emergency departments. The AMA reports that Queensland has not met its ambulance ramping targets for nearly a decade.

One reason ambulances queue outside is that beds are full. That makes timely discharge crucial so that new patients can be admitted. Yet across Australia, almost 2,500 elderly patients are occupying state public hospital beds because there are no federal government aged care beds available. This costs taxpayers $1 billion per year.

Spryszynski recognises this is a complex systemic problem that straddles both state and federal governments and requires a full system-wide solution. Hospitals often find themselves caught between different levels of government. Aged care places are federally funded, yet the lack of them leaves state hospital beds occupied by patients who simply have nowhere else to go. Every blocked bed is another ambulance waiting outside.

To address ambulance ramping, Q-bital has deployed modular units staffed by paramedics, where ambulances can hand over low-acuity patients.

As Spryszynski explains, “It’s like an ambulance without wheels. Instead of ambulances ramping up one behind the other, they can drop off their urgent but low-acuity patients at our facility, staffed by a few paramedics who monitor them until they’re admitted to the ED. Meanwhile, the ambulance gets back on the road to attend to the next patient.”

At the other end of the patient journey, Q-bital’s modular facilities can be configured as discharge lounges. Medically fit patients are transferred out of acute beds, creating capacity for new emergency arrivals or scheduled surgeries.

A dual workforce shortage

Australian healthcare faces a dual labour crunch.

On the clinical side, nurses, doctors and allied health professionals remain in short supply. Migration pipelines are reopening, but interstate competition is fierce with retention bonuses, HECS debt relief and other tempting perks on offer. At the same time, federal aged care reforms requiring 24/7 onsite registered nurses are pulling staff away from hospitals.

There is also a well-publicised shortage in construction trades. Australia has 54 major health infrastructure projects worth a cumulative $42 billion under construction (or awaiting a start date). Infrastructure Partnerships Australia warns that, at its peak in late 2026, the labour required to deliver this pipeline will be about 2.5 times the current level. And that is purely for the healthcare sector – it does not factor in key infrastructure projects for the 2032 Brisbane Olympics or the 1.2 million homes to be built by 2029 under the National Housing Accord.

Perhaps this helps to explain why costs for building multi storey car parks at some hospitals have ballooned to up to $250,000 per space, far above benchmark levels of $40-65k.

These shortages in the clinical and trades workforces have real costs such as higher wages, stalled projects, blown budgets and missed deadlines.

Private hospitals under pressure

In addition, private hospitals are increasingly squeezed by rising costs, shifting care models and faltering payment arrangements.

Recent years have seen a shift from lucrative week-long admissions to short stays, same-day or outpatient models of care. While this may suit patients keen to return home, it erodes the revenue base that private hospitals have long relied on.

Operational costs are climbing fast. Hospitals face inflationary pressures in staffing, energy, supply chains and insurance. The sector is struggling to negotiate fair contracts with private insurers, who are pushing back on rate increases even as hospitals claim their costs are under-reimbursed

Specialist fees are another pressure point. High out-of-pocket costs for specialist appointments are suppressing demand. Fewer patients following through on referrals reduces bed utilisation downstream in private hospitals.

“Some of the large operators are posting losses, and buyers are hard to find,” comments Spryszynski. Healthscope, once one of the biggest names in the sector, has been unable to sell its business in full.

Behind all this is a structural misalignment. Fee-for-service payment models reward volume – number of stays, length of stay – rather than health outcomes or efficiency. As system funders and insurers shift expectations (toward shorter stays, outpatient or community care, bundled or outcome-based payments), hospitals operating under traditional models face financial risk.

Spending smarter, not bigger

Capital planning is also under scrutiny.

Earlier in his career, Spryszynski recalls hospitals buying top-tier MRI machines worth double what was needed because of perverse incentives to spend the full budget each year.

The recent Sangster review found Queensland’s $10 billion hospital expansion program was fundamentally flawed — costs have more than doubled, timelines have blown out by years, and many projects proved undeliverable due to poor planning, rushed procurement and workforce shortages.

What’s needed? “We need to focus on fit-for-purpose spending,” argues Spryszynski. That means directing capital into infrastructure that meets real clinical and community needs, rather than defaulting to the most expensive option. Wherever possible, infrastructure should be adaptable so it can respond to changing demographic trends.

Q-bital’s approach aligns with this shift: modular theatres, wards, and diagnostic suites that can be installed quickly, used to meet current need, then repurposed when demand shifts.

Considerations for CEOs and hospital boards

Spryszynski suggests hospital C-suites and Boards consider issues such as:

• Funding models: Move from fee-for-service to outcomes-based funding. Payments should reward results rather than volume.
• Capacity use: Shift lower-value, high-volume work into dedicated spaces to free up major theatres for complex cases.
• Capital clarity: Define what the investment is meant to achieve before signing off. The most expensive technology is rarely the right answer.
• Workforce planning: Anticipate scarcity. Build retention into budgets and consider modular builds that require fewer trades.
• Resilience tools: Use modular facilities to manage surges, refurbishments, and disasters without shutting down services.

Buying time to think strategically

Q-bital does not claim to solve every challenge. What it provides is breathing space – facilities that allow hospitals to keep running while leaders plan better for the long term.

The company’s first Australian client was a prestigious one – The Alfred Hospital in Melbourne. One of its theatres had been damaged in a severe storm and closer inspection revealed asbestos. Q-bital rapidly deployed a modular laminar flow operating theatre where The Alfred’s surgeons famously performed open-heart surgery “in the car park”.

The Prince Charles Hospital in Brisbane cut its colonoscopy waiting list thanks to Q-bital’s modular endoscopy suite, decontamination facility and 8-bed ward. In Goondiwindi, Q-bital provided a mobile operating room to mitigate potential complications during childbirth for 35 expectant mothers when the main theatre was being refurbished, saving families relocating to Warwick or Toowoomba for care. When Grafton Base Hospital – the only provider of surgery across a 10,000km² area – suffered a catastrophic failure in its central sterile services department, Q-bital installed a mobile facility onsite, enabling surgeries to continue.

As Spryszynski puts it: “What we do buys people a chance to deal with the urgent issue so they can have some headspace and plan properly.”

The bottom line

Australia’s hospital infrastructure is under stress from every angle: demand, staffing, and capital. But pressure can also drive change. Leaders who rethink care models, demand clarity on capital projects, and embrace flexible infrastructure will put their hospitals in a stronger position to withstand the squeeze.

Q-bital’s work shows that resilience is not about spending more, but about spending smarter, and giving hospitals the time they need to plan for tomorrow.