Life-cycle sustainability assessment of public general hospital buildings in China

Under the backdrop of China's "dual carbon" goals and the high-quality development of healthcare, general hospitals-characterized by high energy consumption and emissions-require systematic and quantitative evaluation to support sustainable transformation. Based on the Life Cycle Sustainability Assessment (LCSA) framework, this study develops a comprehensive evaluation model integrating Environmental Life Cycle Assessment (ELCA), Life Cycle Cost (LCC), and Social Life Cycle Assessment (SLCA). Using "per bed" as the functional unit, an empirical analysis was conducted on 16 public general hospitals across four representative climate zones in China. Through multi-source data collection, questionnaire surveys, and expert weighting, indicators including carbon emissions during construction and operation, lifecycle cost, and patient satisfaction were standardized and integrated into a comparable LCSA index. The results suggest that: (1) climate zone was associated with differences in CO₂e-based environmental performance, with higher per-bed carbon emissions observed in colder regions; (2) operation and maintenance account for 55-60% of total life-cycle cost, and intelligent energy management combined with renewable energy can simultaneously reduce LCC and ELCA; and (3) social performance is generally moderate, with building comfort, spatial organization, and doctor-patient interaction identified as key determinants of patient satisfaction. Significant differences in sustainability performance were observed among cases, with newly built or green-renovated hospitals equipped with intelligent management systems performing better. The findings highlight that LCSA reflects the coupling relationships among environmental, economic, and social dimensions, where improvements in one dimension may generate synergies or trade-offs with others. The proposed framework provides a quantitative and stakeholder-oriented decision-support basis for hospital administrators, architects, and policymakers to promote low-carbon, cost-effective, and human-centered hospital building transformation.