This master thesis studies the role of health insurers in stimulating the transition towards circular hospitals in the Netherlands, addressing a critical gap in current research. The Dutch healthcare sector contributes significantly to national carbon emissions, with hospitals being major contributors. As the government targets a fully circular economy by 2050, understanding how health insurers can facilitate this transition is vital.

Conducted within a master thesis internship at Zilveren Kruis, the largest Dutch health insurer, this research employs a complex systems perspective. The methodological framework consists of three phases, primarily using system diagrams and semi-structured interviews. The first phase involved a literature study and interviews with health insurers, leading to the development of the Insurer-driven Circular Hospitals model. The second phase included additional interviews with health insurers and hospitals to identify the effects of possible interventions and system barriers. The third phase focused on substantiating the responsibility roles of health insurers, based on the interviews.

Findings show that health insurers can use their financial, facilitating, and connecting roles to stimulate circularity in hospitals. Eight potential interventions were identified, with the most promising being: going into conversation with hospitals to provide suitable support, sharing good examples to enhance knowledge exchange, and offering financial support to counter financial barriers. Additional interventions include improving the measurability of hospital progress, including circularity criteria in procurement policy, collaborating with suppliers, collaborating with all health insurers, and involving patients.

The research highlights that achieving circular hospitals is a shared responsibility within the healthcare sector, necessitating collaborative efforts. The study contributes to the existing knowledge base by applying a systems approach to circular healthcare, validating known barriers such as financial constraints and procedural standards, and emphasizing the importance of awareness and collaboration. Future research should expand the participant base, explore system transformation approaches, quantify intervention impacts, and broaden the definition of circular hospitals to include recycling strategies.

This project aims to answer the question of how cross-plant safety can be improved in a general way, including the prevention of domino effects. The main research question is: How do we improve collaboration between companies in a chemical cluster, in so that an overall safety gain is achieved? From the literature review and the interviews a list of the main drivers and impediments have been created.

There are 10 drivers that drive cross-company collaboration on safety: (1) Economic benefits, (2) Reduction of safety and security risk, (3) Support of decision-making on the prevention of domino effects, (4) Improvement of efficiency in safety training, (5) Improvement of efficiency
of safety management, (6) Improvement of safety inspection and maintenance of infrastructure, facilities and services that are related to domino effect prevention, and a few more that are removed due to confidential matters.

Additionally ten impediments have been found that hamper collaboration on cluster safety: (1) Communication and information sharing impediment, (2) Knowledge gaps, (3) Mistrust among companies, (4) Collaboration costs, (5) Difference in interest, (6) Insufficient policy and legislation support, (7) Cluster risk identification and recognition gaps, (8) Confidential issues and restrictions from mother company, and a few more that are removed due to confidential matters.

The conventional QRA framework is not build for cluster-wide safety and could be improved. The improved QRA includes a loop for additional analysis of installations that are affected by escalations of other installations. Further research could be done in analysing the link between types of collaborations (sharing information, learning from each other, sharing facilities & equipment, etc.) and the drivers and impediments.