Background Hospitals contribute to climate change because of their consumption of natural resources and the waste that they generate. For instance, the United Kingdom National Health Service (NHS) estimates its carbon footprint at over 18 million tonnes CO2/year, or 25% of the greenhouse gas emissions of the entire UK public sector. According to US Environmental Protection Agency (EPA) estimates, the 73 billion kilowatt hours consumed annually by the American health system have a cost of $600 billion in the form of direct energy consumption and health externalities arising from pollutant emissions. Objectives The main goal of the LIFE SMART Hospital project is to increase the resilience of hospitals to climate change by developing action plans dealing with energy, water and waste. The approach will be demonstrated at the Hospital Universitario Rio Hortega (HURH), in Valladolid (Spain). Specific actions undertaken by the project will be: Energy measures including: o Installation of high-efficiency incinerators; o Improvement of the performance of boilers; o Improved lighting system management; o Rationalisation of the ventilation system or installation of heat recovery systems in operating theatres; o Reduced greenhouse gas emissions through energy rationalisation measures; o An energy audit to assess the effectiveness of the measures. Water measures will include actions fully aligned with the objectives of (the Water Framework Directive (2000/60/CE): Water-saving measures such as the installation of flow-control devices or dialysis water reuse;>li> o Improvements to the treatment of effluent generated by the hospital before discharge into public water systems; o Implementation of a system for water consumption control; o A water audit to assess the effectiveness of the implemented measures. Waste measures will be aligned with European legislation such as the Waste Framework Directive (2008/98/CE) and Packaging and Packaging Waste Directive (2004/12/CE): o Improvements to the current design of waste classification, separation and collection systems; o Implementation of measures for the traceability of waste and customised staff training; o A waste audit to assess the effectiveness of the implemented measures. Creation of a network of experts in sustainable management of hospitals. Expected results: 10% reduction in the carbon footprint of the demonstration hospital; 5% saving in the fuel used in incinerators and boilers; 10% saving in power consumption resulting from improvements to the lighting system; 30% reduction in energy consumption from better ventilation of operating theatres; 30% reduction in the water footprint of the hospital; 35% reduction in the hospital's water consumption; 20% reduction of pollutant load discharges from the hospital; 5% reduction in the amount of non-separated waste; 1% reduction in the amount of waste currently going to landfill; and Awareness raising about the demonstration project in at least 20 hospitals or regional health management organisations.