Abstract
Abstract Healthcare facilities operate at the intersection of climate change mitigation, climate adaptation, and service continuity. High energy demand, strict ventilation and indoor environmental requirements, and the need for uninterrupted clinical operations mean that decarbonization is usually implemented across the entire estate rather than through a single technological solution. As a result, many providers pursue net-zero goals through portfolio roadmaps and decarbonization plans aimed at embedding and maintaining operational change. This study examines global evidence on net-zero and low-carbon practices in healthcare facilities published between 2010 and 2026, using a PRISMA-ScR scoping review. Records were retrieved using the OpenAlex Works interface (n = 547) and screened for relevance to built assets. Following title and abstract screening (n = 507) and full-text eligibility assessment, 99 studies were included. Reported practices were organized across a design, retrofit, and operations continuum, covering (i) design and capital strategies related to building performance and whole-life carbon impacts, (ii) retrofit and refurbishment pathways feasible under disruption and service continuity constraints, and (iii) operational and estate management programs supported by monitoring, maintenance, and governance routines. The results indicate that operational and governance-related practices are reported more often than design-oriented and whole-life frameworks in the included studies. Reporting is inconsistent, with key descriptors such as asset boundaries, baselines, units, intensity metrics, and emissions scopes often missing from titles and abstracts, which limits comparability and synthesis. This study maps reported practices across the design, retrofit, and operations stages, offers a preliminary typology of practice families, and highlights gaps to guide future facility-level research and implementation guidance for net-zero healthcare estates. These findings are globally relevant because healthcare systems across diverse contexts face similar challenges related to decarbonisation, resilience, service continuity, and long-term estate management.