"Everyone finds sustainability important, and that's how it stays on the agenda."

The environmental impact of our healthcare is substantial. The sector consumes abundant resources, generates non-circular waste, and contributes to 7 percent of CO2 emissions in the Netherlands. Professor dr. ir. Jan Carel Diehl aims to significantly reduce this impact. "As industrial designers, we are the negotiators, facilitators, and provocateurs in the sustainability process."

Jan Carel Diehl is a professor at the Faculty of Industrial Design at Delft University of Technology and has recently been appointed as a Medical Delta professor at the Erasmus MC.

You have been appointed as a Medical Delta professor. What does this mean for you?

"It is a tremendous honor for me. Earlier this year, I became a professor in Delft, and now, I am also a Medical Delta professor at Erasmus MC in Rotterdam, where I reside. This dual appointment makes it quite special.

As industrial designers, we work in a highly interdisciplinary manner, and this appointment reinforces that. It is also a commitment for the long term. Although we already have a living lab together, I was always a visitor at Erasmus MC. I had a pass, but it only granted access to the bike shed and our Living Lab. This appointment signifies that we are all proud of our collaboration, and it demonstrates our commitment to intensify it.

Sustainability in healthcare is a relatively new topic, spearheaded by Frank Willem Janssen within Medical Delta. He will soon retire from LUMC, offering a great opportunity for me to take over. While everyone acknowledges the importance of sustainability, the challenge is to keep it on the agenda. With this Medical Delta appointment, I can continue and strengthen the theme."

Can you briefly describe your expertise?

"As a designer, I have a broad expertise. My chair at TU Delft is 'Design for Inclusive Sustainable Healthcare,' consisting of two parts. One aspect involves making the healthcare system inclusive in the global south, where large groups have limited or no access to healthcare. The other aspect focuses on reducing the environmental impact of our current healthcare system, ensuring long-term sustainability. This primarily applies to the Netherlands and Europe.

There are also crossovers. Healthcare in the global south often faces limitations and shortages, leading to a frugal use of resources. We can certainly learn from this. On the other hand, healthcare in the south is rapidly expanding, making it crucial to initiate sustainability efforts now.

Within my Medical Delta professorship, sustainability and reducing environmental impact take precedence."

How do physicians, designers, and technologists complement each other in this context?

"The call for sustainability has emerged from the medical sector itself, a bottom-up approach. The sector then invites others to contribute their thoughts, considering the multitude of perspectives that need innovative solutions. Designers can assist in mapping out situations and perspectives as a basis for new solutions. These solutions involve both a medical component and a design and behavioral aspect.

Occasionally, we need to say, 'This is unique and unusual

A typical engineer might delve deeply into technical details, but initially, it is about creating a holistic picture rather than immediately designing a new device. Many factors come into play, and we need to collectively understand and implement interventions. Industrial designers function as negotiators, facilitators, and provocateurs in the sustainability process. Occasionally, we need to say, 'This is unique and unusual.' The peculiar thing in hospitals is that there are many protocols, but the practice sometimes deviates. The uncharted territory is vast, and we help to map it out."

How do you involve practical aspects in your research?

"You have to be willing to get your hands dirty and do things. For instance, we are working on a holder for plastic hospital gloves. Students create a prototype, and we take it back to the hospital department to validate what works in practice. This approach is much faster than fully designing something beforehand. Another example is our exploration of remanufacturing equipment. We created short films from a fictional company, 'Medflow,' situated in the heart of Rotterdam, collecting all equipment. Such videos are essential to envision how the future might look. It provides an idea, an image, leading to the necessary discussions."

What is it like to start collaborating with someone from a completely different discipline?

"I have collaborated extensively with LUMC, focusing on the global south. What I find enjoyable and significant is that we are growing closer to each other. They had to get used to us a bit.

As an industrial designer, I think in terms of solutions, while medics think in terms of evidence-based research. Fortunately, there is an increasing understanding of the approach in parallel

For example, we explored using a mobile phone to detect parasites in a blood sample. One approach is a strict adherence to evidence-based research, spending five years in the lab before understanding its practical implications. We did it differently, sending a student into the field with a simple prototype to gather opinions. This way, you understand the end-users needs at an early stage. Initially, LUMC found it a bit unconventional.

As an industrial designer, I think in terms of solutions, while medics think in terms of evidence-based research. Fortunately, there is an increasing understanding of the approach in parallel. We can learn a lot from each other and accelerate together. Sometimes, my trial-and-error approach works well, but for subsequent studies, an evidence-based approach might be more suitable."

What do you miss in your collaboration to achieve your goals? What call would you like to make?

"I hope that we will consolidate our knowledge more effectively. There is so much happening in the field of sustainability. How can we ensure that we can use each other's knowledge and know what everyone is doing? I don't have the answer yet, but I believe this appointment contributes to that."

You are currently working mainly with hospitals to make healthcare more sustainable, even though most healthcare occurs outside hospitals. Why is that?

"A hospital is an enormous hub with a constant influx and outflow of people. It is said that Erasmus MC consumes as much energy as the entire municipality of Barendrecht. Starting there makes sense as quick wins can be achieved. The thought process begins in the hospital, but we also examine the environmental impact of a care pathway and how to reduce that impact.

We stand at a crossroads; healthcare is evolving. We have the current sector and the question of how we can improve that system. On the other hand, we contemplate the healthcare of the future, incorporating Artificial Intelligence, more home-based care, and personalized healthcare, among other innovations. How can we anticipate ensuring that the new system is inherently sustainable? This also extends beyond hospitals. New devices are emerging, like self-monitoring devices for heart health. To implement them, the device must first reach the patient. However, you also need to consider how it returns for reuse or recycling. How do I close that loop? Perhaps by providing patients with direct instructions on how to use and return it."

The most sustainable care is probably care that is not given. How do you view this?

"Standardizing care makes work and measurement easier. However, if we make healthcare more personalized and deviate from the one-size-fits-all approach, we have choices. We can prevent unnecessary or environmentally burdensome treatments. For example, suppose you can choose between a treatment with an environmental impact equivalent to flying around the world once or a treatment that involves five times around the world with a 1 percent higher chance of success. What would you choose? Some patients are already asking these questions. For instance, in childbirth, there are different routes with varying environmental impacts.

We need to carefully consider why we do things and reassess established norms

Even for necessary treatments, there's room for improvement. Treatments are sometimes prepared but not administered because someone does not show up. Or someone has eaten when they were supposed to fast. This is not only related to sustainability but also to costs. We need to carefully consider why we do things and reassess established norms. When a patient leaves the intensive care unit, the unit is cleaned. Previously, unused items were routinely discarded during this process. In certain cases, this is entirely unnecessary. You need to discuss these matters with common sense.

Another example is an electronic pillbox. One might question its necessity, but if it helps the patient take medication at the right time and adhere to prescriptions, the individual stays healthier, and we prevent the need for more care. It's about a life path and deciding where to intervene."

What can healthcare professionals who want to adopt greener practices do?

"Firstly, continue the current momentum. A lot is happening at Erasmus MC, with a high level of commitment at all levels. New ideas emerge bottom-up, and top-down ensures their implementation. Harmonizing these two aspects can be improved. It involves zooming in and out. Sometimes, there are small things that do not fit into the system, and there is a larger system hindering small improvements. Progress must happen at both levels. It's beneficial to occasionally descend or climb back up."

With your current position, you will likely meet more scientists from different disciplines and institutions. Whose work has genuinely surprised you, and why?

 "Nicole Hunfeld, from the Intensive Care department at Erasmus MC, is very open-minded and thinks like a designer: not stating 'this is how it is' but questioning 'why is it like this.' She is deeply involved in practice and must advance a complex topic like sustainability from there. I find it incredibly impressive how she does that.

The openness of medical professionals, in general, is great. I get asked by everyone to step into the treatment room. 'Put on a white coat and come along.' Then you find yourself standing next to a scanner for hours. The willingness to share is significant. They also occasionally visit Delft. Their creativity is invigorated there. Rediscovering the ability to work on the level of simple mock-ups, building prototypes from cardboard. Reintroducing playfulness. It does not have to be completely crystallized. We are all creative, not just designers, but sometimes, we need to rediscover that in ourselves."

Want to get involved in making healthcare more sustainable? This page contains some helpful signposts.