Elijah Chia

Hospitals are among the most sustainability-conscious institutions in the world, yet they are also among the most challenging places to implement sustainable practices effectively. 'A Chronic Misalignment' is a semester-long thesis investigation exploring this paradox within the ophthalmology department at National University Hospital Singapore.

The project began with a simple observation: three sustainability initiatives were introduced in the department; one succeeded while two did not. The focus of the investigation was not on the failures themselves, but on understanding why they failed and, more importantly, what these failures reveal.

Using ethnographic research methods, the project employed extended observations, semi-structured interviews with staff and a series of live behavioural experiments to map the difference between how sustainability initiatives are designed from the top down and how they are experienced on the ground.

While the findings were not surprising, they revealed that behavioural change initiatives often underestimate the cognitive load faced by clinical staff. Nurses, doctors and support staff are not resistant to sustainability; rather, they are navigating a complex web of protocols, time pressure and patient responsibilities. Recycling compliance does not fail because people lack concern but because the system complicates the process unnecessarily.

The most unexpected finding surfaced from what had initially been dismissed as a problem: the hack bin. Throughout the department, staff had discreetly taped plastic bags to the edges of tables, creating improvised waste receptacles that were neither designed nor approved, yet widely used.

This project illuminated a staff-designed solution that outperformed the official initiative. The hack bin shifted the focus of the investigation from "how do we get staff to comply?" to "what are staff already telling us through their makeshift solutions?"

The project culminates in two interconnected outputs: a design zine that documents the department's bin archetypes, staff behaviours and experimental findings as an editorial artefact, and a set of physical models that speculate on potential improvements for the clinic or hospital.

'A Chronic Misalignment' does not propose a redesigned bin or a new policy. Instead, it argues for a more challenging approach: acknowledging that the mismatch between institutional logic and clinical reality is structural. Surfacing this disparity is more valuable than covering it up with another initiative.

The staff already know what works; the design question is whether the institution is willing to listen.