Design For Reuse - Transparency Is Not Enough to Make the Healthcare Supply Chain More Resilient

Recycling of medical devices is really not a very good solution in healthcare. There are at least three reasons for this: 1) Recycling is a lesser solution from an environmental standpoint than other available circular use solutions, such as re-use, remanufacturing/reprocessing, repair, and repurpose. These are solutions where the device is not re-captured for a different use (which involves a lot of waste), but maintained for another use, avoiding immediate incineration. 2) When a device is recycled, some materials (but not all) are re-used. However, the hospital still needs to purchase a new device. Reprocessed devices have less than half the environmental impact of a new device in terms of carbon emissions. 3) When used devices are broken down to their component parts and recycled, these devices are taken out of the supply chain. At a time where hospitals experience backorder on some of their most critical devices, recycling seriously threatens supply chain resilience.Since the pandemic, hospitals have gathered together to address the issue of supply chain resilience. The Healthcare Industry Resilience Collaborative is arguably the broadest organization for driving this, led by some of the foremost health systems in the country. The organization addresses the need for suppliers to map their suppliers and create redundancies in their supply chain, to provide efficient communication about supply chain disruptions, to have a business continuity plan in place, to provide service level reports, addressing backorders and recalls, and more. Standards in these areas will go a long way towards ensuring service disruptions in healthcare are avoided or at least ensuring that their impact is minimalized. However, I believe the standards represent an absolute minimum level of resilience that suppliers should demonstrate to even be considered for contracting. They largely address the symptoms of a vulnerable healthcare supply chain, but hospital leaders can go further in demanding that healthcare suppliers more fundamentally address the root causes of supply chain vulnerability: An expanded Resilience Scorecard should include resilience in product design and marketing. In a report published just this month, the Agency for Healthcare Research & Quality specifically called out the preference for designing products for single use: “Reliance on single-use disposable medical supplies and devices not only leaves health systems vulnerable to supply chain disruptions, as seen with the COVID-19 pandemic, but they are frequently cited as containing higher life cycle emissions per use compared with equivalent application of reusable alternatives. Healthcare organizations should strongly encourage and facilitate resource stewardship.” Massive amounts of single-use devices are produced and consumed in healthcare. Producing single-use devices increases profits for manufacturers, but when so many devices are thrown away after a single use, hospitals rely on a steady stream of new devices, and with backorders and recalls, this can threaten the continuity of the hospital’s service provision.

Yet, over the past decades, medical device manufacturers have not turned to more sustainable, more resilient manufacturing of re-usable devices. In fact, they have doubled down on the concept, and we have seen devices that were last year marketed as re-usable devices that the hospital can clean, the following year marketed as single-use devices. That is going in the wrong direction, and hospital leaders should ask their manufacturers what they are doing to reduce the number of single-use devices.

...hospital leaders should ask their manufacturers what they are doing to reduce the number of single-use devices.

Now, not all medical devices can or should be re-used after a trip to the Central Sterile Department at the hospital. Some devices are so advanced that the hospital doesn’t have the ability to clean them. In these cases, there are three options: a) Manufacturer could look at deliberately re-designing devices to make them reusable; b) manufacturers could work with advanced third-party reprocessing companies to have used devices cleaned and tested; or c) hospitals could establish advanced reprocessing services as a part of their offering. Some manufacturers have attempted this, but usually as a defensive measure, and integration of reusability and reprocessing into manufacturing operations remains a vision rather than a common practice.

I am not ignoring that turning towards re-usability and reprocessing may result in a short-term reduction in profits, but healthcare simply cannot afford to continue throwing away - for the benefit of a positive quarterly earnings report to the medtech shareholders, and at the cost of supply chain resilience.