Veterans Health Administration Introduction to the Revised VHA EMS Guidebook (GEMS): Reflections on Five Years of Experience Federal Environmental Symposium GEMS Guidebook PAG 2009

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

DVA Organizational Chart: Department of Veterans Affairs VHA Veterans Health AdministrationVBA Veterans Benefits AdministrationNCA National Cemetery Administration

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

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

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 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. 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 Identified the strengths and weaknesses of facilities’ environmental programs Evaluated what was needed to improve management structure and process. Evaluated what was needed to improve management structure and process. Developing training materials that could improve environmental compliance throughout the VA MCs. 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! 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: 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: Executive Order (EO) 13148: –Implement EMS at “appropriate” facilities by 12/31/2005. VHA Directive (3/7/2005): VHA Directive (3/7/2005): –VHA Green Environmental Management System (GEMS) and Governing Environmental Policy

Implementation of GEMS Framework Setup: VHA level VHA level –Establish Environmental Policy –Establish “GEMS Guidebook” (March 2004) based on ISO Standard Describe how the GEMS program was to be implemented: 9-step process. Describe how the GEMS program was to be implemented: 9-step process. Training for Top management at local level Training for Top management at local level VISN Level VISN Level Local (facility) 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 Appoint GEMS Coordinator and Committee 1 Conduct GEMS Gap Analysis3 Identify Significant Environmental Aspects 4 Establish Operational Controls5 Setting & Achieving Objectives and Targets 6 Train Staff on GEMS Policies and SOPs 7 Conduct Environmental Compliance Baseline Audit 8 Annual Program Effectiveness Review and Report 9 Train GEMS Committee 2

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

Roadblocks to GEMS Implementation Organizational Issues: 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. 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. Finding relevant metrics for measuring cost versus benefit, progress, etc. Relevance of GEMS to agency mission. Relevance of GEMS to agency mission.

GEMS Implementation Success: Management Support: 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. Building the GEMS program on existing procedures and processes – don’t reinvent the program, connect with existing elements. Training Training

GEMS Program “Update” 2008

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

Compliance vs. “Greening” Compliance with federal, state and local laws 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. 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” “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 Limitations in local resources Expertise Expertise

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 New Guidebook Setup:

I. Communication i.“Central Office” Monthly GEMS Coordinators Conference call: put together by CEOSHMonthly GEMS Coordinators Conference call: put together by CEOSH Minutes shared through Web-siteMinutes shared through Web-site Web-site information exchangeWeb-site information exchange group for all GEMS Coordinators. group for all GEMS Coordinators. ii.VISN Level Monthly face-to-face meeting or conference call for Facility level GEMS Coordinators 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. 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. GEMS Coordinators participate in VISN Level committees and decision making groups. iii.Local Level GEMS Committee meetings GEMS Committee meetings Mandatory Training Mandatory Training Local Newsletter publications Local Newsletter publications Program updates

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

Program updates IV. Community Involvement I.Participation in Groups outside of the Department: H2E: Hospitals for a Healthy EnvironmentH2E: Hospitals for a Healthy Environment II.Local Level: Example: New York Harbor participates in the Greater New York Hospital AssociationExample: New York Harbor participates in the Greater New York Hospital Association New York Health and Hospital Corporation (Part of NYC Government)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: 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 Legal Council at the highest organizational level –Environmental Lawyer –NEPA Compliance Officer HAIG Survey HAIG Survey Establish environmental leadership awards: recognize outstanding performance Establish environmental leadership awards: recognize outstanding performance Establish procedures for internal and external communication 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: 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. Reviews Identified Significant Aspects and Impacts. Advises on appropriate action plans. Training: Training: –Provides environmental management training

VISN Environmental Manager Responsibilities Program Audits/ Inspections Program Audits/ Inspections –Gap Analysis: GEMS Consultants are ISO Lead Auditor Certified GEMS Consultants are ISO Lead Auditor Certified Procedure to monitor and measure on a regular basis the key characteristics of the organization that can have significant environmental impacts Procedure to monitor and measure on a regular basis the key characteristics of the organization that can have significant environmental impacts Evaluate compliance Evaluate compliance Evaluate GEMS as a second party audit: Whether facility GEMS program conforms to VA GEMS program and Has been properly implemented and maintained Evaluate GEMS as a second party audit: Whether facility GEMS program conforms to VA GEMS program and Has been properly implemented and maintained Audit procedures are established, 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 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 Focus Areas: Some of the Environmental Aspects that will be addressed through the new Guidebook support documents

Energy Facilities Level Management: 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: Design and Construction: –Incorporate Energy issues into the design and construction process from an early phase. Procurement: Procurement: –“Alternative” Energy sources: solar, wind, bio-diesel etc. –Equipment purchases, Energy Star –Life-cycle analysis Contracting: Contracting: –Energy Savings Performance Contracts –Co-generation

Construction Facilities Management Facilities Management –Use whole building design guide for major renovations projects –NEPA impact statement –Greenhouse Gas Emissions Contracting: Contracting: –Enhanced Lease Options Design and Construction: 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: GSA Approved Procurement Options: –Vehicles: cars, trucks and buses Credit card holders Credit card holders Comprehensive Procurement Guidelines Comprehensive Procurement Guidelines

Centrally controlled purchases of electronics & medical equipment: 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: Disposal: –Logistics service –Transportation requirements (Facilities Management) Operational issues and Power management options: 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 Electronics

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

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

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