In a recent article in MedCity News, “Healthcare must move toward a circular economy, and single-use device reprocessing offers a template to follow”, I outlined what hospitals can do to force a transition to more environmentally friendly and economically responsible practices by focusing on re-use based on a single-use device reprocessing model, which has already proven itself as a circular economy solution:

Identify medical supplies that are expensive and single-use. This could be medical devices, but it could also be any number of consumables the hospital uses in the cafeteria, in transportation, in visitor management, etc. Some of the most expensive hospital supplies are single-use devices. Most of these are not reprocessed.

• Analyze: Perform a cost-benefit analysis to determine that re-use doesn’t imply added costs.
• Determine if the selected supplies can be safely cleaned and re-used. Many medical devices and other supplies cannot be safely re-used because of their design, their complexity, or due to safety risks for patients.
• Ensure: Work with hospital departments, manufacturers, reprocessing companies, or other outside partners to ensure reprocessing or remanufacturing processes are safe, operationally feasible and economical. In some cases, this will mean asking manufacturers to change their products or asking reprocessors to seek clearances for devices they haven’t previously been able to reprocess: Many devices that could be reprocessed are not currently reprocessed.
• Create a collection and re-use infrastructure. This includes collection containers in which to place used supplies, instructions about how to handle used supplies, signage, new SOPs, and routines for storing and buying back/re-entering supplies into the inventory management system.
• Train appropriate staff to follow collection and re-use instructions – from capturing used supplies to buying back and inventorizing.
• Mandate compliance with re-use process. This is often the toughest part. It is hard to change a hospital staff’s routine, particularly because the staff is often over-burdened.

Identify-Analyze-Determine-Ensure-Create-Train-Mandate is a highly practical and empirically based roadmap to reuse. However, in transitioning to more environmentally friendly circular economy practices, hospital engagement in creating more financially sustainable and environmentally friendly device usage practices is not enough. In the healthcare marketplace, it is the role of the hospital (=the customer) to make demands of their suppliers – such as medical device manufacturers. They are deeply financially and technologically embedded in the single-use paradigm, and unless they are told that a program that points towards reuse needs to be put in place, there is no incentive to do so.

Identify-Analyze-Determine-Ensure-Create-Train-Mandate is a highly practical and empirically based roadmap to reuse.

Here are three things hospital leaders should demand from medical technology suppliers:

1. Stop making single-use devices: For more than 20 years, medical device suppliers have made more and more devices “single-use”, a designation made by the supplier, which means that on-label use implies throwing the device away after one use. With a “single-use” designation, the manufacturer doesn’t need to tell the hospital how to make a device ready for re-use - risk is minimized and profitability maximized. Devices that once were reusable have been made “single-use”, and as a consequence, more plastics are thrown away and more money is spent buying new devices. Today, we even see cables (yes, cables, insulated wires used for transmitting electricity) labeled as “single-use”. Can anybody see a reason for this? Ask your supplier if this is really necessary? Do the designers consider the option of using more durable materials and designing device mechanics that lend themselves to extended use? Or are they focused on minimizing the lifetime of the device? Can we get back to making durable devices that hospitals can reuse after re-sterilization and testing? Customers have a right to ask this question.  
   
   
2. If devices, by the nature of their use or the patient risk involved, cannot be made re-usable - work with reprocessors to make them reprocessable. It has been very interesting to me to experience over the last few years that innovative hospital supply companies have come to single-use device reprocessors like Innovative Health and said: “We have this new device, can you work with us to make them reprocessable? Here are the blueprints”. They do this, so they can offer a quality product to hospitals while making its adoption environmentally sustainable and fiscally responsible. Meanwhile, NONE of the 4-5 large medical device suppliers that dominate the electrophysiology space have made this approach (one of them has a reprocessing division, but that is not enough to claim a change in financial and technological strategy, especially since several new, complex, and expensive devices are not included in their reprocessing program). I suspect this is because their market share is not really under threat and THAT is something hospital leaders can change. Shift market share to suppliers that create circular economy solutions, and demand that dominant suppliers start collaborating with reprocessors – to the benefit of hospital economics and the environment.
   
   
3. If devices cannot be reused and there is no way to reprocess them, demand that used devices are collected by the manufacturer and the component parts recycled to be used in the manufacturing of new devices. Plastics can be recycled, right? Have you asked your medical device suppliers if they re-use material? Have any of them created a collection infrastructure to ensure that environmental harm is minimized? Customers have a right to ask this question.  

The circular healthcare economy is a topic that has been elevated due to the pandemic and associated supply chain shortages and device costs concerns. Environmental considerations continue to weigh heavily on healthcare practitioners, and circular economy solutions hit on the trifecta of concerns – supply chain resiliency, healthcare cost reduction, and reduced waste. But this is not just a “consumer issue”, where hospital employees fix the problem by recycling plastic cups; it needs to be made a SUPPLIER issue, and suppliers should be reminded they need to be part of the solution, not part of the problem.