Many different evaluation systems are today available to assess buildings’ performance. Concerning sustainability, especially of healthcare structures, the most widely recognized and commonly used systems are the American LEED, the British BREEAM and, within the Italian reality, the ITACA system; all of these are then surrounded by other minor management evaluation systems. So after a deep analysis of the state of the art, focusing in particular on the previously mentioned evaluation systems, it was possible to identify the main strengths and weaknesses of such tools with respect to the Sustainable Healthcare’s project final objective. An interesting starting point is their hierarchic structure, employing a scoring system based on appropria...