Due to the limited studies related to healthcare services future expanding demand, required resources and utilities, and related environmental and economic challenges; this research is carried out to complement other researchers in other economic sectors to identify the gaps, highlight good potentials of sustainability achievements and recommend necessary actions. This research investigates the future expanding demand of healthcare services; the environmental and economic challenges related to this expand and its environmental and economic impacts and the opportunities to overcome these impacts in order to improve healthcare services sustainability and performance. The research follows a SLR to discover earlier works related to environmental sustainability in buildings and healthcare facilities. The environmental challenges related to expanding in healthcare facilities found in the literature are increase in energy consumption and waste generation. The environmental impacts related to these challenges are excessive CO2 and GHG emissions. The economic impacts are escalations of project expenditures, operating expenditures and utilities expenditures. The research uses SD Analysis, as a methodological approach, to framework and understands different healthcare system elements and to develop models that are representing the dynamic relations between these elements. Bahrain healthcare system is selected as a research context due to the availability of good quality healthcare secondary data, the small size of the country that makes it a good model to implement and test new concepts, the limited country resources, and the country keenness to implement sustainability plans to meet sustainability objectives. This research numerically tests and subsequently, supports the implication of stated environmental and economic challenges. It also develops a number of important technical parameters and indicators such as energy and water benchmarks for different healthcare facilities. The research also determines another two sources of environmental challenges related to expanding in healthcare facilities. The first challenge is excessive water consumption. Availability of enough treated water for healthcare applications, especially in countries with limited fresh water resources and depending on 90% of its water need on desalination like Bahrain, a tangible environmental challenge needs to be addressed. The second one is a group of environmental challenges related to the practicing of healthcare services that can expose personnel and environment to high risks. These challenges need to be efficiently managed to improve the environmental sustainability and the social sustainability of healthcare facilities. The research also investigates the effectiveness of a number of mitigation measures used to overcome the environmental and economic negative impacts, such as using energy efficiency technologies, renewable-based energy resources and waste energy recovery. In this regard, the research numerically tests and subsequently supports the implication of stated environmental and economic impacts and the effectiveness of tested measures in mitigating the undesirable results on healthcare facilities. The developed SD Model, as one of the main contributions of this research, is considered as a strategic planning and decision-making administrative tools to forecast future healthcare facilities demand and required resources. It is also considered as a risk assessment tool to assess environmental challenges related to utilities and its environmental and economic impacts in order to improve healthcare facilities sustainability and performance. The potential of utilities saving and utilities expenditures saving in healthcare buildings are high and it is recommended to work toward energy efficiency and renewable energy deployment to achieve sustainable healthcare buildings. Recovery of energy from Medical Waste incineration to be kept under consideration as it is offsetting double the quantity of CO2e emissions resulting from the incineration process. Safe recycling of wastewater of some healthcare processes is highly recommended as it can reduce water consumption and contributes to the reduction of healthcare facilities CO2e emissions. Sources of gray water and gray water applications must be carefully selected to avoid any contradiction with Infection Control regulations or other healthcare regulations. It is recommended to conduct utilities assessment studies on wide sample of healthcare facilities to avoid low peaks and odd operation periods.

Hotels constitute one of the main, and still expanding, pillars of the tourism sector and are highly unique among other commercial buildings. Resource intensive and frequently inefficient systems and operational routines applied in the sector, result in considerable environmental impact and indicate an urgent need for more environmentally sound practices and products in the hotel industry. A certain level of activity in the area of reducing resource use has been observed for quite some time but the motivation for this was related to cost-benefit issues rather than the environment. Furthermore, most of the initiatives are still considered to be best practice case studies and not daily routines. The constantly increasing prices of basic commodities, such as energy resources and water, encourage the implementation of energy and water efficiency and conservation measures in hotel facilities. To this end, numerous guidelines and initiatives have been produced by hotel-related organisations. The study of attitudes among 610 European hoteliers indicated that, at the moment, the level of environmental awareness among hotel managers is not high enough to introduce significant changes, although attitudes differ depending on the country of origin and the corporate policy. The prospects of significant cost savings, as well as customer demand were identified as the most likely parameters to enhance environmental responsibility among hoteliers. The popularity of CSR reporting and sustainability indices, especially among the larger companies, leads the author to believe that the industry is preparing to change. Many of the companies running hotels are also reporting their environmental management goals and indicators of environmental performance, while benchmarking and all types of comparison league tables are gaining popularity. There is, however, no system or methodology of data collection and monitoring that is universally accepted or applicable throughout the hotel sector. Furthermore, the accuracy and validity of the published performance indicators and benchmarks is widely debated due to large variations in the figures reported. The analyses performed on data from over 180 upscale and mid-market European chain hotels (Hilton International and Scandic) indicated that even among relatively uniform (service-wise) hotels the amenities offered did influence consumption, further complicating the concept and applicability of uniform benchmarking and resource consumption modelling. It was thus concluded that, creating a uniform model for all hotels is almost impossible, or would require a significant amount of very detailed input data, and that the results could still be highly inaccurate. Instead, it was suggested that it might actually be more accurate to develop models for individual hotels. Such an approach would allow for the modelling of the behaviour of all types of hotels with no size, type of services or standard limitations. Multi-variate step-wise regression analyses performed on individual Scandic hotels in Sweden indicated that energy consumption was dependent on the outdoor air temperature/actual heating degree days, while water consumption was mainly influenced by the number of guest-nights sold. Experience gained by the author during the process of the Hilton Environmental Reporting system upgrade allowed for the formulation of a set of rules of thumb that ought to be followed in the design of similar schemes. The experience of various regions and numerous companies also suggests that well designed and implemented environmental and resource management programs bring significant benefits at an individual as well as a corporate level. This study provides an indication of the strategies that can be used by various stakeholders in the process of development and implementation of such programs. This research further suggests that future developments in environmental performance indicators and benchmarking may best be served by disaggregating hotels into modules (such as guest-rooms, catering outlets, conference centres) and developing consumption models and best practice indicators for these particular components. The individual efficiencies/performance indicators should then be combined and weighted to provide a just overall evaluation of a facility that could then be compared to a benchmark (developed in the same manner). In a similar manner, sustainability assessment schemes and indicators for destinations and communities could be developed. However, more accurate and differentiated knowledge of the individual performance of sub-systems is necessary to proceed with such an alternative. In addition, the methodologies for data collection and reporting procedures, at all levels of the company and sector, need to be standardized and detailed / QC 20100818