Expert Insights: In Conversation with Karen Titchener

At the World Hospital at Home Community on UNLOK, we bring together leading voices advancing the future of Hospital at Home and complex care beyond the traditional hospital setting. Through our expert interviews, we explore real-world perspectives on innovation, implementation, clinical practice, and the evolving role of technology, helping healthcare professionals translate experience and evidence into better care at home.

Meet the Expert

Karen Titchener

Karen Titchener is internationally recognized for her expertise in Hospital at Home (HaH), with more than 20 years of experience developing and implementing HaH programmes across urban and rural settings for the UK’s NHS. She also spent five years developing and growing one of the nation’s first Oncology Specialty Care at Home programmes at the University of Utah’s Huntsman Cancer Institute. Karen has personally managed more than 15,000 HaH admissions, including leading a London-based programme with more than 85 staff and over 3,000 annual patient admissions.

Currently Vice President of Hospital at Home Operations at Maribel Health, Karen is a founding member and secretary of the UK Hospital at Home Society and regularly speaks nationally and internationally on HaH and complex care in the home. Her work and research have helped demonstrate the potential of Hospital at Home to improve patient outcomes while reducing hospitalizations, length of stay, emergency department utilization, and costs.

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?

At the heart of it is something no one can take away from me a genuine love and care for patients. Right at the turn of the century, I was involved in building a programme of intermediate care for older people with a multidisciplinary team. We focused on early supported discharge alongside admission avoidance, and that’s what first sparked my interest in managing acutely unwell patients in their own homes including delivering up to 72 hours of continuous care at home where needed. I saw first-hand how much patients preferred to be cared for at home, and how much faster they progressed towards independence when they were in their own environment rather than a hospital bed.

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?

When it’s established the right way, Hospital at Home lets clinicians work to the top of their professional scope of practice, managing acutely unwell, high-acuity patients at home with the support of a multidisciplinary team. For patients, it means being cared for in their own environment by a team that can assess their needs and adapt the home itself to help them stay as independent as possible for as long as possible while avoiding the risks and complications that come with hospital admission. For health systems, a well-established, 24/7 Hospital at Home programme should mean acute beds are reserved for the patients who genuinely can only be cared for in an acute setting, which improves overall bed capacity.

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

We still lack robust, more large-scale data on the benefits of Hospital at Home and not just to the patient, but to the whole health economy. Just as importantly, local health systems often interpret the data they do have in the wrong way and fail to see the real benefit of Hospital at Home. Only last week I heard of a health system that cut £1–5 million from its Hospital at Home budget because their data suggested it wasn’t reducing A&E attendances. Too many Hospital at Home programmes are at the mercy of poorly selected and poorly interpreted data, and that stops investment where it’s needed most. Hospital at Home was never going to be the sole answer to reducing A&E attendances but we need much stronger research to tell that story properly and make the case for continued, and growing, investment.

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?

Clinicians and healthcare professionals working in Hospital at Home need a genuinely unique skill set. Being a guest in a patient’s home, engaging with the patient and their family on their terms, and carrying out diagnosis and treatment autonomously in that setting is a complex skill set that not all healthcare professionals and clinicians have. These aren’t skills that hospital-based staff necessarily bring with them. Any education programme that helps teams build these competencies and expand their scope of practice is a real asset to the field.

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?

What excites me most is the potential for Hospital at Home to advance hand-in-hand with technology and using it to support the care of complex, acutely unwell patients at home, not to replace in-person visits, but as an essential complement to them. I’d love to see Hospital at Home genuinely replacing the majority of inpatient care, so that only the very sickest patients need to be in hospitals. My one concern is that instead of pushing ahead into that more complex care provision, the field risks being watered down or folded into virtual wards, OPAT, or generic community services. Getting the next stage right means holding onto that pioneering, ambitious version of Hospital at Home rather than settling for the diluted one.