“You mean you just want me to throw all that packaging away? There’s enough waste here to fill three trash cans!” The fact that we repeatedly get feedback like this during patient interviews these days highlights just how important the environmental impact of a product has become. Safety and efficacy still come first for patients of course, but their sensitivity to sustainability is becoming increasingly influential when it comes to evaluating treatment regimens. 

It’s the radical innovators who will unlock a sustainable future for medical devices.

Patients who suffer from chronic disease tend to be better informed about therapy options and are often confident about making their own care decisions. Environmental considerations don’t just affect their perception of the various treatment options but have the potential to contribute to long-term brand loyalty. 

Unsurprisingly, medical device manufacturers are responding and engaging with the sustainability conversation that’s flowing across industries. When it comes to action, many are initially looking inwards to make their activities more efficient and realize quick wins in terms of environmental impact and cost savings. That’s all well and good, but it’s important they don’t forget downstream factors in a product lifecycle.  

A product can have an impact on the environment throughout its life. But the final steps associated with its end-of-life management are often left entirely to the patient end user, who is often the least set up to address them from an environmental perspective.  

In the case of medical electrical equipment, standards such as the International Electrotechnical Commission’s 60601-1-9 requires the manufacturer to provide instructions for minimizing environmental impact during use. It also stipulates information on proper disposal at the end of life. But this only goes so far. I believe there is an opportunity to improve the way we design medical devices to reduce environmental impact associated with their use and end-of life-management. There are also better ways to design the patient’s user experience to support environmentally responsible behavior. 

User-facing design considerations  

Packaging design directly impacts sustainable considerations throughout the product lifecycle. It also has a big effect on product usability and brand perception. Balancing medical considerations such as sterilization, child proofing and labelling requirements – with the desire to reduce the amount of material and material types from a sustainability perspective – can be challenging.   

Smaller, single material or easily dividable packaging solutions could reduce waste and support improved recycling. Alternatively, multi-functional packaging enables reuse and an extended lifetime for those products. Either route provides opportunities to reduce packaging waste and support a more sustainable experience.  

Other sources of environmental impact during the home use of medical devices include energy, water and chemical usage. They are associated with using the device itself or complementary activities such as cleaning. Developing a product with a well-designed cleaning process – less frequent or one that does not require harmful chemicals for example – has advantages from both sustainability and usability standpoints. It makes it more likely and easier for the user to clean the device and causes less environmental impact while they do so. 

A successful cleaning process will also reduce the environmental impact of the device by allowing it to be useful for longer. Removing drug residue will maintain mechanical function, for example. Charging of electromechanical devices is another potential area for improvement. Considering ways to conserve power usage and motivate good charging behaviors – display time outs, limited use of charging docks and so on – through product design could help support responsible use.  

Many home use medical devices end up in the household garbage – including sharps, biohazard, chemical and electronic waste. But products and experiences can be designed that reduce the amount of waste generated by making them smaller, increasing product lifetime, enabling less frequent use or making more of the system reusable. Supporting proper recycling – with design for disassembly, for example – and proper disposal and/or reuse of appropriate components can also ensure a positive end-of-life experience. 

While sharps containers are widespread and, in many cases, now distributed alongside products in pharmacies, they must be taken to appropriate locations for disposal. Similarly, electronic waste must be delivered to alternate sites. Meanwhile, devices like metered dose inhalers, which have no sharps or electronic components to them, require their own disposal stream due the presence of drug product and the canister. As most patients are not set up to easily and properly dispose of these products, and cannot reuse them, there is an opportunity to provide a positive touchpoint in reclaiming them for proper disposal and, where possible, reuse.  

Motivating behavior change  

Designing more sustainable medical products is only half the challenge. Getting users to then actually perform sustainable behaviors often provides a steep obstacle for many companies. Interventions to encourage activities such as energy saving or recycling are often developed without a systematic method, or without drawing on evidence and theories produced in the behavioral and social sciences. They often lead to failure. The biggest mistake companies often make is to try to search for the magic bullet that will force people into action, only considering one type of intervention to bring about behavioral change.  

Behavioral science research has shown that magic bullets rarely exist. Instead, what is often needed is to plan in a variety of interventions. One of the most notable models of behavior change is the COM-B model developed by researchers at University College London. This states that in order to change behavior, one must have the capability (psychological and physical), opportunity (physical and social) and motivation (automatic and reflective) to do so – and all three conditions must be met at the same time. By using frameworks such as the COM-B model, designers can start to research and identify what are currently key barriers and promoters of sustainable behavior. 

For example, simply educating users on proper end-of-life management through a pamphlet or product branding and labelling (improving psychological capability) will not change behavior if people have limited access to the appropriate disposal or recycling facilities (poor physical opportunity) and are eager to get rid of the device immediately (poor automatic motivation to hold on to it until it can be disposed of properly).   

Providing a buy back, return or upgrade program which allows users to quickly and easily send back their devices – and potentially receive a reward towards future treatment – may provide users with the opportunity and motivation in terms of responsible end-of-life management. 

University College London academics have also developed behavioral change techniques (BCTs) which can be used to inspire solutions to support desired behaviors. Applying them to medical development will require considerations across the design of the product, its packaging, branding and supporting business case. But it is this kind of comprehensive approach to a sustainable user experience that will encourage responsible use and end-of-life management.  

By taking such a route, companies are not just supporting their sustainability initiatives. They are improving the patient’s experience, improving the patient’s perception of the manufacturers brand and encouraging loyalty. That loyalty will endure as the patient goes from the end of life of one device to the start of their experience with the next. Designing a truly sustainable patient experience really does pay dividends – so please do drop me an email if you’d like to discuss the topic in more detail.  

Karen Unterman
Director, Human Factors & Applied Strategy, Boston Medical Technology