Healthcare Industry Research

Healthcare Industry The Problem

One person, per day produces 8kg of waste

Waste in healthcare a setting in Australia is a growing concern for officials, noting that the problem is becoming so large it's hard to understand the extent of the problem (Terzon, 2019). The Healthcare system is complex on its own with many internal and external systems that contribute to the production of waste, them being: Internal System Waste Production in Hospitals e.g., Water usage, Energy , Single use items, Packaging Inventory Procurement / Ordering Waste management Infrastructure and Planning Patient care

5,000 tonnes of plastic waste is produced in Australia.

External System Waste Disposing Different suppliers / vendors Transportation of Goods Manufacturing of products Packaging Legislation / Regulations

Australian Hospitals contribute to

7%

The Context

Matthew Bowles: n11073047 Winston Fong: n10624155 Joseph Dwyer: n11079461 Team 2 ID6

Waste Produced Australia generated 43,000 tonnes of clinical waste from public and private hospitals every year.

PVC represents.

5-10% of all total waste in Australia

Of all Australian emissions

For our chosen context, we have decided to focus on sustainability in a health care setting. There are many contributing sectors that make up the large amounts of waste produced in hospitals around Australia. As a group we have identified key areas of waste production with them being:

1 nurse will go through 10 single plastic gowns and 25 pairs of disposable gloves

1. Procurement / Inventory Levels 2. Hospital Waste 3. Recycling / Disposing of waste.

We have analysed these systems using different types of graphs to determine key areas for opportunity.

Waste Produced In the Health Care Industry Statistics

92% of waste from operating theatre was misplaced.

Clinical Waste costs

10 times

more than regular waste

Procurement of goods and services results in

3.58kg

90%

Waste produced per patient treated.

Of Health care emissions

REFERENCES:

35,722 kilotonnes Of carbon emissions produced in the healthcare industry

98% of single use plastics are made from fossil fuels.

Less than 10% of plastic is recycled.

Disrupting Australia's approach to medical waste. (2021, July 29). Retrieved April 4, 2023, from https://www.anu.edu.au/news/all-news/disrupting-australia%E2%80%99s-approachto-medicalwaste#:~:text=%22One%20person%20per%20day%20can%20produce%20around%208kg, was%20around%2043%2C000%20tonnes%20per%20year%2C%22%20Ryan%20says.

Environmental sustainability in health care - 2019. (2020, June 03). Retrieved April 4, 2023, from https://www.ama.com.au/position-statement/environmental-sustainability-healthcare-2019 Terzon, E. (2021, October 13). Healthcare workers are 'dressed in oil' during COVID. they want something to be done about it. Retrieved April 4, 2023, from https://www.abc.net.au/news/2021-10-13/healthcare-waste-covid-plastic-recyclingreusing-hospitals/100533552

Sustainability in Healthcare Brain Dump The Brain dump allowed us to map out the entire Health care system where waste would be prevalent or where it would contribute to the waste produced. From here then utilizing more maps to further find more problem areas in more detail. Key areas for importance are: Many different types of waste need to be put into certain bins; it's hard to keep track of which bin the waste must go into resulting in incorrect recycling numbers.

Waste management after it's been compiled together from around the hospital is on a large scale.

Brain Dump

Waste management is usually handled by janitor staff and supervisors.

Incorrect amount of waste figures can lead to the amount of stock being over or under-ordered.

Advantages It gave us a broad overview of the entire system which helped us identify areas of problem.

Gave us a few ideas it's which direction we wanted to take.

Disadvantages Didn't go to in-depth because of the size of it.

We found it to be overwhelming, due to the large scale.

Best Aspects Initial research and compiling the research.

Worst Aspects Had to research in-depth.

We found it to be lost in research without the specific research.

Stakeholders Stakeholder Insights During our Stakeholder Mapping, many insights presented themselves, not just about who is part of the waste disposable process in a hospital, but how they are involved in the process.

Stakeholder Map

Seniority of medical staff has a direct correlation to how involved they are in the waste disposal system of the hospital.

The more senior you are, the less you have to do with throwing away used medical products, taking out bags to the large bins in the loading dock, and taking the waste ways in a large rubbish truck.

Many non-medical and non-waste management professionals in a hospital are not educated in and do not make use of all waste disposal units (Sharps, General, Infected Plastics, Infected Waste and Glassware).

Leverage Points Goals, structure, rules, delays and parameters arises due to the mindset or paradigm of the system

Advantages You are able to see stakeholder's relation to the problem as well as their connections and hierarchy between stakeholders The combination of multiple systems provides a broader perspective.

Disadvantages No specific information about the stakeholder's job description can be shown.

Best aspects Having a visible hierarchy in the waste management of the hospital system (very specialised) can insight new opportunities.

This hierarchy allows us to see from the stakeholder's perspective of the system.

Worst Aspects This required the combination of multiple systems.

REFERENCES:

20 Highest Paid Non-Physician Jobs in Healthcare. (2019). Healthcare-Management-Degree.net. https://www.healthcare-management-degree.net/highest-paid-non-physician-jobs-in-healthcare/ admin. (2020, November 7). Disposable Syringe Manufacturing Process (Guide for Manufacturers) | Operon Strategist. How to Start the Manufacturing of Disposable Syringes. https://operonstrategist.com/how-to-start-manufacturing-of-disposable-syringes/ SHARPS WASTE SEGREGATION GUIDELINE. (2018). https://uwaterloo.ca/safetyoffice/sites/ca.safetyoffice/files/uploads/files/sharps_waste_segregation_guideline_v.1.0_july2018.pdf The Hospital Medical Hierarchy Every Pre-Med Should Understand. (2019, April 23). MedSmarter Prep. https://www.medsmarter.com/blog/hospital-hierarchy-every-pre-med-should-understand/

MIM

Advantages

Using a MIM map, we mapped out waste along the whole system. From what type of waste to where it ends up and also different factors that can influence waste management and consumption through the system. In the MIM map, the MIRCO circle shows specific types of waste and the most concerning wasteful items. The INTERMEDIATE circle shows influencing factors and also broadens the range where the specific waste goes. The MACRO lens shows the overarching framework and other influential factors.

It provided us with the opportunity to research deeper into the types of waste.

Able to analyse the system in which waste takes.

We were able to map out the key influences of waste management

Department of Health Victoria. (2021). Cleaning and waste disposal procedures - infection control. Www.health.vic.gov.au. https://www.health.vic.gov.au/infectious-diseases/cleaning-andwaste-disposal-procedures-infection-controlHealth-care waste. (n.d.). Www.who.int. Retrieved April 5, 2023, from https://www.who.int/news-room/fact-sheets/detail/health-carewaste#:~:text=Of%20the%20total%20amount%20of%20waste%20ge nerated%20byHow to manage healthcare waste sustainably. (n.d.).

Cleanaway. https://www.cleanaway.com.au/sustainablefuture/medical-waste-segregation/Sondashi, D. (2020, November 19).

List Of Disposable Items Used In Hospitals - Kmed-Leading infusion set manufacturer,disposable medicals supplier.

Https://Www.kmedhealth.com/. https://www.kmedhealth.com/listof-disposable-items-used-in-hospitals/

Disadvantages Can only focus on one component of the system.

Found it hard to focus on one component.

Best Aspects

Leverage Points

Provided the framework to add information.

Guided the research.

Structure of information flow.: Reporting of waste can have effect on the communities, recycling companies and regulatory bodies.

Rules of the system (such as incentives, punishment constraints,) : Strengthen the rules around wastage can have a heavy effect on the health care system.

MACRO

REFERENCES:

Worst Aspects Didn't know the reach of the map.

Had trouble not staying on topics of waste tracking

Journey Map

INTERMEDIATE

Highlights real examples of issues Displays personal touchpoints and feelings.

Worst Aspects

Disadvantages Only viewed through one perspective.

Biased in a way through the creator.

Daily Scenario

Name: Amy Medical Waste Facilities Manager Age: 36 Gender: Female Relationship: Single Income: Under $60,000

A typical day for Amy includes monitoring the various forms and levels of waste that flow into her department. Whether it be hazardous or infectious waste, these materials are treated very carefully. The different categories of waste include General, Sharps, Biohazardous, Radioactive, Cytotoxic

Isn't always an accurate representation. of a real individual

Roles and Responsibilities Overseeing the design, implementation and inspection of waste disposal systems, including waste disposal sites and recycling facilities Maintain inventory of waste on site Review generation rates of different streams of waste

Phase 1

Phase 2

Phase 3

Phase 4

Action

Persona

Sets clear objectives for change.

Collecting the forms of rubbish from each department. Wheeling the bin unit down to the waste management area.

Categorizing and sorting the waste to prevent contamination, sealing up the infectious waste bags.

Putting the waste into the correct dumpsters, ready for the recycling external companies to take away.

Monitoring the levels of each waste category. Each category of rubbish has to be compared against the national benchmark to ensure proper wastage levels.

Thinking

MICRO

Best Aspects

Advantages

This map of a specific persona was included so that a physical example of waste tracking through hospitals could be viewed. By laying out direct interactions Amy has with waste disposal and categorizing the complex forms of waste in her hospital, it forms personal touchpoints in which we can see her everyday process.

"Covid 19 has made this entire process a lot harder for all of us, these are filling up fast"

"A lot of this could be sterilized and re used"

"The levels of general waste have been ever increasing, it feels like it won't ever stop"

"We need to do something about all this single-use plastic packaging, the levels are so high"

Journey Map

MIM Map

Hospital Waste & Disposal

Inventory and Procurement is another area where their waste is an issue, in terms of over ordering, tracking stock and tracking wastage products, where there is a direct link to how much waste is produced to how much a hospital orders.

Advantages The PACT analysis allowed us to mind the connection between the stakeholders and their responsibilities.

It highlighted the technologies which can be disrupted.

Highlights the collaboration between the consumer and provider team.

P.A.C.T Analysis The use of a PACT Analysis allows you to understand the role of technology and the impact it has on the people function and the broader workforce (CIPD, 2022) Using this PACT Analysis were we able to analyse the procurement, inventory management and stock use in a hospital setting. Identifying our key stakeholders for each context and following the flow to see where we were able to find an opportunity for improvement.

Disadvantages Only highlighted the procurement and not the cost analysis.

Doesn't highlight negative influences that could disrupt the system.

Best Aspects Creates a structured approach where you're able to connect each context.

Can follow the main flow and then the branching aspects of that context.

Leverage Points The structure of material stocks and flow: Changes made to the Manufacturing aspect may have any effect to procurement of items.

Power to add, change, evolves, or self- organize system structure: Promoting new way of manufacturing and sustainable measure will ultimately reduce waste in healthcare.

REFERENCES:

ou =;, c=AU; o=The S. of Q. ou=Queensland H. ou=; (n.d.-a).

Enhancing Queensland’s supply chains Queensland Government Critical Supply Reserve. Www.health.qld.gov.au.

Retrieved April 5, 2023, from https://www.health.qld.gov.au/systemgovernance/suppliers/critical-supply-reserve/enhancingqueensland-supply-chainou =;, c=AU; o=The S. of Q. ou=Queensland H. ou=; (n.d.-b). Order delivery requirements.

Www.health.qld.gov.au. Retrieved April 5, 2023, from https://www.health.qld.gov.au/systemgovernance/suppliers/information/order-deliveryrequirementsou =;, c=AU; o=The S. of Q. ou=Queensland H. ou=; (n.d.-c). Purchase orders (POs). Www.health.qld.gov.au.

Retrieved April 5, 2023, from https://www.health.qld.gov.au/systemgovernance/suppliers/information/purchase-ordersou =;, c=AU; o=The S. of Q. ou=Queensland H. ou=; (n.d.-d). Standards and specifications Queensland Government Critical Supply Reserve.

Www.health.qld.gov.au. Retrieved April 5, 2023, from https://www.health.qld.gov.au/systemgovernance/suppliers/critical-supply-reserve/standardsspecificationsou =;, c=AU; o=The S. of Q. ou=Queensland H. ou=; (n.d.-e). System Procurement. Www.health.qld.gov.au. Retrieved April 5, 2023, from https://www.health.qld.gov.au/systemgovernance/suppliers/procurement

Worst Aspects It's not user-focused, so it doesn't highlight pain points.

If one system or contexts is changed then the whole system becomes affected.

Journey Map

Thinking

Action

This specific persona and journey map was included to represent the physical procurement and restocking journey of an individual very familiar with the amount of waste being produced. We get a first-hand account of Jason's day-to-day roles and the thoughts he has every time he utilizes needles.

Although Jason represents a small section of the supply and demand for hospitals, we can see the large amounts of waste that he has to contribute to.

Persona

Daily Scenario

Name: Jason Registered Nurse Age: 27 Gender: Male Relationship: Engaged Income: $80,000

No day is the same being a nurse for Jason. Jason works day shifts in a private practice, and begins the day by assisting with ADL activities. He takes his usual lunch break and could be doing anything from checking vital signs to administering life saving medicine through IV needles.

Roles and Responsibilities Assessing patients vital signs Administering necessary medicine Supervising EN's and junior RN's Taking detailed notes about patients medical history and current symptoms Drawing blood samples Implementing and assessing care plans

Phase 1

Phase 2

Phase 3

Phase 4

Jason looks up the stock on the inventory system to see the levels. Jason retrieves a packaged needle from the stock cupboard

Jason forgets to record that he's taken that object from inventory. Jason uses unwraps the needle and uses it to take a blood sample from a patient.

He then throws away both the single use packaging into the general waste, as-well as the needle itself into the sharps bin.

Jason notices that when he goes back to the inventory room that some of the syringes had expired so he throws them away in the general waste.

"I wonder how many of these I unwrap each day, it feels like far too many"

"This is all for a good cause though, without these I don't know what I'd do"

"I have to throw both of these away every-time, its very disappointing"

"Perhaps someone could implement a sterilisation system for these needles" "I feel bad for throwing away these they look fine"

Journey Map

P.A.C.T Analysis

Inventory & Procurement

Opportunities As a team, we have identified 5 areas for opportunities through leverage points in our graphs, in each opportunity we have also added a few sub-sections which dive a bit deeper into the individual opportunities to highlight more specific areas for disruption.

Through the knowledge of Impact Lab 3, we have identified 3 SDGs goals that apply to the area of focus for our project, following the recommendations for change from the United Nations, this helped us further identify opportunities.

Manufacturing

Procurement

Through the use of the maps, we were able to identify a key area of importance in the manufacturing stage when reducing waste in the healthcare industry.

Obtaining new stock from suppliers, in a sustainable manner.

1. How might we improve the manufacturing process of medical products through the use of emerging technologies?

2. How might we reduce the wastage produced in the healthcare industry by better-improving material selection in the manufacturing process.?

The Australian medical product manufacturing industry hasn't shown a lot of innovation in the past year sticking to what works and what can be approved.

Health and Safety laws and regulations, which new innovations cannot compromise.

Packaging is a big issue currently facing the health care system, with many single-use items being packaged in these plastic packets.

A key area for concern is that single-use items are being disposed of incorrectly and ending up in landfill instead of being recycled properly.

1. How might we influence the health industry into choosing more manufacturing/suppliers who adopt sustainable measures into their process?

REFERENCES:

United Nations. (2015). Goal 12 | Department of Economic and Social Affairs. Sdgs.un.org; United Nations. https://sdgs.un.org/goals/goal12United Nations. (2021). Goal 11 | Department of Economic and Social Affairs. United Nations; United Nations. https://sdgs.un.org/goals/goal11United Nations. (2022). Goal 13 | Department of Economic and Social Affairs. United Nations; United Nations. https://sdgs.un.org/goals/goal13

Waste Management

Education

Reducing waste that ends up in landfill / incineration that creates a toxic environment around the area is the ultimate goal however is an ongoing problem facing the health care industry.

Ultimately the reduction of waste is on the stakeholders who contribute to the large amounts, and changing the lack of knowledge around waste consumption will ultimately reduce the waste.

Tracking how much stock is being used is also to be identified as a growing area of concern.

1. How can we educate hospital employees to become more conscious of the amounts of products they go through per day?

2. How we might better identify new inventory that arrives in the hospital?

1. How can we reduce the amount of waste that ends up in landfill, through the use of recycling sterilization and repurposing?

Influencing suppliers, to deliver their goods in sustainable packaging instead of pallets and plastic wrapping of boxes.

2. How can we reduce the amount of wasteful water used in a healthcare setting through the laundry?

Selecting suppliers that use sustainable manufacturing materials and methods in the production of disposable single use items.

Items that are thrown away in hospital waste are either thrown in landfill, recycled, or incinerated depending on their chemical properties.

Incinerating waste that contains chemicals pump harmful gases into the Earth's atmosphere. Landfill can affect the soil around it, contributing to large amounts of carbon emissions produced.

Redesigning products that can be either sanitised, recycled or repurposed for other options.

Identifying the area between safely sterilizing certain items without compromising patient safety

2. How can we educate hospital employees to follow proper disposing of waste?

Understanding the cost of single use items compared to the cost of recycling.

Education on where items can be used and where they don't so the overall amount of each item is reduced.

Providing a more complex system, in which each product can be disposed of so that hospital members are disposing of correctly.

Provide knowledge to the hospital workforce so they better understand recycling and its purpose to make them aware of the consequences of overuse.

Inventory Management

1. How can we better improve the identification of different types of waste?

The process of recording inventory and tracking how much of each product is used, is a problem area in terms of record keeping which influences ordering, creating a surplus in stock, expired goods and duplicating items.

Keeping a record of how much of each waste produced is used, is a guideline for Queensland Health, however keeping these records accurate is difficult because of the large amounts of waste being disposed of incorrectly.