Transitioning towards a circular (healthcare) economy: Circular Economy principles, leadership, policy and decision-making

Authors

Bart van Straten
Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, The Netherlands
https://orcid.org/0000-0003-0269-6593
Bruno Bruins
Recycling company Renewi
https://orcid.org/0009-0005-0949-0661
Tim Horeman
Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, The Netherlands
https://orcid.org/0000-0002-8527-4486

Keywords:

Circular economy, sustainability, circular engineering, recycling, circular healthcare economy

Synopsis

Educational level: Bachelor / Master

This book offers a comprehensive roadmap toward a circular and sustainable healthcare system, structured into three distinct parts.

Part I describes circular principles and policy tactics. Chapter 1 outlines the essentials of sustainable healthcare and designates the paradox in daily practice of sustainability and the circular economy. In Chapter 2 the impact of leadership on policy together with best practices is discussed. The legislation and infrastructural web, in which many stakeholders and circular economy initiatives are strangled, is described. Despite the fact that politicians and policymakers are motivated to encourage sustainability, the infrastructure is designed to discourage circular economy projects. This chapter shows examples of setting-up intrinsic motivated teams of hospital staff, green teams, industry leaders and scientific motivated research teams. Swimming against the current is about the legislation paradox. In chapter 3 described as how legislation should be redesigned to accomplish the goals as set out in the green deal and the climate law.

Part II serves as a practical guide to implementing circular strategies. In chapter 4 the reader is guided through the fundamentals of circular strategies by visualizing the circular economy. Chapter 5 reveals successful design strategies for products and processes which contribute to a zero-waste society. Using recycled materials by using waste as input for new products is described in chapter 6. In chapter 6 we will explore (surgical) waste as input for new products. Recycled should and could be used more. This is a fundamental concept within circular design principles but hardly used until this moment.

Part III explores circular economy design principles on basis of successful examples. This part dives into real-world applications and measurable outcomes. It showcases successful circular design concepts and business models that have reshaped the market. Chapter 7: Is about leading by design. Success stories of circular concepts which have effectively changed the market with circular products and services are designated. Also entrepreneurial success stories of circular economy business models are presented. Chapter 8 investigates how to measuring effectiveness and impact of circular economy products and processes. In particular how reliable some facts are which are used by many to sell products or introduce new policies or legislation. How trustworthy is data from life cycle assessments (LCA’s)? What are the pitfalls? Is it possible to manipulate these data? Why should we characterize one-sided data from an LCA as greenwashing? Circular Economy principles, sustainability and, in broader sense, the climate discussion seem to trigger emotions. Using fundamental and reliable data is essential in order to be able to judge whether a product or process indeed reduces CO2 emissions is essential in decision-making.  Chapter 9 focusses on how universities can contribute to sustainable solutions by presenting different cases which resulted in actual results which were implemented or are ready for upscaling. The role of universities as innovation hubs is highlighted through case studies with proven impact. The final chapter offers a reflective and forward-looking analysis on how circular strategies in healthcare can shape future societal developments.

The authors reflect on the content in chapter 10. A final part in which a critical analysis is presented and the impact it could have on future developments and the society.

Downloads

Download data is not yet available.

Author Biographies

Bart van Straten, Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, The Netherlands

Bart van Straten is an expert in the field of the circular healthcare economy and holds a doctorate in BioMedical Engineering. He is affiliated with several public institutions and private companies including Van Straten Medical. He co-founded GreenCycl, an organization with a mission to decrease the amount of medical waste. A Field Lab for experimental research on reprocessing surgical waste into new raw materials and medical products. His research and teachings won several awards. Bart is affiliated to the research group Sustainable Surgery & Translational Technology at TU Delft, where he is a lecturer on medical device prototyping and several related courses. Bart developed a Field Lab together with Tim Horeman for experimental research on reprocessing surgical waste into new raw materials and medical products. His research has led to his book ‘Creating a circular healthcare economy’ and won several awards, for example in the Utrecht Circular Innovation Top 20, as builder of the world’s first recycling process for hospital waste. His drive is to bridge the gap between science, business and healthcare professionals with the aim to make societal impact emerging from the scientific field.

Bruno Bruins, Recycling company Renewi

Bruno Bruins is Chief Strategy Officer of recycling company Renewi and is previous member of the Dutch State Council. As politician he served as Minister for Medical Care in the Third Rutte cabinet from 26 October 2017 to 19 March 2020. Before that he served as State Secretary for Education, Culture and Science from 29 June 2006 to 22 February 2007 in the Third Balkenende cabinet. Bruno is specialist in management and public administration. Having a background in Law and Public Administration (University of Groningen), Bruno was co-teacher in the online MOOC courses from TU Extension School which were developed by Bart van Straten and Tim Horeman and instructs in this course aspects such as the climate law, the Green Deal and other circular economy strategies leading to sustainable healthcare.

Tim Horeman, Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, The Netherlands

Tim Horeman is Associate Professor in Sustainable Surgery & Translational Technology and Academic Portfolio Director (APD)-Medical technology of TU Delft. Tim has ample experience in the objective assessment of surgical skills and surgical instrument functioning based on interaction force, instrument motion and other data sources. Currently, Tim is leading the development of a new generation of sustainable surgical instruments for advanced (robot) surgery, that should foster the introduction of more functional instruments in less wealthy parts of the world.

As it is essential to bring lifesaving surgical innovations in reach of surgeons and healthcare workers, Tim became a distinguished serial medtech entrepreneur with a strong focus on surgical devices and evidence-based implementation studies. He is PI and (co)founder of the international companies GreenCycl, MediShield & ForceSense, SATA Medical and SuperSeton, which have brought multiple innovations to the worldwide market of surgical equipment. Tim is (co)author of over 80 journal publications, inventor on 18 patent (families) and PI on multiple international research projects in the field of surgical instrument waste processing, SMART implants, global instruments and Minimally Invasive Surgery. In 2016, Tim was awarded the Dutch royal engineer of the year award for his contributions to the healthcare sector. In 2018 and 2022 Tim was elected Tech Committee member of the European Association of Endoscopic Surgery with a strong focus on sustainable surgical instruments and processes.

References

Todorov, A. V. [1986]: ‘Reply’, Journal of Applied Climate and Meteorology, 25, pp. 258–9.

Werndl, C. (2016). On defining climate and climate change. The British Journal for the Philosophy of Science. https://www.journals.uchicago.edu/doi/full/10.1093/bjps/axu048.

NASA (2011). What Are Climate and Climate Change? Retrieved from: https://www.nasa.gov/learning-resources/for-kids-and-students/what-are-climate-and-climate-change-grades-5-8/#:~:text=Earth's%20climate%20is%20the%20average,average%20annual%20rainfall%2C%20for%20example.

Peter Hildebrand, Director of the Earth Science Division at NASA's Goddard Space Flight Center, USA.

Hildebrand, P. (2013). Ask A Climate Scientist - Lagging CO2. Nasa Scientific Visualization Studio. Retrieved from: https://svs.gsfc.nasa.gov/11362.

A. Nientker. De Klimaatklem. 2023. ISBN 978-94-648-9614-5.

Rosa, D., Kalvig, P., Stendal, H., & Keiding, J. K. (2023). Review of critical raw material resource potential in Greenland. MiMa rapport, 1, 124.

Rudko, H. I., Lytvyniuk, S. F., & Karly, V. Е. (2021). Deposits of critical mineral raw materials of Ukraine. Condition and prospects. Innovative development of resource-saving technologies and sustainable use of natural resources, 97.

Soufi, Y. (2020). Strategic Raw Materials, International Mining Firms and the Democratic Republic of the Congo. International Mining Firms and the Democratic Republic of the Congo (February 15, 2020).

Gulley, A. L. (2022). One hundred years of cobalt production in the Democratic Republic of the Congo. Resources Policy, 79, 103007.

Anderson, P. (2023). Cobalt and corruption: The influence of multinational firms and foreign states on the Democratic Republic of the Congo. Journal for Global Business and Community, 14(1).

Deberdt, R., & DiCarlo, J. (2024). Pericentricity on the Congolese copperbelt: how the DRC shapes Chinese cobalt supply chains and the low-carbon transition. Globalizations, 21(8), 1496-1517.

Ille, E. (2016). Complications in the classification of conflict areas and conflicts actors for the identification of ‘conflict gold’from Sudan. The Extractive Industries and Society, 3(1), 193-203.

Afriyie, F. A. (2024). Sudan: Rethinking the Conflict Between Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF). India Quarterly, 80(3), 439-456.

Aoun, M. C. (2013). Oil and gas resources of the Middle East and North Africa: A curse or a blessing?. In The New Energy Crisis: Climate, Economics and Geopolitics (pp. 133-160). London: Palgrave Macmillan UK.

Waste. Practice Greenhealth. Accessed on 01 June 2024. Retrieved from https://practicegreenhealth.org/topics/waste/waste-0

van Straten, B., Alvino, L., & Horeman, T. (2023). Creating a circular healthcare economy: Circular strategies for sustainable healthcare. Delft University of Technology.

van Straten, B., Dankelman, J., Van der Eijk, A., & Horeman, T. (2021). A Circular Healthcare Economy; a feasibility study to reduce surgical stainless steel waste. Sustainable Production and Consumption, 27, 169-175.

Pathak, Pankaj & Sharma, Susmita & Ramkrishna, Seeram. (2023). Circular Transformation in Plastic Management Lessen the Carbon Footprint of the Plastic Industry. Materials Today Sustainability. 10.1016/j.mtsust.2023.100365.

van Straten, B., van der Heiden, D. R., Robertson, D., Riekwel, C., Jansen, F. W., Van der Elst, M., & Horeman, T. (2021). Surgical waste reprocessing: Injection molding using recycled blue wrapping paper from the operating room. Journal of Cleaner Production, 322, 129121.

van Straten, B. (2022). From surgical waste to medical products. Delft University of Technology]. https://doi.org/10.4233/uuid:5fb99bbc-f0c2-4864-b9bf-f7c222631d59

Olin, D. (2014). Paradox. Routledge. https://doi.org/10.4324/9781315710532

Hahn, T., Figge, F., Pinkse, J. et al. A Paradox Perspective on Corporate Sustainability: Descriptive, Instrumental, and Normative Aspects. J Bus Ethics 148, 235–248 (2018). https://doi.org/10.1007/s10551-017-3587-2

Smith, W. K., & Lewis, M. W. (2011). Toward a theory of paradox: A dynamic equilibrium model of organizing. Academy of management Review, 36(2), 381-403.

Ellen MacArthur Foundation. (2013). Towards the Circular Economy: Economic and business rationale for an accelerated transition. Retrieved from: www.werktrends.nl/app/uploads/2015/06/Rapport_McKinsey-Towards_A_Circular_Economy.pdf

Wakefield, F. (2022). Top 25 recycling facts and statistics for 2022, in. World Economic Forum. Retrieved from: https://www.weforum.org/agenda/2022/06/recycling-global-statistics-facts-plastic-paper/

McCormack, M. H. (1996). What They Don't Teach You at Harvard Business School about Executive Travel: Hit the Ground Running. NewStar Press.

Singapore Gov. Agency. Green Building Masterplans. (2006). Accessed on 12 August 2024 via: https://www1.bca.gov.sg/buildsg/sustainability/green-building-masterplans

van Straten, B., Ligtelijn, S., Droog, L. et al. A life cycle assessment of reprocessing face masks during the Covid-19 pandemic. Sci Rep 11, 17680 (2021). https://doi.org/10.1038/s41598-021-97188-5.

Tim Napier-Munn, Is progress in energy-efficient comminution doomed?, Minerals Engineering, Volume 73, 2015, Pages 1-6, ISSN 0892-6875, https://doi.org/10.1016/j.mineng.2014.06.009. (https://www.sciencedirect.com/science/article/pii/S0892687514002076).

Chen Q, Li C. The Green Paradox in NEV Manufacturing: Regulatory Impacts on Innovation from a Stakeholder Perspective. Energies. 2024; 17(14):3508. https://doi.org/10.3390/en17143508.

van Straten, B., Robertson, P. D., Oussoren, H., Espindola, S. P., Ghanbari, E., Dankelman, J., ... & Horeman, T. (2021). Can sterilization of disposable face masks be an alternative for imported face masks? A nationwide field study including 19 sterilization departments and 471 imported brand types during COVID-19 shortages. PLoS One, 16(9), e0257468.

De Man, P., van Straten, B., van den Dobbelsteen, J., Van Der Eijk, A., Horeman, T., & Koeleman, H. (2020). Sterilization of disposable face masks by means of standardized dry and steam sterilization processes; an alternative in the fight against mask shortages due to COVID-19. Journal of Hospital Infection, 105(2), 356-357.

Waste Framework Directive EU 2008/98/EC. (2024). European Commission. Accessed on 24 July 2024: https://environment.ec.europa.eu/topics/waste-and-recycling/waste-framework-directive_en.

Council Directive 91/689/EEC of 12 December 1991 on hazardous waste. (1991). European Union. Accessed on 24 July 2024: https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A31991L0689.

European Climate Law. (2021). European Union. Accessed on 24 July 2024: https://climate.ec.europa.eu/eu-action/european-climate-law_en

Visualising the Circular Economy. (2019). Ellen MacArthur Foundation. Accessed on 25 July 2024: https://www.ellenmacarthurfoundation.org/circular-economy-diagram.

McDonough, W., Braungart, M., Anastas, P. T., & Zimmerman, J. B. (2003). Applying the principles of green engineering to cradle-to-cradle design. Environmental science & technology, 37(23), 434A-441A.

Braungart, M., & McDonough, W. (2009). Cradle to cradle. Random House. Accessed on 25 July 2024: https://books.google.nl/books?hl=nl&lr=&id=13hfHzBstcEC&oi=fnd&pg=PT2&dq=Cradle+2+Cradle.+Braungart+%26+McDonough+&ots=IeoVaOuOZC&sig=erLMlgYxZew3q5e_HxsSuXlS5Ss.

Ellen MacArthur Foundation. The biological cycle of the butterfly diagram. (2022). Accessed on 24 July 2024: https://www.ellenmacarthurfoundation.org/articles/the-biological-cycle-of-the-butterfly-diagram.

Maik Feldmann, Johannes Fuchs, 5 - Injection Molding of Bio-Based Plastics, Polymers, and Composites, Editor(s): Hans-Peter Heim, Specialized Injection Molding Techniques, William Andrew Publishing, 2016, Pages 211-237, ISBN 9780323341004, https://doi.org/10.1016/B978-0-323-34100-4.00005-5.

Pomare, C. (2019). United Nations (UN) Sustainable Development Goals (SDG) and accountability framework. Encyclopedia of the UN Sustainable Development Goals: Partnerships for the Goals.

Ellen MacArthur Foundation. The butterfly diagram: visualising the circular economy. (2019). Accessed on 24 July 2024: https://www.ellenmacarthurfoundation.org/circular-economy-diagram.

World Resources Institute. Resilience in a Warmer World: The Future of Extreme Heat. (2024). Accessed on 24 July 2024: www.wri.org.

Braungart, M., & McDonough, W. (2009). Cradle to cradle. Random House.

ISO. ISO 14001:2015 Environmental Management Systems. (2015). Accessed on 24 July 2024: https://www.iso.org/standard/60857.html.

M. Geissdoerfer, P. Savaget, N.M.P. Bocken, EJ. Hultink. The Circular Economy – A new sustainability paradigm? Journal of Cleaner Production., 143 (2017), pp. 757-768. https://doi:10.1016/j.jclepro.2016.12.048.

Moreno, G. S. B., Calcedo, J. G. S., González, A. G., & Salgado, D. R. (2019). Sustainable solutions for thermal energy saving in hospital operating theatres. In E3S Web of Conferences (Vol. 85, p. 01002). EDP Sciences.

Coca Cola Company. 100% plant-based. (2023). Accessed on 24 July 2024 via: https://www.coca-colacompany.com/media-center/100-percent-plant-based-plastic-bottle.

Fairphone. Recycle your old phone(s). (2024). Accessed on 8 August 2024 via: https://shop.fairphone.com/recycle.

Ellen MacArthur Foundation. Packaging from ‘mushroom plastic’: Ecovative. (2021). Accessed on 8 August via: https://www.ellenmacarthurfoundation.org/circular-examples/packaging-from-mushroom-plastic-ecovative.

Dell. Design for Environment. (2024). Accessed on 8 August 2024 via: https://www.dell.com/learn/vg/en/vgcorp1/corp-comm/closed-loop-recycled-content.

Bart van Straten…. Tim Horeman, et al. Reprocessing Zamak laryngoscope blades into new instrument parts; an ‘all-in-one’ experimental study, Heliyon, Volume 8, Issue 11, 2022, ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2022.e11711. (https://www.sciencedirect.com/science/article/pii/S2405844022029991).

International Organization for Standardization (ISO). (2006). ISO 14040:2006 – Environmental management – Life cycle assessment – Principles and framework. ISO.

Boberg, L., Singh, J., Montgomery, A., & Bentzer, P. (2022). Environmental impact of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies. PLoS One, 17(7), e0271601.

Donahue, L. M., Hilton, S., Bell, S. G., Williams, B. C., & Keoleian, G. A. (2020). A comparative carbon footprint analysis of disposable and reusable vaginal specula. American journal of obstetrics and gynecology, 223(2), 225-e1.

Morris, M. I. R., & Hicks, A. (2022). Life cycle assessment of stainless-steel reusable speculums versus disposable acrylic speculums in a university clinic setting: a case study. Environmental Research Communications, 4(2), 025002.

Rizan, C., Steinbach, I., Nicholson, R., Lillywhite, R., Reed, M., & Bhutta, M. F. (2020). The carbon footprint of surgical operations: a systematic review. Annals of surgery, 272(6), 986-995.

Sørensen, B. L., & Grüttner, H. (2018). Comparative study on environmental impacts of reusable and single-use bronchoscopes. American Journal of Environmental Protection, 7(4), 55-62.

Friedericy, H. J., van Egmond, C. W., Vogtländer, J. G., van der Eijk, A. C., & Jansen, F. W. (2021). Reducing the environmental impact of sterilization packaging for surgical instruments in the operating room: a comparative life cycle assessment of disposable versus reusable systems. Sustainability, 14(1), 430.

Samenjo, K. T., Ramanathan, A., Gwer, S. O., Bailey, R. C., Otieno, F. O., Koksal, E., ... & Diehl, J. C. (2023). Design of a syringe extension device (Chloe SED®) for low-resource settings in sub-Saharan Africa: a circular economy approach. Frontiers in Medical Technology, 5, 1183179.

Lalman, C., Karunathilake, H., & Ruparathna, R. (2023). To dispose or to reuse? Analyzing the life cycle impacts and costs of disposal, sterilization, and reuse of electrophysiological catheters. Sustainability, 15(6), 5363.

Unger, S., & Landis, A. (2016). Assessing the environmental, human health, and economic impacts of reprocessed medical devices in a Phoenix hospital's supply chain. Journal of Cleaner Production, 112, 1995-2003.

Hogan, D., Rauf, H., Kinnear, N., & Hennessey, D. B. (2022). The carbon footprint of single-use flexible cystoscopes compared with reusable cystoscopes. Journal of Endourology, 36(11), 1460-1464.

McGain, F., & McAlister, S. (2023). Reusable versus single-use ICU equipment: what’s the environmental footprint?. Intensive Care Medicine, 49(12), 1523-1525.

Goedkoop, M., Heijungs, R., Huijbregts, M., De Schryver, A., Struijs, J., & Van Zelm, R. (2009). ReCiPe 2008. A life cycle impact assessment method which comprises harmonised category indicators at the midpoint and the endpoint level, 1, 1-126.

S. Ing, “It’s a Wrap! Everything You Need to Know About Sterilization Pouches - Medicom,” 7 2021.

T. P. Company, “All About Autoclave Bags - Types, Industries and Selection Criteria,” 2023.

E. F. De Ridder, H. J. Friedericy, A. C. Van Der Eijk, J. Dankelman, and F. W. Jansen, “A New Method to Improve the Environmental Sustainability of the Operating Room: Healthcare Sustainability Mode and Effect Analysis (HSMEA),” Sustainability, vol. 14, p. 13957, 10 2022.

R. Faesal and W. Bdaiwi, “Recycling of Waste Medical Plastic Syringesin Manufacturing Low-Cost Structural Sections,” Materials Science Forum, vol. 1050, pp. 115–123, 1 2022.

M. Hansen, “Recycling of Autoclave-Laminated Material: An Analysis Of Waste Management Techniques and Recycling Processes,” MSc Thesis Literature Study, pp. 1–29, 3 2023.

A. Dehal, A. N. Vaidya, and A. R. Kumar, “Biomedical waste generation and management during COVID-19 pandemic in India: challenges and possible management strategies,” Environmental Science and Pollution Research, vol. 29, pp. 14830–14845, 10 2021.

Y. Q. Gill, M. Khurshid, U. Mehmood, M. Irfan, and F. Saeed, “Upscale recycling of nonwoven polypropylene waste using a novel blending method,” Journal of Applied Polymer Science, vol. 139, 7 2022.

J. Patil, H. H. Patil, R. Sankpal, D. Rathod, K. Patil, P. R. Kubade, and H. B. Kulkarni, “Studies on mechanical and thermal performance of carbon nanotubes/polypropylene nanocomposites,” Materials Today: Proceedings, vol. 46, pp. 7182–7186, 1 2021.

ASTM. “Standard Test Method for Tensile Properties of Plastics” 7. 2022.

Recycling Inside, “Ink removal in plastics recycling plants,” 11 2021.

N. C. f. C. D. P. Division of Oral Health and H. Promotion, “Sterilization: Packaging storage — FAQs — Infection control — Division of Oral Health — CDC,” 2 2016.

G. Suzuki, N. Uchida, L. H. Tuyn, K. Tanaka, H. Matsukami, T. Kunisue, S. Takahashi, H. V. Pham, H. Kuramochi, and M. Osako, “Mechanical recycling of plastic waste as a point source of microplastic pollution,” Environmental Pollution, vol. 303, p. 119114, 6 2022.

D. N. Bikiaris, “Microstructure and properties of Polypropylene/Carbon Nanotube Nanocomposites,” Materials, vol. 3, pp. 2884–2946, 4 2010.

L. Wigchert, T. Horeman, B. van Straten, “Reprocessing of uni-directional biosense webster ablation catheters: a novel disassembly method,” 2023.

G. Ditac, P. Cottinet, M. Le, D. Grinberg, J. Duchateau, K. Gardey, A. Dulac, A. Delinière, C. Haddad, J. Boussuge-Roze, F. Sacher, P. Jaïs, P. Chevalier, and F. Bessière, “Carbon footprint of atrial fibrillation catheter ablation,” EUROPACE, vol. 25, pp. 331–340, Feb. 2023.

Ellen McArthur Foundation. 2023. What is a circular economy? Retrieved from: https://ellenmacarthurfoundation.org/topics/circular-economy-introduction/overview

Image of disposed single-use medical instruments

Published

July 1, 2025

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Details about the available publication format: View PDF

View PDF

ISBN-13 (15)

978-94-6518-050-2

Publication date (01)

2025-07-01

How to Cite

van Straten, B., Bruins, B., & Horeman, T. (2025). Transitioning towards a circular (healthcare) economy: Circular Economy principles, leadership, policy and decision-making. TU Delft OPEN Books. https://doi.org/10.59490/mg.217