Smarter Hospitals

Project description, aims, design and method

Virtual models of care (i.e. consultation by telephone, video-conferencing and remote-monitoring of health conditions supported by digital patient information and wearable devices) have been employed throughout Australia for many years to provide care to regional and remote locations. Virtual care models have gained significant traction (including rapid adoption in metropolitan areas) in response to the covid-19 pandemic, creating evidence of their viability, acceptability and potential value towards health system sustainability. Notable gains include the potential for virtual models of care to create efficiencies in health service delivery and redress inequities in system and service access, with particular opportunities for the improving patient experiences, costs and clinical outcomes for people with chronic conditions in hospital outpatient settings. Lack of prospective planning for the integration of virtual care models and relevant change management approaches constrains the realisation of benefits, with health facility infrastructure identified by our Partner Organisations and in the wider literature as a key barrier. Through partnership between  academic institutions, Health Infrastructure, and five health services in NSW, Victoria and Queensland, we seek to unlock the potential for smarter hospitals that integrate virtual models of care in the Australian health system by removing the infrastructure barriers in healthcare facility design supported by strong Virtual models of care (i.e. consultation by telephone, video-conferencing and remote-monitoring of health conditions supported by digital patient information and wearable devices) can improve access to services, patient experience, efficiency and health outcomes whilst reducing costs of care compared to face-to-face care. change management.

Project aims

To provide evidence and solutions for health services nationally to improve patient and service delivery outcomes for virtual care models facilitated by best-practice change management.

Specific aims are to:

1. Produce fundamental new knowledge of the impact of virtual models of care on patient health and service quality outcomes, including for priority populations.
2. Evaluate the context, circumstances and populations for whom virtual care models work, and economic impact of virtual care.
3. Test the effectiveness of a Specialised Change Methodology for improving workforce change readiness and capability for integrating virtual models of care compared to current practice.
4. Co-produce and integrate theory and evidence-based Virtual Care Design Principles, Evaluation Framework and Specialised Change Methodology for improving health and service outcomes of virtual models via a national community of practice.

Design and method

Area 1)

Lack of prospective planning for virtual care in the design of health facility infrastructure is a major contributing factor that constrains the realisation of virtual care benefits of improved patient experiences, health outcomes and reduced costs. Uniquely positioned with state-wide responsibility for capital works projects in health and associated change management, Health Infrastructure has identified a critical need for transformative infrastructure innovation to inform current facility planning across Australia. Drawing upon the experiences of the Partner Organisations (POs), their staff and consumers, we will co-produce a set of Virtual Care Design Principles to complement the Australasian Facility Planning Guide to support the design of health facilities that enable the implementation of virtual and hybrid models of care with face-to-face care.

Area 2)

Previous research collaborations (1, 2) between the CI team and POs have identified an absence of large-scale evidence to demonstrate whether virtual models of care deliver equivalent or improved patient health or service delivery outcomes when compared to face-to-face care; for whom current virtual care models work best; and the supports required for priority population groups to experience high-quality virtual care. We will leverage existing population-based data from the Partner Organisations to evaluate the patient health and service delivery impact of using virtual care models for four major outpatient health conditions (oncology, renal care, rehabilitation, mental health) that our Partners have identified as having high service demand and burden of disease. We will then use realist evaluation to provide nuanced evidence of the contexts and supports required to implement virtual care to achieve improved patient health and service delivery outcomes for diverse populations.

Area 3)

Virtual care does not mimic in-person care; for healthcare staff and consumers engaging in virtual care requires new behaviours that may be a substantial departure from current practice. The lack of implementation support for healthcare staff to adopt and sustain virtual and hybrid models of care requires urgent solutions. Our Partner Organisations require a change management methodology that is underpinned by evidence-based behavioural change techniques to ensure their workforce are confident and ready to adopt and sustain virtual care models. To meet this need, we will develop and evaluate a Specialised Change Methodology supported by behavioural change techniques.

Resources and publications

1. IQBAL, M. P., NEWMAN, B., ELLIS, L. A., MEARS, S. & HARRISON, R. 2023. Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis. Patient Educ Couns, 115, 107922.
2. HARRISON, R. & MANIAS, E. 2022. How safe is virtual healthcare? International Journal for Quality in Health Care, 34.
3. HARRISON, R., CLAY-WILLIAMS, R. & CARDENAS, A. 2022. Integrating virtual models of care through infrastructure innovation in healthcare facility design. Aust Health Rev, 46, 185-187.

Further information

External project members

Kathryn Joseph - Deakin University (Research Assistant)

Principal Investigators

Professor Elizabeth Manias- Monash University
Professor Rebecca Lawton – University of Leeds
Associate Professor Natalie Taylor – UNSW

Associate Investigators

Nyan Tieu
Dr Michelle Moscova
Associate Professor Deepak Bhonagiri
Professor Wei Chua
Professor Sabe Sabesan
Dr Bradley Christian
Associate Professor Craig Nelson
Dr Alexander Cardenas

Collaborators

NSW Health Infrastructure; Western Health; Northern Health; Townsville Cancer Centre; South-West Sydney LHD; Western NSW LHD.