Bottero Marta Carla - Improving Sustainability During Hospital Design and Operation a Multidisciplinary Evaluation Tool

Springer International Publishing Switzerland 2015

Stefano Capolongo 1 , Francesco Mantua 4, Slobodan Miljatovic 5, Maria Nickolova 5, Marco Rostagno 4, Salvatore Speranza 5 and Lia Volpatti 5

Abstract

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 peoples 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.

Keywords

According to the World Health Organization (WHO), Health can be described as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization ).

Access to healthcare is deeply influenced by a variety of social factors such as economic conditions or existing national health policies, thus greatly varying across countries, populations and individuals (Capasso et al. ).

Public health is recognized as a resource that must be preserved and improved. Within this context, hospitals are the healthcare systems most recognized structures pursuing this goal: one would therefore, naturally, believe such structures to be designed to protect public health. Continuous studies though have unveiled how traditional hospital structures, theoretically built to preserve public health, actually have an indirect negative effect on public health and, on a wider level, on the community and environment they are set in.

The Italian hospital network, with its 1,170 hospital structures spread across the country, is not only extremely complex but also considerably old. Italian hospital structures are, on average, outdated both in their infrastructures and, especially, in the way they have been designed. Today, fewer than 50 % of these structures have been opened, less than 20 years ago, with 5 exceptional hospitals having been functioning in the same facilities since before the 1900 (Nuovo Sistema Informativo Sanitario ).

If one therefore considers the traditional problems that affect the National Health Service (NHS) and its hospital network, the Italian hospital reality is brought to face an even more difficult scenario because of the age of its healthcare infrastructure.

The recent increase in public conscience towards environmental issues has brought an immediate focus on the importance of environmental sustainability: whereas hospital facilities are the symbol of a system supposed to defend peoples health, their outdatedness actually brings them to be part of those structures which pose the greatest threat to us if put into the environmental perspective. There are therefore increasingly more issues facing hospitals on the environmental front, with regulators and communities now clearly changing their expectations of healthcare facilities for energy reduction and environmental improvements (Cantlupe ).

The involuntary negative impacts that hospital structures may have on their communities and on the environment affect a variety of fields, with this being even more true for outdated facilities. From the environmental point of view, for example, the existing hospitals are extremely complex buildings that have more or less three times the energetic consumptions of a residential building with the same size, not to mention their water consumption. Furthermore, these often obsolete structures continuously produce high amounts of air emissions (in the United States, the Department of Energy states the nations hospitals contribute 2.5 times the carbon dioxide emissions of commercial buildings), together with solid and liquid wastes which also can be dangerous or toxic. Hospitals generate an excess of 2 million tons of general waste each year: according to a Johns Hopkins University study, they are the second largest waste producers after the food industry (Cantlupe ). Hospital structures also have a noteworthy social impact: their establishment within an urban or suburban center significantly alters the locations equilibrium, for example through the naturally consequent increase in traffic, noise and surrounding means of transportation. Furthermore, their spaces host a variety of different individuals, cultures, stories and professional backgrounds, all framed within an extremely delicate environment where joy and pain are intrinsically intertwined. Once again, the inconveniences in such spheres are particularly emphasized as the hospitals age increases, both because of the obsolescence of the project and of course, because of the unavoidable transformations that both the hospitals facilities and its urban setting face over time.

Parallel to this, healthcare forms a significant part of a countrys economy but according to the WHO, a well-functioning healthcare system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality services (World Health Organization ). In 2010, the healthcare industry consumed an average of 9.5 % of the Gross Domestic Product (GDP) across the most developed Organization for Economic Co-operation and Development (OECD) countries, with the United States (17.6 %), the Netherlands (12 %), France and Germany (11.6 %) being the top spenders.

Within this context, Italy placed itself slightly below OECD average with 9.3 % of GDP spent on healthcare activities in 2010 (Nuovo Sistema Informativo Sanitario ).