Mapping circular economy product and material flows in healthcare
A visual taxonomy
Tamara Hoveling (TU Delft - Design for Sustainability)
Jelle Ijzenbrandt ( Erasmus Universiteit Rotterdam)
Saba Hinrichs-Krapels (TU Delft - Policy Analysis)
Linda Ritzen (TU Delft - Design for Sustainability)
Wichor M. Bramer (Erasmus MC)
Erik van Raaij ( Erasmus Universiteit Rotterdam)
Jeremy Faludi (TU Delft - Design for Sustainability)
Conny Bakker (TU Delft - Design for Sustainability)
Jan Carel Diehl (TU Delft - Design for Sustainability)
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Abstract
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.
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