What can we do to achieve sustainable development of our medical products in the future?

An external impulse based on the doctoral thesis by Diana Mitsch

Consumer expectations with regard to products are shifting: People are demanding more transparency in the development, production and distribution channels of everything from consumer goods and food products to vehicles and medical technology. The “Green Product Design” initiative, launched as part of the ZEISS Key Group Program “Sustainability”, is making it clear that we too will be developing medical technology in a sustainable manner in the future. ZOOM MED is on the hunt for an external impulse.

Point of departure
The context
Evaluation schemes
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The point of departure for sustainable product design

Characteristics of sustainable products

Sustainable product design involves the interplay of ecological, social and economic criteria that come together to form a complex web of sustainability-relevant requirements. From resource, material and component procurement to production, use and end of life, all phases of the product lifecycle involve aspects of sustainability.

The challenge for medical technology companies

The number one priority in the design of medical technology is the adherence to directives, legal provisions and compliance requirements. With regard to the product definition, (international) remuneration systems also play an important role. It is not uncommon for political and societal demands to come into conflict with existing directives and requirements. “Medical products are not manufactured with environmental protection in mind, but rather to provide the earliest, fastest and most accurate diagnoses and treatment possible of illnesses and injuries.”1

Sustainable lifecycle management for medical products

Taking sustainability requirements into account in the design of products is an extremely complicated endeavor and one which requires knowledge of many facets as well as interdisciplinary collaboration. Mitsch sets forth a framework for sustainable lifecycle management, lifecycle assessment (LCA) from cradle to grave, which makes it possible to analyze product-related environmental and sustainability aspects and their impact on the entire product lifecycle. According to Mitsch, each team involved in the specific definition of a product should include an expert for environmental requirements.2

Products in the context of sustainability

Ecologically sustainable products

We are all familiar with the idea of the ecological footprint. On the one hand, nature provides us with raw resources. On the other hand, it also takes on the role of a sink for emissions, waste water and garbage. The more consistently we think about how to reduce resource consumption and emissions and about reuse and recycling processes, the more ecologically sustainable are products will be. As Mitsch shows, there are a multitude of tools available for ecological design, but the analyses are performed late in the product lifecycle. Instead, these should be placed at the beginning.

Socially sustainable products

Medical technology aids the early detection, diagnosis and treatment of illnesses and hence contributes to health care — a criterion of social sustainability which enables recovered patients to once again participate in everyday society and to contribute to the gross national product. According to Mitsch’s description of this criterion, it is possible for a single system and its far-reaching functionality to shape the health care system in a lasting way (such as in the case of ZEISS Gold Standards). In addition to this, she recommends transparent communication (brochures, for example) regarding product design (manufacturing conditions, background information), as this strengthens customers’ trust in a product.

Economically sustainable products

To operate economically, companies need to keep their systems on the market as long as possible and ensure that they have long product lifecycles. As Lauric Weber emphasized in a ZOOM MED interview, this is exactly what ZEISS products stand for. According to Mitsch, economically sustainable products are also defined by the risks they are associated with: Parameters designed to work against long-term damage to the environment and the company’s image must be set out in the early stages of the product’s lifecycle. Another criterion is the accessibility of the product to a broad class of consumers and which responds to global primary medical care. According to Mitsch, economic sustainability can benefit not only from modular system designs (ZEISS Cataract Workflow) but also from software updates, connectivity and offering basic models (e.g. ZEISS TIVATO Essential).

Indicators and evaluation schemes for sustainable products according to Mitsch

A framework for creating a model for sustainable product design:

Mitsch’s work shows that established models for analyzing sustainable product design often only look at one sustainability characteristic and that the tools available also have shortcomings. First and foremost for the implementation of ecodesign there exist detailed analysis tools that provide Mitsch with a certain framework [ISO 14040] into which she integrates economic and social aspects. According to Mitsch, the specific requirements placed on the development of sustainable medical products stem from the macro environment [see the illustration].

Requirements from the macro environment placed on the development of medical products (illustration based on Mitsch 2018, fig. 40, p. 205)

Dealing with information deficits:

Information deficits which make it difficult to evaluate sustainability aspects in the early definition phase of a product are considered uncertainty factors. Mitsch recommends using available empirical data and information in public databases as well as applying the environmental due diligence method, which requires that all actors along the product lifecycle operate with due diligence.3  Due diligence aids the preventative and systematic assessment of risks and is performed in accordance with checklists that, according to Mitsch, should cover the following criteria for the definition of a product:4

  • Existing and future legal restrictions (restricted product contents); product approval requirement
  • Requirements resulting from competition and the market
  • The establishment of other (voluntary) obligations, such as an expanded product take-back strategy or eco-labels

Surveys as data collection methods:

In order to identify effects of individual product characteristics that are potentially relevant for sustainability, it is necessary to collect data repeatedly during product development. For this, Mitsch recommends using standardized quantitative surveys that allow for the inclusion of open-ended questions. During the early phases of product development — the so-called "fuzzy front end of innovation" — these survey are answered by the experts (i.e. the production definition team) themselves. During the later phases of development, non-experts (customers) are asked the same questions. The repeated collection of data over a longer assessment period ultimately makes it possible to compare the results.5

Risk analysis:

According to Mitsch, risk management processes are another way to minimize existing information deficits. For her, they are used specifically to collect data regarding resource availability and resource scarcity. The goal should be an objective consideration of intergenerational justice — consequences should not be deferred to other geographic regions or passed on at the expense of future generations. The evaluation criteria should take into account ecological (environmental risks), economic (strategic use) and social risks (political risk).6

Specific indicators for medical products:

Mitsch specifies a series of industry-specific indicators for product-related sustainability which she describes in concrete terms for medical products within the framework of the macro environment and which she assigns specific metrics. For Mitsch, these form the basis for potential evaluation schemes and can be seen as levers for analysis and sustainable product design which should be integrated into the individual product lifecycle phases at the beginning of the product lifecycle:7

FORMEL:

Product sustainability analysis = lifecycle assessment + risk analysis + quantitative surveying

Industry-specific, generic indicators for product-related sustainaility (illustration based on Mitsch 2018, fig. 39, p. 204)
  • Environmental impact e.g. product contents whose impact assessment can be performed using the risk analysis developed by Mitsch.
  • Innovativeness e.g. surveying a product's sufficiency in terms of reimbursement capability and hence the possibility of billing the use of the product through the patient or health insurance provider (quantitative survey for product expert team and users).
  • System functionality depends heavily on the users. Open-ended questions can be used, for example, to ask users about their preferred type of diagnostic imaging (color or black-and-white).
  • External communication should make it possible to gather information about how the product and its use is perceived and should show what is done with the product at the end of its lifecycle (quantitative survey for product expert team and users).
  • Mitsch does not provide any specific metrics for internal communication, but she does provide her own draft of a process model.8
  • 1 The statements and illustrations presented on this page are based on the work of Diana Mitsch: Das Design nachhaltiger Medizinprodukte (The Design of Sustainable Medical Products), Wiesbaden 2018 (here p. 9).
  • 2 See Mitsch 2018, p. 56f
  • 3 See Mitsch 2018, p. 184, 187f and 222f.
  • 4 See Mitsch 2018, p. 187f
  • 5 See Mitsch 2018, p. 189ff
  • 6 See Mitsch 2018, p. 196ff
  • 7 See Mitsch 2018, p. 207ff
  • 8 See Mitsch 2018, “Praxistest” from p. 232.