Making circularity in healthcare work: lessons from practice and research

The environmental impact of healthcare has never been so visible. Hospitals operate in highly complex environments where large volumes of materials are processed, resources are used and waste is generated. As innovators in this space, we believe new healthcare solutions should not further increase this impact and, where possible, even actively help reduce it. Through the Design 4 Circularity subsidy call of Circular Flanders, we had the opportunity to investigate how circular principles can be meaningfully integrated into our work. Together with AZ Sint-Jan Bruges and DC Venturing, we explored how circular thinking can shape both products and business models in healthcare. This article is our reflection and an attempt to bring nuance into a debate that is often simplified.

When circular practices meet operational reality

Hospitals have been relying on circular practices for decades. Surgical instruments, for example, are designed to be reused over long periods of time. They are used during surgery, cleaned in the sterilization department and returned into circulation again and again.

In our work with hospitals, however, we repeatedly observed how inefficiencies in surgical instrument management undermine the effectiveness of this circular practice. Instruments move through complex workflows involving multiple teams, handovers between different departments, and obligated checks. Many of these steps are still executed manually, such as counting instruments after surgery.

In practice, this leads to incomplete sets before and after surgery, misalignment between the operating room and sterilization department, and limited transparency across the instrument flow due to fragmented communication and a lack of digitisation. When these structural limitations accumulate, they put pressure on daily operations and weaken the performance of an otherwise circular system.

One consequence of this pressure is a growing shift towards single-use instruments. Not because they are superior, but because they reduce complexity. Single-use instruments remove the need for tracking and reprocessing. From an operational perspective, they offer predictability. From a sustainability perspective, they are a step backwards. High-quality products are discarded after being used once, simply because the surrounding system cannot reliably support reuse. When reuse becomes hard to manage, the system gravitates toward disposal.

This illustrates an important point: circularity in healthcare depends on whether the surrounding processes make circular behaviour workable in practice. If circular solutions add uncertainty or workload, they will be bypassed.

Fixing the system before scaling circularity

Before thinking about circular business models or environmental impact, the underlying system must work. Circularity only becomes meaningful when products solve real operational problems in daily practice. That’s where our focus lies: strengthening the workflows around reusable assets so that circular choices become reliable, efficient and scalable. Within the Design 4 Circularity project, we therefore deliberately started with a very concrete question: can we reduce the time and effort spent managing surgical instrument sets after use?

Addressing this pain point has a clear environmental effect. By making the management of reusable instruments more reliable in daily practice, hospitals are less likely to drift toward single-use alternatives. In addition, improved process reliability has a secondary impact: it reduces the number of unnecessary sterilization cycles, and with that the use of water, energy and packaging materials. This way, improving operational efficiency does not change the circular principle itself, but strengthens it and reduces the environmental impact that results from inefficiencies.

When attempting to quantify this impact, we encountered another structural challenge: the lack of reliable, consistent data. Measurements often depend on manual reporting and fragmented systems, making it difficult to calculate environmental impact with confidence. Without stronger digital foundations, hospitals struggle to actively steer on sustainability, even when the ambition is there.

Beyond products: circular business models

The challenges observed at the level of products and processes are not unique. They also surface when organizations attempt to translate circular principles into their business models. In theory, models such as Product-as-a-Service align well with circular thinking: the supplier retains ownership, remains responsible over the full lifecycle, and is incentivised to design durable, repairable and upgradable solutions. Hospitals, on the other hand, benefit from lower upfront investments and more predictable service. A no-brainer, right? Implementing such models in practice is far from straightforward, especially for startups. Retaining ownership requires significant upfront capital, while revenues are spread over time. It demands mature operational capabilities for asset management, maintenance, refurbishment and reverse logistics, as well as reliable partners to support these activities. A circular business model is therefore not just a pricing decision, but a long-term organisational commitment.

For that reason, we did not approach circular business models as an all-or-nothing choice. Together with DC Venturing, we explored circular value modelling as a continuum: from classic sales models with circular design principles, to more service- and outcome-oriented approaches over time. This allows circularity to grow alongside organisational maturity — both for technology providers and for hospitals.

The bottom line

Circularity rarely fails because of missing ambition. It fails when it performs worse in practice than the linear alternative. As long as circular solutions introduce uncertainty, friction or additional effort, they will be bypassed — regardless of how strong the sustainability argument is.

For companies, the takeaway is clear: a circular solution must be at least as effective in daily practice as the linear one it aims to replace. Whether through better products, processes or services, circularity has to improve how systems function, not complicate them. The same realism applies to circular business models, which are long-term commitments that need to grow in line with organizational maturity. Ultimately, circularity becomes sustainable when the changes it requires are compatible with how organisations can realistically operate and evolve.

‍