Structural accreditation of healthcare facilities: comparison of the requirements by Italian Presidential Decree 14/01/1997 and regional regulations. A proposal for updating the minimum environmental units at national level A proposal for updating the minimum environmental units at national level

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Marco Gola
Martina Sapienza
Faris Slama
Laura Brundu
Roberta Campus
Stefano Manai
Roberto Nicosanti
Silvia Ogana
Marco Orrù
Giovanni Maria Ortu
Giulia Piga
Daniele Ignazio La Milia
Chiara Cadeddu
Gaia Ferraguzzi
Silvia Mangili
Gianfranco Damiani
Carlo Favaretti
Antonio Azara
Stefano Capolongo
Walter Ricciardi


Healthcare facilities, hospital design, Accreditation, Minimum structural requirements, Environmental units, Hospital functional design, Italian context


Background and aim. The Decree of the President of the Italian Republic 14/01/1997 is the reference norm related to the accreditation of public and private healthcare structures. This guideline establishes the minimum structural, technological and organizational requirements that each structure operating in the Italian territory must comply with.

Methods. In occasion of the project work for the postgraduate training course in healthcare management by ALTEMS School, a team of researchers conducted a survey on the state of updating of the minimum structural requirements indicated in the norm-in particular those relating to hospital facilities- with those adopted by the individual regions through the analysis of the most up-to-date regional regulations.

Results. Precisely starting from the comparison of regional references and from the regulations on the subject of structural accreditation which suggest strategic environmental units and which address some key-aspects relating to the contemporary design of healing environments (i.e. semi-intensive care units, hybrid operating theatres, etc.), the outcome of the project work is to define a proposal to update the national reference document, also in the light of the currently changing needs in terms of hospital design.

Conclusions. The research aims to become a starting milestone for future investigations. The team investigated – in this first phase – the functional areas listed in the norm, and the next step aims to extend the analysis also to the innovative functions (i.e. buffer spaces, hybrid operating theatres, sub-intensive care units, etc.) and/or introduced only the last years which have only been regulated in some regions.


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1. Zsóka Á, Vajkai É. Corporate sustainability reporting: Scrutinizing the requirements of comparability, transparency and re-flection of sustainability performance. Society and Economy. 2018; 40(1). doi: 10.1556/204.2018.40.1.3e.
2. World Health Organization (WHO). Preamble to the constitution of the world health organization. New York, Official Rec-ords of the World Health Organization. 1946. n.2, p 100.
3. Capolongo S, Buffoli M, Oppio A, Petronio M. Sustainability and Hygiene of building: future perspectives. Epidemiol Prev. 2014;38(6): 46-50.
4. Signorelli C, Capolongo S, Buffoli M, et al. Italian Society of Hygiene (SItI) recommendations for a healthy, safe and sustaina-ble housing. Epidem Prev. 2016; 40(3–4):265–270. doi: 10.19191/EP16.3-4.P265.094.
5. Tripartite and UNEP support OHHLEP’s definition of ‘One Health’. World Health Organization; 2021 [Accessed 12 Feb-ruary 2023]. Available from: (https://www.who
6. Adams JM. The Value of Worker Well-Being. Public Health Rep. 2019;134(6):583-586. doi:10.1177/00333
7. World Health Organization. International joint estimates of the work-related burden of disease and injury, 2000-2016: global monitoring report: Geneva: World Health Organization and the International Labour Organization; 2021.
8. KPMG. The time has come. Survey of sustainability reporting; 2020 [(Accessed 09 February 2023] KPMG. Available from:
9. Eizenberg E, Jabareen Y. Social Sustainability: A New Conceptual Framework. Sustainability. 2017; 9(1):68. doi: 10.3390/su9010068.
10. Proper KI, van Oostrom SH. The effectiveness of workplace health promotion interventions on physical and mental health outcomes - a systematic review of reviews. Scand J Work Environ Health. 2019; Nov 1;45(6):546-559. doi:10.5271/sjweh.3833.
11. Alonso-Nuez MJ, Cañete-Lairla MÁ, García-Madurga MÁ, et al. Corporate social responsibility and workplace health pro-motion: A systematic review. Front Psychol. 2022; 13;13:1011879. doi: 10.3389/fpsyg.2022.1011879
12. Capolongo S, Buffoli M, Oppio A, Nachiero D, Barletta MG. Healthy indoor environments: how to assess health performanc-es of construction projects. Environ Eng Manag J 2013;12(S11): 209-212.
13. Capolongo S, Buffoli M, Oppio A, Rizzitiello S. Measuring hygiene and health perfomances of buildings: a multidimensional approach. Ann. Ig. 2013; 25(2):151-7. doi: 10.7416
14. Grawitch MJ, Gottschalk M, Munz DC. The path to a healthy workplace: A critical review linking healthy workplace practic-es, employee well-being, and organizational improvements. Consult Psychol J Pract Res 2006;58(3), 129–147. doi: 10.1037/1065-9293.58.3.129.
15. Al-Jubari I, Mosbah A, Salem S.F. Employee Well-Being During COVID-19 Pandemic: The Role of Adaptability, Work-Family Conflict, and Organizational Response. SAGE Open. 2022; 12(3) doi: 10.1177/21582440221096142.
16. Aldana SG. Financial impact of health promotion programs: a comprehensive review of the literature. Am J Health Promot. 2001;15(5):296-320. doi: 10.4278/0890-1171-15.5.296.
17. Di Fabio A. Positive Healthy Organizations: Promoting Well-Being, Meaningfulness, and Sustainability in Organizations. Front Psychol. 2017 Nov 14;8:1938. doi: 10.3389
18. Chowdhury EH, Backlund Rambaree B, Macassa G. CSR Reporting of Stakeholders’ Health: Proposal for a New Perspec-tive. Sustainability. 2021, 13, 1133. doi:10.3390
/ su13031133.
19. Evangelinos K, Fotiadis S, Skouloudis A, et al. Occupational health and safety disclosures in sustainability reports: An overview of trends among corporate leaders. Corp Soc Resp Env Ma. 2018; 25: 961– 970. doi:10.1002/csr.1512.
20. Dura C. Occupational health and safety integration in corporate social responsibility policies within B.R.D. - G.S.G. Ann Univ Petroşani Economics 2014; 14 (1): 59-70.
21. Koskela M. Occupational health and safety in corporate social responsibility reports. J Safety Res 2014; 68:294-308. doi: 10.1016/j.ssci.2014.04.011.
22. Pronk NP, Malan D, Christie G, Hajat C, & Yach, D. Health and well-being metrics in business: The value of integrated re-porting. J Occup Environ Med. 2018; 60(1), 19. doi:10.1097/JOM.0000000000001167.
23. Macassa G, McGrath C, Tomaselli G, Buttigieg SC. Corporate social responsibility and internal stakeholders’ health and well-being in Europe: a systematic descriptive review. Health Promot Int. 2021 Aug 24;36(3):866-883. doi: 10.1093/heapro/daaa071.
24. EFRAG (European Financial Reporting Advisory Group). Current non-financial reporting formats and practices. 2021; [Accessed 10 February 2023]. Available from:
25. Global Reporting Initiative (GRI). Foundation: 2016 GRI Standards; 2016 [Accessed 10 February 2023]. Available from:
26. National Safety Council. Connecting Sustainability with workplace safety and health. Position Paper; 2022 [Accessed 06 February 2023]. Available from:
27. Global Reporting Initiative, Robert Wood Johnson Foundation. Linking the GRI Standards and the Culture of Health for Business (COH4B) Framework. GRI – Standards; 2021 [Accessed 10 February 2023]. Available from: https://www
28. UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development; 2015 [Accessed 10 Febru-ary 2023] A/RES/70/1. Available from: https://www
29. KPMG. Big shifts, small steps. Survey of sustainability reporting. 2022 [Accessed 06 February 2023]. Available from:
30. European Commission. Proposal for a Directive of the European Parliament and of the Council amending Directive 2013/34/EU, Directive 2004/109/EC, Directive 2006/43/EC and Regulation (EU) No 537/2014, as regards corporate sustainability reporting. Official J Eur Union 2021;537):1–65.
31. International Organization for Standardization. Occupational health and safety management systems — Requirements with guidance for use. Geneva: ISO; 2018 [Accessed 10 February 2023]. Available from https://www occupational-health-and-safety.htmln.
32. World Health Organization (WHO). Regional Office for Europe. Workplace Health in the Public Health Perspective; 2003 [Accessed 26 March 2023]. Available from: //
33. Organization for Economic Cooperation and Development (OECD). Population and employment by main activities; 2021[Accessed 25 March 2023]. Available from:
34. Peters SE, Dennerlein JT, Wagner GR, Sorensen G. Work and worker health in the post-pandemic world: a public health perspective. Lancet Public Health. 2022;7:e188-e194. doi:10.1016/S2468-2667(21)00259-0
35. Backhaus I, Sisenop F, Begotaraj E, et al. Resilience and Coping With COVID-19: The COPERS Study. Int J Public Health. 2021; 66:1604007. doi: 10.3389/ijph.2021.1604007
36. McKinsey&Company. Great Attrition or Great Attraction; 2023 [Accessed 27 March 2023]. Available from:
37. Macassa G, Rashid M, Rambaree BB, Chowdhury EH. Corporate Social Responsibility Reporting for Stakeholders’ Health and Wellbeing in the Food and Beverage Industry: A Case Study of a Multinational Company. Sustainability. 2022; 14(9):4879. doi: 10.3390/su14094879
38. Buffoli M, Capolongo S, di Noia M, Gherardi G, Gola M. Healthcare sustainability evaluation systems. In: Capolongo S, Bot-tero MC, Buffoli M, Lettieri E. (eds.) Improving Sustainability During Hospital Design and Operation: A Multidisciplinary Evaluation Tool. Cham, Switzerland: Springer Briefs in Applied Sciences and Technology; 2015. p.23-30. doi: 10.1007/978-3-319-14036-0_3
39. Brambilla A, Morganti A, Lindahl G, Riva A, Capolongo S. Complex Projects Assessment. The Impact of Built Environment on Healthcare Staff Wellbeing. In: Gervasi O, Murgante B, Misra S, Garau C, Blečić I, Taniar D, et al. (eds.) Computational Science and Its Applications – -ICCSA 2020. Cham: Springer International Publishing; 2020. p. 345–354. doi: 10.1007/978-3-030-58814-4_24

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