Enhancing Sustainability in Healthcare Facilities: The Role of Energy Performance Contracts in Hospital Renovation

Healthcare facilities are among the most energy-intensive public infrastructures due to their continuous operations, complex systems, and critical service requirements. In this context, Energy Performance Contracts (EPCs) have gained increasing attention as a strategic tool for enhancing energy efficiency and sustainability in healthcare facilities. This paper investigates the potential and implementation of EPCs in the hospital sector, with a particular focus on their integration within Public–Private Partnership (PPP) frameworks. The study addresses that gap through a cross-case analysis of fourteen hospital EPC projects implemented in Italy, the United Kingdom, the Nordic countries and Central-Eastern Europe, mapping their technical scope against a three-family taxonomy (envelope, plant systems, regulation and monitoring) and benchmarking their energy and economic performance. All figures reported derive from project documentation and contractual monitoring records. The results show that envelope-led configurations deliver the deepest reductions in primary and final energy consumption (up to 50% on the baseline), while plant-side measures, and trigeneration in particular, generate the largest absolute CO2 savings (from approximately 500 to 17,000 tCO2eq/yr); lighting, and building management systems (BMS) retrofits, although ubiquitous, account for a 20–25% band when deployed in isolation. The findings reframe EPCs as a configurable contract for decarbonization in healthcare environments and offer practitioners a reading grid for scoping future hospital retrofits under this framework.