Focus on design and business case great success for entrepreneurs 'Circular Operating Rooms'

Photo by Anna Shvets

Text: Anke van Ravenstijn

A full house at Rotterdam's BlueCity for the Next Steps workshop of the CIRCO Track "Circular Operating Rooms. Participants are major suppliers of medical instruments such as B Braun, Medica, Medtronic, Fresenius Kabi and a science-entrepreneur consortium from GreenCycl and TU Delft. The central topic is: how can we design instruments for operating rooms so that there is no waste? Earlier this year, as the conclusion of the CIRCO Track, participants pitch their ideas for the business case of reusable or recyclable attributes. They also collectively look ahead, for example to the frameworks for waste from the Ministry of Infrastructure and Water Management (IenW), and a unique Dutch company presents its findings for recycling.

Circular operations is a relevant issue, as 7% of CO2 emissions come from the healthcare sector, this is as much as aviation. Moreover, there is great value destruction in the chain of instruments for operating rooms. Can this loss of value be turned into opportunities, including commercial ones? An important question, because it must be economically relevant to take steps. In this Track, the parties looked for the tipping point: when can a reusable alternative be deployed? And then, for example, are the sterilization rooms large enough?

'Zooming in on the business case is of great importance for our large American company; sustainable arguments alone won't get you there in the US,' says Corine Libregts of Metronics, a company with 97,000 employees worldwide. 'Now that they see that it can be economically interesting, the board does want to listen.' Libregts is presenting at the Next Steps workshop the pitch on repossessing medical generators she is going to make to the U.S. board. 'A kind of lease contract, through which you retain ownership of the (valuable!) raw materials contained in the generator. Now they 'disappear' from our radar, sometimes you even see them back on Ebay! It is very nice that through this CIRCO Track I got this story and business case sharp.'

Medica, manufacturer of medical trays, instead of designing the business case, actually zoomed in on designing their own product. Their product consists of several components, which ones do you actually need? More components also means more cleaning, more packaging and therefore more waste. Medica wants to look critically at design, because 'sometimes we do things out of habit, too.' 'But we also need customers who want to look at products differently. That's why a CIRCO Track is beneficial for us, here we can listen and talk to customers, waste incinerators and suppliers. This transfer of knowledge between these parties is very important to get to a good product design!'

Indeed, this "doing it together" also came out of Track as one of the learning points, the other learning points being:

1. Chain cooperation is indispensable, i.e. cooperation between raw material suppliers, producers, waste processors, hospitals, ect;
2. From disposable to reusable is desired, and clarity on what requirements are now in place.
3. Waste separation could be better, there is a lot of discussion what is "special hospital waste (MSW)" and what is residual waste. Residual waste is much cheaper to process. But where should a bloodied doctor's coat go, for example?
4. Circular product design: how can we design products to be recyclable?

The Ministry of IenW is currently working on a 'circular materials plan', mentioned in point 3 above. Madelon de Leeuw of the ministry is working on tightening the criteria of what is and what is not SZA. This (still) concept is there to save costs but also to clarify what belongs where. If any parties from the CIRCO Track want to discuss this, de Leeuw is open to this. CIRCO trainer Korthorst makes a preliminary suggestion and distinguishes three promising streams after the Track:

1. Disposable Instruments
2. Plastic packaging
3. Disposable textiles

Fresenius Kabi with 350,000 employees worldwide did a pilot project with waste collection of IV bags. Hans Looman of Fresenius Kabi honestly admits that the pilot failed: users in the hospitals did not participate sufficiently in the collection. Still, they learned a lot from the pilot, such as that users are very important in such a project! But also how you could stimulate collection with, for example, financial incentives or deposits. Furthermore, the project created clarity about reducing the types of materials in the infusion bag and what is and is not allowed by European legislation.

One step further goes GreenCycl: they are the only company collecting medical waste in the Netherlands and are the first company to repair medical instruments. Bart van Straten also speaks on behalf of Renewi, Molnlycke and TU Delft, all of which participate in the company. It is a consortium working on circular care by doing: for example, there is a field lab for cleaning medical items. Bart cites the example of a medical stainless steel "stapler," which costs 600 to 700 euros each. These non-devices are used once! He points out the resources lost this way and what it can yield. So a box of collected staplers (about 700 pieces) yields a few tons of yield in materials! Additionally, reusing raw materials reduces dependence on China, for example.

According to him, these are the goals of the circular economy:

1. Reducing dependence on primary raw materials
2. Reducing waste streams
3. Reducing climate impact

Discussions during the CIRCO Track led Van Straten to the idea of "urban hospital mining": what resources are lying around in hospitals? And what energy is needed to extract them? He passes around in the room a block of granules, these GreenCycl has made from melted surgical gowns. Many technical pilots are being conducted with the heating. For example, they are also working on powdering metal instruments. Van Straten knows he is setting an example with his company and therefore calls for encouragement from the government and also for funding for machinery and research. He also calls for ideas, for products from the hospital and industry. Because the business case is positive and creates jobs. Moreover, circular initiatives create their own raw materials, which increases geopolitical independence.

In conclusion, this Next Steps workshop was a success; the audience was very enthusiastic about the pioneering steps several companies were taking. Since 80% of a product's environmental impact is determined in the design phase, focusing on product design and business case yields great benefits. Moreover, it is possible to be economically lucrative while reducing waste materials as well as climate impact.