The hospital of the future: what does it look like?

The twentieth-century hospital developed largely around an episodic model of care, whereby patients were admitted for a defined illness and discharged once treatment was complete. This approach was well suited to the treatment of acute, communicable diseases, where an identifiable cause could be addressed through a discrete episode of treatment. Consequently, it helped establish the bricks-and-mortar (BAM) hospital as a physical location where specialist medicine was concentrated.

There was a sound economic and clinical logic to that concentration. Co-locating specialists, diagnostic equipment and operating theatres helped spread the high fixed costs of infrastructure across more patients, supporting economies of scale and bringing different teams together when patients needed complex treatment. Alongside this, centralisation made capabilities available that would have been difficult to sustain across many smaller sites.

Much of that logic remains attractive, especially where care depends on immediate access to several specialties or sophisticated equipment. Yet the circumstances in which hospitals operate have changed. Three broad shifts, among other developments, invite us to reconsider how hospital capabilities are organised.

The first shift cuts across changes in demography and epidemiology. An ageing population and the growing prevalence of chronic, non-communicable disease mean that more patients require continuous and integrated care, often for several conditions at once (‘co-morbidities’). However, while an admission may resolve an immediate problem, their underlying needs persist. Multidisciplinary teams (MDTs) must therefore bring different professional perspectives into a holistic plan for the person’s care, including support between episodes of care. General and acute care physicians’ expertise in managing complex, multi-system illness provides a foundation for this approach.

Second, rapid technological change is expanding the possibilities for responding to illness. Remote monitoring through wearables and connected devices can extend clinical observation beyond the ward, whilst artificial intelligence (AI) offers opportunities to support diagnosis and improve operations. The promise of tools such as AI scribes to perform administrative work could also free up time for the human encounter central to the healing vocation. Yet AI also carries myriad challenges, as CHA has discussed elsewhere.

Elsewhere, precision medicine, particularly multi-omics, is enabling predictive and preventive care, alongside more tailored treatment, whilst robotics is changing surgical practice and training through more precise interventions. These developments affect the hospital’s internal organisation as much as its geographical reach, raising questions about workforce skills and how research informs everyday care.

Finally, greater emphasis on person-centred care is changing what patients should expect from hospitals. To be sure, for Catholic providers this is nothing new but rather builds on community relationships sustained for over a century. Take St Vincent’s Lismore, established by the Sisters of Charity in 1921, which has grown alongside the Northern Rivers community as its needs have changed.

Responding to those needs today means giving patients’ circumstances and preferences greater influence over how services are organised. For someone living far from specialist services, access depends partly on whether expertise can reach them locally, and whether services work together without leaving the patient to organise the connections.

The future hospital, today

These shifts invite us to consider a broader understanding of the hospital as a service, rather than just a building, with its physical campus supporting a wider network of care. For example, MDTs could link hospital physicians with nursing and allied health colleagues across primary, aged care and community services, so hospital treatment reflects the support available locally. In turn, local teams could draw on specialist advice to manage deterioration and help avoid unnecessary admissions.

Such a network would retain the benefits of co-location through a hub-and-spoke model that is supported by virtual care. Shared information and clear clinical responsibilities would connect hospital capabilities with local teams, bringing expertise closer to patients whilst allowing BAM hospitals to focus on higher-acuity care.

For this to work effectively, decisions about location should reflect clinical requirements, recognising that duplicating facilities or spreading a limited workforce across more sites can undermine economies of scale.

Catholic providers are already exploring elements of this approach. Cabrini’s planned genomics laboratory, expected to open in 2027 within its Malvern cancer precinct, illustrates how the physical hospital can bring research and treatment together.

Building on that concentration of expertise, virtual care can extend specialist support elsewhere. At Werribee Mercy Hospital, telemedicine connects local teams with specialist neurologists during emergency assessment and subsequent inpatient care, supporting multidisciplinary care and rehabilitation planning.

St Vincent’s Health Australia is taking this further through its commitment to deliver half of its health and aged care at home or virtually by 2030. Alongside Hospital in the Home, its strategy includes clinical support for aged care teams to manage deterioration on site. Strengthening that capability can help residents avoid unnecessary admissions, illustrating how care outside hospital also supports the hospital’s ability to function.

Making change possible

These changes will require radical policy reform across the care economy.

To start, we will need a funding system that allows hospitals to sustain existing services whilst incentivising new models of care. Where an episode of care involves several services, payment arrangements should recognise the work of coordinating that care, whilst also giving greater attention to outcomes. Implementing these models will also require funding for staff and systems outside hospital, including in aged care and community services that help avoid unnecessary admissions.

Operational and change management will be essential to making effective use of that investment. For example, increasing surgical activity without sufficient recovery or discharge capacity can create bottlenecks, so teams need time and support to plan capacity and redesign pathways together. Addressing these interdependencies and reducing avoidable duplication could improve efficiency and equity of access without necessarily producing immediate savings. Better value and slower cost growth would therefore be more useful measures of success.

Such coordination also depends on connected and interoperable information systems that allow MDT members to see and act on one another’s decisions, particularly when operating across different providers. As services become more dependent on these systems, cybersecurity and operational resilience will help protect continuity of care, whilst workforce planning must ensure staff can use technology effectively to support professional judgement.

For these digital connections to improve access equitably, a minimum viable digital standard should be established with targeted investment nationwide, particularly in the bush and other hard-to-reach areas. Here, innovations such as low-Earth orbit satellite services – notably Starlink – will help to close connectivity gaps where terrestrial networks are limited. Patients may also need equipment or assistance to participate, with suitable alternatives where treatment at home is impractical.

Whether these arrangements deliver quality and acceptable care must also be assessed through patients’ experiences and outcomes, since clinically effective treatment can still impose demands a person or family cannot manage. Their experience should inform implementation and evaluation, alongside informed choice and clear clinical accountability.

Catholic providers’ experience across the care economy gives our sector a useful perspective on these connected questions. We should draw on it to shape a hospital of the future that preserves the benefits of specialist medicine while making care more continuous, accessible and responsive to the person at its centre.