Portrait and video of Erik van Raaij

Erik van Raaij is Professor of Sustainable Procurement in Healthcare at Erasmus School of Health Policy & Management (ESHPM) and at the Rotterdam School of Management, Erasmus University Rotterdam. Earlier this year, he was also appointed as a Medical Delta professor with a position at the Faculty of Industrial Design Engineering at Delft University of Technology (TU Delft).

On Wednesday, June 6, Van Raaij will deliver his inaugural lecture at Erasmus University Rotterdam, titled “Purchasing tomorrow: Weaving planetary health into healthcare procurement.” You can register for this lecture and the preceding symposium here.

What does this appointment mean to you?  

“For me personally, it means a lot. I was trained as an engineer at the University of Twente, but in my work I couldn’t always make use of that background. Now, with this appointment at TU Delft, the engineer in me is coming back to life. I’m naturally a process thinker, and I see that as a typical way of thinking for engineers.

Design-oriented research has always played an important role in my work. During my time at TU Eindhoven, I learned that scientific research doesn’t only have to be about forming or testing hypotheses—it can also be about designing solutions to practical problems. That really appealed to me, and it aligns well with the design-driven approach of the Faculty of Industrial Design Engineering at TU Delft.

A third reason: my chair aligns closely with the work of fellow Medical Delta professor Jan Carel (‘JC’) Diehl, with whom I already had a good connection. We’re both active in the field of sustainability, and now we’ll be colleagues at the same faculty. Funny enough, we’re also almost neighbours in Rotterdam.”

What does it mean for your work?

“I work at the intersection of procurement management, sustainability, and healthcare. If you want to develop solutions in that area, you often end up having to redesign products or processes. Sometimes a hospital needs to do things differently, sometimes a supplier needs to adapt. These are all redesign challenges. Thanks to this role, I now receive more input from Industrial Design, which allows me to continue at full speed with the work I was already doing.”

Can you briefly describe your area of expertise? 

“At its core, my expertise lies in procurement management—that’s where it all started. In Twente, and later in London, I taught marketing. When I returned to the Netherlands, I started working at TU Eindhoven and made the switch to procurement management. These two fields are closely related: from selling to buying. In 2006, I joined Rotterdam School of Management, where from 2010 onward I began focusing specifically on procurement in healthcare. At the end of 2021, sustainability was added to that. This created a triangle: procurement, healthcare, and sustainability. Procurement management is my specific area of expertise, and this is the first chair in that field within Medical Delta. I believe that’s a valuable addition.”

The healthcare system is under increasing pressure. What does this mean to you? What transition do we need to undergo, and how can your research contribute to that? 

“The pressure on healthcare has several causes. What we need is a sustainable transition—but sustainability means different things to different people. For some, it’s about personnel sustainability: continuing to deliver the same care with fewer hands at the bedside. For others, it’s financial sustainability: ensuring that healthcare costs remain manageable. Currently, 25 percent of the Dutch national budget goes to healthcare, and I don’t think that should increase any further.

I’m primarily talking about a third form of sustainability: environmental, the green side. In healthcare, there is relatively little attention given to this, even though the sector consumes enormous amounts of raw materials. The impact on climate and the environment needs to be reduced, but without compromising the quality of care. I believe this is possible, and it doesn’t even have to be more expensive.

There are many reasons to take this seriously. Geopolitics plays a role. We’re dependent on countries like China, who can change their policies as producers. Raw materials are running out. The current system of single-use products that are discarded simply isn’t sustainable.

What we need is a sustainable AND circular transition. Many medical products are not designed to be cleaned and reused. They are explicitly intended for single use and are incinerated after use. No infection risk, but a huge burden on the environment. We are depleting resources and emitting extra emissions during incineration.

The question is: how do we change the entire value chain? From the very beginning, in product development, we will need to focus on different designs. That also means something needs to change in procurement. We need to ask different questions to the market, influence suppliers, and perhaps change the way we pay. Maybe in the future, we won’t pay for the product but only for its usage. This would give the supplier an incentive to develop something much more sustainable.

This requires a different business model. No longer making a profit by selling as many products as possible, but by ensuring those products are used for a long time and intensively. What would such a system look like? How do we create the right incentives in the right places? That’s what my research is about.”

Medical Delta builds bridges between scientific disciplines, but also between science and practice. Why is that important? 

“At the Faculty of ESHPM, together with my colleague Chiara Cadeddu, I am the theme lead for developing the ‘planetary health’ theme. It’s about the planet, the environment, and the health of all life on the planet. The balance between what we do and what it means for the health of the planet is by definition transdisciplinary. It touches on medicine, behavioural sciences, environmental studies, product development, and supply chains. Everything is interconnected.

A good example I found was an article about a certain medication, where someone had researched how its production chain works. Many medications are made in China and India, where a lot of the raw materials also come from. In this example, semi-finished products were transported from Asia to Germany for quality control, then sent back to China or India for the next step in the production chain, such as packaging. After that, the medication travelled the world again toward the final user. So, this medication has already travelled many kilometres before it even reaches our pharmacy.

This shows that for these kinds of issues, you need various disciplines. It’s not just about drug development, but also about production, logistics, and everything in between. If we really want to make a change here, we need collaboration across many disciplines.”

What will a patient or healthcare professional notice from your work? What will the practice look like in 5 or 10 years? 

“Hospitals will look different in the future. The materials logistics will have completely changed. Right now, we have efficient inventory management systems with small stocks that are replenished just-in-time. In the future, I see a hospital with a large cleaning and sterilization department and an advanced system for managing materials. Everything will be scanned, and we’ll keep track of how often a product has been used and where it’s located. A material-smart hospital, where you always know where everything is and what its quality status is.

One of the most interesting theses I’ve been able to supervise recently was exactly about this. A student mapped out what a hospital would look like if it worked with a lot more reusable products. What stood out is that you would need much more square footage to do this properly. This could really only happen if you build a new hospital or during a major renovation. This type of research shows how concretely practice is woven into our research.

Suppliers also need to join in this change. The constant push for increasing the number of products sold should no longer be the guiding principle. There must be a shift in how revenue is managed, but in a different way—not by shipping as many products to hospitals as possible.

In principle, patients won’t notice much of these changes. We certainly don’t want the infection risk to increase or the quality of care to decline. The biggest changes will take place behind the scenes. But more and more patients are becoming aware of how polluting healthcare actually is. For that group, changes can be made visible if they want.

Take certain types of inhalers for asthma, for example: some have a much larger environmental impact than others. Some doctors say: I decide as a physician to switch my patient to the sustainable alternative, because I know the quality is the same. You can also discuss such a switch first to raise awareness. Another example is Another example is paracetamol in tablet form. That’s much more sustainable than through an IV. You can also explain that to a patient. This way, we’re making healthcare more sustainable together without compromising quality.”

With the new programming, Medical Delta places more emphasis on the needs from practice. How do you incorporate the needs of healthcare practice into your research? 

“That fits perfectly with design-oriented research. You design a solution for a practical problem, but you do so in a scientifically grounded way. It’s theory-informed, based on previous research. So, practice is actually involved from the very beginning.
In the ESCH-R project, in which I participate, we work with a consortium that also includes industry partners. They want to understand their role: as a supplier of medical technology or as a raw materials provider. In all the important research I do, practice is at the table. Often, these are suppliers.

Healthcare providers, the users, are also closely involved. Nicole Hunfeld from Erasmus MC is the principal investigator of the ESCH-R project and a healthcare professional. Patients aren’t a major stakeholder at the moment, but healthcare professionals are very much so. They are the ones who will need to process waste streams differently in the future. That will have a huge impact on their work. Additionally, procurement professionals are also involved in my research.”

Large and complex issues such as the transition of health care require large and comprehensive solutions. What role does collaboration between wo-hbo-mbo play in this?

“In the ESCH-R research project, for example, we involve higher vocational nursing education. A lot depends on what happens in the workplace: what choices are made there, what is the impact, and are nurses willing to support those new choices?

We are not yet working directly with vocational education (MBO) at this moment, but I can imagine that it will become important in the future, especially when it comes to material use and production processes. Ultimately, it all comes down to the question: how do we design products, how do we assemble them, and who will carry out that process in the future?”

Which other scientists or practice partners have been important for your work and why? 

“Emeritus Professor Arjan van Weele from TU Eindhoven was crucial in helping me make the switch from marketing to procurement management. That is really the core of what I now bring to Medical Delta. I was actually looking for a job in marketing, but he said, ‘Come and talk about procurement management.’

Meeting JC Diehl and Nicole Hunfeld was also an important moment. We sometimes call ourselves the ‘three musketeers of sustainable healthcare.’ In 2021, I was looking for a guest speaker for a course I was teaching on procurement management in healthcare, but I also wanted a lecture on sustainability. Nicole came as a speaker, and shortly after, she invited me to talk with her and JC about writing a research proposal together.

I also have a colleague here at ESHPM, Maike Tietschert, who encourages me to look much more critically at sustainability, but also at issues like diversity and inclusion. Her expertise lies in transitions, particularly in how to coordinate transitions in healthcare. She often reminds me to be conscious of my language: is it inclusive? Am I not only featuring men in my panel? She’s really an important stimulator in my thinking about ‘sustainable inclusion.’”

What do you need from others, what is still missing in your collaboration to achieve your goals? What call to action would you make? 

“What I need, is for all the partners in the ecosystem to dare to think radically differently about their role. Imagine this: you’ve always been focused on selling as many products as possible. Can you then, even if only as a thought exercise, imagine that your success no longer depends on sales volume, but on using as few virgin, non-renewable materials as possible?

What if we use this as a performance indicator: only using renewable raw materials, and reusing as many products made from them as possible? Are you willing to take that step? Are you willing to let go of the linear system? I can imagine that this is very challenging, especially if you work here in the Netherlands for an American parent company, where everything revolves around quarterly sales figures. You’re caught in a dilemma, and you have to be willing to bridge that gap.

Dare to think with us about what that circular system could look like. That’s my call to action.”