Date of Conferral



Doctor of Healthcare Administration (D.H.A.)


Health Services


Brittany Smalls


Eco-friendly healthcare delivery concepts are becoming more accepted as hospital leaders seek to control energy costs, mitigate contributions to climate change, and preserve scarce resources. Leadership in Energy and Environmental Design (LEED) offers healthcare leaders a framework for designing and constructing sustainable facilities that meet efficiency goals. The purpose of this quantitative cross-sectional study was to build an understanding of whether LEED certification influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. Using complex systems theory as the framework, the research questions were focused on exploring if higher levels of LEED certification led to greater HCAHPS overall hospital ratings, if an association existed between LEED certification and HCAHPS overall hospital ratings, and if there were differences in HCAHPS scores across the survey’s 10 dimensions between LEED-certified and non-LEED-certified hospitals. Data from the United States Green Building Council, Centers for Medicare and Medicaid Services, and American Hospital Directory were analyzed using descriptive statistics, analysis of variance, Pearson correlation, regression, and independent samples t tests. Results of the analyses showed that higher LEED certification did not produce greater HCAHPS overall hospital ratings, LEED certification was not associated with HCAHPS overall hospital ratings, and that LEED-certified hospitals exhibited higher HCAHPS ratings for certain dimensions of the HCAHPS survey. The study contributes to positive social change by developing a deeper understanding about LEED adoption among hospitals in the United States, which can reduce healthcare’s environmental footprint.