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This book describes the Sustainable High Quality Healthcare (SustHealth) project, which had the goal of developing an original multidisciplinary evaluation tool that can be applied to assess and improve hospitals’ overall sustainability. The comprehensive nature of the appraisal offered by this tool exceeds the scope of most current rating systems, which typically permit a thorough evaluation of relevant environmental factors when designing a new building but fail to consider social and economic impacts of the design phase or the performance of the hospital’s operational structure in these fields. The multidisciplinary evaluation system was developed, from its very inception through to its testing, by following a scientific experimental method in which a global perspective was constantly maintained, as opposed to a focus only on specific technical issues. Application of the SustHealth rating tool to a currently functioning hospital, or one under design, will identify weaknesses and guide users to potential low-cost short-term solutions and longer-term strategies for improvement.



Chapter 1. Healthcare Sustainability Challenge

Healthcare structures are supposed to protect and improve Public Health, but in the meanwhile they are highly energy-demanding and socially impactful structures, which cause negative side effects on the people’s health and on the environment. Building hospitals able to cope with the definition of Health as complete well-being and which can fit to the future means therefore constructing sustainable structures. Such complex realities work as a whole, single organism, that can be robust and productive only if every single part is healthy. So when it comes to healthcare facilities, sustainability has to be taken into account as both a main requirement and a quality issue, since they must be capable to deliver high standards also in changing circumstances. Starting from these assumptions the Sustainable High Quality Healthcare project is born with the aim of providing a new original insight into such a complex subject. Its goal is to define, through the construction of an innovative assessment system, solutions and strategies towards the realization of sustainable existing operative or in-design hospitals, where sustainability applies to the main macro-areas.
Stefano Capolongo, Marta Carla Bottero, Emanuele Lettieri, Maddalena Buffoli, Andrea Bellagarda, Matteo Birocchi, Elisa Cavagliato, Arlind Dervishaj, Michela di Noia, Giulia Gherardi, Marco Gola, Francesco Mantua, Slobodan Miljatovic, Maria Nickolova, Marco Rostagno, Salvatore Speranza, Lia Volpatti

Chapter 2. Current Scenario Analysis

The analysis of a scenario as complex as a healthcare facility cannot be accomplished only through theoretical studies: researches have therefore been conducted by taking into account the mainly acknowledged theories and by directly experiencing the hospital reality with a user-centred perspective. The stakeholders’ analysis highlighted how diverse are the groups of people which may have any interest in healthcare, ranging from Public Administration to employees and patients, to volunteers and local communities. However, their needs and the possibly arising controversies can be defined, taking into account overlapping and interrelationships, according to the three pillars of sustainability: the environmental, social and economic spheres. Through the analysis, by means of interviews and on-site visits, of different case-studies in Italy and sustainability best-practices around Europe were individuated the Niguarda Hospital, the Hospital del Mar, the Humanitas Research Hospital, the Meyer Hospital, the New Legnano’s Hospital and the next New Karolinska Solna Hospital. It was then possible to identify more specific and concrete users’ needs, to be translated into specifications for the newly developed tool. Every hospital represents a peculiar reality, dealing with many common concerns, but also with numerous issues tightly related to the local context.
Stefano Capolongo, Maddalena Buffoli, Michela di Noia, Marco Gola, Marco Rostagno

Chapter 3. Healthcare Sustainability Evaluation Systems

Many different evaluation systems are today available to assess buildings’ performance. Concerning sustainability, especially of healthcare structures, the most widely recognized and commonly used systems are the American LEED, the British BREEAM and, within the Italian reality, the ITACA system; all of these are then surrounded by other minor management evaluation systems. So after a deep analysis of the state of the art, focusing in particular on the previously mentioned evaluation systems, it was possible to identify the main strengths and weaknesses of such tools with respect to the Sustainable Healthcare’s project final objective. An interesting starting point is their hierarchic structure, employing a scoring system based on appropriately weighted credits. Undoubtedly though, these evaluating instruments focus on the built structure and its environmental impact, lacking in multidisciplinarity and in considering all the three spheres of sustainability, not including, for instance, neither user-centrality, health outcomes, nor managerial issues. The research analyses also the Joint Commission International accreditation, that works with healthcare organizations, governments and international advocates to promote rigorous standards of care and provide solutions for achieving peak performance. In fact, its goal is to improve the efficiency quality and safety in healthcare.
Maddalena Buffoli, Stefano Capolongo, Michela di Noia, Giulia Gherardi, Marco Gola

Chapter 4. A Multidisciplinary Sustainability Evaluation System for Operative and In-Design Hospitals

The Sustainable Healthcare project developed an original multidisciplinary evaluation tool, specifically designed to assess and improve a hospital’s global sustainability by considering together the environmental, social and economic issues, so to give a comprehensive evaluation of the hospital, according to an appropriate concept of sustainability. The system, which aimed to be simple, light and easy-to-use, includes the main weighting to enhance sustainability, organized in a hierarchical way: specific indicators are contained in a series of criteria, which represent the most critical factors and the most effective starting points for hospital’s sustainability improvement. They are finally divided into the three macro-areas of sustainability: social, economic and environmental sustainability. In order to take into account the different interrelationships among the various components of the system, a weighting process was carried out according to the Analytic Network Process method by Saaty in 2005. This allowed to take into consideration different users’ points of view and, most importantly, the human factor, thanks to the development of a weighting system based on the opinions of specific focus groups, which included experts and professionals from different healthcare sectors. The evaluation system’s application to a hospital allows the structure’s global sustainability to be assessed.
Marta Carla Bottero, Maddalena Buffoli, Stefano Capolongo, Elisa Cavagliato, Michela di Noia, Marco Gola, Salvatore Speranza, Lia Volpatti

Chapter 5. Testing the SustHealth Evaluation System

The SustHealth evaluation system was successfully experimentally tested through its application to an existing operative and a new hospital located in the Italian region of Lombardy. The whole evaluation was carried out in no more than 2 months, realizing interviews, questionnaires, on-site inspections and measurements. Every criterion demonstrated to be easily evaluable thanks to its clarity, objectivity and to data availability, providing interesting results, in terms of both emerging criticalities and possible measures for improvement. The developed tool has therefore demonstrated to be easy-to-use, simple and effective. It could be further improved considering its application to a higher number of hospitals, both in Italy and abroad, deepening the understanding of the surrounding international scenario. Moreover, it could also concur in the realization of a national database of healthcare structures, useful both for managers and patients.
Elisa Cavagliato, Michela di Noia, Giulia Gherardi, Marco Gola, Maria Nickolova, Marco Rostagno, Salvatore Speranza, Lia Volpatti
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