The healthcare sector in the Netherlands is responsible for about 7% of the CO2 emissions. The Erasmus Medical Center (EMC) has committed to enhancing its environmental sustainability efforts by signing the Green Deal 3.0. This agreement sets ambitious targets for the EMC, including a 55% reduction in CO2 emissions by 2030 compared to the 2018 Green Deal Samen Werken Aan Duurzame Zorg (Green Deal 3.0) | Greendeals, n.d.). These targets are ambitious and call for immediate action.
The endoscopy department is found as the third highest largest contributor to hospital waste (Siau et al., 2021). This highlights the importance of improving the sustainability of the endoscopy department to meet the set targets.

This project set three main goals:
1. Creating an overview of all the consumables within the workflow of HCPs used in colonoscopy procedures at the Erasmus Medical Center.
2. Identifying and addressing the environmental impact hotspots of colonoscopy procedures.
3. Enhancing the sustainability of the reusable colonoscope with a redesign.

To achieve the first goal, the Product Journey Map method is used. Data on waste streams and the human interactions during the use of the colonoscope are gathered through observations and interviews conducted at the endoscopy department at the EMC.

After visualizing the Product Journey of the colonoscope in the EMC, it was easier to identify the environmental impact hotspots. The Value Hill model with the R-strategies was used to design sustainable interventions, to reduce the environmental impact of the hotspots. The identification of the environmental impact hotspots and the design of sustainable interventions are also carried out in a co-creation session with HCPs. Mapping out the colonoscopy procedure in a visual, including waste streams and human interactions, accelerated the ideation process with HCPs.

Furthermore, the focus of this project was on redesigning the colonoscope to enhance its sustainability. To achieve this, the literature was first explored to compare single-use with reusable colonoscopes. It became clear that implementing single-use colonoscopes would result in a 40% increase in net waste mass compared to reusable colonoscopes (Baddeley et al., 2022). However, one of the advantages of single-use colonoscopes was that they were easy to use. This was as an inspiration for the redesign of the reusable colonoscope which detects maintenance on time and prevents the damage that can occur during the use of it.

Finally, all the designed sustainable interventions and the redesign of the colonoscope are compiled into a revised Product Journey map. This revised PJM compares the new ideas with the practices, illustrating how the environmental impact of colonoscopy procedures can be reduced.

This master’s thesis presents a comprehensive redesign of the vaginal speculum, an essential yet historically problematic device used in women’s healthcare. The project focuses on addressing three main issues: enhancing patient comfort, fulfilling physician needs, and ensuring environmental sustainability. This work aims to resolve the persistent discomfort and anxiety associated with pelvic exams, which are exacerbated by the current design of the speculum, while also considering the environmental impact of the healthcare sector.

The vaginal speculum has seen little change since its invention in 1845, despite its controversial history and the discomfort it causes to patients. Traditionally, its design prioritized the needs of healthcare providers, often neglecting the experience of the patient. The discomfort caused by the device has been a significant deterrent for women undergoing gynecological examinations, contributing to delays in the diagnosis and treatment of various health conditions. While some modern adjustments have been made—such as the shift from reusable metal speculums to single-use plastic versions—these changes have increased the environmental burden of healthcare, particularly in the context of global greenhouse gas emissions.

The project followed the three diamond design method, encompassing the phases of Discover, Define, Ideate, Conceptualize, Develop, and Deliver, to create a new speculum design. The process began with an in-depth exploration of the needs of three primary stakeholders: patients, healthcare providers, and the environment. This included literature reviews, hands-on explorations, and interviews to understand the diverse perspectives and challenges faced by each group.

The resulting design, named "Lilium," integrates patient-centered features such as improved ergonomics, reduced invasiveness, and enhanced aesthetics to alleviate patient discomfort. For healthcare providers, the design offers a more efficient and user-friendly tool that facilitates better access and visibility during examinations. In terms of sustainability, the Lilium speculum is designed for reusability, with a focus on materials that reduce environmental impact while maintaining high standards of hygiene and safety.

It is widely known that the healthcare industry is under pressure. On one side the costs keep increasing while on the other side the push to decrease environmental impact grows (Capolongo et al., 2015). Within this graduation project circular methodologies will be used to make a step in decreasing the environmental impact of the healthcare sector. Findings from report 2.1 from a consortium called DiCE are used intensively. One of the aims for this project is to contribute to this consortium as well. As a case study, the focus product is the electrocardiogram (ECG) lead set. A set of cables that are used to measure heart frequencies. Within the impact of the ECG lead set, the increase in the use of single patient use (SPU) lead sets is a problem. This results in the lead set system having more impact. The solution for this is the multi patient use (MPU) lead sets. But with MPU lead sets other problems pop up. To get more hospitals to switch (back) from SPU Lead sets to MPU lead sets multiple aspects are important. First is cleaning. Interviews, observations and research show that MPU lead sets are harder to clean (Albert et al., 2010). The next aspect is the quality of the MPU lead set. Prolonged use increases the risk of a lower quality lead set. Which could result in needless extra alarms and so in dangerous alarm fatigue for the nurses (Albert et al., 2014). To ensure quality a quality control system on lead sets will need to be implemented. Further important aspects for designing for a MPU lead set in a circular proposition would be the durability of the lead set and the ease of use within a hospital system. The proposed concept tackles these problems in the following way. The lead sets are monthly deep cleaned and checked on quality by a centralized cleaning department. The MPU lead set itself is redesigned to be easier to clean and a special cleaning tool is developed to help with cleaning. Combined this will create a system in which the MPU lead set will be a viable solution for hospitals again.

This study explores nudging strategies to improve user abilities in order to promote the voluntary return of digital health products, with a focus on the smart pillbox. The two objectives were to create specific design recommendations for the smart pillbox and derive general design guidelines to support a circular lifecycle for future digital health innovations. The study revealed four key design aims: enhancing user abilities, establishing reliable return mechanisms, reducing participation barriers and exploring the wide range of potential applications.
The investigation combined thorough analysis, engaging users and refining designs through iterations. The key findings emphasized the crucial factors of product hardware design and strategic communication in influencing users' abilities and willingness to return the smart pillboxes. Innovations in designing smart pillboxes, such as state switches, clear printed instructions, and digital reminders, have been introduced. Preliminary validations suggest that they are effective, but there is a need for further research to explore their combined impacts. Interestingly, this research highlights the importance of "Returners" as crucial stakeholders in the product return ecosystem. This underscores the need for tailored comprehension and design to meet their unique requirements.
Although the recommended guidelines have the potential to benefit a wider range of smart health devices, it is essential to validate them with more extensive participant groups. It is worth noting that the current research mostly focused on user ability, however, future studies are encouraged to explore the motivation dimension, which participants identify as a critical factor. This would help create a holistic approach to encourage voluntary product returns.