Expert Insights: In Conversation with Dr. Nirit Pilosof

At the World Hospital at Home Community on UNLOK, we bring together leading voices shaping the future of Hospital at Home and healthcare beyond the traditional hospital setting. Through our expert interviews, we explore new perspectives on care delivery, innovation, design, technology, and the transformation of healthcare systems.

Dr. Nirit Pilosof

Dr. Nirit Pilosof is an architect and researcher specializing in healthcare innovation, transformation, and design. She is a Senior Lecturer at Tel Aviv University, Associate at Cambridge Judge Business School, and Head of Research in Healthcare Transformation at Sheba Medical Centre. Her work focuses on Hospital at Home, hybrid care models, and designing healthcare systems that can adapt to future needs.

Her research has received international recognition from the American Institute of Architects and the American Hospital Association, and she has contributed to research on Hospital at Home and Ageing-in-Place across Israel and Europe. Her work explores how people, processes, technology, and the built environment can come together to create more flexible and resilient models of care.

You are internationally recognized for your work in healthcare innovation and/or Hospital at Home. What first inspired you to explore new ways of delivering hospital-level care outside the traditional hospital setting?

I am an architect specializing in healthcare design and transformation. I spent many years planning and designing hospitals and healthcare facilities, focusing on innovation and evidence-based design. My master’s thesis at McGill University and my PhD dissertation at the Technion explored “Planning for Change”: the challenge of designing hospitals to support unknown future needs. As we often say, by the time a hospital is designed and built (which can take seven to ten years), it is already obsolete and requires adaptation. Over time, I realized that the challenge is not only to design a flexible building, but to design a flexible healthcare system that can evolve beyond the hospital walls.

This became particularly evident during COVID-19. As part of my postdoctoral work at Cambridge Judge Business School, in collaboration with ARC Innovation at Sheba Medical Center, I studied how telemedicine and remote care provided flexibility and enabled hybrid models between hospital and home. My recent work in the EU THCS-funded Ageing Right Care(fully) project has further shown how different social, cultural, and physical contexts shape Ageing-in-Place and Hospital at Home models in the Netherlands, Sweden, and Israel. In many ways, my work has evolved alongside a broader shift: from designing hospital buildings to designing care systems.

People are often surprised that, as an architect, I focus on “Healthcare without Walls” and on remote care that extends beyond the physical boundaries of the hospital. For me, however, this is a natural continuation of my work on “Planning for Change.” The design questions have simply expanded: How can HaH make healthcare more flexible and resilient, particularly in times of crisis? What does this mean for the design of future hospitals? And how might AI help patients navigate physical and digital care environments while helping organizations manage increasingly complex operations?

But my interest in HaH is not just professional; it is also deeply personal. Ten years ago, my father died in the hospital from a hospital-acquired infection. He had recovered from stage 4 cancer with state-of-the-art treatment, but during one of his many hospitalizations, he contracted an infection that caused a severe deterioration. I was left with the painful thought that he should not have been hospitalized in such a vulnerable condition, and that if he had been treated at home, he might have survived. That experience inspired me to study and support the development of HaH models and, importantly, their safe integration with acute hospital operations.

Hospital at Home is changing the way we think about where and how healthcare can be delivered. What do you see as its greatest value for patients, healthcare professionals, and health systems?

The greatest value of Hospital at Home is that it can bring hospital-level care into the context of the patient’s life. In healthcare design, we work hard to make hospitals more personal and healing, yet they remain standardized environments. When clinically appropriate, care at home allows patients to remain in familiar surroundings, sleep in their own bed, maintain daily routines, and stay close to the people and objects that give them comfort and identity. In addition to potentially reducing hospital-related risks such as infections, delirium, and falls, the home can support the patient’s motivation to recover.

HaH also expands the choices available to patients and families. Rather than treating location as a fixed decision, care can move between hospital and home according to clinical needs, personal preferences, and changing circumstances. This can restore a sense of agency at a time when patients often feel they have lost control. The home also gives professionals access to information that is largely invisible in the hospital: how a person moves, manages medication, eats, sleeps, and receives support. That context can reveal both risks and resources, enabling care to be more precise and relevant to the patient’s everyday life.

For professionals and health systems, HaH creates both clinical insight and operational flexibility. Teams can manage physical beds in the hospital and virtual beds at home as part of one continuum, relieving pressure on inpatient wards while reserving hospital resources for patients who need facility-based care. This model depends on reliable coordination, logistics, and escalation pathways. When the same team, or a closely connected team, remains responsible across settings, it can also strengthen continuity of care and allow patients to move safely between home and hospital as their condition changes.

Where do you see the biggest gaps between the evidence supporting Hospital at Home and its implementation in everyday clinical practice?

We often say, “There Is No Place Like Home,” but not every home can readily become a place of care. Our international research shows that the home environment significantly shapes the feasibility, safety, and experience of HaH. We therefore need more context-aware models that consider the social, technological, and built dimensions of patients’ homes. As we advance the vision of a “Hospital without Walls,” we must account for this diversity when designing, implementing, and evaluating HaH models. Otherwise, this promising transformation may unintentionally deepen health inequalities. Just as we have designed hospitals to support care, we must now ask: How can we design and adapt homes to support diverse care needs across different living environments?

In my view, this is one of the most important gaps between evidence and implementation. Clinical eligibility criteria are relatively well developed, but environmental readiness is assessed less consistently. Space, accessibility, housing quality, digital connectivity, and neighbourhood services can determine whether the same clinical model is safe and feasible for different patients. Many programs also depend on a relative who is present and able to undertake monitoring, coordination, or practical care, yet this work is often treated as an invisible resource. HaH models should assess caregiver capacity, provide training and respite, and avoid transferring hospital responsibilities to families without adequate support. We must also recognize that home is not inherently comforting for everyone. For people who live alone or have limited social support, acute care at home may increase isolation or anxiety. Implementation should therefore include social as well as clinical assessment and offer alternatives when home is not the best place for care.

Our studies also show that sustainable HaH requires a systems design approach that coordinates change across human, technological, and spatial dimensions. The People-Process-Place (3P) framework offers a practical way to design, evaluate, and improve these models. HaH reshapes the roles, relationships, and responsibilities of staff, patients, and family members (People); restructures patient journeys, workflows, financing, and governance (Process); and changes the physical and digital environments in which care is delivered (Place). The implementation gap persists when one of these dimensions — often Place — is treated as secondary. HaH should therefore be understood not simply as a new service, but as a transformation of the healthcare system.

How can education and initiatives such as the World Hospital at Home Education Portal and Congress help healthcare professionals develop the knowledge and confidence to implement and advance Hospital at Home models?

Attending WHAHC in Vienna in 2024 was an important moment for me. I felt I was in the right place at the right time, witnessing a global movement led by passionate people to improve healthcare. It reinforced my belief that we cannot keep building more hospitals when there is a global shortage of resources and workforce. We must innovate in how we use existing capacity across the built environment. The Congress demonstrated the value of openly sharing experience across countries, including what has worked and what has not.

At the same time, I became aware that the home environment was often absent from the discussion. Clinical, operational, and economic outcomes received considerable attention, but homes in Singapore, London, Amsterdam, and Tel Aviv, for example, differ profoundly. Education initiatives such as the Portal and Congress can help professionals worldwide learn from one another while also developing the judgment to adapt HaH models to local cultures, housing conditions, family structures, infrastructure, and health systems.

We also tend to develop HaH programs by medical specialty — internal medicine, cardiology, or oncology — just as hospital departments have historically been organized around organs. HaH offers an opportunity to move beyond this logic and develop integrative, holistic programs for people with multimorbidity, rather than reproducing hospital silos inside the home.

Education should therefore extend beyond clinical protocols and technical skills. Professionals need to understand the home as someone else’s territory, communicate differently with patients and families, and recognize the emotional, social, cultural, and spiritual dimensions of care. I often return to a simple phrase: when professionals enter a patient’s home, they are the patient’s guests; when patients enter the hospital, they are the staff’s guests. This reversal captures both the potential and the challenge of HaH transformation.

In this regard, the Portal and Congress can build confidence by bringing clinicians into dialogue with patients, caregivers, managers, technologists, architects, designers, and policymakers — the range of perspectives needed to redesign care, not merely relocate it.

What developments in Hospital at Home are you most excited about in the coming years, and what do you think will be needed to take the field to the next level?

I am excited by the possibility of designing homes that can adapt as people’s health and abilities change. This does not mean turning every home into a hospital. It means incorporating accessibility, flexible space, connectivity, and discreet support for care into housing design so that people can remain independent and receive appropriate care across the life course.

At the same time, we need more context-aware HaH models for the diversity of homes that already exist. Future services should match both the patient and the setting rather than be delivered as a standardized package. A combined assessment of social support, technological readiness, and physical conditions could guide eligibility, adaptations, equipment, and the intensity of professional support, making HaH more inclusive without compromising safety.

Environmental considerations should also be incorporated more fully into HaH policy, practice, and research. They should become part of program standards, evaluation, and funding. We need evidence not only about clinical outcomes and costs, but also about which home and neighbourhood conditions enable good care, which adaptations are effective, and who should pay for them. This would help prevent environmental disadvantage from becoming a hidden exclusion criterion.

The next level is a connected continuum rather than a binary choice between hospital and home. I envision hybrid hospitals that integrate physical and virtual care and work closely with community health centres, home-care teams, local services, and municipalities. In this broader “Healthcare without Walls” ecosystem, the neighbourhood and city become part of the healthcare infrastructure.

AI may help detect deterioration earlier, interpret continuous monitoring data, coordinate complex pathways, and tailor information to individual patients. More importantly, it may change who has access to knowledge and how patients and professionals share decisions. Its success should therefore be judged not only by efficiency, but also by whether it strengthens trust, meaningful choice, equity, and the human experience of care.