Moving healthcare home

Chalmers University of Technology

​In the future, more health care will be provided at home, instead of in the hospital. Together with several partners, Chalmers is now starting the initiative Hospitals at home, which brings together research and pilot projects under one umbrella. ​Healthcare is changing, and increasingly moved to the patient’s home. There are several reasons for this development. An aging population, often with chronic and sometimes complicated diseases, is putting pressure on healthcare and makes it necessary to change the way it is organized. At the same time, new technical solutions enable a more flexible healthcare, wherever and whenever we want. Some examples are digital consultations, mobile healthcare services, self-monitoring in the home, and the development of both medical technology and digital health.

A shift from hospital care to healthcare at home thus means that resources can be used better, for the benefit of more people – a more sustainable healthcare system is created – while giving the individual greater opportunity to influence their own illness, care and health. But change also requires both technical and organizational development.

Requires a broad collaboration

The initiative Hospitals at home brings together initiators from three of Chalmers’ departments, and thus weaves together expertise in medical technology, architecture, and management. Based on their specialties and research areas, the initiators contribute with different, but all very important, aspects. In collaboration with, among others, Sahlgrenska University Hospital, Närhälsan, the City of Gothenburg and relevant parties from the business community, a platform for collaboration and knowledge development is now formed.
And a collective grip is required. That is the opinion of Andreas Hellström, Senior lecturer and head of Chalmers’ centre CHI, Center for Healthcare Improvement.

“The technology is seldom the problem. But to achieve full benefits, technology must be put in an organizational and societal context – we need to envision the whole system. The transition to future healthcare is exactly this; system innovation covering the whole ecosystem. Everything from digital healthcare services to purely spatial solutions, healthcare service models and technology for new solutions”, he says.

“The common goal here is to organize healthcare based on the needs of the public and patients. Healthcare must move closer to the individual. Actually, we are all talking about the same thing, but with different starting points and dialects.”
The pandemic has accelerated the development of future healthcare, with digital meetings and mobile care services.
“This has exploded! We do not want individuals, such as the fragile elderly or others in risk groups, to leave their home unnecessarily. New solutions have then been accelerated.”

Making the patient an active participant

With a new way of looking at healthcare, the patient also becomes an active participant in their own care – as Andreas Hellström has long advocated. A person who manages his or her own monitoring, and controls the illness, also learn to understand it in a completely new way.
“This knowledge strengthens the patient, and at the same time relieves the healthcare system. The relationship becomes more balanced. A fundamentally important aspect in which there is great transformative power”, he says.
A number of projects are included in the new initiative (see below). The initiators view it as absolutely necessary to gather partners from all arenas; hospitals, primary care, municipal health and care, research, industry, and last but not least patients and citizens – to bring about effective collaboration for a coherent healthcare ecosystem.
“Within our initiative, we will work to find solutions to concrete problems, and develop knowledge about these. To do this, we want to have all parties at the table. And we are happy that say that the initiative has been met with great interest from all sides”, says Andreas Hellström.

Voices about Hospitals at home:

Maria Taranger, Chief physician and Area Manager, Sahlgrenska University Hospital

“This is really one of the most important issues, for people to have continued confidence in the public sector and a well-functioning society. People want to, and can, take much greater responsibility for the healthcare they need, but they also need support in this from us. People should only come to a physical hospital when necessary.

For example, we now have a project with a small portable X-ray machine. By X-raying suspected fractures in the home, those who do not have a fracture avoid entering the hospital. And those who turn out to have a fracture can get pain relief and help with surgical preparations, outside the hospital, and enter only when an operating room is prepared.
We need to do research on both technology and how we work. A major mental adjustment is required for hospital care staff to dare to relinquish control of some measures to the sick individuals, or to staff employed in other organizations.”
Ann Ekberg-Jansson, Medical strategist, Närhälsan

“Närhälsan is in an extensive development phase, where the transition to so-called Close healthcare is central. Thus, working to develop the concept Hospitals at home together with other central parties is completely in line with this. Gathering different stakeholders at the same table generates added value, as you reflect on important issues from different perspectives to reach the end goal: the best situation from the perspective of the patient, or resident. We will learn from each other, but also get an opportunity to achieve a collective process with all parties present.”

Carin Bringestedt, Head of division at Health and healthcare, City of Gothenburg
“The municipal healthcare still has a long way to go before we arrive at a user-friendly e-health and digital services. The initiative Hospitals at home will entail more collaboration, with

healthcare even more based on the individual’s needs, participation, and co-determination in managing their health and care.

Permanent collaboration forums at the organizational level will play less of a role, and variable forms – close and in collaboration with the individual – must be developed. This applies not only to collaboration between health- and medical care facilities, but also to collaboration with, for example, home care services, care and nursing homes, and other municipal activities.
We have a shortage of licensed employees. Demand exceeds the supply of nurses, occupational therapists, and physiotherapists in municipal healthcare. We must therefore work smarter, with maintained or higher quality. Collaboration between inpatient care, primary care, and municipal healthcare, will become increasingly crucial for good care as hospitals move home.”

Facts about the initiative Hospitals at home:

The initiative Hospitals at home will partly be based on ongoing projects but will also be linked to new initiatives identified by the collaboration group. Examples of projects already in progress are:
• ASAP/Autumn Leaves, a recently started project focusing on healthcare at home, including home monitoring, support from specialist healthcare and caregivers, in collaboration between municipality, region, industry etc. Autumn Leaves is run by the Digital Health group at the Department of Electrical Engineering.
• ViSMoT (video support for mobile teams): Solutions to facilitate patient assessments in collaboration with higher medical competence, thereby increasing precision, quality and safety of the assessments. The project is led by the Digital Health group at the Department of Electrical Engineering.
• Digi physical service offerings to patients with long-term needs, a project conducted in collaboration between Närhälsan in Region Västra Götaland and the Centre for Healthcare Improvement at the Department of Technology Management and Economics.
• Healthcare centers of the future, a concept program/project led by the Centre for Healthcare Architecture at the Department of Architecture and Civil Engineering. The project is a mapping of the primary care’s organization, location and use of premises, and will provide a basis for concepts for future solutions.
• Out Fit, a doctoral student project (where doctoral students can receive a double degree from Sahlgrenska Academy and Chalmers), with focus on health-promoting qualities in a physical outdoor environment in support of health and rehabilitation in special accommodations. Intends to develop evidence-based guidelines and methods for physical outdoor environments. The project is ongoing in collaboration with Sahlgrenska Academy and the Swedish University of Agricultural Sciences.
• The Patient Innovators is a research project based on the fact that patients’ own experience of living with chronic or long-term illnesses can be the basis for innovation and development. The project is led by the Centre for Healthcare Improvement at the Department of Technology Management and Economics.
The initiative Hospitals at home have received initiative funding from Chalmers Health Engineering Area of Advance.

Initiators are:

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