A recent study from Ethicon and the Cleveland Clinic outlined opportunities and barriers to better sustainability practices in operating rooms. We spoke with Vishnu Kalra, President of U.S. Ethicon, to learn more about the study’s findings, Ethicon’s efforts to develop more sustainable products and practices, and how other companies can support hospital’s sustainability initiatives and reduce their environmental impact.

What led to this study and Ethicon’s involvement in improving sustainability in ORs?

Kalra: Our approach to sustainability is deeply grounded in our understanding that human health and environmental health are fundamentally linked. As one of the world’s largest and most broadly based healthcare companies, we take our position to make a difference on a global scale seriously. This goes beyond innovative products. We also want to ensure that we are making a positive societal impact and delivering a positive environmental impact. That is part of our value system and how we think is an organization.

We have set aspirational goals, such as 100% of our electricity will come from renewable sources by 2025, achieving carbon neutrality for all of our corporations by 2030, and reducing absolute upstream value chain emissions by 20%. Today, 65% of Johnson & Johnson’s global electricity comes from renewable sources and in Europe 100% of our electricity is currently from renewable sources.

When you take that to a product level, that includes looking at opportunities for recovery, reprocessing, recycling and or reuse when designing products. We also do a lot of work across the industry to educate our end users on end-of-life management of our products to drive this agenda of sustainability.

This led us to partner with the Cleveland Clinic to identify and analyze HCP and hospital decision-maker beliefs and perceptions of sustainability in the operating room, both in the U.S. and around the globe. The study outlined some of the key barriers to sustainability, and it really helped us understand that although HCPs and surgical staff are very keen to participate in sustainability initiatives, they cite a lot of barriers that prevent their participation. These include lack of awareness, lack of education, lack of guidance on how to improve sustainability and recycling, and lack of funding at the hospital level to effect these changes.

Do you have any advice in terms of first steps a hospital or HCP could take if they want to start addressing some of these barriers?

Kalra: Absolutely. The first step is asking, what is problem we are solving? This helps everyone identify the challenges, perceptions or beliefs, and opportunities.

We engage with hospital groups around the world to determine opportunities for us to engage and partner. For example, we partnered with a hospital system in Germany to put a recycling/waste segregation program in place. Even though there were barriers that were identified by the institutions and the HCPs, we worked with them to come up with solutions that were meaningful and customized to that specific hospital system. That program allowed the hospital to recycle specific metals and plastic components from both Ethicon and Biosense Webster products. Through this program we salvaged materials such as steel, titanium, aluminum, copper, etc. from more than 25,000 single-use products in 2021 and 2022. Not everything is reusable, but we reused what can be reused and also helped the hospitals quantify the carbon footprint impact that exercise had. The program also covered things such as aluminum-based packaging that we were able to recover and reprocess.

There is no one size fits all approach. Different hospital systems have different regulations. You start with what problem do you want to solve and what are the key challenges? Then you partner with the different hospitals to come up with solutions that can be implemented.

What can device manufacturers do in their own facilities to develop sustainable products?

Kalra: There are loads of initiatives related to packaging. For example, there are suppliers that are diverting waste from landfills to develop technologies that turn the waste into new materials. In 2022, Ethicon entered into an agreement with Eastman to purchase its copolyester for medical device trays. Eastman is a global specialty company that produces a broad range of materials and chemicals. By purchasing its copolyester, we were able to attribute a portion of the weight of each tray to materials that Eastman collects for recycling. With each tray, we are able to divert waste from landfills and support new recycling technologies that transform this hard-to-recycle material into plastics.

We have also identified opportunities to reduce the overall packaging weight and box size for our surgical procedural kits, which has resulted in a 20% reduction in post-consumer waste.

Are there any industry-wide efforts where other MedTech developer and manufacturers can learn from what others are doing?

Kalra:  We are all early in our sustainability journeys, and there’s a lot of great progress happening not just in our industry but across all Industries. This is going to require everyone to come together—no one company will have all the answers. But this is where our industry plays at its best, in sharing best practices and seeing how we can collectively make a bigger impact. One of the areas that all companies are looking at is transportation—how do we drive decarbonization in the delivery of our products?

Are there any examples of hospitals or ORs that have implemented practices that people can look to as an example?

Kalra: Emre Gorgun, MD, at the Cleveland Clinic was a co-author of the study. He is a leader in medical sustainability and advocacy. In addition to partnering with hospitals, we look at our own supply chain. We are looking for partners that are sustainable in their practices and whose value systems and approach to environmental sustainability matches our own. That is also the approach that hospitals are taking. They are partnering with companies that have a like-minded approach. While Europe may be ahead in the move toward sustainability, the U.S. healthcare system is also recognizing the importance of sustainability and increasingly prioritizing working with organizations where sustainability is a priority. Typically you see more of this work happening at the academic healthcare systems, but it is certainly a priority that I am seeing across the board.

In the study, the authors mentioned that a first step may be creating a sustainability panel at your healthcare organization. Is that something you’re seeing or are you approaching individual physicians?

Kalra: Diversity of thought and diversity of input is important. These initiatives need all stakeholders. Many of our conversations are with clinicians and also nonclinical stakeholders who have a deep interest and desire to make a difference. It’s not one individual and it’s not one organization, there is a huge appetite among industry to have these conversations. In fact, we recently engaged with some of the medical societies. We often work with them on education, and they wanted our help to facilitate dialogue around sustainability. The conversation is front and center with both clinicians and nonclinical stakeholders and education is key because we are early in this journey and we need everybody’s input.