Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context.

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context.


  • Andrea Brambilla a:1:{s:5:"en_US";s:39:"Politecnico di Milano, Dipartimento ABC";}
  • Lara Ergur School of Architecture and Urban Planning (AUIC), Politecnico di Milano, Milan, Italy
  • Stefano Capolongo Design&Health Lab. Department of Architecture, Built Environment and Construction Engineering (DABC) Politecnico di Milano, Italy


site sustainability, healthcare facilities, public private partnership (PPP), hospital evaluation, assessment tool, mega hospital, one health


Background and aim: Healthcare facilities are large and complex infrastructures designed to respond to a growing need of sanitary services in specialized environments to serve an increasing population number while containing costs. New financial and design models emerged for large sized Hospital ­Facilities (Mega-hospitals) but their site sustainability is questioned. Methods: The paper focuses on a comparison ­between European region case studies of Public Private Partnership (PPP) Mega-Hospitals. A total of 21 large sized hospitals in operation after 2010 have been compared with the application of the Assessment Tool for ­Hospital Site Sustainability (ATHOSS). A specific focus on Turkish Hospitals has been also provided as the PPP model is widely adopted in this country. Results: This analysis shows that Turkish cases gets general lower scores than European ones in terms of Construction Density and Community Connectivity (28%;50%), Alternative Transportation (18%; 50%), Site Development (26%; 38%). Connection to Natural World (30%; 52%) and Heat Island Effect (33%; 43%). Only in Development Density criteria (30%; 16%) the score was higher. It also emerged that gross floor area per bed ratio is much larger for Turkish cases (334m2/bed; 198 m2/bed) which can be interpreted as one of the weaknesses related to oversizing such infrastructures. Conclusions: The tool application highlighted some point of attention to be considered when designing and planning Mega-hospital facilities and improvement strategies for site sustainability are ­suggested.


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How to Cite

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context. Acta Biomed [Internet]. 2023 Aug. 30 [cited 2024 Jun. 17];94(S3):e2023156. Available from:

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