Assessing Environmental Sustainability in Acute Care Hospitals: A Survey-Based Snapshot from an Italian Regional Health System

Background: The healthcare sector plays a significant role in environmental degradation, particularly through energy consumption, emissions, and resource use associated with hospital operations. Despite growing global awareness of the impacts, environmental sustainability remains only partially embedded with the design, planning, management, and evaluation of hospital facilities, and empirical evidence is still limited. Methods: This exploratory study employed a mixed-method, two-phase approach. First, a scoping literature review identified key environmental dimensions and approaches for environmental sustainability in hospitals infrastructures. Second, a structured survey was distributed to Italian hospitals from Lombardy Region, between May and June 2024, to assess environmental performance and environmental strategy adoption. Results: Eight (n = 8) core environmental sustainability dimensions emerged from the review: energy efficiency, resource and waste management, transportation and mobility, materials and construction, environmental compliance, emissions, site sustainability, and design strategies. The subsequent based on these dimensions, gathered responses from (n = 18) healthcare facilities from Lombardy region, Italy. Findings revealed substantial gaps, since key measures such as on-site renewable capacity, water reuse systems, environmental certification application and health-island mitigation practices appear to be adopted sporadically. In addition, many of the surveyed facilities show consumption levels that exceed the benchmarks outlined in the literature. Discussion: The findings of this study reveal a notable misalignment between the sustainability debate, maturity promoted in the academic literature and the actual practices implemented in the Italian regional context. This mismatch highlights the importance of developing more uniform evaluation tools, policy requirements, and strengthening the organizational capabilities, to improve environmental performance in Italian hospital facilities.