The transition to reusable medical products in NHS hospitals in England and Wales: A theoretical domains framework informed qualitative study

Carrie D Llewellyn, Anya Robinson, David Cameron, Rosie Hillson, Rachel McLean, Petar Tabakov, Frances Mortimer and Mahmood F Bhutta

PLOS Sustainability and Transformation, 2026, vol. 5, issue 10, 1-15

Abstract: The National Health Service (NHS) faces environmental and financial pressures linked to the widespread use of single-use medical devices. Transitioning to reusable alternatives presents an opportunity to reduce waste, carbon emissions, and long-term costs while maintaining clinical outcomes. This study examined the readiness of NHS Trusts and Health Boards across England and Wales, United Kingdom, to adopt high-priority reusable products and identified barriers to implementation. Semi-structured qualitative interviews were conducted with stakeholders across clinical, procurement, and sustainability roles. Interviews were guided by the Theoretical Domains Framework (TDF) and supplemented with elements of the NASSS-CAT framework to explore behavioural, organisational, and systemic influences. Data were analysed using Framework Analysis and reported in accordance with COREQ guidelines. Thirteen NHS organisations participated. A common implementation structure emerged involving procurement teams, clinical leads, infection prevention and control (IPC), and decontamination services. Approval processes typically required clinical protocols, risk assessments, and senior leadership sign-off. Despite successful pilot initiatives, permanent adoption was often hindered by staff turnover, unclear governance, and financial hesitancy. Key barriers included the absence of a standardised implementation framework, limited leadership engagement, insufficient training, capital constraints, and inadequate infrastructure. Fragmented procurement systems and poor visibility of reusable options within NHS Supply Chain catalogues further impeded uptake. Risk perceptions within IPC teams varied widely across organisations. In conclusion, system-level leadership, governance, and infrastructure must be strengthened to support the transition to reusable medical products. A flexible, standardised implementation framework aligned with NHS quality improvement structures is needed. The role of patients and the public in this transition remains underexplored.Author summary: This study investigates how NHS Trusts and Health Boards in England and Wales are preparing to transition from single-use to reusable medical devices, addressing urgent environmental and financial challenges. Through qualitative interviews with stakeholders in clinical, procurement, and sustainability roles, the research identifies key behavioural, organisational, and systemic influences guiding the adoption of reusable products. Analysis revealed that implementation typically depends on multidisciplinary engagement—procurement teams, clinical leads, infection prevention, and decontamination services—requiring clinical protocols and senior leadership support. However, widespread adoption remains limited due to staff turnover, fragmented governance, capital constraints, and inconsistent risk perceptions regarding infection prevention. The lack of a standardised framework and incomplete visibility of reusable options within NHS procurement systems further complicate uptake. Strengthening system-level leadership, governance, and infrastructure, alongside a flexible yet standardised implementation framework, is essential to foster sustainable transformation. The study highlights the need for greater engagement with patients and the public in driving sustainable change in healthcare.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pstr00:0000283

DOI: 10.1371/journal.pstr.0000283

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