A Patient Centred Hospital at Home: A qualitative study of patient collaboration in healthcare service development

Abstract

Introduction: The One Bromley Healthcare's initiative to develop a person-centred Hospital at Home service for adults is a testament to innovative community health. The service was developed in response to the escalating shortage of hospital beds in the UK, a challenge amplified by the Covid-19 pandemic. Our approach prioritised patient and carer experiences, embedding their voices directly into the service design from conception to dissemination ensuring a unique and tailored approach that met the specific needs of those receiving care. Methods: We adopted a co-design methodology, engaging patients, carers, and healthcare professionals through surveys, workshops, and forums and integrated insights from successful healthcare initiatives such as Covid-19 management strategies, respiratory winter pilots, and community-based antibiotic administration. This inclusive process was pivotal in shaping the service's development, ensuring a holistic and user-focused outcome. Over 200 survey responses and input from dedicated co-design group of 13 people with lived experience and healthcare professionals provided the foundation for our tailored care pathway. Results: Our co-design approach resulted in four distinct themes which underpin the service model and are closely aligned with patient needs and the practicalities of delivering hospital-level care at home. These are: people focused outcomes – using personalised care plans to meet the unique and diverse needs of individuals, accessibility – providing information on the service in multiple formats including video and multiple languages, use of technology – introducing accessible remote monitoring and clear information about the service developed in partnership with patients. Plans are underway to incorporate lived experiences into staff training and to enhance decision-making with user participation in board meetings. These initiatives represent a commitment to inclusivity, continued improvement, addressing health inequalities and enhancing the patient and carer experience. Discussion: This collaborative process has honed the service's focus on patient experience but also fostered a sense of community ownership. The outcomes demonstrate that person-centred care is not just a philosophy but a practicable approach that can be systematically designed and delivered, ensuring a more responsive healthcare provision.