Department of Veterans Affairs VA Maryland Health Care System

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Department of Veterans AffairsVA Maryland Health
Care System Green Environmental Management
System

• Presented by
• Angela Wood
• VA Maryland Health Care System, Green
  Environmental Management Coordinator

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VA Maryland Health Care System (VAMHCS)
Health Care System providing comprehensive care
to veterans across Maryland. 2,500 staff (not
including research) and 1,300 volunteers. We have
727 licensed beds and approximately 600,000
outpatient visits each year. The VAMHCS is a
part of the VA Capital Health Care Network (VISN
5).
Maryland Facility Locations
Baltimore Facility, Baltimore City -Tertiary Care
facility (inpatient, OR, ER) -Attached to
UMMC -Active research program animal lab
Perry Point, Cecil County, MD Mental Health
facility 400 acres 50 buildings, 10 or so for
health care Long short term mental health care
Baltimore Rehabilitation Extended Care Center
(BRECC), Loch Raven, Baltimore,
MD -Rehabilitation physical therapy -Nursing
home -Also has an outpatient clinic
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Green Environmental Management System (GEMS)
Purpose of a GEMS Program Combine all
aspects of environmental management into a
centralized program to promote Pollution
Prevention, Regulatory Compliance. Continuous
Environmental Improvement and integrate healthy
environmental practices into VAMHCS Management!!!!

• What lead the VA to GEMS?
• OFEE - Executive Order (EO) 13148, entitled
  Greening the Government through Leadership in
  Environmental Management Use reduction,
  Release reduction, Pollution Prevention,
  compliance, environmental Management, etc.
• VA Directive 0057 VA Directive 2005-011
• Green Environmental Management Systems Guidebook
  
• NOTE The VA called our program GEMS to
  distinguish it from our Environmental Management
  Service (EMS)

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GEMS Model
Based on ISO 14001 standard for environmental
Management systems

• Focus
• Continual Improvement
• Pollution Prevention
• Employee Involvement
• Top Management Leadership
• Integration

Continuous Improvement

• Elements
• Policy Statement
• Planning
• Implementation Operation
• Checking correcting
• Management Review

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Concepts of the GEMS Program
The Nine Steps of GEMS Appoint a GEMS Coordinator
Designate a GEMS Committee Train GEMS
Committee Conduct GEMS GAP Analysis Indentify
Significant Environmental Aspects Establish
Operational Controls Set Objectives
Targets Train Staff on GEMS Policies
SOPs Conduct Environmental Compliance Baseline
Audit Annual Program Effectiveness Review Report
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GEMS Coordinator Committee
The committee meets at the discretion of the GEMS
Coordinator, we are currently meeting every other
month.
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GEMS Committee Training
Awareness training, EO 13148 training, Program
implementation training, basic compliance
training.
GEMS GAP Analysis
A review of the management system itself the
analysis looks at the gaps in the program it
does not look at regulatory compliance gaps.
Identify Significant Environmental Aspects
A process to identify where the program should
focus its attention to accomplish the most with
the least effort this is one of the staples of
any EMS. It requires the participation of all
areas of the facility and a review of each of
their activities.
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Aspects Impacts - Expanded
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Setting Objectives Targets from Aspects
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Setting Objectives Targets from Aspects
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Setting Objectives Targets from Aspects
TOP TEN ASPECTS BY
ASPECT SCORE The cumulative score of each
environmental aspect rated on compliance, risk,
frequency of activity, and VAMHCS control.
Frequency The overall amount of activities with
in the VAMHCS that impact each aspect.
1) Pharmaceutical Waste Management 2) Hazardous
Waste Generation-Rags 3) Medical Waste
Generation 4) Potential for Green Purchasing 5)
Potential for Spills Leaks Pharmaceuticals 6)
Exposure to Biological Contaminates 7) Total
Recyclable Materials 8) NEPA Compliance 9)
Radioactive Waste Generation 10) Potential for
spills leaks
1) Total Recyclable Materials 2) Energy
Consumption 3) Hazardous Waste Generation 4)
Potential for Green Purchasing 5) Hazardous
material storage/use 6) Air Emissions 7)
Potential for Leaks Spills 8) Medical Waste
Generation 9) Exposure to Biological
Contaminates 10) Handling disposal of
detergents (sanitary sewer) 11) Pharmaceutical
Waste Management
CY 2009 Draft Goals (in addition to goals
carrying over from CY 2008) 1) Pharmaceutical
Waste management (continued from CY 2008) 2)
Medical Waste Generation 3) Potential for Green
Purchasing 4) Total Recyclable materials
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Establishing Operational Controls Training Staff
In order to maintain continuous improvement of
our program to mandate compliance with
significant aspects objectives operational
controls must be established. Staff are then
educated on these policies procedures.
The policy is then reviewed every 3 years
requires updated training ever year
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Conduct Environmental Compliance Base Line Audit
The regulatory compliance audit should cover all
environmental regulations impacting the medical
center and include those promulgated by the
federal, state, and local agencies. Mock EPA
Inspection - Base line Audit every three years
thereafter
Annual Program Effectiveness Review Report
Corrective action plans Audit findings Gaps in
program Review of previous goals Approval of new
goals Recommendations for future development
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Additional Requirements for GEMS
EO 13423 Strengthening Federal Environmental,
Energy, and Transportation Management
-Increase of renewable power -Sustainable
Building -Water conservation -Affirmative
Procurement -Pollution Prevention -Electronics
management
-Alternative Vehicles -Petroleum
conservation -Alternative fuel usage -Energy
efficiency -Greenhouse gas reduction
Information Letters, Directives, Guidebooks,
additional EOs
13123- Energy Efficient Management 13149-
Federal Fleet Transportation Efficiency 13221-
Energy Efficient Standby Power Devices 13101-
Waste prevention, recycling, federal
acquisition 13302- Actions to expedite energy
related projects 13352- Facilitation of
cooperative conservation
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GEMS at the VAMHCS
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Benefits of GEMS
-Systematic development of a program -Improved
environmental compliance recognition of
environmental non-compliance -Regular meetings
to discuss environmental findings, goals,
issues -Wraps all environmental programs into one
program -Required group that is dedicated to
developing enforcing environmental
policies -Acts as a catalyst for environmental
issues to be brought to management
attention -Document control under one service
office
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Growing Pains Ongoing Issues
Initial development
VA CO Directives Guidebooks All information
sent only to GEMS Coordinator
GEMS coordinator at Facilities Develop Programs
Facilities report to VISN who report to CO
Minimal guidance is sent down from CO or VISN to
other sections of the hospital making
environmental requirements known. Examples
Green Purchasing, Recycling
Management Support
We hired a GEMS Coordinator, now we are done
Service Chief Clinical Centers Response
Its not my job, thats why we have a GEMS
coordinator
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Growing Pains Ongoing Issues
GEMS Coordinator position at the VAMHCS
Director
Chief of Staff
Associate Director of Operations
Social Work
EMS
AMM
NFS
IRM
Engineering
Research
Pharmacy
Police
Pastoral care
Consumer Relations
Chief Nurse executive
Clinical Center Directors
Safety Manager/Safety program
Nurse Managers
GEMS Coordinator
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Solving the Issues

• Updating Meeting Minutes with recommendations to
  management.
• Associate Director on GEMS committee
• Service chiefs complete their Aspects Impacts
  mandated by Directors EA
• Each committee member will report to the group.
• Service goals
• Distribution of VAMHCS Goals
• Program audits
• Program recognition outreach
• Making and example of staff (EMS)
• Updating PDs Functional statements

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Compliance Accomplishments
1. Developed an Underground Above Ground
storage Tank (UST AST) compliance policy. 2.
Developed a Refrigerant Recovery policy  For air
pollution prevention 3. Development of
Environmental Assessment for construction
projects in order to comply with NEPA. 4.
Improvement to our Hazardous Material Waste
management policies procedures 5. Increased
compliance to our pharmaceutical waste management
program made it through an EPA inspection 6.
Conducted 2 external environmental audits 7.
Compliance with the following regulations
-Air (Emissions Reports, generator run times,
ODS, generator permits) -Water (Sewer Permits,
storm water permits, drinking water) -Hazardous
Universal Waste regulations- Biennial
reporting -AST UST SPCC plans -TIER II EPCRA
reporting -Pesticide reporting
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Additional Accomplishments
1. Reduced Regulated Medical waste by 8 since
2006 Our 2008 RMW was 277 tons, down from 302.3
tons in 2006. 2. Reduced Solid waste (municipal
trash) by 7 since 2006 Our 2008 solid waste was
1796 tons, down from 1933.4 tons in 2006. 3.
Increase our recycling efforts by 46 since
2007  In 2008 the VAMHCS recycled 290.6 tons of
waste up from 156 tons in 2007. 4. Began working
on strategies to increase green purchasing for
AMM Purchase card holders 5. Reduced hazardous
waste from 2006 to 2007 by 7 6. Established
training for staff  7. Implementation of a
Battery Recycling program  8. Implementation of
a Toner Ink recycling program  9.
Implementation training for Cardboard
Recycling  10. Provided face-to-face training
for NEPA, Hazardous Waste Management, green
purchasing, spill response, and recycling,
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GEMS CY 2009 GOALS FOR IMPROVEMENT
Improve Pharmaceutical Waste Management
Comply with EO 13101 by establishing an
Affirmative Procurement Policy and training as
needed.
Develop a single stream recycling program
throughout the VAMHCS
Insert Environmental wording into Position
Descriptions for Service Chiefs, Senior
Management, and Department Heads
Develop a Comprehensive training program for All
Employees and those services which have a
significant impact on the environment.
Reduce Medical Waste by 10 over the next 2 years
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Will an EMS work for you?
Answer the following questions about your
facility
1. Do you have the infrastructure to support an
EMS? Management buy in, staff able to dedicate at
least 50 of their time to orchestrating the
program. 2. Do you have compliance issues that
need to be brought under one program? 3. Do you
have a committee that regularly meet to discuss
environmental issues? If not do you feel that you
need one? 4. Do you want to your program to be
ISO 14001 compliant or just improve your current
program?
QUESTIONS??
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Additional Information Contact Angela Wood,
VAMHCS GEMS Coordinator [phone] ext
6574 Angela.Wood2_at_va.gov