Aiming for Sustainability

When Jill Petkash, CTPO, started working at the University of Michigan Orthotics and Prosthetics Center (UMOPC) about 25 years ago, there was something about her fabrication job that shocked her. “I couldn’t believe how much we were throwing away,” says Petkash, purchasing manager and senior technician. “It broke my heart and I thought that we could do better.” The Ann Arbor facility, which fabricates about 1,800 devices a year for University of Michigan Hospital patients, wasn’t handling its waste any differently than similar fabrication shops at the time. But that didn’t mean it was doing as well as it could. Petkash, who has always valued conservation and efficiency, vowed to make a change. UMOPC now has reduced the amount of waste it creates, recycles what it can, works with a nonprofit organization to take extra scraps, and has developed a system to reuse packages so the department hasn’t had to buy any boxes or packaging materials for years. Petkash has been tracking their progress in a spreadsheet since 2017 and estimates that the changes have kept about 14,000 pounds of waste out of landfills. She’s proud of her work but says it hasn’t been easy. They’ve had to develop fabrication processes that cut down on waste while still producing top-quality devices. Convincing technicians to buy into these methods took time and effort. Also, it has always been a struggle to find recyclers, and, even when she found one, it was a challenge to keep their business. Still, the hard work is worth it, she says. “My mantra is that it takes a lot of effort to save the world,” she says. “It won’t happen on its own.” She says that the O&P industry, like all industries, should be willing to put in the hard work to do its part. “It is a mission, and we need to stay focused.” Why Sustainability Matters O&P sustainability experts applaud the work that the profession has done to improve the lives of its patients. Now, they say, it’s time for the industry to do its part to help save the world for future generations. “It’s our responsibility to ensure that our kids and grandchildren have the same or better quality of life in the future,” says Bergthora Skuladottir, global sustainability director, Össur. “It’s of utmost importance to ensure that the planet will continue to be inhabitable for us.” She says that as the world has placed more of an emphasis on monitoring the environmental impact of industries, developing sustainable business practices and work culture isn’t just a good thing to do. It may soon also be a requirement. Regulatory changes in Europe, which may filter down to the United States, mean that being environmentally friendly won’t just be a goal for companies, says Skuladottir. New regulations mean that tracking carbon emissions and waste is necessary for public companies. “We are moving away from something that’s nice to have toward something that’s a requirement,” she says. “From 2024 on, we will need to report sustainability data information the same way we do with financial data.” She suggests that O&P companies should begin work now to reduce emissions and waste, so they have time to figure out what works best for them before being forced to make quick decisions. “We’ve been making a steady and positive journey, which has enabled us to be ready for what’s ahead from the regulatory side, versus being hit with it almost overnight.” Challenges to Sustainability The biggest sustainability challenge, from large companies like Össur to fabrication facilities like UMOPC, is finding a way to recycle or reuse leftover materials in the fabrication process. This challenge became even more pronounced in 2018 when China stopped importing plastics from other countries. Finding a recycling facility willing to take the waste produced during fabrication can feel almost impossible at times, the experts say. Recyclers won’t consider any material that is contaminated. A piece of plastic used in an O&P device is considered contaminated once a patient puts it on, but also as soon as foreign materials are introduced to it. Dyes, adhesive, and foam added to the plastic during the fabrication process are all considered contaminants and make the material ineligible for recycling. Unfortunately, the addition of these materials to plastic is standard operating procedure in the fabrication process. “In the healthcare field, as in the food industry, most recyclers want virgin materials,” says Mark Shriver, director of safety and environmental affairs for Curbell. “This is, in part, the problem with recycling. That’s always a challenge.” And that’s only part of the problem, the experts say. It has become increasingly difficult to recycle even scraps of uncontaminated raw materials. Petkash says she tried contacting several recycling facilities in her area, but many said they would only consider her business if she was recycling huge containers holding literal tons of waste. “From our perspective, it seemed like we were creating a huge amount of waste, and from their perspective, as a bulk recycler, we were small potatoes,” she says. Her department paired with the Department of Sustainability at the University of Michigan that helped work out a deal with a recycler willing to take their waste. Even with the university’s help, it’s been a struggle, she says—they are working with their third recycling company. “We had to kiss a lot of frogs to get to this point,” she says. “I’m not sure if the other two are now defunct or decided we weren’t worth their business.” She says they are lucky to have their university partnership, and she’s not sure how other fabrication facilities without a similar partnership would be able to find a recycling source. However, she says, even if companies have a hard time recycling there are still many steps they can take to make environmentally friendly businesses. Creating Less Waste Given the nature of the O&P fabrication processes, some waste will always be a given. However, companies that think creatively and develop efficiencies in their processes can make a difference. Reducing waste is one of the best steps a company can take when it comes to being more environmentally friendly. If a company has less waste, there is less to send to a landfill and less to try to recycle. That’s not just good for the environment, it’s good for business, the experts say. “If you are able to use a smaller sheet of plastic, you are starting with less material, which means you will create less waste, and you’ll also save some money,” says Jeff Wilson, Curbell Plastics’ senior business development manager for orthotics, prosthetics, and podiatry. Fabrication labs can also reduce their energy needs by making sure their ovens and fabricating equipment are running as efficiently as possible, he says. “Sometimes the ovens aren’t calibrated correctly and are just burning energy,” he says. At the University of Michigan, Petkash says they buy larger pieces of plastic and get as many cuts as they can. Technicians also work to get a closer measurement so they don’t have as much scrap, and then they use small pieces of leftover carbon cloth or plastic for reinforcement. They also pack up the foam inserts that come with Alpha Liners to keep the silicone from sticking and donate them to a nonprofit organization that sells the scrap materials by the bin. Curbell Plastics does its best to find a home for all leftover materials, says Shriver. Scrap plastics have been donated to local university engineering or robotics departments and even an aeronautics museum. Shriver says it’s not just the fabrication materials they find new homes for. If a saw breaks down, they refurbish it, so it doesn’t go to waste. They look to donate anything that may no longer be needed. They donate office supplies and other materials to Habitat for Humanity. At the office, employees can bring in their plastic bags or broken-down electronic equipment to be added to the corporate recycling bin, Shriver says. He’s been known to follow custodial employees around at night to take pictures of recyclable materials in the garbage to show employees how they can improve. “We’re sending a message not only to our industry but also to the people who work here that we care, and they should too.” A Culture of Sustainability Recycling more, reducing waste, and cutting back on greenhouse gas emissions will take more than the effort of the employee who cares the most, the experts say. It takes a corporate culture and buy-in from every person to be careful about how they produce waste and use energy. Building this culture takes time, says Petkash. She says it was difficult at first to get technicians, who were used to working one way, to change their processes to reduce waste. Some of the technicians changed and some didn’t, she says. But over time all new employees knew what was expected when they came on. “It slowly evolved over time until it became our standard operating procedure,” she says. Outside pressure also helped. In 2018, when the University of Michigan’s then President Mark Schlissel made sustainability a priority, Petkash says that she got even more buy-in from her fellow employees. “That kind of helped to reinforce the fact that we were doing the right thing, and everyone should probably get on board with it,” she says. Even though Össur has a sustainability director, Skuladottir says she needs every single employee to do his or her part. Her job has been to develop the company’s overall strategy, but every department in the large company has had to take ownership of its own environmental impact. “Across regions, across departments, we work to have everyone on board with this purpose of integrating sustainability into most aspects of the company,” she says. Shriver says that small, easier wins helped build the culture at Curbell and helped motivate everyone toward tackling the harder problems. When he started recycling the raw materials that had once previously been thrown away, his managers quickly realized that they were paying less money to haul away trash and were even getting some back by recycling. This got them excited enough to start thinking about other ways they could make an impact. “As you achieve more victories, you get more support, but it takes sustained effort,” he says. “Employees come and go, and every employee changes your culture a little bit. It’s more of a sales pitch. You are trying to get them to do the right thing by encouraging them.” Keeping Track Just as clinicians should use data-based evidence in how they choose to treat their patients, so too should the industry use data to help it reach its sustainability goals, the experts say. If O&P clinics and fabrication facilities don’t know how much trash they produce or how much energy they are using, then they won’t know if they are meeting their goals. Different places have used different methods. Össur has been thoroughly tracking every part of its sustainability progress with the goal of reaching net-zero operations by 2050. They have mapped out and tracked the company’s greenhouse gas emissions, set science-based targets, and have a third-party organization to help keep the company accountable. The process has been painstaking but worth the effort, says Skuladottir . They’ve learned that their biggest challenge, like most fabricators, is to reduce the emissions from materials used in their products. They’ve also learned how they can improve and are gradually changing their packaging systems so the packages they send out come from sustainable materials and are lighter, thus reducing overall emissions in transportation. Shriver says that any way of keeping track of waste and emissions is a good start. The industry won’t know how to improve if it doesn’t first understand the scope of the problem, he says. “You need some baseline data,” he says. “You need to know what you are doing. You have to look at your facilities and the energy you are using.” With that data, companies can then target their efforts, he says. “Everybody can do a little bit if you know what you will address or what problem to attack,” Shriver says. “Then you can take it from there.” Looking Toward the Future As sustainability, recycling, and reducing a company’s carbon footprint become more of a priority, the experts say changes are on the horizon that will help the industry. Wilson says that as 3D printing technology and materials improve, they will be a solution to creating less waste. Instead of using large sheets of plastic to fabricate devices, thus creating waste from the scraps, technicians will be able to 3D print devices to their exact specifications. Currently, he says, the materials used for printing are not as robust as extruded plastic sheets necessary for O&P products, but Wilson thinks that it is only a matter of time until they are. “Material scientists are going to figure this out, but it’s still many years down the road,” he says. Össur has started to investigate the options for reducing waste and emissions by leasing devices or components, says Skuladottir . This way, when the products reach their end of life, they could be returned to the company, which would then be able to reuse or repurpose them. “We hope to move away from the linear economy of making, using, and then throwing it away,” she says. “We’re looking into whether we can refurbish or use some parts of them again.” This idea is still in its beginning stages, she says, and the company is still looking into how to do this while ensuring their products meet patient safety and regulatory standards. “This idea of moving to a circular economy does not happen overnight,” she says. “We are looking at how we can do this in a smart way that serves our customers, our patients, and is economically feasible at the same time. Because it all has to make sense.” She says that another change on the horizon is that some manufacturers are researching how to build recycling programs for the raw materials they sell. This way, companies like Össur would be able to buy the material for its products, recycle the scraps, and the manufacturer can then use and sell the materials again. “This way, the materials go back to those who know the most about them,” she says. “It’s a win for everyone.” Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com . Image: Anna/stock.adobe.com

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