Environmental Sustainability in Next-Generation Hospitals. Identifying Needs and Requirements from Healthcare Organizations and Industry Stakeholders.

Environmental Sustainability in Next-Generation Hospitals. Identifying Needs and Requirements from Healthcare Organizations and Industry Stakeholders.

Authors

  • Michele Dolcini Design&Health Lab, Department Architecture Built Environment Construction Engineering (DABC), Politecnico di Milano, Milan, Italy
  • Andrea Brambilla Design&Health Lab, Department Architecture Built Environment Construction Engineering (DABC), Politecnico di Milano, Milan, Italy
  • Silvia Mangili Design&Health Lab, Department Architecture Built Environment Construction Engineering (DABC), Politecnico di Milano, Milan, Italy
  • Stefano Capolongo Design&Health Lab, Department Architecture Built Environment Construction Engineering (DABC), Politecnico di Milano, Milan, Italy

Keywords:

Hospital sustainability; sustainable healthcare; healthcare infrastructure; sustainability survey; next generation hospital

Abstract

Background. Hospitals are among the most resource-intensive infrastructures, consuming significant amounts of energy, water, and materials while contributing 5.2% of global carbon dioxide emissions. Despite growing awareness and international commitments, hospitals face financial, structural, and operational barriers in implementing sustainability strategies. Study design. The study assesses the maturity of healthcare stakeholders regarding environmental sustainability, exploring key drivers, barriers, and strategies for integrating sustainability into healthcare facilities. Methods. A national web-based survey was conducted within the Joint Research Partnership Healthcare Infrastructures between November 2022 and January 2023, gathering 30 responses from 32 partners (94% participation rate). The analysis focuses on the environmental sustainability dimension, using descriptive statistics to identify trends, challenges, and best practices. Results. Healthcare stakeholders selected the most relevant Sustainable Development Goals for hospitals. Sustainability is widely recognized as a priority, yet resource allocation emerges as marginal. The most frequently cited constraint for improving environmental sustainability was financial constraints (n=27/30). Indeed, some hospitals are implementing energy-efficient retrofitting, high-efficiency thermal power plants, and sustainability building certification. The adoption of Building Energy Management Systems and retrofit interventions to maximise energy efficiency suggests increasing interest in sustainability performance measurement. Conclusions. Despite growing awareness, financial and regulatory support must be strengthened to facilitate hospital sustainability investments. Early integration of sustainability principles, access to public and private models and multi-stakeholder collaboration are crucial. Future research and action should foster multi-stakeholders approaches, develop sector-specific sustainability frameworks and assess the long-term impact of sustainability initiatives in healthcare.

References

1. European Commission, Eurostat. Healthcare expenditure statistics by function, provider and financing scheme [Internet]. 2024 [cited 2024 Dec 12]. Available from: https://ec.europa. eu/eurostat/statistics-explained/index.php?title=Healthcare_ expenditure_statistics_by_function,_provider_and_financing_scheme&oldid=626160 [Last accessed: 2025 Mar 31].

2. Buffoli M, Gola M, Rostagno M. Making hospitals healthier: how to improve sustainability in healthcare facilities. Ann Ig. 2014 Sep-Oct;26(5):418-25. doi: 10.7416/ai.2014.2001. PMID: 25405372.

3. Carnero M. Assessment of Environmental Sustainability in Health Care Organizations. Sustainability. 2015 Jun 29;7(7):8270-91. https://doi.org/10.3390/su7078270.

4. Romanello M, Napoli CD, Green C, Kennard H, Lampard P, Scamman D, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a healthcentred response in a world facing irreversible harms. Lancet. 2023 Dec 16;402(10419):2346-94. doi: 10.1016/S0140-6736(23)01859-7. Epub 2023 Nov 14. PMID: 37977174; PMCID: PMC7616810.

5. Romanello M, McGushin A, Di Napoli C, Drummond P, Hughes N, Jamart L, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet. 2021 Oct 30;398(10311):1619-62. doi: 10.1016/S0140-6736(21)01787-6. Epub 2021 Oct 20. PMID: 34687662; PMCID: PMC7616807.

6. Alotaiby R, Krenyácz É. Energy efficiency in healthcare institutions. Soc Econ. 2023 Nov 7;45(4):494-511. https:// doi.org/10.1556/204.2023.00013.

7. McGain F, Naylor C. Environmental sustainability in hospitals – a systematic review and research agenda. J Health Serv Res Policy. 2014 Oct;19(4):245-52. doi: 10.1177/1355819614534836. Epub 2014 May 9. PMID: 24813186.

8. Sebire NJ, Adams A, Celi L, Charlesworth A, Gorgens M, Gorsky M, et al. The Future Hospital in Global Health Systems: The Future Hospital Within the Healthcare System. Int J Health Plann Manage. 2025 Jan 15. doi: 10.1002/hpm.3891. Epub ahead of print. PMID: 39815953.

9. Sherman J, Thiel C, MacNeill A, Eckelman M, Dubrow R, Hopf H, et al. The Green Print: Advancement of Environmental Sustainability in Healthcare. Resour Conserv Recycl. 2020 Oct;161:104882. https://doi.org/10.1016/j.

resconrec.2020.104882.

10. United Nations Framework Convention on Climate Change. Report of the Conference of the Parties on its twenty-eighth session, held in the United Arab Emirates from 30 November to 13 December 2023. Addendum. Part two: Action taken

by the Conference of the Parties at its twenty-eighth session [Internet]. Report No.: FCCC/CP/2023/11/Add.1. Available from: https://unfccc.int/documents/637067 [Last accessed: 2024 Apr 5].

11. Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, et al. Health and climate change: policy responses to protect public health. Lancet. 2015 Nov 7;386(10006):1861914. doi: 10.1016/S0140-6736(15)60854-6. Epub 2015 Jun 25. PMID: 26111439.

12. Bouzid M, Hooper L, Hunter PR. The Effectiveness of Public Health Interventions to Reduce the Health Impact of Climate Change: A Systematic Review of Systematic Reviews.

PLoS One. 2013 Apr 25;8(4):e62041. doi: 10.1371/journal.

pone.0062041. PMID: 23634220; PMCID: PMC3636259.

13. Campbell-Lendrum D, Neville T, Schweizer C, Neira M. Climate change and health: three grand challenges. Nat Med. 2023 Jul;29(7):1631-8. doi: 10.1038/s41591-023-02438-w. Epub 2023 Jul 18. PMID: 37464036.

14. Or Z, Seppänen AV. The role of the health sector in tackling climate change: A narrative review. Health Policy. 2024 May;143:105053. doi: 10.1016/j.healthpol.2024.105053. Epub 2024 Mar 20. PMID: 38537397.

15. Capolongo S, Dolcini M, Brambilla A. Building Health: The Evolution of Healthcare Infrastructures Through the Lens of Human Evolution and Social Changes. In: Lara-Hernandez JA, Melis A, Boarin P, Besen P, eds. The Dusk of Design [Internet]. Cham: Springer Nature Switzerland; 2025 [cited 2025 Feb 3]. p. 205-18. (Integrated Science; vol. 34). Available from: https://link.springer.com/10.1007/978-3-031-768675_16 [Last accessed: 2025 Apr 5].

16. World Health Organization (WHO). Hospitals of the future: a technical brief on re-thinking the architecture of hospitals. Copenhagen: WHO Regional Office for Europe; 2023.

17. Albers Mohrman S, (Rami) Shani AB, eds. Organizing for Sustainability [Internet]. Emerald Group Publishing Limited; 2011 [cited 2024 Apr 3]. (Organizing for Sustainable Effectiveness). Available from: https://www.emerald.com/insight/publication/ doi/10.1108/S2045-0605(2011)1 [Last accessed: 2025 Apr 4].

18. Singh VK, Paul L. Planning and Designing Healthcare Facilities: A Lean, Innovative, and Evidence-Based Approach [Internet]. 1st ed. Singh VK, Lillrank P, eds. Productivity Press; 2017 [cited 2024 Apr 4]. Available from: https://www. taylorfrancis.com/books/edit/10.1201/b21814/planning-designing-healthcare-facilities-paul-lillrank-vijai-kumar-singh [Last accessed: 2025 Apr 4].

19. World Health Organization (WHO). WHO guidance for climate-resilient and environmentally sustainable health care facilities [Internet]. Geneva: World Health Organization; 2020. ISBN 978-92-4-001222-6. Available from: https:// iris.who.int/bitstream/handle/10665/335909/97892400122 26-eng.pdf?sequence=1 [Last accessed: 2025 Mar 31].

20. Loud ES, Woolf GR, Ralph A, Gadhia T, Navaratnam AMD, Watson L, et al. Climate change and public health: An evaluation framework for local government. Public Health Pract (Oxf). 2024 Jun 24;8:100524. doi: 10.1016/j.puhip.2024.100524. PMID: 39040977; PMCID: PMC11261007.

21. Durán A, Wright S, eds. Understanding Hospitals in Changing Health Systems [Internet]. Cham: Springer International Publishing; 2020 [cited 2025 Feb 24]. Available from: http:// link.springer.com/10.1007/978-3-030-28172-4 [Last accessed: 2025 Mar 31].

22. World Health Organization (WHO). Shaping the vision: strategic hospital transformation within WHO European Region health system. Copenhagen; 2025. Report No.: WHO/ EURO:2025-10686-50458-76212.

23. Blass AP, Gouvea da Costa SE, Pinheiro de Lima E, Tortato U, Borges LA. Environmental Performance Measurement in Hospitals: A Bibliometric Review of Literature (1987–2017). In: World Sustainability Series [Internet]. 2020. p. 133-45. Available from: https://www. scopus.com/inward/record.uri?eid=2-s2.0-85073209581&doi=10.1007%2f978-3-030-30306-8_8&partnerID= 40&md5=c6cdd751bd5b3785b6ea5ae1648fc794 [Last accessed: 2025 Mar 31].

24. Borges De Oliveira K, De Oliveira OJ. Making Hospitals Sustainable: Towards Greener, Fairer and More Prosperous Services. Sustainability. 2022 Aug 8;14(15):9730. https://doi. org/10.3390/su14159730.

25. Brambilla A, Sun TZ, Elshazly W, Ghazy A, Barach P, Lindahl G, et al. Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation. Int J Environ Res Public Health. 2021 Oct 31;18(21):11478. doi: 10.3390/ijerph182111478. PMID: 34769993; PMCID: PMC8583089.

26. Brambilla A, Apel JM, Schmidt-Ross I, Buffoli M, Capolongo S, Testing of a Multiple Criteria Assessment Tool for Healthcare Facilities Quality and Sustainability: The Case of German Hospitals. Sustainability. 2022 Dec 14; 14(24): 16742. https://doi.org/10.3390/su142416742.

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Published

2025-05-13

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Section

Original research

How to Cite

1.
Dolcini M, Brambilla A, Mangili S, Capolongo S. Environmental Sustainability in Next-Generation Hospitals. Identifying Needs and Requirements from Healthcare Organizations and Industry Stakeholders. Ann Ig. 2025;37(5):565-573. doi:10.7416/ai.2025.2708