Healthcare is a major contributor to the negative effects on the environment, leading to adverse effects on the physical and mental health of people globally (IPCC, AR6). The Dutch healthcare sector alone is responsible for 7-8% of the national carbon footprint, 4,2% of total waste and 13% of raw material extraction (Steenmeijer et al. 2022).
This project was set up in three main parts to identifying opportunities for sustainable interventions in colonoscopy procedures for the EMC gastroenterology department. Throughout the project, a human-centered design approach was maintained. Research was done in literature on sustainability in healthcare and environmental impact of endoscopy, empirical context research and material flow analysis (MFA) in the form of a waste audit.

Based on circular strategies Reduce and Recycle, the research outcomes were synthesized into an intervention that aligns to the EMC's policy statements for sustainability:
- reduce waste with 10%
- increase recycling with 20%

Waste audit data was used as an input for co-creating with endoscopy nurses, where the focus was put on retrieving plastics from GMW because of their significant contribution to total emissions when incinerated (López-Muñoz et al., 2023).

Ideation was done in co-creation sessions to solve the problem of integrating waste segregation inside the complex environment of a colonoscopy treatment room for current system boundaries.
Outcomes
While it is ideal to implement higher R-strategies for designing out waste early on in the process, waste cannot be ruled out completely. Therefore, implementing a waste segregation system in the endoscopy treatment room presents an opportunity to enhance waste management in EMC and align with sustainability goals.
The proposal is a demonstration rather than a product concept, to show small incremental changes within the current system boundaries can help achieve the EMC goals. The intervention was estimated to reduce the weight of incinerated GMW with at least 40% with segregation of plastic products, and additional 16% by disposing of absorbent products in TONTO. Additional research is needed to determine the true recyclability potential of the plastics.
With the foresight of the implementation of new products in the system and a circular model where materials of these products have to be kept in the loop, the endoscopy nurses will be equipped and trained to accomodate these changes, and maintain sustainable practices.