| dc.description.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. | |
