Fraser Health Authority
Reimagining Acute Care Delivery Through a Hospital at Home Model
Researching and developing a service blueprint for a hospital at home service
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Project Overview
Designing the foundations of a Hospital at Home program by focusing on usability and patient–provider experience
The shift toward virtual care is one of the most significant changes happening in healthcare today. Hospital at Home (H@H) is a model that allows eligible patients to receive acute-level care in their own homes while remaining closely connected to healthcare providers through digital monitoring, video visits, and remote support.
At Fraser Health, the introduction of an H@H service is both an opportunity and a challenge. The opportunity lies in freeing up hospital beds, reducing patient exposure to hospital-based risks, and supporting care that feels more comfortable and personal. The challenge lies in ensuring that technology, workflows, and systems are designed around people rather than forcing people to adapt to technology.
My role in this project was to apply human-centred design (HCD) principles to anticipate barriers and needs of both patients and Fraser Health care teams. This required bringing together insights from service design discovery sessions, global research on existing H@H models, and lessons learned from Fraser Health’s own Virtual Psychiatry Unit (VPU).
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The Opportunity
Listening First: Service Design Discovery
The Patient Engagement team began by grounding the work in the voices of those most affected: patients, providers, and caregivers. Through discovery sessions, they explored how people currently use technology, what barriers they face, and how care could feel more accessible in a virtual context.
A consistent theme emerged: technology must be simple, intuitive, and supportive. For patients, this meant tools they could use confidently without technical expertise. For providers, this meant solutions that integrated smoothly into existing workflows rather than adding new burdens. Family members and caregivers also emphasized their need for involvement, particularly for patients who might struggle with digital literacy.
These insights highlighted that adoption is not just about providing devices — it is about creating confidence, clarity, and support around new ways of receiving and delivering care.
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Secondary Research
Learning from Global Models
Hospital-at-home models have already been trialled in the U.S., Europe, Asia, and Australia, providing a valuable evidence base for Fraser Health’s own approach. Reviewing these international examples offered not just proof of concept, but also insights into what makes such services succeed — and where they can come up short:
Improvement in patient satisfaction
In some European models, patients reported feeling safer and more comfortable in their home environment, while still benefiting from close clinical oversight through digital monitoring.
Reduction in readmission
the United States, pilot projects showed promising reductions in readmission rates, suggesting that virtual follow-up can support better continuity of care.
Technology can strain the patient–provider relationship
Providers in Stanford’s hospital-at-home service, for example, noted difficulty building rapport virtually, and patients expressed concerns about self-monitoring tasks that felt unfamiliar or intimidating. These issues suggest that technology must be carefully balanced with touchpoints that preserve trust and human connection.
Device choice significantly shapes user experience
In Australia and the U.K., patients often accessed services through tablets or smartphones supplied by the health authority, while others used their own devices. Device fragmentation created inconsistent experiences: applications performed differently on desktops versus mobile, and older patients often preferred larger screens for visibility and ease of use.
By examining both successes and pitfalls, we were able to build a more realistic understanding of what adoption could look like at Fraser Health. This helped shift the focus from “what’s possible” to “what’s practical and sustainable for our communities.”
The image below outlines a high-level storyboard of the hospital-at-home experience with Fraser Health.
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Surfacing Assumptions
Understanding Our Diverse Audience
Assumptions shape design decisions, often invisibly. We identified and articulated several key assumptions early on:
Mobile-first adoption: With 92.9% of B.C. households owning a cellphone, it’s reasonable to assume patients will prefer mobile access.
Demographic differences: Younger populations are typically faster adopters of digital tools, while older populations may require more support.
Device limitations: Smaller screens constrain usability for complex tasks, even if they are more convenient.
Impact on relationships: Virtual care can dilute the sense of rapport between patients and providers compared to in-person settings.
Vendor maturity: Canadian-approved health software is still less advanced than systems in the U.S. or U.K., which may limit available functionality.
By naming these assumptions, we created a framework to test, challenge, and adapt our solutions as the service evolved.
Understanding how people interact with different devices was also another critical step. People have different feelings toward smartphones, tablets, and desktop experiences.
Smartphones: Highly portable, familiar, and preferred by patients under 65. Their popularity makes them a natural choice, though small screens create accessibility challenges.
Tablets: Often used for entertainment, but can substitute for smartphones in some contexts. They provide a larger screen experience without the bulk of a desktop.
Desktops/PCs: Best for handling complex input and documentation, but impractical for patients moving around their homes.
These findings informed the creation of a device decision matrix that balanced ease of use, cost, portability, and functionality. The takeaway: flexibility is key. Patients should be able to use their own devices when possible, but Fraser Health must also be prepared to supply hardware for those who lack access.
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Prior Learnings
Building on Local Experience: Learnings from the Virtual Psychiatry Unit (VPU)
Fraser Health’s Virtual Psychiatry Unit provided an invaluable precedent. While the service successfully expanded access, it surfaced several lessons that directly apply to Hospital at Home:
Device-agnostic solutions are essential. Features must function consistently whether accessed on desktop, mobile, or tablet.
Security must balance usability. Multi-factor authentication, while important, created significant frustration.
Enterprise over fragmentation. Patients struggled when required to download multiple apps; a unified solution is far more sustainable.
Provider discretion matters. Clinicians need control over what information is shared with patients in digital portals.
Dedicated support is non-negotiable. Patients calling clinics for tech help consumed provider time and eroded patient trust. A separate technical support layer is critical.
These lessons provided concrete evidence that adoption depends as much on thoughtful service design as on technical capability.
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Recommendations
Visualizing the Future of Patient Communication
Translating research, discovery insights, and global learnings into action required distilling what matters most for patients, providers, and the organization. These recommendations are not just about technology choices — they reflect the conditions necessary for adoption, trust, and long-term success.
By focusing on usability, clarity, and support, Fraser Health can ensure that Hospital at Home is more than a digital service: it becomes a safe, accessible, and sustainable extension of care beyond the hospital walls.
Choose Contextually Appropriate Hardware
Allow patients to use personal devices whenever possible. Where Fraser Health must provide hardware, select devices that balance cost, portability, and usability. Smartphones are the most practical choice, though other options may be better suited for complex tasks.
Provide Clarity and Build Trust
For many, H@H represents an unfamiliar way of receiving care. Patients and providers alike need clear, transparent communication about how the model works, what technology is required, and what they can expect. Setting expectations is essential to building trust.
Support Education and Troubleshooting
Create accessible, multilingual onboarding materials in multiple formats (videos, guides, pamphlets). Equally important is the establishment of a dedicated technical support team to ensure that technology challenges do not disrupt care or fall to already-busy clinical staff.
Establish Continuous Feedback Loops
Adoption is not a one-time event but an ongoing process. To refine the service over time, Fraser Health must: conduct user testing during rollout, collect feedback from both patients and providers, and define Key Performance Indicators (KPIs) to track success in patient experience, provider efficiency, and equitable access.
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Design Outputs
Making It Tangible
While research and global learnings set the foundation, it was equally important to create visual, human-centred outputs that helped leadership and stakeholders understand the lived experience of Hospital at Home. These artefacts translated abstract insights into concrete, relatable narratives.
User Journeys
I mapped detailed journeys for both patients and practitioners.
The patient journeys illustrated what it feels like to move from the ER intake process into the Hospital at Home model, including kit onboarding, daily monitoring, and follow-up care. These journeys captured touchpoints, emotions, and pain points that leadership could immediately relate to.
The practitioner journeys showed providers’ workflows: onboarding patients into the program, reviewing remote monitoring data, conducting video visits, and managing follow-up care. This highlighted both efficiencies and potential friction points within staff experience.
Storyboards
To bring the journeys to life, I created sketch-based storyboards that visually depicted scenarios such as:
A nurse explaining the Hospital at Home kit to a patient in the ER
A patient connecting to a video call from their living room
A doctor reviewing remote vital signs on a tablet.
These visuals helped stakeholders quickly “see” how the service would unfold in practice, making it easier to empathize with both patients and providers.
Jobs to Be Done (JTBD) Models
To capture the underlying motivations, I structured findings into Jobs to Be Done frameworks for both patients and providers. These concise models distilled complex needs into simple, actionable design imperatives for leadership.
ecosystem map
I created a service ecosystem map to illustrate the touch points of how patients, providers, technologies, and support systems connect across the Hospital at Home model.
By combining journeys, storyboards, JTBD models, and an ecosystem map, I created a shared language for leadership, clinicians, and technical teams. Instead of debating abstract technology features, stakeholders could anchor their discussions in the actual lived experiences of patients and providers.
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Reflection
Our Learnings
The potential benefits are enormous — shorter hospital stays, safer care environments, and more empowered patients — but these outcomes are only possible if systems are built with empathy, clarity, and inclusivity.
What excites me most is that this work is not about replacing human connection but reimagining how it can be sustained in new contexts. By combining evidence from research, lessons from local and global models, and the lived experiences of patients and providers, Fraser Health is laying the foundation for a virtual care service that is both innovative and deeply human.
