As the energy and carbon landscape evolves, the design and construction of hospitals must change to meet new challenges. New techniques, perspectives and methodologies must be applied to drive innovation and achieve outstanding results. From the dual perspective of a CPHC and experienced HVAC design engineer, we will provide an overview of Passive House principles in the context of hospital design and construction. We will review three case studies: one occupied, one in construction, and one in design. Through these examples, we will demonstrate how the application of Passive House principles radically increases design optionality and improves the overall energy performance of hospitals.