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

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.