Penn Medicine x CHTI: Reducing Regulated Medical Waste (RMW)

A comprehensive redesign of the waste management system in the Operating Rooms (ORs) at the Hospital of University of Pennsylvania (HUP) - aimed to significantly reduce Regulated Medical Waste (RMW).

Role

Design Consultant, UX Researcher

Timeline

10 weeks, Spring 2024

Tools | Skills

Figma, Rhino, Procreate | UX Research, Industrial Design, Design Strategy

Results

Presented the redesigned waste system, which reduced mis-sorted RMW by over 10%, to design executives at HUP and the Center for Healthcare Transformation and Innovation (CHTI)
Validated concepts through user research and in-hospital A/B testing
Developed mid-fidelity, physical prototypes that served a strong foundation for further innovation
Created an interactive experience to educate healthcare workers on proper waste management, which was further developed into a hospital training procedure after we left

Overview

Background

In the healthcare sector, waste is divided into two primary categories: medical waste and regulated medical waste (RMW). RMW includes blood-soaked items, making it bio-hazardous and requiring separate disposal into a different bin. RMW is also more environmentally harmful, more labor-intensive to manage, and significantly more expensive to treat than general medical waste. Additionally, the treatment facilities for RMW are often located near disadvantaged communities, disproportionately affecting their health. Despite these serious negative impacts, proper waste management often takes a back seat to other pressing priorities that healthcare workers must address.

"How Might We Transform the Waste Disposal Process to Minimize Mis-sorted RMW?"

Through observational studies, user interviews, and in-hospital testing, our team designed both physical and systemic solutions aimed at reducing waste-sorting errors at Penn's hospital, with a specific emphasis on decreasing RMW.

Waste Practices at HUP

Out of the 5 billion pounds of medical waste generated in the US every year, the CDC recommends that only 3% should be classified as RMW.
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HUP generates nearly 10x the CDC's recommendation - with 27.9% of its total waste being RMW.

In its pursuit of greater sustainability, Penn Medicine committed in 2024 to an ambitious national pledge to significantly reduce, and ultimately eliminate, carbon emissions by 2050. Cutting down RMW is a critical step toward achieving this goal.

Research

C-Section Observations

Click image to enlarge

We observed two C-section procedures to understand how healthcare workers manage medical waste in real time — all while navigating unexpected challenges, time constraints, and the demands of prioritizing patient care.

Previous Interventions Review

We also consulted with two medical students who had previously tackled waste-sorting challenges at HUP to gain insights into the most effective initiatives and identify designs to avoid.

Intervention 1 - Educational Nurse Huddles

Monthly 30-minute educational huddles led by volunteer medical students to train nursing staff on proper waste management procedures.

Limitations

Inconsistent engagement from staff
High effort
Minimal reach and impact

Intervention 2 - Educational Stickers

Postcard-sized stickers on red waste bins, clearly outlining what items should be disposed of in the bin.

Limitations

Lack of metrics in tracking changes in mis-sorted waste
Limited visibility
Required workers to pause and read

Healthcare Worker Interviews

The team conducted formal and intercept interviews with 25+ healthcare workers to gain deeper insights into their workflows and assess their understanding and accuracy in waste-sorting. We found that:

Healthcare Workers Do Not Prioritize Accurately Sorting Waste In Their Daily Routines.

Workers overly depend on RMW bins.

The stressful demands of their roles, combined with unclear waste management guidelines and inconvenient OR bin layouts, often lead workers to discard most of their waste into RMW bins — even when it isn’t blood-soaked.

There is no personal incentive to sorting waste properly.

Proper waste sorting lowers hospital costs and minimizes environmental impact, but healthcare workers often feel disconnected from these benefits. Facing the highest infection risk from improperly sorted RMW, they commonly follow the motto: "When in doubt, throw it out (in red)."

Synthesizing Insights

Re-Imagining the Waste System

The team collaborated with design strategists at CHTI to consolidate key insights and identify primary stakeholders. It took several weeks of planning, diagraming, and collecting feedback to define a design direction and formulate a hypothesis.

Ultimately, the team hypothesized that:

Emphasizing the municipal waste bin as the default option will help reduce the amount of mis-sorted RMW.

Given the minimal impact of previous educational efforts, we opted for a different strategy— altering the OR layout and redesigning the physical bins to emphasize the municipal bins. This approach aimed to change healthcare workers' behaviors subconsciously, without requiring additional effort on their part.

Current Waste System Experience

The current OR typically has:

3 large RMW bins
1 medium RMW bin (holds suction canisters)
1 small RMW bin (kick bucket)
1 large municipal bin

The overabundance of RMW bins compared to municipal bins leads workers to frequently discard regular waste into RMW bins. Furthermore, the placement and design of these bins increases the risk of infection and requires workers to walk long distances to properly dispose of waste.

Overflowing RMW bins, consisting of 90% mis-sorted municipal waste

Inconvenient kick bucket placement forces workers to throw bloody gauze across considerable distances

Flawed canister disposal design fails to keep canisters upright, leading to the spillage of contaminated waste.

Ideation

Design Criteria

Based on research and observational insights, the team established the following design criteria for our re-imagined waste system:

The design must be intuitive and easy to use.
The design must not add to the workflow or mental load of healthcare workers.
The design must adhere to sterility standards.

New Waste System Experience

After refining our top ideas, we chose three that work together to create a more sustainable and efficient waste system. These solutions utilize the physical environment to subtly encourage workers to be more intentional about their waste disposal habits.

Solution 1 - Combo Bin

This design features a large municipal bin with a detachable smaller RMW bin attached to the side, ensuring users always have the option to utilize the municipal bin rather than defaulting to the RMW bin.

Solution 2 - Table-side Bin

This table-side bin enables users to dispose of various types of waste (municipal, recycling, and RMW) within arm's reach, removing the need to throw waste into inconveniently placed kick buckets. It features a clamp mechanism for easy mobility, allowing it to adapt to different OR layouts and worker preferences. After procedures, EVS can quickly detach the plastic bags from the bin's frame for efficient disposal.

Solution 3 - Cylindrical Canister Bin

Our third solution is a cylindrical bin specifically designed for the disposal of canisters. Its shape prevents canisters from toppling over and spilling contaminated contents. Users can easily drop used canisters into the bin, allowing them to slide down securely into a stack. A hatch on the side functions like a gate, enabling EVS to open the cylinder and effortlessly remove the canisters for disposal.

Prototyping & Testing

Lo-Fi Prototypes

The team created low-fidelity prototypes of each concept using laser cutting, 3D modeling, and modifications of existing products.

Combo Bin

Table-side Bin

Cylindrical Canister Bin

Testing

Participants (16)

Nurses, Doctors, Medical students at HUP
Familiar with OR setting and procedures

Goals

Determine whether the new waste system resonates with workers and improves efficiency
Track metrics to assess whether RMW is reduced and waste is sorted more accurately
Gather feedback on ways to enhance integration into the workflow and OR setting

The team conducted A/B test sessions in simulation ORs where groups of healthcare workers competed to complete as many puzzles as possible, simulating the concentration and time pressures of surgical operations. Periodically, during the competition, the groups were given various types of fake waste to sort correctly. These tests were performed twice: once using the current waste system and once with our redesigned waste system to compare their effectiveness.

Current Waste System

Redesigned Waste System

Workers competing to complete Tangram puzzles against the clock

Workers sorting a mix of fake waste

Workers utilizing redesigned waste system

Takeaways

Efficient Design in High-Stakes Healthcare

Designing within the healthcare space presented a unique challenge, as we had to be extremely mindful not to add any extra steps to the users' workflow. Designers typically aim to simplify and streamline user experiences, and this was especially crucial in healthcare, where even a few seconds can mean the difference between life and death. Therefore, we needed to find ways to encourage the desired behaviors from our users without adding any additional burden to their daily responsibilities.

Guiding Behavior Through Environmental Design

Rather than explicitly instructing users on desired behaviors, I recognized the value in subtly guiding them by adapting physical designs and the environment, making behavior change feel like an unconscious decision.

The Power of User Feedback

Direct engagement with healthcare workers and observing their daily workflows was incredibly insightful—not just for guiding our design refinements, but also for fostering a deeper appreciation of the extraordinary care and dedication they provide.