Health systems worldwide face a value crisis: the cost of healthcare continues to rise without commensurate improvements in outcomes or equitable access. The digital transformation of healthcare is accelerating, promising to bridge this gap between rising demand and finite resources - But what determines whether the same digital intervention succeeds in one health system and fails in another?
Transformational change is inherently context-dependent: Achieving value depends on the system around it, including the human, physical and digital infrastructure that enables it to be adopted, adapted and scaled.
KPMG and Hassell have come together to connect health system transformation with infrastructure design, to ensure what we build today enables how care needs to work tomorrow. In this report, we explore what an increasingly digital future for healthcare could look like, and what this demands of the way we plan, design and deliver health infrastructure. We argue for a different approach: design infrastructure from the outside in, starting with how and where care should be delivered, and design beyond the hospital, treating the home, community, virtual clinic and acute core as one connected system.
This report is for anyone grappling with how all the moving parts fit together: health system stewards, transformation leaders, infrastructure planners, clinicians, digital leaders, architects and designers.
Download the report
Demanding a digital design
What do our future health systems demand of what we build today?
Healthcare needs are outpacing population growth
Population growth alone does not explain the increasing pressure on healthcare services. Health needs are also becoming more complex.
Health systems cannot build their way out of demand
Australia is undertaking its largest hospital infrastructure program in a generation, with public health infrastructure expenditure up 94% over the past decade.
Against a backdrop of global construction constraints, the need for new hospital capacity is expected to exceed the market’s capacity to deliver it. More beds cannot be the only answer; we need new ways to create capacity across the health system, not just within the hospital.
Digital by default: Reorganising the health system for future care
What if healthcare came to the patient, rather than the patient journeying to the infrastructure?
Digital by default changes the choice architecture of health system planning: physical care is no longer the assumed starting point, but one modality selected where it creates the greatest value. When digital becomes the starting point, health systems reorganise care across settings, shifting the hospital from the centre of the system to one part of a connected care network.
Health systems can accelerate transformation through digital-by-default principles, using policy, funding and planning to build trust, shift incentives and enable adoption. Digital by default creates the conditions to redistribute care and capacity across settings, reducing the hospital’s role as the system’s default destination.
High-performing health systems recognise that digital value is a system design challenge, not a technology challenge. They shift from digital health to digital-in-health, making digital integral to the design of care rather than an add-on.
5 principles for success
Four connected settings can operate as one care ecosystem
Health infrastructure design must translate the future model of care, with digital by default, into a practical spatial framework across four connected settings:
Ultimately, the opportunity at hand is to design a single, connected care network that links home, community, virtual and acute settings to ensure people experience a continuous system of care. Each setting must be designed around the specific care it needs to deliver, aligning place, technology, workforce, workflows and governance accordingly.
This creates the conditions for care to move to the most appropriate setting, including outside of hospitals where appropriate, freeing up the acute core to focus on complex, high-acuity and procedural care. The result isn’t just a more digitally-enabled healthcare system, but one designed around how and where we can deliver the greatest value to patients.
Frequently asked questions
Digital by default means digital and remote care are considered the starting point where clinically appropriate, accessible and equitable. It does not mean digital-only. Physical care and alternative access pathways remain available according to patient need.
Digital-in-health moves beyond treating digital technology as a separate program. It embeds technology, data and digital capability across care delivery, infrastructure, public health and health system management so these elements work together as one ecosystem.
Hospitals are long-lived and difficult to change, while care models, workforce practices and technology evolve more quickly. Defining the future model of care first helps ensure the physical asset supports future pathways rather than locking the system into current assumptions.
The framework connects the home, community node, virtual clinical workplace and acute core. Each has a distinct role, but shared information, workflows and clinical responsibility allow them to operate as one service.
Action can begin at system, organisation or professional level. Priorities include aligning investment and governance, redesigning pathways, building digital delivery capability, testing clinical and spatial models, and preparing facilities and workforces for distributed care.
Download the full report
Demanding a digital design
What do our future health systems demand of what we build today?
Meet the team
Jonathan Di Michiel
Partner, Digital Health Practice, Health, Ageing & Human Services
KPMG Australia
- Dan Jefferson
- Louise Skilbeck
- Jonathan di Michiel
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