The Sustainable Healthcare Podcast

Hospitals use many single-use products.

So why do the disposables stay?

Heidi Annala studies the routines and protocols that keep single-use in place, and explains why reaching for a single-use item is often not really a choice.
 
About the guest: Heidi Annala is a PhD candidate in the Environmental Policy Group at Wageningen University & Research. She works in "How we act", the work package on hospital culture and care professionals' practices in ESCH-R (Evidence-based Strategies to create Circular Hospitals), a Dutch research consortium coordinated by Erasmus MC, the university medical centre in Rotterdam. Her fieldwork takes her inside hospital departments, from a dialysis ward in Utrecht to obstetrics in Rotterdam.
 
Three things you'll take away:
Single-use is often not a choice. In the wards Heidi observed, there is often one product for a given clinical need, so the disposable is simply how the job gets done. As some staff told her: "Well, I don't have a choice."

Ask about practices, not individual behaviour. Instead of "why is somebody not doing what I want them to do?", Heidi asks "why is this way of doing things normal?", which opens cultural, material and organisational routes to change.

Nobody changes a protocol alone. Microbiologists and infection prevention specialists tend to come up, and because protocol work sits on top of clinical work, change can meet friction even when nobody opposes it.
 
Timestamps:
00:00 Cold open
00:36 Welcome, and the link to episode 088 with Nicole Hunfeld
02:08 Meet Heidi: Wageningen, ESCH-R and the "How we act" work package
04:48 What is a hospital protocol?
06:26 When going against protocol is good practice
07:48 The problem statement: what's up with the single-useness?
09:53 Practices versus behaviour versus products
12:28 Fieldwork on a dialysis ward
17:25 Low-hanging fruit? Dialysate bags and specialist knowledge
20:34 Is reaching for single-use really a choice?
23:09 What might be driving single-use, and a detour into the US reuse market
30:28 Where protocols come from, and who can change them
35:10 When protocol work sits on top of clinical work
37:23 What gives Heidi hope
 
References mentioned:
ESCH-R consortium: https://esch-r.org
Dutch national clinical guidelines (Richtlijnendatabase), the kind of database Heidi describes: https://richtlijnendatabase.nl
Clifford Geertz, "Deep Hanging Out", The New York Review of Books, 1998: https://www.nybooks.com/articles/1998/10/22/deep-hanging-out/
M.C. Escher's work: https://mcescher.com
 
Links:
Heidi Annala on LinkedIn: https://www.linkedin.com/in/heidiannala
Heidi's profile at Wageningen University & Research: https://www.wur.nl/en/persons/h-heidi-annala
Environmental Policy Group, Wageningen University & Research: https://www.wur.nl/en/chair-groups/wageningen-sustainability-governance-hub/environmental-policy
 
You might also enjoy:
Episode 088, Circular material flow of medication in the intensive care unit, with Nicole Hunfeld and Jasper Klasen (ESCH-R): https://carepathwayconsulting.com/podcast/podcast-episode-088/
Episode 087, Sustainability insights from 290 nurses and clinicians, with Michael Maagaard: https://carepathwayconsulting.com/podcast/podcast-episode-087/
Episode 097, Visualizing Circular Healthcare: A Taxonomy for Sustainable Medical Device Flows, with Tamara Hoveling: https://carepathwayconsulting.com/podcast/podcast-episode-097/
 
Host links:
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com
 
"I think what is a more interesting question that a practice perspective lets you ask is: why is this way of doing things normal? Why is this routine there, and why does it look the way it does?"
Heidi Annala

What happens when you move acute hospital care into the patient's own home? Maria Normand Larsen shares the results of Denmark's first hospital-at-home randomised trial.

About the guest: Maria Normand Larsen is a medical doctor and researcher at Herlev Hospital who recently completed her PhD on remote care. Her randomised trial, run at Nordsjaellands Hospital, tested whether acutely ill patients treated at home do better than those admitted to a conventional ward.

Three takeaways:
Patients treated at home were measurably more physically active than those in hospital, which matters because the drop in activity during admission drives functional decline and slower recovery.
- They were also more satisfied with their treatment, so the better-for-recovery option was also the one patients preferred.
- Hospital at home is a complex intervention, not just a change of location. It only works when hospital teams, municipalities, patients and relatives are aligned, and a model proven in one department cannot simply be lifted onto the shelf elsewhere.
Timestamps:
00:00 - Intro and why remote care
02:00 - What is a care model, and the trial's goal
05:00 - The findings: more active, more satisfied
09:00 - Why it's a complex intervention
12:00 - Which patients it suits
17:00 - A first step for teams who want to try it

References:
Hybrid Hospital at Home and Physical Activity RCT (JAMA Network Open): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2850565
- Informal caregivers in a hybrid hospital-at-home model (BMC Health Services Research): https://research.regionh.dk/en/publications/caring-beyond-hospital-walls-informal-caregivers-experiences-in-a/
- Nordsjaellands Hospital: https://www.nordsjaellandshospital.dk
- Maria Normand Larsen on LinkedIn: www.linkedin.com/in/maria-normand-larsen
You might also enjoy:
Telemedicine: Reaching Drawdown with a Decentralised Healthcare System (Ep 016)
- The Transition From the Sick Care System to a Preventive Care System (Ep 008)
Hosts:
Joachim Almdal: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"It's not just a shift of location. It's more complex than that. Just because we showed we could do it at one hospital doesn't mean everyone else can take it off the shelf and implement it."

If we want to fix sustainability in healthcare, one of the most powerful levers sits at the gate where new health technologies get approved: Health Technology Assessment (HTA).

In this episode of the Sustainable Healthcare Podcast, Frederik Dam van Deurs speaks with Melissa Pegg, Senior Research Consultant in Environmental Sustainability in HTA at the York Health Economics Consortium (YHEC), University of York, and co-lead of the first HTAi Working Group on environmental sustainability in HTA.

Disclosure: All opinions are Melissa's own and not the opinions of York Health Economics Consortium (YHEC) and the National Institute for Health and Care Excellence (NICE).

About the guest: Melissa Pegg leads YHEC's environmental sustainability work, bringing environmental impact methods into HTA and health economics for the NHS, government bodies and industry. She holds a master's in HTA (University of Glasgow), spent 18 years in industry before academia, and was a fellow in sustainable surgery for the BMJ.

Three things you'll take away:
HTA works as a "gatekeeper", and adding environmental impact alongside safety, efficacy and cost could reshape which technologies reach patients.
- The "information conduit" and "parallel" approaches: getting environmental data into HTA now, reported alongside health-economic data, without waiting for agencies to build new capacity.
- A real case study with the Scottish Health Technologies Group: reusable vs single-use endoscopes came out around 50% less environmentally impactful, with a more favourable budget impact and QALY, and still held up when the 3,000-use assumption was quartered under sensitivity analysis.
Timestamps:
00:00 Introduction
01:00 Life in York: yoga, two boys, philosophy
03:00 What HTA is, and why it's a gatekeeper
07:00 National vs global: WHO, NICE and the devolved-nation agencies
09:00 The "reference case" and how agencies differ
15:00 Adding the environmental and planetary-health perspective
17:00 Safety for whom? Bringing the environment into the safety domain
22:00 Can it work? The information-conduit approach
24:00 Case study: reusable vs single-use endoscopes with SHTG
30:00 The figures: around 50% lower impact, favourable budget and QALY
33:00 The "just transition" and the classic objections to reusables
39:00 Sensitivity analysis and the 3,000-use assumption
45:00 What makes Melissa hopeful

References mentioned:
Green Surgery report (UK Health Alliance on Climate Change, 2023): https://ukhealthalliance.org/sustainable-healthcare/green-surgery-report/
Cliff Goodman, HTA 101: Introduction to Health Technology Assessment: https://www.inahta.org/wp-content/uploads/2014/09/HTA-101_Goodman_2004.pdf
HTAi Environmental Sustainability in HTA (ESHTA) Working Group: https://htai.org/engage-with-us/working-groups/htai-eshta/
Toward including environmental sustainability in HTA (Cambridge, IJTAHC): https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/toward-including-environmental-sustainability-in-health-technology-assessment/2FF6BA84AC3E7FB280DA2DF3F17D6130
Environmental sustainability in diabetes (Cambridge, IJTAHC): https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/environmental-sustainability-in-diabetes-improving-the-quality-of-diabetes-management-through-hta-and-systemlevel-change/E9B3804A2EB373D31752F6A2587C084A
How Can HTA Shape a More Sustainable Future for Healthcare? (YHEC): https://www.yhec.co.uk/resource/how-can-hta-shape-healthcare-sustainability/
Scottish Health Technologies Group (SHTG): https://shtg.scot/
NICE: https://www.nice.org.uk/

Links:
Melissa Pegg on LinkedIn: https://www.linkedin.com/in/melissapegg1/
Melissa's email: melissa.pegg@york.ac.uk
Melissa's publications (YHEC Environmental Impact): https://www.yhec.co.uk/what-we-do/environmental-impact/
York Health Economics Consortium: https://www.yhec.co.uk/

You might also enjoy:
Episode 103, LCA in Surgery and Specialty-Level Carbon Literacy with Anna Roe Rasmussen: https://carepathwayconsulting.com/podcast/podcast-episode-103/

Host links:
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"HTA is a gatekeeper. The opportunity right now is to get environmental data into HTA and report it alongside everything else, without yet expecting agencies to act on it. That alone would be a huge step forward." - Melissa Pegg

How do you cut 40% of the carbon out of a clinical trial without changing the price? You rent the equipment instead of buying it.

In this episode of the Sustainable Healthcare Podcast, part of our mini-series with the Sustainable Healthcare Coalition's Community of Practice for Clinical Trials, Frederik Dam van Deurs speaks with Alejandra Medina, Chief Sustainability Officer at Quipment, the French, B Corp-certified provider of equipment solutions for clinical trials.

About the guest: Alejandra Medina is Chief Sustainability Officer at Quipment SAS, a Nancy-based company founded in 2010 that equips and maintains clinical trial sites across 110+ countries. She joined as quality director and led Quipment through its B Corp certification.

Three things you'll take away:
An equipment-rental ("equipment-as-a-service") model is circular by design: returning, reprocessing and redeploying devices keeps them in near-constant use across the value chain.
- Quipment's benchmark, built for B Corp certification, shows a 40% carbon-footprint reduction moving from a linear to a circular model, comparable to the saving the Sustainable Markets Initiative estimates from more digital trials.
- The real bottleneck for circularity isn't the technology, it's convincing the actors in the trial supply chain that circular is just as safe, compliant and high-performance as linear.
Timestamps:
00:00 Introduction
02:00 Meet Alejandra: from Mexico to Nancy
03:00 What Quipment does: equipping and maintaining trial sites
05:00 The portfolio: ECGs, infusion pumps, data loggers and 3,000+ products
07:00 Becoming a B Corp: how the assessment revealed a circular model
09:00 Circular by design: rent, return, reprocess, redeploy
13:00 Where circularity breaks down in clinical trials
16:00 The cost question: services at the same price
18:00 Informing the choice: tools over mandates
19:00 The Quipment Carbon Compass: a comparator, not a calculator
20:00 40% carbon reduction, linear vs circular
23:00 The new seven-pillar B Corp standard
25:00 What gives Alejandra hope

References and links:
Sustainable Healthcare Coalition, Community of Practice for Clinical Trials: https://shcoalition.org/sustainable-clinical-trials-knowledge-hub/
B Corp certification (B Lab): https://www.bcorporation.net/
Quipment B Corp profile: https://www.bcorporation.net/en-us/find-a-b-corp/company/quipment-sas/
Alejandra Medina on LinkedIn: https://fr.linkedin.com/in/alejandra-medina-3315185
Quipment: https://www.quipment.com/

You might also enjoy:
Episode 102, Sustainable Clinical Trials (1): Convien & myoncare with Christian Hieronimi: https://carepathwayconsulting.com/podcast/podcast-episode-102/

Host links:
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"Quipment Carbon Compass isn't a calculator, it's a comparator. We didn't change anything; we just changed the way we explain our business. We were circular by design from the beginning." - Alejandra Medina

Structured Material Selection: Building Sustainable Medical Devices with Plastics
How do you make a medical device more sustainable without blowing up the business case? Lucas Pianegonda breaks down the structured way to choose plastics, and why the first win is usually deleting a requirement, not changing a material.

ABOUT THE GUEST
Lucas R. Pianegonda is founder and lead plastic expert at Gradical (Switzerland), a consultancy that helps medtech companies select materials that are technically sound, compliant, and lower-footprint. Material scientist by training, he also hosts the podcast now called MedTech Sustainability by Design.
KEY TAKEAWAYS
- Over-requirement is the biggest hidden source of cost and carbon. Challenge every "must be medical grade" before you reach for a greener material.
- The plastic pyramid: moving down from high-performance plastics (PEEK) to engineering or commodity grades, where the part allows, cuts footprint and cost at once. Twenty years ago we just called it optimising.
- You don't need a 50,000 euro LCA to decide. A rough Excel or OpenLCA estimate gets you within ~20-25%. The certified LCA is for making public claims, which the EU's Empowering Consumers Directive now requires you to back with data.
TIMESTAMPS (adjust to audio)
00:00 - Intro and Lucas's path into materials
04:00 - Four forces driving sustainability in medtech
12:00 - Why SME device makers struggle to specialise
18:00 - Structured material selection and the value analysis
24:00 - The plastic pyramid and downgrading
30:00 - Rough vs. certified LCA, and what an LCA really costs
38:00 - Selling sustainability: the commercial translation gap
REFERENCES
- OpenLCA, free life cycle assessment software: https://www.openlca.org
- Empowering Consumers for the Green Transition Directive, Directive (EU) 2024/825 (applies from 27 September 2026)
- Pharmapack Europe: https://www.pharmapackeurope.com
- Science Based Targets initiative (SBTi): https://sciencebasedtargets.org
- Lucas's podcast, MedTech Sustainability by Design: https://www.buzzsprout.com/2389989
LINKS
- Lucas R. Pianegonda on LinkedIn: https://www.linkedin.com/in/lucas-r-pianegonda-81142b110/
- Gradical: https://gradical.ch
YOU MIGHT ALSO ENJOY
- Episode 096 - Recycling pharmaceutical transport packaging, with Arne Kloke (SCHOTT Pharma)
- Episode 097 - Visualizing Circular Healthcare: A Taxonomy for Sustainable Medical Device Flows, with Tamara Hoveling (TU Delft)
HOSTED BY
- Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
- Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
- Care Pathway Consulting: https://carepathwayconsulting.com
"Sustainability can't be a strategic advantage if you can't sell the device." - Lucas Pianegonda