Building a Circular Economy Strategy in the Healthcare Organisations: The Role of the Group Purchasing Organisations

The UN strategy 2030 calls all actors to contribute to the achievement of the Sustainable Development Goals; among them the sustainability of healthcare systems represents a relevant target as they are considered responsible for 4%–5% of the emissions of greenhouse gases worldwide (Rodríguez-Jiménez et al., Journal of Advanced Nursing 79:2830–2844, 2023). In England, over 1.4% of supply chain emissions are due to single-use devices, some of which could be refurbished and reused, saving both carbon and money. The healthcare systems could reduce emissions from their supply chain in three ways: more efficient use of supplies; low-carbon substitutions and product innovation; and by ensuring our suppliers are decarbonising their own processes (Delivering a “Net Zero” National Health Services, Policy paper. https://www.england.nhs.uk/greenernhs .). To this regard, the extension of the lifetime of medical equipment and devices through practices like sharing, maintenance, repair, and refurbishment have been acknowledged (Wuyts, W. et al., 2020. Circular economy as a COVID-19 cure? Resources, Conservation and Recycling, Vol. 162, 105,016.). The healthcare industry is characterised by a complex supply chain; this is key to contribute to the overall performance of the industry and to support the successful implementation of circular economy (CE) strategies (Hazen et al., The International Journal of Logistics Management 32:510–537, 2021). In this context, the relationship between the supply chain members is a key determinant of the healthcare system. The original equipment manufacturers and healthcare organisations often see a third actor in the group purchasing organisations, an intermediate entity responsible for specific functions. In the healthcare setting, a variety of authors have attempted to address how the CE practice may contribute to improve the environmental sustainability (Quintana-Gallardo et al., Polymers 15:1130, 2023). Nevertheless, the implementation of CE practices faces several challenges: for instance, recycling hazardous waste requires a huge revision of the collection infrastructure and logistics, accompanied by a risk-cost–benefit and environmental impact analysis (Wuyts, W. et al., 2020. Circular economy as a COVID-19 cure? Resources, Conservation and Recycling, Vol. 162, 105,016.). Other barriers to the CE in healthcare include liability, costs, and complexity of developing and an in-house reprocessing infrastructure for single-use devices, obsolescence, and practices to discourage the disassembly by original equipment manufacturers, lack of clear standards for reusable devices reprocessing, lack of clarity on devices’ infection risks (MacNeill et al., Health Affairs 39:2088–2097, 2020). Consequently, fostering the transition of healthcare systems towards a circular economy requires collaboration among various stakeholders (MacNeill et al., Health Affairs 39:2088–2097, 2020). Based on the above premise the aim of the paper is to investigate the extent to which specific green and CE practices could be extensively routed in the government funded healthcare system and the challenges experienced in the public sector. To this regard, a qualitative study has been designed and conducted in the Italian healthcare setting, where the healthcare system is government funded, diversified on a regional base, and highly regulated. Data have been collected through online semi-structured interviews to leading actors of purchasing intermediate entities in the sector. The interviews have been recorded and transcribed and analysed through deductive thematic analysis approach (Fereday and Muir-Cochrane, International Journal of Qualitative Methods 5:80–92, 2006) to provide an overview of the extent to which it is feasible for public healthcare system to adopt CE and greening actions to contribute, through their procurement process, more effectively to mitigate the climate change. The study contributes to the stream of literature about sustainability management providing a discussion of the type of CE practices relevant to enhance the contribution of the public healthcare system to the sustainable goals, from a managerial perspective.