The Detroit VA Healthcare System is implementing a systemwide sustainability strategy through its Green Environmental Management System (GEMS), designed to reduce waste, lower energy consumption, and improve operational efficiency. The program recently earned Practice Greenhealth’s “Top 25 Environmental Excellence Award.”

Through coordinated efforts across departments and a commitment to innovation—particularly in high-resource areas like dialysis—the Detroit VA works to demonstrate how environmental stewardship and clinical care can go hand in hand.

SBN Detroit interviewed Andrew Deppner, clinical nurse manager of the hemodialysis unit at the Detroit VA, to learn more about the system’s approach and what other healthcare institutions can adopt from their progress.

Q: Why do you think sustainability is such a crucial part of healthcare today?

A: Sustainability is relevant to all human operations today—we’re working with finite resources, and being good stewards of those resources is imperative. That’s especially true in healthcare. The population is aging, and we’re seeing more people living longer with chronic health needs. Meanwhile, healthcare itself is becoming more expensive. That means we need to be smarter about how we allocate and use resources.

At the VA, we serve 9 million–10 million veterans every year with a workforce of nearly half a million staff members. The sheer scale of our operations means our environmental footprint is significant. So our responsibility is twofold: Providing top-tier care and managing the institution in a way that honors that care through sustainability.

Q: Walk me through the structure of the GEMS program. How do departments collaborate to implement sustainability initiatives across such a large system?

A: GEMS operates as a committee that meets quarterly to evaluate all relevant projects—whether it’s new construction, repairs, upgrades, or procedural changes. One of our key parameters for approval is sustainability. We always ask: Can this process or improvement be made more sustainable?

We also assess best practices across the larger VA health system and use that insight to inform local decisions. That structure allows us to prioritize environmental responsibility across the board while tailoring solutions to our specific needs.

Q: In terms of winning Practice Greenhealth’s Top 25 Environmental Excellence Award, what do you think sets the Detroit VA apart, and what might others learn from your example?

A: Honestly, it comes down to our scale and our passion. We deliver a huge volume of patient care, so the impact of our sustainability efforts is magnified. But what truly sets us apart is that our team is fully committed. Stewardship isn’t just an initiative here—it’s a value we live by. That passion influences every decision we make, and it shows up in the way we approach both large-scale projects and day-to-day operations.

If there’s one thing other systems can take away, it’s that passion drives results. When your team is genuinely invested in sustainability, it shows up in your outcomes.

Q: How did your team reimagine the system to reverse the traditional water-use ratio in dialysis—and are other departments applying this kind of thinking?

A: Traditionally, reverse osmosis (RO) systems in dialysis operate with significant water waste, which is 60% to 80% efficient. We are working at about 98% efficiency.

We achieved this by choosing a high-recovery RO system over a standard one. That decision alone results in millions of gallons of water saved each year. When we received quotes from vendors, we made high-recovery RO our top priority, even though it required more investment and more work on our end. We believed it was worth it, and our team embraced the challenge.

Q: What were some of the biggest challenges you encountered when trying to drive sustainability in a healthcare setting, and how did you overcome them?

A: One challenge was our water room construction project. We decided to partner with a smaller, less globally established engineering company. That meant we had to take on a larger share of the planning and preparation ourselves. The tradeoff was that we had more control over the sustainability aspects of the project, but it also required more time and resources.

Despite the extra effort — more vendor coordination, more problem-solving — it paid off. We now have a highly efficient system that we believe in. It was more work, but we were willing to do it because the outcome aligned with our values.

Q: How does the Detroit VA balance sustainability with the demands of clinical care, especially in high-intensity or resource-heavy departments?

A: It starts with commitment. Everyone on our team is dedicated to serving our veterans. That shared purpose enables us to pursue ambitious projects without compromising care. I’ve been able to focus on our sustainability efforts because I trust my clinical team implicitly. Their professionalism and passion have freed me to work on these broader initiatives, and I know the patient care side is in excellent hands.

Q: If you could share one key takeaway or piece of advice with other healthcare systems looking to follow your lead, what would it be?

A: Plan ahead. You can’t foresee every variable, but the more proactive you are, the better your outcomes will be. Anticipate your resource needs early and map out the process thoroughly. If you do that, you’ll be in a stronger position to allocate budget and support before problems arise.

Sustainability is about systems thinking, and that starts with good planning.

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