Veterans Health Administration Introduction to the Revised VHA

Veterans Health Administration Introduction to the Revised VHA EMS Guidebook (GEMS): Reflections on Five Years of Experience Federal Environmental Symposium GEMS Guidebook PAG 2009 Presented by Donald Horning, REHS Regional (VISN) Environmental Consultant

Presentation Setup • VHA Organizational Structure – DVA and VHA – Management • A history of the GEMS Program implementation: – The need for GEMS • Program Limitations • GEMS Upgrade: – Next steps

DVA Organizational Chart: Department of Veterans Affairs VHA Veterans Health Administration VBA Veterans Benefits Administration NCA National Cemetery Administration

Organizational Structure of the VHA • Central Office - Diverse Operations with multiple decision making centers (parallel management Structures): – Clinical side: • Medical • Pharmaceuticals – Infrastructure: • • • Engineering, Facilities management, Housekeeping Planning and Design: Renovations, Major Capital projects Information Management (IRM) • “Networks”: De-centralized management structure – Veterans Integrated Service Networks (VISN) - • VA Medical centers: Facility level management

Who is Responsible for VHA Environmental Programs in the Field? • VISNs – VISN Health and Safety Program Manager – VISN GEMS Consultants. • VAMCs: – – VAMC GEMS Coordinator Environmental Engineer Industrial Hygienist Safety Manager – – – Facilities Management/Engineering Service Associate Director’s Office Quality Management • Organizational Locations of VAMC GEMS Program

GEMS Program History

When and Why did VHA Initially get involved with EMS: • 2002 EPA Federal Facilities Enforcement Office (FFEO) inspected several VA Medical centers (VAMCs) and observed similar compliance issues at a number of them. • August 2002: The EPA and VA agree to collaborate on a number of initiatives to improve environmental compliance at VAMCs. – Environmental Management Reviews (EMRs) at selected VHA facilities: • Identified the strengths and weaknesses of facilities’ environmental programs • Evaluated what was needed to improve management structure and process. • Developing training materials that could improve environmental compliance throughout the VA MCs. • EMR conclusion: the VAMCs had in place many of the pieces that would be required for a successful environmental program. What was needed was a way to pull them all together!

…Environmental Management System: EMS VHA Drivers for Implementation of EMS: • Need to improve environmental performance: – Centralize and improve management of regulatory compliance and become better environmental stewards – Develop a structured way of determining root causes of environmental issues and come up with solutions. • Executive Order (EO) 13148: – Implement EMS at “appropriate” facilities by 12/31/2005. • VHA Directive 2005 -011 (3/7/2005): – VHA Green Environmental Management System (GEMS) and Governing Environmental Policy

Implementation of GEMS Framework Setup: • VHA level – Establish Environmental Policy – Establish “GEMS Guidebook” (March 2004) based on ISO 14001 Standard • Describe how the GEMS program was to be implemented: 9 -step • process. Training for Top management at local level • VISN Level • Local (facility) Level – Establish local level Environmental Managers: GEMS Coordinators – Establish GEMS Committee: getting all the parties involved. – Follow “GEMS Guidebook” as a Step-by-step guide for GEMS implementation

Nine Steps to Establish a Successful EMS (GEMS) at a Local – Facility - Level 1 3 Appoint GEMS Coordinator and Committee 2 Conduct GEMS Gap Analysis Train GEMS Committee 9 Annual Program Effectiveness Review and Report 4 Identify Significant Environmental Aspects 8 Conduct Environmental Compliance Baseline Audit 5 Establish Operational Controls 7 Train Staff on GEMS Policies and SOPs 6 Setting & Achieving Objectives and Targets

GEMS Program Support: • Central Office (CO) – Provide national oversight – Develop Policy – HAIG Survey • CEOSH (works for CO): – Develop Guidebooks – CP-Track and E-Safe Software – Implementation tools

Roadblocks to GEMS Implementation • Organizational Issues: – Natural resistance to change by employees and organizations. – Contention regarding where environmental program should be located in the VAMC. – Person responsible for environmental compliance does not want to relinquish total control of environmental program. – Budget limitations. • Overcoming lack of top management involvement and visibility. – VAMC organizations do not believe they have any environmental responsibility. “That’s the environmental guy’s responsibility. • Finding relevant metrics for measuring cost versus benefit, progress, etc. • Relevance of GEMS to agency mission.

GEMS Implementation Success: • Management Support: – Active support and commitment by senior management at VHA CO, VISN and VAMC levels. – Selection of GEMS Coordinators – Robust GEMS Committee • Building the GEMS program on existing procedures and processes – don’t reinvent the program, connect with existing elements. • Training

GEMS Program “Update” 2008

Additional Objectives set by EO 13423: 1. 2. 3. 4. 5. 6. 7. 8. Energy Efficiency and Green House Gas Emissions – Reduce energy intensity 3% annually through FY 2015 Renewable Energy – Half of renewable energy consumed comes from renewable sources – Implement renewable energy generation projects Water Consumption – Reduce water consumption intensity Acquisition – agency goods and services use sustainable environmental practices Reduction of toxics – Reduce toxic and hazardous chemicals use Construction Transportation – Reduce consumption of petroleum products, Increase non petroleum fuel consumption and promote the use of plug in hybrid vehicles Management of Electronics

Compliance vs. “Greening” • Compliance with federal, state and local laws – It could be accomplished at the facility “local”: • Examples include design and installation requirements, training, inspections, documentation etc. – Local level senior leadership is sufficient to promote and maintain compliance through clearly articulated roles and responsibilities • “Greening the Federal Government” – It involves “big picture” items that oftentimes can best be accomplished at a national or regional level: • Limitations in local resources • Expertise

New Guidebook Setup: Framework: Five step process Step 1: Develop an Environmental Policy Step 2: Planning Environmental Improvements Step 3: Implementation and Operation of of the GEMS Program Step 4: Checking – Monitoring and Measuring the Effectiveness of the GEMS Program Step 5: Management Review and Evaluation of Effectiveness

Program updates I. Communication i. ii. • • iii. • • • “Central Office” Monthly GEMS Coordinators Conference call: put together by CEOSH Minutes shared through Web-site information exchange E-mail group for all GEMS Coordinators. VISN Level Monthly face-to-face meeting or conference call for Facility level GEMS Coordinators Use of economies of scale were applicable and evaluate synergies between facilities as well as other, outside, local hospitals. Example: Establish VISN-wide contracts GEMS Coordinators participate in VISN Level committees and decision making groups. Local Level GEMS Committee meetings Mandatory Training Local Newsletter publications

Program Updates II. Development of New GEMS Guidebook I. Reflect new GEMS program philosophy and EO 13423 III. Advisory Groups I. • • II. III. • • GEMS-PAG: What is it: Professional Advisory Group established with a membership of Top-level management and GEMS Coordinators Centralized Decision making. Sharing of expertise. Focus on “attaching” the issue through a “top-down” approach. Minutes shared through Web-site. Also used for other types of information exchange. CP-TRACK Advisory Group (Compliance Tracking Software) Updating Examples: Spearhead a Department-wide approach to Pharmaceutical waste management. Establish Contract language Training: – – AGT and UST On-going compliance training for GEMS Coordinators.

Program updates IV. Community Involvement I. Participation in Groups outside of the Department: • II. • • H 2 E: Hospitals for a Healthy Environment Local Level: Example: New York Harbor participates in the Greater New York Hospital Association New York Health and Hospital Corporation (Part of NYC Government)

Update Central Office Functions Structure of program in CO and how it operates: • Top managements: – Clearly defines roles, responsibilities and authorities – Communicate objectives and target – Update Job Descriptions and Performance Contracts • Legal Council at the highest organizational level • • • – Environmental Lawyer – NEPA Compliance Officer HAIG Survey Establish environmental leadership awards: recognize outstanding performance Establish procedures for internal and external communication

Veterans Integrated Service Network (VISN) Level GEMS Consultants Roles and Responsibilities

VISN Environmental Manager Responsibilities • Overall program manager for VISN: – Provides guidance for Implementation and ensures availability of resources • Reviews Identified Significant Aspects and • Impacts. Advises on appropriate action plans. Training: – Provides environmental management training

VISN Environmental Manager Responsibilities • Program Audits/ Inspections – Gap Analysis: • • • GEMS Consultants are ISO 14001 Lead Auditor Certified Procedure to monitor and measure on a regular basis the key characteristics of the organization that can have significant environmental impacts Evaluate compliance Evaluate GEMS as a second party audit: Whether facility GEMS program conforms to VA GEMS program and 14001 Has been properly implemented and maintained Audit procedures are established, implemented and maintained – Coordinates third-party Environmental Compliance Review and Audit (Acts as the Contract Officer for such work) Leadership Awards – Recognize outstanding environmental, energy or transportation related initiatives.

Focus Areas: Some of the Environmental Aspects that will be addressed through the new Guidebook support documents

Energy • Facilities Level Management: – Promote the use of Energy Management Control Systems. This would include Advanced Metering systems as well as improved overall Building Control Systems. – Provide centralized funding and engineering support on implementation, operation and maintenance. • Design and Construction: – Incorporate Energy issues into the design and construction process from an early phase. • Procurement: – – – “Alternative” Energy sources: solar, wind, bio-diesel etc. Equipment purchases, Energy Star Life-cycle analysis • Contracting: – Energy Savings Performance Contracts – Co-generation

Construction • Facilities Management – Use whole building design guide for major renovations projects – NEPA impact statement – Greenhouse Gas Emissions • Contracting: – Enhanced Lease Options • Design and Construction: – Update of Master Plans and specifications to reflect “Green Building” Design objectives – Specifications that optimize energy efficiency and renewable energy – Options for LEED Certification

Acquisitions • GSA Approved Procurement Options: – Vehicles: cars, trucks and buses • Credit card holders • Comprehensive Procurement Guidelines

Electronics • Centrally controlled purchases of electronics & medical equipment: – – Purchasing criteria: EPEAT, Energy Star Life-cycle cost analysis Leasing programs Disposal and substitution (LCDs for CRTs) must be taken into consideration: universal waste procedures and centrally administered recycling contracts (UNICOR) • Disposal: – – Logistics service Transportation requirements (Facilities Management) • Operational issues and Power management options: – Two sided printing – Automatic shut-down (“sleep” mode): computers must be “on” for regularly software patches and updates. Power management solutions are being investigated. – Screen savers

Pharmacy Waste • VACO Managed Contracts for Reverse Distributer – Credit for pharmaceuticals returned • Current efforts underway to: • Evaluate VHA formulary for EPA listed waste types • Evaluate life-cycle process of acquiring and disposing of pharmaceuticals • Evaluate best practices used by VAMCs for pharmaceutical management. – Develop guidebook to assist VAMCs in their management of pharmaceuticals

Water Use • Facilities Management – – – Infiltration & Intrusion Process water Irrigation Water conservation in bathrooms NEPA impact statement Greenhouse Gas Emissions • Contracting: – Major renovations projects • Design and Construction: – Water cooled condensers and compressors – Specifications that optimize water efficiency and reuse

Conclusions: • GEMS: An evolving program! • More robust Environmental Management System: – Integrate Environmental decisions into top-management activities. – Promote Communication and awareness • Guidance Groups – Make experts available to local facility GEMS programs – Funding Environmental compliance review and audits • Management Review of program: – Evaluate effectiveness as well as overall operational efficiency – Target “kinks” in the system