The circular hospital:

Healthcare at no cost to the environment

Seven garbage bags of waste per intensive care patient per day, and that is just a fraction of the environmental impact of entire hospitals. Circularity is the answer, but how to achieve that without impacting the quality of healthcare or straining an already overburdened work force? An interdisciplinary Convergence collaboration rises to the challenge. 


100% circular

The COVID-19 pandemic has been a mixed blessing in a time where single-use plastics in healthcare were rapidly becoming the new normal. ‘On the one hand, we were so busy providing high quality healthcare under an insurge of patients that any sustainability efforts were put on the backburner,’ Hunfeld says. ‘But hallways full of wastebaskets crammed with single-use protective gear also sent a powerful, urgent message.’ If that weren’t enough, the volatility in supply, caused by long supply chains and harbours being closed at a moment’s notice, also stressed the need for circularity.

As soon as the COVID dust had settled somewhat, an upbeat interdisciplinary team set to work. ‘Now is the time to reduce the healthcare sector’s ecological footprint – for healthy people and a healthy world,’ Diehl says. ‘We have the combined ingenuity of TU Delft, Erasmus MC, and Erasmus University, more than 15 green teams in Erasmus MC are all geared up, and the national Green Deal 3.0 on Sustainable Healthcare has just been signed. We believe that a 100% circular intensive care department is feasible by 2030, and entire hospitals by 2050.’

Now is the time to reduce the healthcare sector’s ecological footprint – for healthy people and a healthy world

Jan Carel Diehl

TU Delft

Healthy Start Academic Lead, Professor in Design for Inclusive Sustainable System Interventions

Total value chain approach

Combining expertise in medical sciences, engineering, design, policy, operations research, supply chain management, and behavioural sciences, the team applies a total value chain approach following the ten R’s of circularity (refuse, rethink, reduce, reuse, recycle, etc.). ‘We address product choices, user behaviour, sterilisation for multi-use, and recycling,’ Van Raaij says. ‘On the procurement side, we can for example switch to suppliers that use recyclable packaging and those who offer multi-use rather than single-use products. Erasmus MC also excels at co-developing new solutions through innovation procurement.’

Switching to multi-use products may appear to be low-hanging fruit, but it requires investments in in-house sterile processing, on the procurement side and, potentially, from the users. ‘If nurses now dispose of scissors after using them, we can’t expect them to spend two minutes cleaning them prior to sterile processing,’ Hunfeld says. Diehl adds that an effort towards circularity may start with looking into a single product, but it always affects an entire logistics chain and the context in which they are used in a hospital. ‘These off-product impacts come to light during the different ‘mapping’ methods we apply such as product and user journeys and materials flow analysis.’

Awareness training is at the heart of the envisioned transition as it helps ensure that the correct choices are made and implemented on a daily basis. ‘Take personal protective gear; there is an overuse in items such as gloves, eye protection and other protective gear,’ Hunfeld says. ‘We address this by clarifying and refining protocols. But what we really want is for whole departments, the entire hospital, to live and breathe sustainability.’

We address product choices, user behaviour, sterilisation for multi-use, and recycling

Prof. dr. ir. E.M. (Erik) van Raaij

Erasmus University Rotterdam

Purchasing and Supply Management in Healthcare, Rotterdam School of Management

Capitalising on enthusiasm

The Sustainable Hospital Living Lab is where students, early-career researchers and staff from Erasmus University, Erasmus MC and TU Delft can meet, conduct research, and co-create sustainable interventions. Diehl: ‘Core to our strategy is that we do not “investigate sustainability” or “perform lab experiments”. We focus on immediate practical use, using evidence-based approaches. We capitalize on existing enthusiasm by showing what is possible.’

And enthusiasm abounds, amongst the three project leaders, students and hospital staff. ‘Especially the younger generation wants to make a difference,’ Hunfeld says. ‘They grew up separating their waste. They expect to do no less at work. Throwing something away after a day, half an hour, or simply because it was unwrapped – even if it is for infection prevention – it doesn’t make sense to them.’ Students are also lining up for cross-disciplinary research in sustainable healthcare. Diehl: ‘Each semester, we supervise a large group of master’s students from both TU Delft and Erasmus.’

Especially the younger generation wants to make a difference. They grew up separating their waste. They expect to do no less at work.

Dr. N.G.M. (Nicole) Hunfeld

Erasmus MC

Programme coordinator Sustainable Research, Erasmus MC Chair of the Green Intensive Care Network

Plug and play

The team aims to address at least nine use cases concerning disposables, devices, and equipment in each of the clinical departments of Oncology, Obstetrics, and the Intensive Care Unit. But that is just the tip of the iceberg as the ultimate goal is to build an evidence-based transition model that can be rapidly adopted by any medical department and other (international) hospitals. Van Raaij: ‘Right now, it takes a multidisciplinary team of scientists and practitioners to tackle any hospital-based sustainability issue. We want our circular methods for the hospital environment to be plug and play, for any product group and for any nurse, doctor or manager who wants to reduce the ecological impact of his or her workplace.’

Numbers: use of products per patient