A Select Review of VHA’s Implementation of the VA Sustainability Plan

The VA Office of Inspector General (OIG) conducted a select review of Veterans Health Administration’s (VHA's) implementation of the 2022 United States Department of Veterans Affairs Sustainability Plan, which describes priority actions for achieving federal environmental sustainability goals outlined in Executive Order 14057. The review consisted of three healthcare delivery objectives to estimate VHA’s progress toward environmental sustainability. Objective 1 broadly looked at VHA’s approach to implementing the plan; objective 2 focused on a foundational priority action to help VHA’s sustainability efforts; and objective 3 examined the sustainability of VHA’s healthcare activities by analyzing purchased inhalational anesthetics to determine their contribution to greenhouse gas emissions, waste stream processes and tracking, and ethylene oxide use for sterile processing. Although VHA has started planning and implementing environmental sustainability actions, the OIG identified areas that would benefit from further evaluation. Most facility leaders reported that Green Environment Management System program managers are responsible for leading the implementation of the sustainability plan but the corresponding national program office reported program manager workload capacity as a barrier. VA, inclusive of VHA, implemented training focused on climate change but did not “incorporate environmental stewardship values,” as the executive order required. VHA increased attention to the use of inhalational anesthetics and the impact on greenhouse gas emissions, but the long-term cumulative environmental impact of inhalational anesthetics warrants consideration of a comprehensive mitigation strategy. VHA tracks waste streams and diversion rates from landfill but prohibits repurposing single-use medical devices, which impedes improvement of diversion rates. VHA reported elimination of ethylene oxide usage in sterile processing for healthcare operations. The OIG made one recommendation to the Secretary of Veterans Affairs to incorporate required training content, and four recommendations to the Under Secretary for Health related to position responsibilities, training content, and sustainable health care practices.