From Fragmented DMD Management Toward Digitally Enabled Circularity: A Conceptual Operations Framework for Durable Medical Devices

Durable medical devices (DMD) are essential healthcare assets, yet their management in public hospitals is constrained by fragmentation, limited traceability, reactive maintenance, and weak lifecycle integration. This study proposes a framework for digitally enabled, sustainable, and circular DMD management. A mixed-methods design integrated a literature review, expert consultation using the Best–Worst Method, weighted technology nominations, and case-based process mapping in Brazilian hospitals. Eleven experts assessed the criteria guiding Industry 4.0 technology selection for DMD management and the technologies best responding to these priorities; nine consistent judgments were aggregated. Patient-Centered Care, Operational Efficiency, and Resource Efficiency and Cost Reduction emerged as the leading influences on technology selection. Big Data and Analytics, Artificial Intelligence, the Internet of Things, Cloud Computing, Cyber-Physical Systems, Smart Sensors, and Machine Learning formed the priority portfolio, accounting for 84% of the weighted score. The cases contextualized these priorities by revealing discontinuous information flows, limited asset visibility, corrective maintenance, fragmented governance, and weak end-of-life practices. By connecting decision priorities and technological capabilities with observed gaps, the TO-BE framework organizes sustainable procurement, traceable use, predictive maintenance, redeployment, refurbishment, and responsible disposal through material and information flows, providing a pathway for digital and circular transformation in resource-constrained healthcare systems.