Taking the hospital to home

When nurse William Ho talks about caring for patients, he rarely starts with hospitals. Instead, he talks about homes - quiet living rooms, kitchen tables, and familiar surroundings where recovery feels less clinical and more human.

As manager of Grampians Health’s Hospital Without Walls, William and his team have an important role: to provide hospital level care in patients’ homes and the community.

“Regardless of where patients are, we should be able to provide hospital-level care to them,” he says. 

Hospital Without Walls is a recently created department at Grampians Health, bringing together a range of services, including Grampians Health at Home (GH at Home) Ballarat and Horsham, Post Acute Care and Grampians Watch. Currently, GH at Home Ballarat has five clinical streams, including acute medical and surgical care, complex conditions, home-based cancer care, and an Older Person Stream, which focuses on supporting elderly patients to regain independence, with additional clinical and allied health involvement.

At its centre is GH at Home, a program that functions as a hospital ward without a physical location. Medical teams, nurses, allied health teams, and pharmacists all collaborate to deliver coordinated care across patients’ comfortable home environment instead of hospital wards.

“Whatever the ward is doing, we are providing the same level of care at the patient’s home,” William says.

Instead of long stays in hospital, eligible patients are discharged earlier and supported at home with the same level of clinical oversight they would receive on a ward. Under the program, nurses travel instead, covering distances of up to 35 kilometres from Ballarat and Horsham to reach patients who would otherwise need to make regular trips into hospital.

And the model is working. Today, GH at Home Ballarat can care for 50 patients at any one time, sometimes reaching as many as 55 patients, clocking a 20% increase in capacity. In practical terms, Will says that makes GH at Home one of the largest wards in the health service but just without walls.

However, the work is complex, and it relies heavily on experienced nursing staff. Unlike hospital settings, where teams are physically close by, nurses in GH at Home often provide care alone in patients’ homes, making critical decisions in real time. For that reason, the program typically recruits nurses with at least five years of clinical experience in acute, subacute and critical setting.

“They need strong clinical judgement,” William says. “They’re on the road, they’re assessing patients, they’re responding to urgent changes or deterioration of patients. There’s a high level of autonomy.”

That autonomy is matched by the kind of care provided. Patients receiving treatment at home may require intravenous antibiotics, complex wound management, post-surgical monitoring or ongoing infusions. Allied health teams are regularly involved, with physiotherapists, dietitians and occupational therapists visiting patients alongside nurses to ensure recovery is holistic, not just clinical.

But despite the scale and complexities, William and team are emboldened by the impact they’re able to bring to their patients’ lives daily. 

“Our Home-Based Cancer Care stream has saved patients more than 150,000 kilometres of travel over the past five years. We’re saving the patient from having to travel and reducing the burden on the family and trying to maintain their life at home as much as we can,” he said.

William’s own path into this work was anything but conventional. Originally trained in hotel management and later human resources, he made a late pivot into nursing, completing an intensive master’s program at Monash University in 2017. He first encountered hospital-in-the-home care during the early days of the COVID-19 pandemic, and the model stuck with him.

“It’s challenging,” he says. “But it’s also very rewarding because you can see the difference it makes.”

Now, just months into his role at Grampians Health, he is overseeing a program that is expanding in real time, with plans to increase capacity further over the next two years. Demand is rising, particularly in regional communities, and Hospital Without Walls is preparing to meet that. Currently, the health service has rolled out a pilot of virtual discharge clinic that allows patients to return home while waiting for test results, with follow-up consultations conducted via video.

“We know we’re growing,” he says. “And we’re trying different ways to improve, to innovate, to help patients in the community.”

On International Nurses Day, the work of Hospital Without Walls’s nurses offers a different lens on the profession. It is not defined by physical walls or traditional roles, but by adaptability, leadership, and a willingness to meet patients where they are.

For William, the message is simple.

“Nurses are the backbone of the health service,” he says. “And there are so many different ways we can care for patients.”