The design of a hospital environment involves many concerns related to the satisfaction and well-being of the medical personnel, patients, and administrators, and at the same time requires strong social responsibility and has a high impact on a city. Currently, it seems that most of this type of building is not designed or used in a sustainable way, although some initiatives and tools have already been developed to support decision-making to optimize building sustainability.

To introduce sustainable practices in these buildings to achieve a high level of performance, it is necessary to take actions in two main life-cycle stages: design phase (to help the decision makers, mainly the design team, to implement solutions that improve building sustainability); and use phase (to achieve a high level of efficiency, by supporting managers and users in the adequate maintenance of equipment and building operation).

Based on this context, the aim of this research work is to discuss the barriers to the dissemination of sustainable practices in healthcare buildings, and to propose a methodology that facilitates the incorporation of sustainability principles during the different life-cycle stages of a hospital building while overcoming some of the identified barriers. The structure presented is oriented to the Portuguese context and is based on the work done to date by the ISO and CEN organizations and other international sustainability assessment schemes already available on the market. 

Since the last decade of the twentieth century, this industry is paying attention to the environmental impact of their buildings and therefore new regulations, policy goals, and Building Sustainability Assessment (BSA) methods are being developed and implemented. Based on this context and having in mind that there isn’t in Portugal any methodology to support decision making to promote a more sustainable healthcare sector, the propose of this study is to developed a Healthcare Buildings Sustainability Assessment that is suitable for the Portuguese context. For this assessment, it is necessary to establish a criteria structure and a set of benchmarks related with their life-cycle performance. They are both essential to rate the sustainability of a project and to support designers and other stakeholders in the process of designing and operating a sustainable building, by allowing the comparison to be made between a project and conventional and best market practices.

As a result, it is presented a method composed of fifty-two sustainability indicators divided between twenty-two categories according to five areas. This method can be applied to all healthcare providers with inpatient capacity or ambulatory service, during the use phase or design of a new or retrofitted healthcare building in urban areas.

It is believed that the use of the developed method is one of the most efficient ways to archive sustainability in the healthcare sector, because it allows to compare the sustainability of different scenarios and to support the decisions making at different design stages. This method has an adaptive capacity and allows to be improved and updated over time.