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C.A. Bakker
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1
Mapping circular economy product and material flows in healthcare
A visual taxonomy
Journal article
(2026)
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Tamara Hoveling, Jelle Ijzenbrandt, Saba Hinrichs-Krapels, Linda Ritzen, Wichor M. Bramer, Erik van Raaij, Jeremy Faludi, Conny Bakker, Jan Carel Diehl
Background
The healthcare sector contributes substantially to environmental pollution, affecting ecosystems and public health. Circular economy (CE) strategies offer potential solutions, but existing frameworks provide limited guidance for healthcare, overlooking factors such as infection control, decontamination, and staff workload.
Methods
We developed the Circular Healthcare Flows visual, a taxonomy of CE strategies for medical devices, using observations in sterilization departments, recycling facilities, and manufacturing plants; 21 expert interviews; and a systematic review of 1104 studies (68 full-text reviews). Additional stakeholder feedback validated and refined the taxonomy.
Findings
The taxonomy identifies 13 CE strategies—refuse, replace, rethink, reduce, reuse, maintain, repair, refurbish, remanufacture, repurpose, recycle, renew, and recover—and organizes them in a healthcare-specific framework. Iterative feedback ensured that the taxonomy is clear, practically applicable, and addresses sector-specific regulatory, clinical, and operational constraints.
Interpretation
The Circular Healthcare Flows visual provides a practical tool to standardize terminology and guide the implementation of CE strategies in healthcare. By offering conceptual structure and actionable guidance, it supports informed decision-making, facilitates collaboration among stakeholders, and encourages consistent application of circular strategies across the sector.
Funding
IJzenbrandt was partially funded by Erasmus University Rotterdam and the Health and Technology Convergence Alliance of TU Delft, Erasmus MC, and Erasmus University Rotterdam. Hoveling was funded through the DiCE project (EU grant agreement no. 101060184). Opinions expressed are those of the authors and do not necessarily reflect those of the EU or REA. ...
The healthcare sector contributes substantially to environmental pollution, affecting ecosystems and public health. Circular economy (CE) strategies offer potential solutions, but existing frameworks provide limited guidance for healthcare, overlooking factors such as infection control, decontamination, and staff workload.
Methods
We developed the Circular Healthcare Flows visual, a taxonomy of CE strategies for medical devices, using observations in sterilization departments, recycling facilities, and manufacturing plants; 21 expert interviews; and a systematic review of 1104 studies (68 full-text reviews). Additional stakeholder feedback validated and refined the taxonomy.
Findings
The taxonomy identifies 13 CE strategies—refuse, replace, rethink, reduce, reuse, maintain, repair, refurbish, remanufacture, repurpose, recycle, renew, and recover—and organizes them in a healthcare-specific framework. Iterative feedback ensured that the taxonomy is clear, practically applicable, and addresses sector-specific regulatory, clinical, and operational constraints.
Interpretation
The Circular Healthcare Flows visual provides a practical tool to standardize terminology and guide the implementation of CE strategies in healthcare. By offering conceptual structure and actionable guidance, it supports informed decision-making, facilitates collaboration among stakeholders, and encourages consistent application of circular strategies across the sector.
Funding
IJzenbrandt was partially funded by Erasmus University Rotterdam and the Health and Technology Convergence Alliance of TU Delft, Erasmus MC, and Erasmus University Rotterdam. Hoveling was funded through the DiCE project (EU grant agreement no. 101060184). Opinions expressed are those of the authors and do not necessarily reflect those of the EU or REA. ...
Background
The healthcare sector contributes substantially to environmental pollution, affecting ecosystems and public health. Circular economy (CE) strategies offer potential solutions, but existing frameworks provide limited guidance for healthcare, overlooking factors such as infection control, decontamination, and staff workload.
Methods
We developed the Circular Healthcare Flows visual, a taxonomy of CE strategies for medical devices, using observations in sterilization departments, recycling facilities, and manufacturing plants; 21 expert interviews; and a systematic review of 1104 studies (68 full-text reviews). Additional stakeholder feedback validated and refined the taxonomy.
Findings
The taxonomy identifies 13 CE strategies—refuse, replace, rethink, reduce, reuse, maintain, repair, refurbish, remanufacture, repurpose, recycle, renew, and recover—and organizes them in a healthcare-specific framework. Iterative feedback ensured that the taxonomy is clear, practically applicable, and addresses sector-specific regulatory, clinical, and operational constraints.
Interpretation
The Circular Healthcare Flows visual provides a practical tool to standardize terminology and guide the implementation of CE strategies in healthcare. By offering conceptual structure and actionable guidance, it supports informed decision-making, facilitates collaboration among stakeholders, and encourages consistent application of circular strategies across the sector.
Funding
IJzenbrandt was partially funded by Erasmus University Rotterdam and the Health and Technology Convergence Alliance of TU Delft, Erasmus MC, and Erasmus University Rotterdam. Hoveling was funded through the DiCE project (EU grant agreement no. 101060184). Opinions expressed are those of the authors and do not necessarily reflect those of the EU or REA.
The healthcare sector contributes substantially to environmental pollution, affecting ecosystems and public health. Circular economy (CE) strategies offer potential solutions, but existing frameworks provide limited guidance for healthcare, overlooking factors such as infection control, decontamination, and staff workload.
Methods
We developed the Circular Healthcare Flows visual, a taxonomy of CE strategies for medical devices, using observations in sterilization departments, recycling facilities, and manufacturing plants; 21 expert interviews; and a systematic review of 1104 studies (68 full-text reviews). Additional stakeholder feedback validated and refined the taxonomy.
Findings
The taxonomy identifies 13 CE strategies—refuse, replace, rethink, reduce, reuse, maintain, repair, refurbish, remanufacture, repurpose, recycle, renew, and recover—and organizes them in a healthcare-specific framework. Iterative feedback ensured that the taxonomy is clear, practically applicable, and addresses sector-specific regulatory, clinical, and operational constraints.
Interpretation
The Circular Healthcare Flows visual provides a practical tool to standardize terminology and guide the implementation of CE strategies in healthcare. By offering conceptual structure and actionable guidance, it supports informed decision-making, facilitates collaboration among stakeholders, and encourages consistent application of circular strategies across the sector.
Funding
IJzenbrandt was partially funded by Erasmus University Rotterdam and the Health and Technology Convergence Alliance of TU Delft, Erasmus MC, and Erasmus University Rotterdam. Hoveling was funded through the DiCE project (EU grant agreement no. 101060184). Opinions expressed are those of the authors and do not necessarily reflect those of the EU or REA.
The Cradle to Cradle (C2C) concept takes natural systems as a source of inspiration, striving toward a positive vision where human society and industry regard waste as “food” for new cycles of use, and are powered entirely by renewable energy. Cradle to Cradle is not about efficiency but about effectiveness—waste need not be minimized if it is food for other cycles, providing positive regenerative impacts. However, this is difficult to achieve in practice. The Circular Economy concept elaborates on the Cradle to Cradle model, prioritizing longer product lifetime and recovering whole products over material recovery through recycling.
The Circular Economy also combines ecological thinking with economic thinking, making a business argument for sustainability.
Both concepts have been very influential in shaping the way we think about design for sustainability.
...
The Circular Economy also combines ecological thinking with economic thinking, making a business argument for sustainability.
Both concepts have been very influential in shaping the way we think about design for sustainability.
...
The Cradle to Cradle (C2C) concept takes natural systems as a source of inspiration, striving toward a positive vision where human society and industry regard waste as “food” for new cycles of use, and are powered entirely by renewable energy. Cradle to Cradle is not about efficiency but about effectiveness—waste need not be minimized if it is food for other cycles, providing positive regenerative impacts. However, this is difficult to achieve in practice. The Circular Economy concept elaborates on the Cradle to Cradle model, prioritizing longer product lifetime and recovering whole products over material recovery through recycling.
The Circular Economy also combines ecological thinking with economic thinking, making a business argument for sustainability.
Both concepts have been very influential in shaping the way we think about design for sustainability.
The Circular Economy also combines ecological thinking with economic thinking, making a business argument for sustainability.
Both concepts have been very influential in shaping the way we think about design for sustainability.
Business Models
Presidio Booster
The Business Model Canvas (BMC) is a fundamental tool for both understanding and creating or changing businesses. It diagrams costs, revenues, your customers, suppliers, and more, so you can make sure they all align. Normal BMCs only consider economic profit, but the Presidio Sustainability Booster adds environmental and social sustainability considerations for every part of the BMC. The Presidio Sustainability Booster is a qualitative and creative tool; it does not quantify whether one business model is better than another. The Presidio Sustainability Booster can help you assess an existing business, and/or help you generate ideas for improving a business.
...
...
The Business Model Canvas (BMC) is a fundamental tool for both understanding and creating or changing businesses. It diagrams costs, revenues, your customers, suppliers, and more, so you can make sure they all align. Normal BMCs only consider economic profit, but the Presidio Sustainability Booster adds environmental and social sustainability considerations for every part of the BMC. The Presidio Sustainability Booster is a qualitative and creative tool; it does not quantify whether one business model is better than another. The Presidio Sustainability Booster can help you assess an existing business, and/or help you generate ideas for improving a business.
Business Models
Product Service Systems
Product service systems (PSSs) are revenue models where customers pay the company for the service the product provides, not (only) for the physical product itself.
Designing the revenue model along with the product can align economic incentives with environmental impacts, so the company has an incentive to design products for longer lives.
Both the company and the customer can benefit financially from longer‑lived products billed as services.
Not all product service systems are sustainable environmentally or socially, but if properly designed, they can greatly enable the circular economy. ...
Designing the revenue model along with the product can align economic incentives with environmental impacts, so the company has an incentive to design products for longer lives.
Both the company and the customer can benefit financially from longer‑lived products billed as services.
Not all product service systems are sustainable environmentally or socially, but if properly designed, they can greatly enable the circular economy. ...
Product service systems (PSSs) are revenue models where customers pay the company for the service the product provides, not (only) for the physical product itself.
Designing the revenue model along with the product can align economic incentives with environmental impacts, so the company has an incentive to design products for longer lives.
Both the company and the customer can benefit financially from longer‑lived products billed as services.
Not all product service systems are sustainable environmentally or socially, but if properly designed, they can greatly enable the circular economy.
Designing the revenue model along with the product can align economic incentives with environmental impacts, so the company has an incentive to design products for longer lives.
Both the company and the customer can benefit financially from longer‑lived products billed as services.
Not all product service systems are sustainable environmentally or socially, but if properly designed, they can greatly enable the circular economy.
Implementing circular design strategies through co-creation
An action-research case in the household goods sector
This study examines how co-creation can facilitate the adoption of circular design strategies in product development, including longer-lasting products, repair, refurbishment and recycling. The research was conducted in collaboration with a multinational company producing small household goods. The goal of this research was to explore how the co-creation process can support the implementation of circular design strategies in the product development process. [...]
...
This study examines how co-creation can facilitate the adoption of circular design strategies in product development, including longer-lasting products, repair, refurbishment and recycling. The research was conducted in collaboration with a multinational company producing small household goods. The goal of this research was to explore how the co-creation process can support the implementation of circular design strategies in the product development process. [...]
Integrating Circular Economy Principles in the New Product Development Process: A Systematic Literature Review and Classification of Available Circular Design Tools
A Systematic Literature Review and Classification of Available Circular Design Tools
Nowadays, the circular economy represents a promising strategy for achieving sustainable development through optimising resource efficiency, extending product lifespans, and reducing environmental impacts. Despite the growing interest in circular design practices, companies often face difficulties integrating these principles into their established New Product Development (NPD) processes. This is mainly due to the overwhelming number of available design tools and methods, which are fragmented, challenging to navigate, overlap in functionality, and lack standardisation. This study provides a comprehensive mapping, classification, and analysis of 77 existing circular design tools identified through a systematic literature review and supplementary online searches. The tools were systematically categorised according to format, data type, industry sector, circular strategies, innovation focus, aims, and applicability across the NPD stages. The results indicate a predominance of physical, qualitative, and sector-agnostic tools, emphasising circularity integration within the Discover, Define, and Develop phases of the design process. This structured classification facilitates stakeholder navigation of existing resources, highlighting opportunities for more targeted, industry-specific tool development, consumer-oriented approaches, and the importance of considering Industry 4.0 technologies in circular design practice. Future research could address these gaps by developing customised frameworks, validating tool effectiveness through real industrial applications, and promoting deeper integration of circular design tools within NPD practices and business objectives.
...
Nowadays, the circular economy represents a promising strategy for achieving sustainable development through optimising resource efficiency, extending product lifespans, and reducing environmental impacts. Despite the growing interest in circular design practices, companies often face difficulties integrating these principles into their established New Product Development (NPD) processes. This is mainly due to the overwhelming number of available design tools and methods, which are fragmented, challenging to navigate, overlap in functionality, and lack standardisation. This study provides a comprehensive mapping, classification, and analysis of 77 existing circular design tools identified through a systematic literature review and supplementary online searches. The tools were systematically categorised according to format, data type, industry sector, circular strategies, innovation focus, aims, and applicability across the NPD stages. The results indicate a predominance of physical, qualitative, and sector-agnostic tools, emphasising circularity integration within the Discover, Define, and Develop phases of the design process. This structured classification facilitates stakeholder navigation of existing resources, highlighting opportunities for more targeted, industry-specific tool development, consumer-oriented approaches, and the importance of considering Industry 4.0 technologies in circular design practice. Future research could address these gaps by developing customised frameworks, validating tool effectiveness through real industrial applications, and promoting deeper integration of circular design tools within NPD practices and business objectives.
Designing Electronics for a Circular Economy
How to balance Repair and Recycling
The short lifespans and rapid innovation cycles of electronic products result in the loss of valuable and critical resources (Bakker, Wang, Huisman, & den Hollander, 2014; Baldé et al., 2024). Strategies aimed at extending product lifetimes, such as design for repair, focus on improving the ease of manual disassembly (De Fazio, Bakker, Flipsen, & Balkenende, 2021). However, connections optimized for repairability can hinder the mechanical separation of materials during recycling. This highlights a critical trade-off: improving repairability can often conflict with recyclability, emphasizing the need for balanced design approaches that address both recovery goals. Navigating these trade-offs requires a deeper understanding of how materials and connection types in electronics affect circular strategies. This research aims to investigate tensions between repairability and recyclability by analyzing a diverse set of electronic products and relating the findings to their design architecture. This study seeks to inform design strategies that optimize for both repairability and recyclability, thus prolonging product lifetime while minimizing resource losses at end-of-life.
...
The short lifespans and rapid innovation cycles of electronic products result in the loss of valuable and critical resources (Bakker, Wang, Huisman, & den Hollander, 2014; Baldé et al., 2024). Strategies aimed at extending product lifetimes, such as design for repair, focus on improving the ease of manual disassembly (De Fazio, Bakker, Flipsen, & Balkenende, 2021). However, connections optimized for repairability can hinder the mechanical separation of materials during recycling. This highlights a critical trade-off: improving repairability can often conflict with recyclability, emphasizing the need for balanced design approaches that address both recovery goals. Navigating these trade-offs requires a deeper understanding of how materials and connection types in electronics affect circular strategies. This research aims to investigate tensions between repairability and recyclability by analyzing a diverse set of electronic products and relating the findings to their design architecture. This study seeks to inform design strategies that optimize for both repairability and recyclability, thus prolonging product lifetime while minimizing resource losses at end-of-life.