The Landmark Publication: Co-Designed Principles for Virtual Hospitals in Nature Scientific Reports

Australian researchers have made headlines with their groundbreaking paper published on March 7, 2026, in Scientific Reports, a Nature portfolio journal. Titled "Co-designed principles for establishment of a virtual hospital," the study outlines a visionary framework for building effective virtual hospitals, particularly in the private sector. Led by Dr. Olivia J. Fisher from Wesley Research Institute in Brisbane, the collaborative effort involved experts from Charles Darwin University, University of Queensland, UnitingCare Queensland hospitals, and international partners like Duke-NUS Medical School in Singapore.

This work addresses a critical gap: while virtual hospitals—also known as hospital-at-home or virtual wards—have proliferated globally post-COVID, research has focused more on clinical outcomes than implementation. By using co-design and implementation science, the team crafted principles to guide a new private virtual hospital under UnitingCare Queensland, emphasizing patient-centered care delivered safely at home.

Background: Rise of Virtual Hospitals in Australia

Virtual hospitals deliver hospital-level care remotely, using telehealth, remote monitoring, and hybrid models to admit patients without physical beds. In Australia, public examples like Royal Prince Alfred's RPA Virtual in Sydney (launched 2021), South Australia's My Home Hospital, and Queensland's Virtual Hospital have shown promise. These models reduce hospital stays by 30-50% for suitable patients, cut readmissions, and boost satisfaction, especially in rural areas where 28% of Australians live but access specialist care less frequently.

Private sector lags due to funding hurdles—no Medicare rebates for virtual admitted patients—and reliance on Visiting Medical Officers (VMOs). Yet, demand surges: a 2025 Health x Digital Transformation Report notes 70% of Australians are ready for virtual care, with potential savings of billions amid $270 billion annual healthcare spend. The principles target this, aiming for equitable, innovative delivery.

The Research Team and Co-Design Methodology

Dr. Fisher, a health services researcher at Wesley Research Institute (WRI), spearheaded the project funded by UnitingCare Queensland. Co-authors include clinicians from The Wesley Hospital, St Andrew's War Memorial Hospital, and BlueCare, plus academics from UQ and Charles Darwin University. International input from Duke-NUS added global perspective.

The study followed a prior 2025 paper identifying barriers/enablers via 37 interviews. Three workshops (July-September 2023)—one in-person in Brisbane, two online—involved 36 diverse stakeholders: consumers (8%), carers (6%), nurses (18%), doctors (10%), leaders, allied health, GPs, researchers, and public health experts from metro (92%), regional (6%), rural (3%) areas. Using the PERCS implementation framework, participants critiqued findings, brainstormed in focus groups, and refined principles anonymously. High enthusiasm emerged, tempered by safety concerns.

Four Core Themes Shaping the Principles

Analysis revealed four robust themes, consistent across workshops:

• Take the care to the patient: Prioritize timely, inclusive care in homes/communities, dismantling geographical barriers for rural/remote Australians.
• Virtual is the mechanism, the care is real: Virtual tools enable equivalent or superior care, countering 'not real' perceptions via advanced monitoring and hybrid exams.
• Be ambitious, but build a strong foundation: Innovate boldly with reliable tech, cost-effectiveness, and safety-first governance.
• Build the right workforce: Flexible roles, training, and carer support to re-engage talent and ease burdens.

Safety underpins everything, with patient-centeredness paramount.

Principle 1: Patient-Centred Care Delivery

The foremost principle: Deliver high-quality, culturally safe care in patients' contexts. Quotes highlight demand: 'If you could have care at home, would you?' Most hadn't considered it but embraced it for family settings. Subthemes stress transitions support and inclusivity for First Nations and diverse groups. In Australia, where 7 million live rurally, this could transform access, reducing travel burdens and aligning with 'ageing in place'.

Principle 2: More Than Telehealth—Real Hospital Care

Virtual isn't lesser; it's advanced. Participants noted hospital harms (infections, delirium) vs. home comforts, but stressed physical exams via hybrid models. Advanced wearables enable proactive monitoring, outperforming episodic visits. Challenges like 'virtual feels not real' demand education. For full study details, see the open-access paper.

Principle 3: Adaptable and Innovative Systems

Systems must evolve: reliable internet, interoperable platforms, user-friendly for low-digital-literacy users. Phase rollouts: start acute, expand sub-acute/rehab. Cost-effectiveness via pilots addresses private funding woes. WRI's prior study flagged tech silos; principles advocate integration.

Principle 4: The Right Workforce for Virtual Care

Upskill existing staff, attract telehealth-savvy talent, support informal carers. Flexible roles re-engage injured clinicians. Training in cultural safety vital. Links to higher ed: Universities like UQ train digital health pros—check research jobs or research assistant advice.

Challenges and Barriers from Supporting Research

The 2025 precursor identified enablers (leadership, rural enthusiasm) and barriers: funding (no virtual admitted rebates), tech glitches, workforce shortages, safety doubts. Private VMOs complicate payments. Solutions: policy reform, digital maturity audits.

Virtual Hospitals in Action: Australian Case Studies

RPA Virtual admits 500+ yearly, cutting stays 4 days. QLD Virtual Hospital served 10,000 episodes by 2025. Benefits: 20-30% cost savings, 90% satisfaction. Challenges persist in private: UnitingCare pioneers amid these.

Implications for Higher Education and Research Careers

Unis drive this: UQ, Charles Darwin contribute. Digital health degrees boom—higher ed jobs in telehealth research rising. Policy impact: Frameworks guide curricula. For researchers, co-design models offer actionable insights.

Photo by Enguerrand Photography on Unsplash

Future Outlook: Scaling Virtual Hospitals Nationwide

With National Digital Health Strategy 2026, expect growth. Principles scalable, urging funding reform. Potential: Ease $10B+ bed shortages, equity for 7M rurals. Careers thrive: Australian uni jobs, postdoc advice.

Explore opportunities at Rate My Professor, Higher Ed Jobs, Career Advice.