Exploring the Drivers and Barriers to the Adoption and Implementation of Reusable Medical Devices

Abstract

Introduction Disposable medical devices contribute substantially to the environmental impact of Dutch hospitals. The use of reusable medical devices in cataract surgery could contribute to lowering this impact and advancing the transition towards circular hospitals. One of the medical devices currently used in cataract surgery is a disposable cartridge, but it is also possible to use a day-cartridge that is reused for multiple surgeries. However, there are still complexities to the adoption and implementation of the day-cartridge in the Dutch hospitals, which were identified in this research. Theory The framework to study the Nonadoption, Abandonment, and challenges to Scaleup, Spread and Sustainability (NASSS) of innovations in healthcare was used to identify drivers and barriers to the adoption and implementation of the day-cartridge in Dutch hospitals. This framework was complemented with system functions of the Mission-oriented Innovation Systems (MIS) approach to put the day-cartridge into the context of the transition towards circular hospitals. Methodology A case study design focusing on the potential implementation of the day-cartridge in University Medical Center Utrecht and other Dutch hospitals was used. Data was collected through desk research and 30 interviews within seven stakeholder groups: ophthalmologists, nurses, procurement, sustainability managers, patient groups, infection prevention experts and the day-cartridge’s supplier. Results The most important drivers for adopting and implementing the day-cartridge are its time-saving and waste reduction potential. Barriers identified include the adopter’s concerns of cross-contamination by the day-cartridge. Adopters require additional proof that the day-cartridge is safe before they are willing to use it. Additionally, safe use of the day-cartridge is more dependent on correct usage compared to using a disposable cartridge. Furthermore, circularity plays a limited role when hospitals procure medical devices, which forms a barrier to the implementation of the day-cartridge. There is a lack of knowledge among stakeholders regarding the effects of infection prevention measures and the environmental impact of medical devices, which impedes the adoption of the day-cartridge and other circular solutions. In addition, there is insufficient direction in the transition towards circular hospitals for stakeholders to adopt and implement circular solutions, like the day-cartridge. Conclusion & discussion The novel approach of combining the NASSS framework with the MIS approach provides a unique insight into how the transition towards circular hospitals impacts the adoption and implementation of the day-cartridge. Placing the day-cartridge into the context of the mission for circular hospitals allows for identifying the dynamics between this transition and the day-cartridge.