Assessing the complexity of a healthcare facility as an evaluation tool for reaching economic, social and environmental sustainability in hospital buildings

Healthcare facilities are supposed to improve and protect public health, but they are highly energy-demanding and socially impactful structures, which determinate negative effects on the health of the population and environment. When speaking about architectures for health, sustainability has to be considered as both a main requirement and a quality issue. This research work could be significant in the context of hospital facilities because it attempts to analyse not only the performance of the building itself but also all the organisational and managerial processes, and social aspects that characterise a health facility � items that several scholars and professionals are currently studying. Nowadays there are many rating systems that evaluate different aspects of sustainability and buildings� performance: for healthcare facilities, the most widely recognised and commonly used systems are LEED and BREEAM, while, at a clinical level, there are tools such as the International Joint Commission. Stakeholders� roles have an important impact, too: the analysis highlights the diversity of groups of people who may have an interest in healthcare � from public administration to users such as employees, patients, volunteers, etc. Starting from these notions, the aim of this research is to provide a new tool that defines an innovative rating system for sustainable existing operative and in-design hospitals, where sustainability applies to the main macro areas of social, economic and environmental sustainability. The tool features several criteria and indicators organised according to a hierarchic structure, employing a scoring system based on appropriately weighted credits and built through the multi-criteria methods of analytic network process. The final purpose of the work is practical application to several national and international healthcare facilities. This analysis will allow for the ability to distinguish several deficiencies, to analyse some best practices that can be helpful for improving the sustainability of the structures, and to verify the weighing system obtained through focus groups and interviews with experts, with the goal of increasing the hospitals� quality and performance.