Medical Circular Living Labs Guidebook

Authors

Marcel Crul
Systemic Design Research Group, NHL Stenden University of Applied Sciences, The Netherlands
https://orcid.org/0000-0002-2873-2604
Peter Joore
Systemic Design Research Group, NHL Stenden University of Applied Sciences, The Netherlands
https://orcid.org/0000-0002-4585-008X
Johan Reijenga
Business Innovation Research Centre, Rotterdam University of Applied Sciences, The Netherlands
https://orcid.org/0009-0007-6707-9509
Jan-Carel Diehl
Department of Design for Sustainability, Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands
https://orcid.org/0000-0002-4007-2282

Keywords:

medical living labs, circular living labs, healthcare innovation, circular design, systemic design

Synopsis

How can healthcare become more circular without compromising patient safety, clinical quality, or efficiency?

The Medical Circular Living Labs Guidebook offers a practical framework for turning circular ambitions into action. It shows how hospitals and their partners can create real-world innovation environments in which healthcare professionals, researchers, designers, suppliers, and policymakers, work together to develop, test, and improve circular solutions.

Developed as part of the ESCH-R project - Evidence-based Strategies to create Circular Hospitals - the guidebook builds on the knowledge and practical experience of a multidisciplinary research consortium working to advance circular healthcare. 

Through an eight-step approach, the guidebook supports teams in defining their ambitions, establishing a Medical Circular Living Lab, co-creating and evaluating interventions, embedding lessons within the wider organisation, and working towards lasting systemic impact. Real-world cases demonstrate how these principles can be applied to medical products, material flows, clinical practices, and healthcare systems.

By combining circular design, systems thinking, experimentation, and collaborative learning, this guidebook offers both practical direction and strategic insight. It is a valuable resource for anyone working towards circular and sustainable healthcare - one experiment, one partnership, and one systemic change at a time. 

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Author Biographies

Marcel Crul, Systemic Design Research Group, NHL Stenden University of Applied Sciences, The Netherlands

Dr. Marcel Crul is Associate Professor of Circular Design at NHL Stenden University of Applied Sciences. He has more than thirty years of experience in sustainability, circular economy, innovation, and international development projects. Before joining NHL Stenden, he held research and management positions at Delft University of Technology and worked extensively with international organizations including UNEP, UNIDO, the World Bank, and the European Union. His work focuses on circular design, sustainable value chains, social innovation, and the development and management of multidisciplinary research and innovation programmes. 

Peter Joore, Systemic Design Research Group, NHL Stenden University of Applied Sciences, The Netherlands

Dr. Peter Joore is Professor of Systemic Design and former Professor of Open Innovation at NHL Stenden University of Applied Sciences. His research explores how design-driven innovation can contribute to long-term societal transitions towards a smart, sustainable, and inclusive society. With a background in Industrial Design Engineering and a PhD from Delft University of Technology, he specializes in systemic design, living labs, design-based innovation, and cross-sector collaboration. He is actively involved in connecting research, education, industry, government, and civil society through innovation ecosystems and applied research networks. 

Johan Reijenga, Business Innovation Research Centre, Rotterdam University of Applied Sciences, The Netherlands

Johan Reijenga is a senior lecturer and researcher at the Research Centre for Business Innovation at Rotterdam University of Applied Sciences, specialising in applied research, sustainable innovation and human development. His experience includes seven years with a healthcare living lab at Albert Schweitzer Hospital and current involvement in the ESCH-R Living Lab at Erasmus MC. His work focuses on bringing professionals, researchers, students and partners together to advance circular healthcare through real-world experimentation and learning, with a particular interest in developing human potential across the public and private sectors.

Jan-Carel Diehl, Department of Design for Sustainability, Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands

Jan Carel Diehl is a Full Professor in Design for Inclusive Sustainable Healthcare at Delft University of Technology and Erasmus Medical Center in Rotterdam. His research aims to make healthcare globally accessible and inclusive while reducing its environmental impact. Utilizing a research-through-design approach, he specializes in systemic design—a blend of systems thinking and human-centered design. In addition to serving as Academic Lead of the Convergence Healthy Start program, he co-leads the ESCH-R project (Evidence-based Strategies to create Circular Hospitals) and the Transition towards Zero Emission Endoscopy (ZEE) project.

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Medical instruments and waste

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Published

October 5, 2026

Data Availability Statement

This book presents guidance and practical insights derived from the ESCH-R project. No new research data were generated specifically for this publication. Where applicable, the underlying research data are managed within the ESCH-R project in accordance with the project’s data management arrangements.

License

Creative Commons License

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

Details about this monograph

ISBN-13 (15)

978-94-6518-456-2

Publication date (01)

2026-10-05

How to Cite

Crul, M., Joore, P., Reijenga, J., & Diehl, J.-C. (2026). Medical Circular Living Labs Guidebook. TU Delft OPEN Books. https://doi.org/10.59490/mt.271