109 - What's Up With the Single-Useness? Inside Hospital Routines with Heidi Annala
The Sustainable Healthcare PodcastShow Notes
Hospitals use many single-use products.
So why do the disposables stay?
Heidi Annala studies the routines and protocols that keep single-use in place, and explains why reaching for a single-use item is often not really a choice.
About the guest: Heidi Annala is a PhD candidate in the Environmental Policy Group at Wageningen University & Research. She works in "How we act", the work package on hospital culture and care professionals' practices in ESCH-R (Evidence-based Strategies to create Circular Hospitals), a Dutch research consortium coordinated by Erasmus MC, the university medical centre in Rotterdam. Her fieldwork takes her inside hospital departments, from a dialysis ward in Utrecht to obstetrics in Rotterdam.
Three things you'll take away: Single-use is often not a choice. In the wards Heidi observed, there is often one product for a given clinical need, so the disposable is simply how the job gets done. As some staff told her: "Well, I don't have a choice."
Ask about practices, not individual behaviour. Instead of "why is somebody not doing what I want them to do?", Heidi asks "why is this way of doing things normal?", which opens cultural, material and organisational routes to change.
Nobody changes a protocol alone. Microbiologists and infection prevention specialists tend to come up, and because protocol work sits on top of clinical work, change can meet friction even when nobody opposes it.
Timestamps: 00:00 Cold open 00:36 Welcome, and the link to episode 088 with Nicole Hunfeld 02:08 Meet Heidi: Wageningen, ESCH-R and the "How we act" work package 04:48 What is a hospital protocol? 06:26 When going against protocol is good practice 07:48 The problem statement: what's up with the single-useness? 09:53 Practices versus behaviour versus products 12:28 Fieldwork on a dialysis ward 17:25 Low-hanging fruit? Dialysate bags and specialist knowledge 20:34 Is reaching for single-use really a choice? 23:09 What might be driving single-use, and a detour into the US reuse market 30:28 Where protocols come from, and who can change them 35:10 When protocol work sits on top of clinical work 37:23 What gives Heidi hope
References mentioned: ESCH-R consortium: https://esch-r.org Dutch national clinical guidelines (Richtlijnendatabase), the kind of database Heidi describes: https://richtlijnendatabase.nl Clifford Geertz, "Deep Hanging Out", The New York Review of Books, 1998: https://www.nybooks.com/articles/1998/10/22/deep-hanging-out/ M.C. Escher's work: https://mcescher.com
Links: Heidi Annala on LinkedIn: https://www.linkedin.com/in/heidiannala Heidi's profile at Wageningen University & Research: https://www.wur.nl/en/persons/h-heidi-annala Environmental Policy Group, Wageningen University & Research: https://www.wur.nl/en/chair-groups/wageningen-sustainability-governance-hub/environmental-policy
You might also enjoy: Episode 088, Circular material flow of medication in the intensive care unit, with Nicole Hunfeld and Jasper Klasen (ESCH-R): https://carepathwayconsulting.com/podcast/podcast-episode-088/ Episode 087, Sustainability insights from 290 nurses and clinicians, with Michael Maagaard: https://carepathwayconsulting.com/podcast/podcast-episode-087/ Episode 097, Visualizing Circular Healthcare: A Taxonomy for Sustainable Medical Device Flows, with Tamara Hoveling: https://carepathwayconsulting.com/podcast/podcast-episode-097/
Host links: Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/ Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/ Care Pathway Consulting: https://carepathwayconsulting.com
"I think what is a more interesting question that a practice perspective lets you ask is: why is this way of doing things normal? Why is this routine there, and why does it look the way it does?" Heidi Annala
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