Sustainable approaches to healthcare

Phil Nedin, Arup's global business leader for healthcare, describes the firm's unique approach to delivering sustainable healthcare projects. 

Sustainability can have many different meanings. Most people’s thoughts immediately jump to terms such as ‘carbon neutral’ or ‘energy efficient’, but at Arup there are also four other steps to consider in the design process for healthcare facilities: whole-life costing, future needs, innovation and therapeutic environments.

Profile picture of Phil Nedin
"The aim of our sustainable approach to healthcare is to work in close partnership with providers, funders, clinicians, architects and contractors to deliver world-class facilities that meet the objective of healthcare standing the test of time."
Phil Nedin

Whole-life costing

One of the most important elements of a sustainable design model is economic flexibility.

“It is important to move away from first-cost dominated procurement processes to a whole-life cost model where design, construction, maintenance, energy and operational costs are considered at the earliest stage of the design process and all decisions are made with the life of the facility in mind.

"A truly sustainable healthcare facility can only be achieved if the costs of adopting a certain approach are offset against the expected outcomes throughout its life. An example of this would be comparing the cost of creating therapeutic environments against the benefit of improved patient outcomes, or the cost of a mechanical waste and laundry removal system against the cost of reduced transmission of infection."

Future needs

It is highly probable that healthcare facilities designed today will have to change their use – and even their shape – in six-to-eight-year cycles due to changing models of care, associated care pathways and emerging needs. Any design must therefore be flexible and adaptable.

The concept of future healthcare provision is not an easy one to grasp – changes will occur in medical technologies, the ability to manage chronic illness through drug development and the use of the home as an extension of the hospital for caring for critically-ill patients.

"To visualise this, Arup considers many of the likely changes, including any major demographic changes predicted for the community in question; or developments in drugs, therapies and devices and the levels of investment being planned for healthcare by governments and the private sector. These will all inform the changing shape of the provision of healthcare in the future."


Historically, the design of healthcare facilities has been driven by highly prescriptive codes and guidance. The introduction of innovative solutions into the process is extremely important for leveraging value in the long term.

"There is a need to consider innovations that have evidence based in other sectors such as retail and commercial. These could relate to materials, systems, or plant and equipment. This is particularly relevant when considering a low-carbon strategy for a facility where renewable technologies are needed but perhaps are not identified by the existing guidance".

Therapeutic environment

Creating a therapeutic environment is essential. Healthcare facilities should be non-threatening to patients and visitors, support a more effective recovery and provide a working environment that attracts and retains staff.

Arup's approach considers enhanced natural daylight, privacy and dignity of patients, acoustic sensitivity, occupant control, human scale, ease of way-finding, a relaxed and accessible outlook and reduced transmission of infection.

"The deliberate design of a therapeutic environment creates financial benefits in the long term. Good indoor air quality can improve recovery times, good energy design can cut utility costs, the use of natural light can improve productivity and patient outcomes, and appropriate interior finish and material selection can reduce cleaning and maintenance costs."


  • View of the roof of Alfred Hospital ICU. Credit Rihannon Slatter Photography.Open gallery

    Arup's work on the Alfred Hospital ICU produced a healthcare facility of the highest quality.

  • Medical Spectrum Twente, artists impression of patient room. Open gallery

    At Medical Spectrum Twente, great care has been taken to create a truly therapeutic environment.

  • Entrance to the Scottish Livingstone Hospital.Open gallery

    Botswana's Scottish Livingstone Hospital is designed with sustainable cooling and ventilation features.