Reducing waste in the healthcare sector

A recent study that explored the amount of waste generated in New South Wales, Australia, found that the healthcare system was responsible for 8% of the waste generated in their economy, with hospitals taking up a large part of this sector. Though not all healthcare waste can be recycled, much of it can be but is not.

Speaking to Geoff Paine, Lena Jungbluth discusses her PhD research in exploring the drivers and barriers that contribute to behaviours of poor waste separation in hospital settings. According to Lena, some barriers identified include poor infrastructure for proper waste separation, time-poor hospital staff, insufficient amount of recycling bins, poor access to specific bins for staff, and lack of resources that enables recycling of specific materials.

Grab a coffee, press play, and enjoy this episode of Pocket Change, Reducing Waste in the Healthcare Sector: 

Pocket Change is a series of pocket-size videos about a key aspect of behaviour change.  Each episode features a BehaviourWorks Australia Researcher explaining their area of expertise in a clear and simple manner.  

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Transcript

GEOFF

Hi everyone. This month I'm speaking to Lena Jungbluth, who is a Ph.D. candidate and researcher here at BehaviourWorks Australia. So, many of us may not understand how big the problem is when it comes to hospital or health care waste.

LENA

Yes, the health care system creates huge amounts of waste. So there was a study done a few years ago that looked at waste generated in New South Wales and they found that the health care system was responsible for 8% of the waste generated in the New South Wales economy. And so that's that's obviously the whole health care system and hospitals make up a large part of that.

GEOFF

And did this problem get worse during COVID with all the PPE and all that equipment?

LENA

Yes, absolutely. So COVID generated a lot more waste. And I mean, you're probably all familiar with stories that we've seen at the time of how much more waste it created. I remember certainly reading a lot of articles in different outlets around various waste studies that the stories of the health care system.

GEOFF

Can all health care waste be recycled?

LENA

No. So it depends on what we're talking about when we're talking about health care waste. And there is different terms used for different waste types. It's not always 100% consistent, but generally in health care we've got hazardous waste and non hazardous waste. So hazardous waste is anything that, for example, has blood on it and hazardous waste has various different types like things that are pretty much of a general waste, but also recyclable waste which looks reasonably similar sometimes to what you find in your household.

Like paper, it can be cans, metals, glass. And then there's also specific streams and hospitals that you get or health care that you predominantly find there that can be recycled. Like they, for example, have a sterilisation wrap for them to keep instruments sterile. So that's a specific stream that is recyclable. Some hospitals recycle their single use metal instruments, so that's metal. And I think there's also some existing research that's quite exciting where they're looking into the recycling new products like face masks. And so there's obviously ongoing research around how you can recycle more and more products.

GEOFF

What are some of the drivers and barriers to hospital waste recycling?

LENA

So there is lots and actually they also can differ. So depending on which hospital you look at, the drivers and barriers might be different. But just looking at the literature, what seems to come up pretty consistently is, for example, a lack of space to put additional bins. So a lot of hospitals, they were built in different times and then they're looking at, you know, where can we actually put more recycling bins or take those recycling bins and move them on.

They just run into space issues. So that's a pretty common one. Related to that then is obviously access to bins, because if you can't fit another bin, you can't recycle certain material. If there is no bin for you to do that and there's various other barriers and drivers in the in the literature, one that also comes up a fair bit is sort of the provision of information and lack of knowledge around, you know, what can and can't be recycled and what other sort of detailed rules around that.

And another barrier we can find is, for example, a lack of the recycling system. So there is various materials that could be recycled, but you don't necessarily have a recycler who can deal with them. And I mean, we see this right now because of plastics crisis that there has been challenges around where to put this material once it's been separated and put somewhere for further processing, there obviously needs to be somebody who can take that, there's challenges around that sometimes as well.

GEOFF

So when it comes to hospital waste and recycling, who needs to do what differently, and has this been studied before?

LENA

That is a really good question. It's actually a fairly complex interaction of various different behaviours that you find when you talk about hospital waste recycling, because you have various people, staff groups who in the first place need to sort the recycling material appropriately, so place the materials in the appropriate bin in various streams, obviously. But then it doesn't stop there because then you have a nicely sorted bin which needs to be transported on or the material from within that bin needs to be transported on.

So you've got then the people who are responsible for that, like it can be technicians, it can be cleaners, depending on how the hospital is structured. So you need them to take that stream appropriately to the next location. Then there might be another group who takes it from there to say, the basement or the waste dump or whatever. So there's various sort of steps where this waste goes and you need all these groups to do the appropriate waste management behaviour for the recycling chain to function. So depending on again, I think it depends very much also on the hospitals next. Some are really well set up with that. Others are more in the infancy of setting up recycling processes.

So it's hard to answer this as a sort of silver bullet answer of who needs to do what differently. It's just more working out; who are the actors involved in a given hospital and what do we need them to do? And then checking like, you know, does this already work or do we need to tweak things at a certain stage while others are okay?

GEOFF

Okay, Tell us about your waste audit and waste mapping. This is quite a complex task, isn't it? Because there are so many interconnected teams and individuals.

LENA

It was a big task, but I absolutely loved it. So so having done a previous project, that sort of gave me an insight into what I'm dealing with when I'm talking about behaviours in the waste management area, in hospitals. I knew from my PhD that I needed to get a really good understanding of, you know, who is involved in the waste management. And so in my Ph.D., I'm partnering with the Royal Melbourne Hospital in Melbourne here, and specifically with the operating theatres. And so in the waste mapping, what we did is basically we mapped out exactly like who is dealing with which waste in which theatre location, and then also how does this waste go in the first bin and how does that content from that first bin go into the next bin and who is basically involved with that?

Basically what I just talked about before, how does the waste flow all the way through the hospital until it reaches the waste dock where it's getting picked up by the recycler or the the waste contractor? And we then had a really good overview of, you know, all the different behaviours and staff groups who are performing those behaviours that are involved in the process and with the waste audit.

So essentially doing this map and doing it to the level of detail that we did, we came up with over 180 waste management behaviours, which was obviously way too many to work with, even if it's a PhD of three and a half years. And then we did a number of different prioritisation activities, but one of them was the waste audit, to help us understand, you know, which streams actually have room for improvement when it comes to recycling, because, you know, we just mapped out all the behaviours that existed, that didn't mean that they all had issues with them. Some of them were working perfectly fine. So we just needed to have a look at the actual waste data and see, you know, how much recyclable materials are we finding in the general waste and so forth.

GEOFF

So if you've got 180 different waste management behaviours, how do you prioritise where to begin when you've got so many to choose from?

LENA

Yes, that's another good question that I was thinking a lot about in my Ph.D. because there exists really good tools in the behavioural science literature about how you can prioritise different behaviours. A lot of them assume that you need behaviours that are pretty much independent from each other, which in my case wasn't so much applicable because, as I said before, like, you need the first person, you need the next person, you need the third person.

So they're pretty much interlinked. So we use the map that we had created to work out, you know, where can we start? And did a bit of a group discussion around which behaviours are already working and which aren't. And what we found then in the process was that a lot of the behaviours that had issues were predominantly on the sorting level where people put items in the bin.

So that particular hospital had the transport side pretty much worked out. And it was mainly, you know, putting the right items into the right bins. So that already narrowed it down a lot. And then we could apply some of the existing methods to sort of prioritise like Sarah Kneebone's impact likelihood matrix, which we've talked about in another pocket change.

And yeah, we also used the waste order then to find out, you know, which streams have room for improvement and yeah, so essentially after a long back and forth, various conversations, we then landed on soft plastics recycling and the related sort of plastics recycling behaviours as a priority behaviours for my Ph.D. moving forward.

GEOFF

So, and this may be too big a question, who or what can make the most difference?

LENA

That, again, depends on your local context. I would say like it depends on if you, for example, have a hospital that doesn't have any recycling streams, providing staff with recycling bins, and the processes behind that would probably make a big difference. If you have a hospital that already has all this and it's still not happening, you are obviously looking at other intervention options to get that behaviour happening.

So I think it really depends on the particular facilitators or drivers and barriers in a circumstance that you're working in.

GEOFF

And where are you at with your PhD and your research and your studies - are you close?

LENA

I think so. So I have completed on my data collection as of last month, which is very, very exciting. So now I just need to write everything up for publication and I'll do that next year because I'm having a baby first.

GEOFF

Well, I think the baby takes priority. That's a good prioritisation. Lena, thank you very much.

LENA

Thank you. Thanks for inviting me.

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