| Summary: | Healthcare has been progressively required to improve its environmental performance as have other industries in recent years. In this regard, many new healthcare facilities have been built worldwide adopting sustainability-oriented approaches. However, results have been limited from an ecological and economic perspective, and many projects have rapidly become failures and then been abandoned. A large part of these failures is grounded in the misalignment between the adoption of eco-friendly facilities and greening technologies and the persistence of outdated practices, mindsets and behaviours among healthcare professionals. This study aims at furthering the current debate among leading practitioners and scholars of engineering business management about the combination of organizational and architectural levers for improving the sustainability of healthcare delivery. By taking a socio-technical systems perspective, we developed a literature-grounded framework and relative propositions with respect to the improvement of sustainability-related performances in hospitals through the combination of organizational and architectural levers. Ten levers and their mutual relationships have been identified and described.
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