A practice fit-out might only be the first step when opening a new clinic, but nailing it from get-go can set the clinic on a successful trajectory. Audiologist Dr Signe Steers provides some sage advice from her experience while NextSense offers a glimpse into its newly constructed $75 million centre.
When audiologist Dr Signe Steers opened her independent practice in Forestville, in Sydney’s northern beaches, she ordered scrubs proudly displaying its name, The Audiology Place, on her pocket.
“When I go down the street, I’m a walking billboard for my business in my community,” she explains. “Subliminally, the more people who see it, the better, and also I don’t have to decide what to wear every day!”
After nearly 20 years working for others, the mum of two decided the time was ripe to venture out on her own in October 2024. This followed a Bachelor of Speech and Hearing Science and a Masters in Clinical Audiology from Macquarie University, and working for several independents, networks and an ENT doing vestibular diagnostics.
“Once I turned 40, my kids were at school and I decided to do a Doctorate in Audiology online at A.T Still University, Arizona. It reinvigorated in me all the things audiologists can do,” she says. “I wanted to build a practice where I could do all audiology, not just hearing aids. I took a leap of faith and the doctorate solidified that this is my career and I love it.”
It was initially daunting but spending six months on a business plan consolidated the proposal. “I spent a lot of time developing a business plan, how would it work, would it work and could it work,” she adds.
“Once I bought a business name, it kicked off. It’s my own practice so I can do what I want, and my motto is I cover everything from twinkle to wrinkle – from babies to older people, auditory processing disorders and tinnitus.”
One doctoral subject included a framework for setting up a business and a fellow student who had done so gave Dr Steers’ advice. “She told me what she’d been through and I also got advice from Independent Audiologists Australia members who were available any time for questions, guidance and support, saying I could do it.
“They advised breaking it down to work out how many patients I would need to see a day to add up to a certain number per year to devise an income estimate.”
Dr Steers and her husband Rob broke down appointment costs on a spreadsheet to determine how many patients and hearing aid fits would be needed daily and the consultation mix to make it work.
They subtracted rent and utilities from the patient count, always overestimating. Her accountant advised ‘not everything that goes through the eftpos machine is yours’ and to estimate business tax, transferring an amount every Friday into a separate untouchable account for BAS.
Ideal street facade
Rob did demographic searches to determine a good location with an elderly population that would not encroach on other independent audiologists and would stay within his wife’s contractual obligations of her previous job.
“I wanted it in a street where there’s foot traffic, easy parking, bus stops, a spot for a taxi to stop for the elderly but also where people can go to a café or shops,” she adds.
She initially investigated renting a room in a clinic with other allied health practitioners but quotes were almost comparable to commercial rent of a shop which made her decision easier.
She chose a three-year rental agreement because there were more discounts than for one year rental but it wasn’t as long as five, which seemed overwhelming. She made the most of down time, waiting for renovations to start, by applying for the Hearing Services Program (HSP), and setting up accounts with manufacturers.
“Once you have the venue, you can start the application for being a HSP provider as it takes a while. I started the process early and they were really helpful. When you submit the last document, they can fast track for approval within three days,” she adds.
Dr Steers wrote a master budget of all costs and added more, coming under budget of her estimated startup cost. To find a builder she googled medical fit outs and got lots of quotes.
“It was painful because the brief wasn’t listened to, and extra things were added that I didn’t need. They were quoting $150,000,” she recalls.
The problem was solved by a friend who recommended the builder who had worked on her dental fit out. The builder jumped at the chance of an audiology fit out because it was different.
A lot of planning was done remotely. “Everyone I dealt with in this company from architects to builders, site managers and contractors were great, friendly, kind and observant.”
Using the Steers’ initial sketches, the architect designed the fit-out and they picked colours and materials based on a beach theme. Money was saved by ordering flatpack furniture which friends and family spent weekends putting together.
Dr Steers bought a $30 reception desk from E-Bay which she cut down and painted. She has a wax removal room which she hopes to upgrade to a sound booth when she hires a second audiologist, and a paediatric room.
“I wanted to plan for the future and that’s where the architects came in because I didn’t know how to make this work but they helped it become real,” she adds.
The smallest consultation room is double walled with two layers of noise insulation through every wall and ceiling. The brief was power points on every wall in every room so, thinking to the future, things could change and equipment would still be able to be accessed.
As the premises was previously a hairdressers, money could be saved by preserving the kitchen.
She chose her favourite colour, greenish cyan for trims.
“I felt it was important to go with something I like which was also calming because this is my branding and I’ll be spending a lot of time here. It looks coastal and Rob said it should feel like you’re going for a spa or massage rather than something clinical. It’s clean, calm, and uncluttered and the white is non-medical.
“I want people to walk in and not see pictures of hearing aids – I don’t want to focus on the deficit. I’ll be doing that work but I want a different visual,” she says. “I also wanted the word audiology in the name because it’s important and it’s good to have audio as it’s not just about hearing but auditory processing, tinnitus and so on.”
Dr Steers hand drew the logo – a house containing an ear and a heart so it’s homely – and Rob, who is working in the clinic front-of-house, digitalised it and created a website.
Information sheets for doctors
One manufacturer lent equipment to trial and Dr Steers visited GPs and ENTs alerting them to her new service.
“I let the doctors know I’m offering same day sudden hearing loss services because I believe in early intervention and as I live close by I can pop down and do a sudden hearing loss assessment if needed,” she says.
“Rob and I delivered 98 welcome packs to GPs, ENTs, paediatricians, physiotherapists, psychologists and speech pathologists. We had washing baskets full of them – with referral pads and info sheets about every service I’m offering – each service had its own information sheet.
“The feedback was how valuable it was to have information about what I do, because as one GP said, usually people just drop off their business cards but this shows everything I do. We’re also sending them letters reminding them we’re open.”
Dr Steers says launching a business could be thought of as an overwhelming amount of setup, new things to learn and costs but “once you’re in, you are just doing the same job you’ve always done.”
“It is more work though because you’ve got all the other stuff as well as audiology,” she adds. “I don’t have rose coloured glasses on about how hard it’s going to be; I know there’ll be ups and downs, busy times and times where I’m scrambling.
“But that’s part of my business plan, making sure I’m realistic. When you first feel that self-belief, when I saw my first patient and they happily swiped their card because of me – what a feeling!”
Future plans include letterbox drops and community talks at service clubs. They’ve also documented everything and turned it into a policies and procedures manual to assist future hires.
NEXTSENSE’S INCLUSIVE DESIGN
About 20 kilometres away at Macquarie Park, Sydney a vastly different fitout occurred. When NextSense embarked on its highly ambitious project for a newly constructed $75 million innovation centre, it made sure to consult with experts, staff and clients.
“More than 20 consultants were involved in the design phase of the project leading up to the tender for construction,” head of Cochlear Implant Services, audiologist Ms Eleanor McKendrick, recalls.
“This included people living with, and experts in, vision and hearing loss, creating a benchmark for what’s considered ‘beyond accessible’ (inclusive) architecture and design.”
NextSense has provided diagnostic audiology services since 1991 and runs Australia’s largest cochlear implant program plus early intervention services. It leases the premises for most of its 20 centres, including the site of the centre for innovation.
Its North Rocks campus had been the focal point for national operations since 1963 but was no longer fit for purpose so NextSense sold it and moved to the new centre in August 2024.
The facility provides allied health, disability and cochlear implant services for children and adults, a school, preschool, and a major research and professional education program.
“It’s custom-designed for people who are deaf and hard of hearing, blind or have low vision,” McKendrick says. “The layout creates opportunities for interaction between our school teaching staff, clinicians and administration staff, and those from other organisations like Cochlear and the Australian Hearing Hub.
“We’ve also retrofitted existing commercial premises for some of our other centres, including more recently at Alstonville in northern NSW, Liverpool in southwestern Sydney, and Werrington in western Sydney.”
Many of the children it supports who are deaf or hard of hearing have additional disabilities so it was important to provide an inclusive, welcoming space for all.
Non-clinical and earthy
“Client areas were designed to be non-clinical, with earthy accents, soft furnishings and bright brand elements providing an inclusive and welcoming space for clients and their families. A multisensory wall in the client waiting area provides tactile and sensory activities for children and there’s a dedicated sensory room onsite,” McKendrick says.
The audiology wing, which mainly serves paediatric clients, is away from high-noise areas but close enough to the waiting area to feel welcoming and connected to other spaces.
Wall and ceiling panelling and carpets are acoustically rated. Prefabricated audiometric testing booths were custom-designed and meet Australian Standards requirements in acoustics for audiometric test methods, with acoustic dampening materials and electromagnetic shielding to create a noise-excluding test area.
To create level flooring leading into the booths, the concrete slab was set down into the ground and the booths dropped in.
“Above all, our audiologists wanted audiometric booths to be flexible to accommodate children of all abilities,” McKendrick says. “This included having dimmable lights, castor wheels on all furniture so it could be easily moved, and a setup enabling all types of hearing testing to be carried out.
“This is particularly important for children with sensory and developmental disabilities who may use mobility aids or require careful consideration of lighting.”
There was consideration around power point placement and ensuring there were outlets on all walls. Two booths enable Visually Reinforced Orientation Audiometry (VROA) testing, which provides visual rewards to a young child responding to sound. Adjoining control rooms have one-way glass.
Every element of the design was carefully considered, with state-of-the-art equipment and spaces tailored for people with hearing and vision loss. Accessibility features include the highest possible acoustic standards, a hearing augmentation system to deliver high-quality sound directly to hearing aids and high-contrast walls and furnishings to allow better depth perception.
Wide corridors make it easier for conversations in Auslan and accommodate wheelchairs, large prams and assistance animals.
The design aligns with best practice environmentally sustainable design principles for energy, water, materials, ecology, emissions, transport, indoor environmental quality and innovation.
The building features 368 solar panels, two electric vehicle charging stations, water tanks, shading, ventilation and building materials that minimise energy consumption. The centre has a client parking area with accessible parking and is within walking reach of bus routes. “Extensive consultation with staff, including our audiologists, informed the final design, and for our audiologists, the accessibility and technology of the new facility goes above and beyond,” McKendrick adds.
