Designing healthcare transformation: a hybrid model between the hospital and home for high-risk pregnant women

Abstract

Healthcare organizations are developing hybrid models of care between the hospital and home using remote technologies for monitoring and communication, aiming to transform their healthcare service. While most programs focus on technology integration and adaptation, or on clinical safety and quality, sustainable healthcare transformation requires a system design approach that coordinates change across human, technological, and spatial dimensions. This study investigates a novel hybrid model for women with high-risk pregnancy, offering an alternative to prolonged hospital stays. The model enables home hospitalization through intensive telemonitoring and daily remote clinical encounters, complemented by twice-weekly in-person hospital assessment by the same clinical team. Advanced telemedicine technologies enable women to perform essential maternal and fetal assessments at home under remote guidance, whereas inpatient visits support evaluations that are not yet feasible remotely. The People-Process-Place (3P) framework, which conceptualizes healthcare systems as dynamic configurations of social actors, care processes, and physical and digital places, provides a useful lens for examining the hybrid model as a form of healthcare transformation that simultaneously reshapes human roles, organizational workflows, and care environments. The qualitative study, based on observations and forty interviews of patients, staff, management, and technology directors, examines the transformation of the hybrid model of care by adopting the People-Process-Place (3P) framework to analyze the multidimensional change. The findings demonstrate transformation across all dimensions of the People-Process-Place framework. The hybrid model reshaped professional practice, enhanced patient autonomy, and increased family involvement (People), thereby expanding relational continuity of care. It reconfigured the patient journey, introduced new patterns of technology use, redefined organizational policies and advanced economic models (Process), and expanded care across hospital and home settings, with physical and digital environments provided in diverse locations (Place). At the intersection of People-Process-Place lay safety, trust, and experience, which affect the system's flexibility and ability to manage challenges and scale. The study presents a design framework for healthcare transformation to examine the intersection of human, technological, and spatial change. The case of the hybrid model for high-risk pregnant women demonstrated the complexity of transformation and the need for a design framework to evaluate and develop change processes.