Abstract
Introduction
Inclusive education aims to ensure students with special needs participate equally in societal life (Haring et al., 1994; Shen & Yin, 2024; Winzer, 1993). It is based on the belief that education is both a fundamental human right and the foundation of a just society (UNESCO, 2009). While disability groups receive significant attention, children with severe illnesses are often overlooked in educational discussions. These children are typically told to “heal first, return to school, and catch up later” (Ratnapalan et al., 2009) or to spend their final moments in comfort. However, expecting to achieve a “cure” through a short period of hospitalization is likely an oversimplified view. In fact, these young patients frequently undergo invasive medical procedures, face repeated and lengthy hospitalizations, and are separated from familiar environments like home or school. Consequently, their fundamental right to education is inadequately protected during the lengthy recovery periods. This raises a crucial question: How can education be maintained during such a turbulent and prolonged therapeutic journey? Given that all children have the right to education (United Nations, 1989), the next consequential question is: Who should ensure educational opportunities for students forced to leave school due to serious illness?
In recent years, such an emerging public issue at the intersection of education, healthcare, and social systems has begun to resonate. “Hospital schools” and related support organizations—such as the “Hospital Organization of Pedagogues in Europe” (HOPE) in Europe, the “Hospital Educator and Academic Liaison Association” (HEAL) in North America, the European Union-funded “Learning at Home and in the Hospital” (LeHo), and the “REDLACEH” in Latin America and the Caribbean—represent a global response to this challenge, often referred to as “Home and Hospital Education” (HHE). These schools are often run within hospitals, with different operational models across countries. In Western countries, they are typically supported by government and hospital funding and managed by local school districts, providing educational services to students within the hospital. Two main models exist: One involves public school teachers from the local district, while the other is a collaboration between hospitals and school systems to establish specialized hospital schools. Examples include the UNC Hospital School in North Carolina, which offers specialized programs like makerspace and access to natural sciences, and the Chelsea Community Hospital School in the U.K., which tailors education to individual needs with a focus on arts and “well at school” initiatives. Similarly, there are hospital school programs around the world such as Monash Children's Hospital School in Australia, Central Regional Health School in New Zealand, and Solas Hospital School in Ireland.
For a long time, providing inclusive and high-quality education has been a challenge for East Asian education systems (Pan & Wang, 2024). The “district-based” hospital school model, integrated into the public school system as seen in Western countries, is difficult to implement in China due to its large population, vast territory, and regional disparities. Nevertheless, Chinese educators are exploring various models to achieve “high-quality and equitable” education. In 1954, Hong Kong SAR established the Red Cross Hospital School, funded by the Education Bureau and managed by the Red Cross, which now employs over 60 teachers and operates 26 teaching units across 19 hospitals. Chinese mainland, although starting later, has developed successful programs, such as the “Rainbow Bay” Hospital School, Wuhan Union Hospital's Caring Ward, the “Shenzhen Children's Hospital • Vcare Caring Space” project, and the “Rising Sun Project” in Chengdu. The most extensive of these is the New Sunshine Hospital School, operated by the Beijing New Sunshine Charity Foundation, which is both comprehensive and systematic in scale.
This article seeks to take the New Sunshine Hospital School Program as a case study to explore how the teachers there approach their tasks, and analyze the similarities and differences between the two operational models of hospital schools. Through this analysis, the article aims to show how Chinese teachers, foundations, hospitals, and society cooperate to achieve success, thereby contributing a Chinese solution to this globally shared social and educational issue. Additionally, we believe that hospital schools, as an educational practice under “extreme” conditions, offer insights into the standardized structure of modern school education. As Darling-Hammond (2024, p. 218) pointed out, “Reinventing schools also means rethinking what schools are for.” Informed consent was obtained from all participating teachers, hospital staff, and education personnel before data collection. Participation was voluntary, and privacy and confidentiality were strictly maintained.
Overview of the hospital school curriculum system
Established in 2012, the New Sunshine Hospital School provides free, companionship-based education to seriously ill children aged 3 to 14 who require long-term hospitalization, addressing gaps in education and social services for these children. By the end of 2023, the program had established 43 hospital classrooms across 20 provinces and regions, with 36 full-time teachers. It served over 46,000 children, delivering 820,796 services, and offering 175,239 classes, earning the title of “the largest hospital school system in the world.”
Since the day of diagnosis, these children's lives undergo profound and lasting changes, spanning from the treatment phase to the rest of their lives (Bessell, 2001). Each phase presents different states and needs. In response, the New Sunshine Hospital School has developed a curriculum system tailored to these children, based on their individual treatment cycles (see Figure 1). This system covers four consecutive periods: the hospitalization crisis period, the recurrent hospitalization period, the treatment maintenance and recovery period, and the reintegration into society period.
The curriculum system based on an individual treatment cycle.
The primary goal of services during the hospitalization crisis stage is “adaptation.” Through play-based courses, book recommendations, resource sharing, and “parent meetings” in collaboration with the hospital, the school helps children and families adjust to the medical environment, including medication, hospital logistics, and dietary needs. Additionally, direct companionship provides emotional support to help families adapt to hospital life. The Beijing New Sunshine Charity Foundation also offers financial and medical assistance to families in need.
The educational function of the New Sunshine Hospital School is most evident during the recurrent hospitalization period. To ensure continuity in education and social life, a curriculum system based on the kindergarten framework integrates five areas: “Health, Language, Society, Arts, and Science,” taught in an interdisciplinary manner. One-on-one tutoring or bedside companionship is provided based on individual needs. The school also organizes thematic activities tied to events like Chinese New Year, Mother's Day, World Book Day, and the Winter Olympics, aiming to restore a sense of normalcy for children and families. This effort to create a “normal” environment that resembles a school or society is also reflected in the fact that teachers introduce everyday elements, such as games, activities, classroom discipline, and even the opening ceremony of the school year.
The treatment maintenance and recovery period focuses on home–school connections, one-on-one tutoring, and thematic communication activities, supporting children's reintegration into school and society. After their return, the hospital school continues to provide follow-up support, assisting seriously ill children and their families in their ongoing development, helping them bridge the present and future aspects of life.
Thus, the hospital school not only fills the educational gap during treatment but also serves as a supportive bridge between their “medical state” and “regular community life.”
Two contextualized operational model: Solo and assembly teaching modes
Over the years, the New Sunshine Hospital School has developed a curriculum framework to support seriously ill children, but what stands out is how frontline teachers provide comprehensive educational support in daily operations. Unlike hospital schools in Western countries, which typically employ multiple teachers, each site in the New Sunshine Hospital School Program usually has only one full-time teacher who independently manages the curriculum. This raises an important question: How can a single teacher support such a comprehensive curriculum in a hospital school?
After conducting field research, we found that while the New Sunshine Hospital School Program follows a top-level curriculum design, its implementation still relies on the local teachers’ ability to adapt the curriculum based on the specific context, personal beliefs, and expertise. As such, “while the operation of hospital school maintains a degree of uniformity … there is still significant regional variation in practice.” At the frontline of teaching, teachers at each site have proactively developed diverse, context-specific operational models using a bottom-up approach. These models can be broadly classified into two categories: “Teaching as a solo mode” and “Teaching as an assembly mode.” This article aims to analyze and discuss these two typical models.
Teaching as a solo mode: Leading by example, “instilling hope in children”
Teacher C has worked at the hospital school in Region S for 10 years, managing classroom teaching, communication, and administration. During this time, she developed an integrated curriculum combining picture book reading with hands-on activities, focusing on cognitive development and interdisciplinary knowledge. She has also created strategies to address challenges such as mixed-age groups and high student mobility. Through consistent, long-term efforts, Teacher C has built strong trust and collaboration with hospital staff, nurses, children, and families. For instance, she visits patient rooms before class to remind children to attend, while nurses keep her updated on children's conditions. Parents often consult her during breaks about teaching materials as well as healthcare-related support in finance, material, and daily life support. The successful operation of the hospital school in Region S is largely attributed to Teacher C's direct involvement, which we define as the “Teaching as a solo mode.”
Firstly, this model reflects Teacher C's agency, shaped by her personal background and educational philosophy. She values the fulfillment of directly teaching, interacting with children, and witnessing their growth. Her roles as a counselor, volunteer, and teacher have reinforced her belief in leading by example and “instilling hope in children.” As she explains, “The hospital school serves as a link, connecting the special environment to the child's original life setting, helping them believe that recovery and returning to normal life is possible. A teacher's values must be upright, and their words and actions should guide children onto the right path.” These principles are reflected in her daily teaching. For example, she emphasizes, “The words teachers use are crucial; we must offer children choices to foster a sense of control, with the aim of minimizing trauma.”
Secondly, this model is built on both long-term experience and ongoing professional development. Teacher C shared that her early teaching was based on personal experimentation, for instance when she taught English and struggled with student disengagement. It was through the help of a volunteer (an early childhood education teacher) that her methods evolved, learning Montessori principles and incorporating English into courses like picture books. After these trial-and-error experiences, Teacher C considers the perspective of new teachers when writing lesson plans, noting alternatives, potential reactions, and children's responses. This approach not only provides guidance for novice teachers but also deepens her own reflection on teaching.
However, the hands-on nature of the “Teaching as a solo mode” model also has a downside—“fighting alone.” Teachers who, unlike Teacher C, lack long-term experience or a developed curriculum model may feel overwhelmed. To a large extent, “fighting alone” is a necessity rather than choice. As Teacher C noted, due to high turnover, their involvement is limited to supporting roles like teaching assistants. Similarly, social volunteers often rely on media exposure or specific networks, resulting in sporadic and limited thematic activities.
Teaching as an assembly mode: Mobilizing social resources, “multi-party responses” through collective effort
The program in region N, operating as a flagship site, serves seriously ill children from five surrounding provinces. Led by Teacher W, who has managed the site for 7 years, Region N provides a comprehensive curriculum supported by a wide range of resources. In addition to Teacher W, many adults are actively involved in teaching and activities. Rather than solo teaching, Teacher W uses her expertise in management and resource coordination to build stable, long-term partnerships with volunteer teams. In the classroom, she focuses on observing the children's well-being and interactions while supporting volunteer teachers. This collaborative approach aligns with the “Teaching as an assembly mode,” with Teacher W acting as a “Curriculum Leader” or “Manager.”
This mode is made possible by a well-organized and stable volunteer collaboration mechanism. As Teacher W notes, “Region N has a better foundation for volunteers.” The volunteer base is diverse, with many long-term collaborations, unlike the typical short-term involvement. For example, a local photography studio has visited the hospital school three times to take family portraits. Volunteer groups, such as fan support groups, offer specialized courses in art (e.g., opera face painting, landscape painting) and language (Chinese and English). Teams from nearby universities provide services while using the site as an internship base. Additionally, there are many individual volunteers, such as a retired elementary music teacher, who leads choir rehearsals. Teacher W also involves professional teachers for one-on-one tutoring. Teacher W believes that “each field has its specialists,” and no one can offer such a broad range of courses. However, by mobilizing social resources, “we can offer children more diverse, professional, and engaging educational opportunities.”
Specifically, the success relies on a solid human resource base and stable operations, which involve key steps like volunteer selection, coordination, teaching, feedback, and ongoing communication. Teacher W acts as a “gatekeeper” and “guardian,” carefully planning and organizing. “We also have an admission system; not just anyone can join.” As program leader, Teacher W manages both the team and the curriculum in two main ways: First, she oversees volunteer entry requirements, coordinates efforts, and ensures alignment on teaching strategies. “What we need is to reach an agreement with the volunteers, as the children here may have different educational needs from those in regular schools.” Second, Teacher W collaborates with volunteers to define course objectives and develop the curriculum, followed by collective review. She emphasized, “This is not a top-down approach or a one-person show; it's about collaborative brainstorming … and a comprehensive, annual plan should result from these discussions.”
Furthermore, this mode extends beyond the hospital school's internal workings, focusing on collaboration with external stakeholders to meet the needs of children and their families. A small, supportive community has formed around the children's treatment, including volunteers, parents, and medical staff. In addition to teaching, Teacher W fosters “home–school–hospital” collaboration, mainly through the “parent group” established at the hospital. She noted, “Every three months, we hold a parent meeting, usually in conjunction with the department's volunteer educational outreach.” Given that many families are unfamiliar with the area, Teacher W provides practical support by sharing local resources, such as information on medication, transportation, caregiving tips, and emotional support strategies, thereby connecting families to basic life-related services.
The success of Region N in attracting social resources and implementing the assembly model stems from Teacher W's deep understanding, years of experience, and extensive network. As one of the few successful examples, the “assembly” model is harder to replicate than the “solo” approach, especially for new teachers without experience or resources. During visits to other sites, we observed that new teachers often struggle to balance administrative and teaching duties, leading to fatigue and feeling overwhelmed. To transition into teaching-management roles, new teachers must invest more time and receive resource support from hospital school projects. Despite years of experience and diverse models, the core mission of hospital schools, to provide essential support to sick children and their families, remains the critical focus that requires ongoing reflection and realignment.
Discussion and reflection
The concept of inclusive education challenges educators and educational systems, prompting them to reconsider teaching and learning from various perspectives and approaches (Loreman et al., 2014). For seriously ill children, who are often excluded from inclusive education, the New Sunshine Hospital School stands as a pioneering example in China. Indeed, within China's complex context, the New Sunshine Hospital School has not adopted a single “one-size-fits-all” operational model. The distinction between two modes reflects the inevitable regional differences, diverse needs, and variations in teachers’ backgrounds and resources. At the same time, these distinctions highlight the valuable, localized, and diverse experiences and tacit knowledge accumulated by frontline teachers in their long-term practice. It is in this exploration that we are able to uncover educational wisdom and operational insights distinct from Western models. By describing and analyzing the two organizational modes, where a single teacher manages both teaching and daily operations, we offer a voice from China to the world, while also calling for society to continuously reassess and evaluate the educational welfare of all children.
As Zhengchen Liu, the founder and secretary-general of the Beijing New Sunshine Charity Foundation, has stated, “Providing compulsory education for children during their long treatment periods should be a joint responsibility of the education and healthcare sectors.” How social organizations, policymakers, and educational researchers collaborate to address the genuine educational needs of children in such special contexts remains an important issue requiring ongoing exploration in both practice and theory. Both the hospital school's top-level curriculum design and the distinct operational models of the New Sunshine Hospital School reflect the innovative efforts to meet the special educational needs of children. This practice explicitly breaks free from the dominance of “medical discourse” over “educational discourse” and focuses on addressing the educational needs of sick children and their families. It supplements the education and social services available to children who are hospitalized long-term in China, assuming responsibility for their educational and developmental opportunities.
Takeaway message
• This study highlights the New Sunshine Hospital School in China as a unique case of inclusive education for seriously ill children, contributing a Chinese solution to this global social and educational issue. • The New Sunshine Hospital School integrates its curriculum with children's medical treatment cycles, ensuring educational continuity during their hospitalization. • The research examines two operational models, “solo” and “assembly,” demonstrating how local teachers adapt to diverse needs and contexts. • The success of the program relies on multi-party collaboration between educators, families, hospitals, and social organization, ensuring a holistic support system for hospitalized children.
Footnotes
Acknowledgments
The authors would like to thank the New Sunshine Charity Foundation for their financial support and for granting us the opportunity to engage with this unique educational context. We are also grateful to the New Sunshine Foundation Board of Directors for their valuable insights and collaboration. Our deepest thanks also go to the regional managers and teachers who participated in the interviews. Their insights were not only valuable but also deeply inspiring, reflecting their steadfast dedication to education and heartfelt care for the children.
Contributorship
Yiting Wang formulated the research questions, led the discussion section, created the charts and visuals, and co-wrote the comparison of the two teaching models. Haoxuan Yang reviewed the relevant literature, developed the curriculum overview, and co-wrote the comparison of the two teaching models.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical statement
This study was approved by the University Committee on Human Research Protection (UCHRP) at East China Normal University (Approval Number: HR408-2023; OHRP Registration No.: IRB00013174; FWA Assurance No.: FWA00031560) on August 22, 2023. The study was categorized as exempt under Categories I and II with limited review. Informed consent was obtained from all participating teachers, hospital staff, and education personnel before data collection. Participation was voluntary, and privacy and confidentiality were strictly maintained.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the New Sunshine Charity Foundation for the project “Development and Management System Construction for the New Sunshine Hospital School Education.”
