Hospital sustainability is becoming an accreditation priority as facilities address energy use, emissions and waste. The health sector both treats health problems linked to environmental change and contributes to environmental impact through resource-intensive activity. A cross-sectional analysis published in the International Journal for Quality in Health Care assessed sustainability practices among JCI-accredited hospitals in Italy. JCI introduced Global Health Impact standards in 2024, with compliance required from 1 January 2025. In Italy, environmental sustainability is not yet a formal national accreditation criterion.
Governance and Monitoring Remain Uneven
The analysis covered all 21 JCI-accredited healthcare facilities in Italy as of 1 July 2024, with responses from 20 facilities. Most participating hospitals were located in northern Italy, followed by central and southern Italy. Private institutions predominated across all regions. No statistically significant differences emerged between northern, central and southern Italy for years of accreditation, number of beds, sustainability committees or inclusion of environmental risk assessments in risk plans.
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Governance structures show a mixed level of maturity. Sixty percent of facilities had a person responsible for sustainability-related projects, with reporting lines varying across general management, medical directors, technical offices, finance leadership and university department heads. Only 15% had a formal sustainability committee. Committee membership also varied, with representation from human resources, quality, procurement and logistics, clinical engineering, general management, facility management and medical directorates.
Measurement systems remain incomplete. A quarter of hospitals had a structured indicator system for sustainability progress, while 40% were working on implementation. More than a third had no monitoring tools. These gaps affect the ability to track environmental objectives, compare progress and embed accountability within hospital operations.
Staff Engagement Shows Limited Depth
Staff engagement forms one of the five Global Health Impact domains used to structure the questionnaire. Sixty-five percent of hospitals had initiatives to promote a sustainability culture. Internal newsletters were the most common activity, followed by workshops, seminars and mandatory training. Most initiatives targeted all staff, while some facilities also included leaders, doctors, nurses, healthcare assistants, external partners or suppliers.
The spread of engagement activities remains limited. Forty percent of facilities had one sustainability intervention, 20% had two and only 5% had three. This pattern indicates that communication activity is present in many hospitals, but broader programmes remain less developed. Sustainability can therefore remain concentrated around awareness raising rather than routine participation across clinical, technical and operational functions.
The composition of sustainability committees also points to an inconsistent approach to workforce involvement. Senior management and support functions are present in several structures, but the overall picture remains heterogeneous. The analysis connects this variability with the absence of a national regulatory framework for sustainability within Italian healthcare accreditation. Without more systematic staff participation, sustainability may remain a top-down initiative rather than becoming part of everyday decision-making.
Environmental sustainability also requires several forms of expertise. The relevant areas include clinical services, energy use, product life cycles, waste streams, procurement practices, infrastructure and technical systems. A multidisciplinary structure can therefore support a wider view of environmental impact across hospital activities.
Energy, Waste and Procurement Lead Operational Action
Operational measures are more widely developed than formal governance structures. Ninety percent of facilities had adopted at least one measure to reduce energy consumption, and 65% had introduced more than one intervention. Common approaches included LED lighting, heating, ventilation and air conditioning upgrades, energy management systems and solar panels. Fewer facilities used energy-efficient medical equipment, programmed lighting and climate controls or cogeneration systems.
Waste management practices were also widely adopted. Eighty percent of hospitals had hazardous and medical waste management programmes, 70% had recycling bins throughout the hospital and 60% had recycling programmes for paper, plastic and glass. Measures to reduce disposable materials, compost organic waste and reduce food waste in hospital cafeterias were less common.
Environmental risks were included in the risk management plans of 65% of facilities. Risk areas included land use, building design, regulatory environment, infrastructure protection, resilience planning, essential clinical care services, environmental protection and ecosystem adaptations. Northern facilities more often included environmental risk in risk plans than those in central or southern Italy, although the difference was not statistically significant.
Procurement and supply chain practices show further movement towards sustainability. Fifty-five percent of hospitals considered sustainability criteria when selecting suppliers. Some evaluated suppliers directly, while others relied on certified suppliers. Eighty-five percent had taken steps to reduce supply chain waste, particularly through materials and stock management and monitoring. Packaging management received less attention.
Italian JCI-accredited hospitals show growing activity on environmental sustainability, especially in energy efficiency, waste management, supply chain waste reduction and operational planning. Governance, monitoring and staff engagement remain less consistent. Sustainability committees are uncommon, indicator systems are incomplete and participation beyond leadership varies across facilities. The Italian healthcare system does not currently include environmental impact assessment within national accreditation processes, while JCI standards now require accredited organisations to address sustainability. Existing practices offer transferable elements, but implementation remains heterogeneous across settings.
Source: International Journal for Quality in Health Care
Image Credit: iStock
References:
Perrone PM, Lauria M, Tediosi F & Castaldi S (2026) The sustainability of the healthcare: a cross-sectional study among italian JCI-accredited hospitals. International Journal for Quality in Health Care: mzag056.
