Environmental sustainability in veterinary clinics: best practices for the United States and Canada

Introduction: Veterinary professionals in the United States and Canada are increasingly seeking ways to reduce the environmental impacts of clinical practice, reflecting a broader commitment within the profession to sustainability. While environmental sustainability frameworks are well established in human healthcare, equivalent resources for veterinary clinical practice in North America remain limited. This study aimed to develop evidence-based best practices for enhancing environmental sustainability in veterinary clinics in the United States and Canada.

Methods: We conducted a gray literature review of open-access resources in veterinary medicine and human healthcare to identify explicit sustainability actions. Extracted actions were synthesized and reviewed by a panel of seven subject matter experts through a two-round modified Delphi process. Experts evaluated each action for implementation effort and environmental impact and provided qualitative feedback.

Results: The final set comprised 199 actions, organized into 14 thematic categories. Experts emphasized the importance of leadership engagement, team empowerment, and balancing high-impact, resource-intensive interventions with low-effort “quick wins” to build momentum. Priority areas included energy efficiency, waste reduction (particularly anesthetic gas management), sustainable procurement, and community engagement.

Discussion: The resulting framework provides a flexible, regionally relevant roadmap that clinics can adapt to their context, offering practical entry points for immediate action alongside strategies for long-term change. This resource can support veterinary teams, educators, and industry stakeholders in embedding sustainability into clinical practice, contributing to improved planetary and animal health.

1 Introduction

The triple planetary crises - climate change, pollution, and biodiversity loss - pose an urgent, global threat and demand sweeping, cross-sector action (1). For businesses, this means critically reviewing and refining operations to minimize environmental impacts. The healthcare industry has been particularly proactive, driven by both its substantial environmental footprint and the clear links between environmental degradation and adverse health outcomes (2). The veterinary sector shares these motivations: there is strong professional will to act (3–6), a desire for greater knowledge of sustainable veterinary practices (7), and growing evidence that veterinary clients are also seeking more sustainable options (8).

The development and dissemination of evidence-based best practices can facilitate the transition to more environmentally friendly industries. Such resources offer businesses a clear roadmap for action without the need for extensive independent research. They help prioritize steps, reduce the need for specialized expertise, and can even lower operating costs. When tailored to regional contexts, these recommendations are especially valuable, as they can account for local incentives (e.g., taxes, rebates) and the availability of specific technologies or services. In human healthcare, such evidence-based standards have been instrumental in driving meaningful, system-wide changes. Multiple organizations support sustainability efforts and provide actionable, healthcare-tailored checklists that help facilities reduce their carbon footprint, realize cost savings, and gain recognition for their achievements (9, 10).

Compared with human health, resources to guide sustainability in veterinary practice remain limited (11). While some progress has been made (e.g., Greener Practice Checklist from Vet Sustain in the UK), available action lists may overlook, or overemphasize, measures that are more relevant to specific regions. This project aimed to build upon publicly available sustainability standards in the healthcare and veterinary sectors by adapting them to the context of veterinary practices in the United States and Canada. Our objective was to establish evidence-based best practices for enhancing environmental sustainability in veterinary hospitals and clinics.

2 Materials and methods

2.1 Literature review

We conducted a review of the gray literature to identify existing best practices for sustainable business practices. We specifically searched gray literature as targeted resources were meant to be accessible to veterinary clinics and therefore must be open access and not behind a paywall. We performed two separate searches for: (a) veterinary clinical practice and (b) human healthcare. The inclusion of human healthcare ensured comprehensive coverage of sustainability practices given the a priori understanding that limited resources exist for veterinary medicine.

We used the following search terms for veterinary clinical practice: (veterinar* OR “vet med” OR veterinary medicine) AND (best practice OR standard OR certif* OR path* OR accredit* OR tool* OR program OR metric OR measure* OR performance OR impact OR checklist) AND (environment* (AND footprint) OR sustainab* (AND environment*) OR green OR eco OR “climate change”). Additionally, we performed a directed search of American Veterinary Medical Association (AVMA) and Canadian Veterinary Medical Association (CVMA) websites for resources on environmental sustainability.

Our search terms for human healthcare were: (healthcare OR medicine OR medical) AND (best practice OR standard OR certif* OR accredit* OR tool* OR metric OR measure* OR performance OR impact OR checklist) AND (environment* (AND footprint) OR sustainab* (AND environment*) OR green OR eco OR “climate change”).

We conducted searches using Google.com and continued until reaching three consecutive pages of 10 hyperlinks without identifying relevant documents. Given our a priori knowledge of limited availability of best practices for veterinary clinical practice in the US and Canada, we included global representation in our search. For human healthcare, our inclusion criteria focused on best practices relevant to the US and Canada. Our inclusion criteria specifically sought documents that contained explicit actions detailing best practices for environmental sustainability.

From the resources included, we extracted and compiled a list of individual actions. When actions were duplicative, meaning that they were conserved across multiple informing resources, we recorded the frequency that the action was referenced and, as necessary, developed statements with language that synthesized that action. All actions were thematically grouped via co-author consensus into one of 3 tiers (Core, Clinic, Community) and further categorized into one of 14 categories based on the “Pathway to a More Sustainable Clinic” resource that was co-created by the American Veterinary Medical Association, Canadian Veterinary Medical Association, and Veterinary Sustainability Alliance. Actions that we deemed not applicable to a veterinary clinic setting were excluded.

2.2 Expert opinion

We convened a panel of subject matter experts (SMEs) to review the action list and participate in a relative scoring system described below. We defined SMEs as individuals who have demonstrated leadership in veterinary clinical sustainability, as evidenced by serving on focus groups and committees, publishing on this topic, public speaking, and/or job descriptions.

Given our regional focus, we determined that SMEs were not to exceed 25% outside of the US and Canada. We developed an initial list of experts based on scientific communications or professional roles in clinical veterinary medical sustainability. Each expert was contacted by email to request their participation. We also employed the peer-referential technique of snowball sampling (12, 13) and asked those contacted to suggest the names of additional experts to include in our panel of SMEs. This study was classified as exempt from full review by the Colorado State University Institutional Review Board.

We utilized a modified Delphi approach to engage experts to judge the appropriateness of actions included, identify actions missing, and objectively measure the associated effort and impact of each action. When interpreted together, the effort and impact matrix can identify actions considered easy wins or those with high potential, as well as deprioritize actions requiring increased effort with a low return of impact (14). We defined effort as the work it would be to accomplish this action, with a low effort score meaning an action that is easy to do while a high effort score means more work or cost to achieve, i.e., is more resource intensive. We defined impact as the long-term effects to help future generations meet their own needs, where a high impact score would mean the action has a large effect while a low impact score would mean the action will minimally contribute to future needs. In the first round, we sent the SMEs an Excel table with the individual actions, grouped based on the framework outlined above, with a column for the effort and another for the impact they would attribute to each action. The panel was asked to review the list and add any additional actions missing from it. SMEs submitted scores between 1 and 100 for the effort and impact of each action, with 1 indicating the lowest effort or impact and 100 indicating the highest. In addition, SMEs had open text space to make comments on all actions, as well as comments about each category and broadly about environmental sustainability in veterinary practice.

We aggregated and summarized the results from the first round of SME scoring, including any new suggested actions. SMEs provided comments for specific actions leading to appropriate revisions. In addition to categorizing actions according to the “Pathway to a More Sustainable Clinic,” we also grouped related actions into themes in this version. For example, in the Energy category, themes include “energy efficient equipment” and “energy efficient lighting,” among others. These themes were determined through discussion and consensus among co-authors.

For the second round, the revised Excel table was re-distributed to the SMEs for a final review. We asked SMEs to re-score each action for an effort and impact rating, but instead of 1–100, we asked them to assign a rating of minimal, medium, high, or maximal. We assigned a 1 to 4-point scale to reflect minimal to maximal, respectively, and performed descriptive statistics reporting average effort and impact ratings. SMEs had the opportunity to provide feedback on each action, theme, category, and generally in an open text space. All SME comments and feedback from Round 1 and Round 2 were synthesized into insights for high-level discussion points for each category.

3 Results

Our gray literature review identified eight veterinary medicine specific and four human healthcare specific resources (Table 1). From these resources, actions were thematically grouped into the following pathways: Core (n = 37), Clinic (n = 207), and Community (n = 56). Within Core, actions were further classified into the following categories: Convene (n = 14), Assess (n = 12), Reflect (n = 6), Plan (n = 5). Clinic actions were classified into the following categories: Energy (n = 44), Waste (n = 84), Water (n = 22), Procurement (n = 33), Transportation (n = 24). Community actions were classified into the following categories: Health (n = 8), Stories (n = 9), Connections (n = 9), Policies (n = 2), Nature (n = 28).

Table 1

Table 1. List of resources identified from the gray literature review, informing the list of actions for best practices for environmental sustainability.

Seven subject matter experts were recruited and participated. SMEs represented United States (n = 4), Canada (n = 1), United Kingdom (n = 1), and Australia (n = 1). All SMEs met the expert inclusion criteria, having demonstrated leadership in environmental sustainability as detailed above. All seven SMEs completed both rounds of review for 100% completion.

Based on SME feedback from Round 1, actions were revised, including indicated deletions and additions, and categorized into themes. Additionally, 36 actions were removed based on SME Round 1 recommendations. For the final review in Round 2, the total number of actions by pathway were: Core (n = 29), Clinic (n = 124), and Community (n = 46). No actions were added, updated or removed based on SME feedback in Round 2. The final themes and actions are presented in Tables 2–8, with associated average effort and impact scores in Figures 1–3. Further descriptive statistics are presented in Supplementary material 1.

Table 2

Table 2. The list of actions in the Convene category of the Core tier, grouped by theme.

Table 3

Table 3. The list of actions in the Assess category of the Core tier, grouped by theme.

Table 4

Table 4. The list of actions in the Reflect category of the Core tier, grouped by theme.

Table 5

Table 5. The list of actions in the Plan category of the Core tier, grouped by theme.

Table 6

Table 6. The list of actions in the Energy category of the Clinic tier, grouped by theme.

Table 7

Table 7. The list of actions in the Waste category of the Clinic tier, grouped by theme.

Table 8

Table 8. The list of actions in the Water category of the Clinic tier, grouped by theme.

Figure 1

Figure 1. Sustainability actions under the Core tier are plotted based on their average effort (x-axis) and impact (y-axis) scores for the categories Convene (A), Assess (B), Reflect (C), and Plan (D). Each number corresponds to the actions listed in Tables 2–5, by referenced category.

Figure 2

Figure 2. Sustainability actions under the Clinic tier are plotted based on their average effort (x-axis) and impact (y-axis) scores for the categories Energy (A), Waste (B), Water (C), Procurement (D), and Transportation (E). Each number corresponds to the actions listed in Tables 6–10, by referenced category.

Figure 3

Figure 3. Sustainability actions under the Community tier are plotted based on their average effort (x-axis) and impact (y-axis) scores for the categories Health (A), Stories (B), Connections (C), Policies (D), and Nature (E). Each number corresponds to the actions listed in Tables 11–15, by referenced category.

Our SMEs also provided extensive comments on the process, themes and individual actions. SMEs highlighted the challenge of balancing high-impact and resource-intensive interventions with smaller, team-driven behavioral changes to build momentum. While the current evidence base for many veterinary-specific sustainability actions is limited, there is growing focus and effort within this sphere. Across all domains, leadership buy-in and active team engagement emerged as the foundation of success, alongside considerations such as measurable targets and communication. These emerged as the primary drivers for clinic sustainability success from our SMEs. Long-term commitment and integrating sustainability into daily clinic operations were emphasized throughout as key to progress. Building on these overarching themes, the following sections summarize expert insights within the categories of the “Pathway to a More Sustainable Clinic” framework.

3.1 Core

The Core tier represents foundational, sustainability actions that establish the basis for more advanced interventions. Collectively, these actions highlight the importance of implementation, team empowerment, and leadership alignment as the backbone for progress in sustainability efforts. We had 29 actions in our final list in the Core tier (Figure 1) across the four categories. Convene had 17 actions and 4 themes (Table 2; Figure 1A), Assess had 10 actions and 2 themes (Table 3; Figure 1B), Reflect had 8 actions and 1 theme (Table 4; Figure 1C), and Plan had 6 actions and 1 theme (Table 5; Figure 1D). All actions within the Core categories are aligned with empowering the veterinary team to build clear goals and are thus presented without breakdown within categories.

SMEs emphasized that while creating a sustainability plan is foundational, meaningful impact depends on the comprehensive implementation of coordinated efforts rather than isolated actions. Success on sustainability initiatives depends on empowering a well-supported team with leadership buy-in, adequate resources, clear goals, and shared ownership across the entire clinic staff. While audits and data collection are essential starting points, their value was noted to be in driving follow-up. Engaging the team through gamification and friendly competition can be effective strategies to increase engagement and foster ownership. Ongoing communication can also help sustain momentum. Experts noted that sustainability must be embedded into clinical culture and operations to avoid becoming an afterthought or additional work in the already hectic world of veterinary clinical practice. Long-term commitment with consistent messaging, regular meetings, and integration into budgets and other areas across the clinic is key.

3.2 Clinic

The Clinic tier builds upon the core by focusing on clinic-level sustainability actions. Overwhelmingly, our literature review and SME process identified many more actions within Clinic (n = 124), relative to Core and Community. Clinic actions focus on physical and behavioral changes within specific categories of Energy (n = 21), Waste (n = 48), Water (n = 16), Procurement (n = 25), and Transportation (n = 14). Average effort and impact for actions in the Clinic category are presented in Figure 2. Each Clinic category is further discussed individually below.

3.2.1 Energy

Energy actions aim to minimize energy usage and maximize energy from renewable sources. Our final list of actions in the Energy category was 21 actions and 5 themes (Table 6; Figure 2A). The goal of energy actions is to minimize energy usage and maximize energy from renewable sources. SMEs highlighted several key opportunities and limitations in reducing energy use. Experts noted that infrastructure improvements can yield significant energy savings but often come with high upfront costs and workload. For example, renewable energy use on-site was typically a medium impact action due to limitations in cost, availability, and capacity, while purchasing off-site renewable energy was considered easier to implement with maximal impact. Heating and cooling emerged as a significant clinical energy burden, with noted behavioral challenges in both implementing initial decreases in use, as well as needing to shift culture in order for behaviors to be sustained. Laundry practices, particularly reducing dryer use and using cold washes, were consistently cited as high-impact and feasible interventions. Behavioral actions, such as applying switch-off stickers to encourage turning off unused equipment, often have low effort with potential high impact. However, maintaining behavioral changes emerged as a major challenge. Within the comments, experts emphasized that while certain technical upgrades may have moderate effects with high initial cost, they collectively matter. Structural investment and continued demand for renewable and clean energy solutions can drive sustained change. Overall, expert comments on the energy category focused on a blend of technological upgrades, behavioral changes, and strategic purchasing to optimize impact.

3.2.2 Waste

Waste actions focus on waste management protocols and opportunities to minimize clinical waste generation. The Waste action had the most actions (n = 48) among all Clinic categories, with 6 themes (Table 7; Figure 2B). For the Waste category, SMEs consistently emphasized the geographical specificity of waste management systems, the importance of anesthetic waste in veterinary medicine, and the need to prioritize carbon over physical waste. SMEs noted that while individual waste actions often have a low impact, their cumulative impact is meaningful. However, there was noted emphasis on the idea that waste, especially recycling, can serve as a distraction from the more meaningful high environmental impact areas. However, a strategic waste plan is both valuable for waste reduction as well as encouraging team engagement, as waste is one of the most visible aspects of sustainability and an entryway for interest. Waste audits may prompt further engagement in sustainable efforts in the clinic (15). Waste management was noted to be complicated by the diversity of clinic waste streams, as well as regulatory constraints associated with regional variation. Practical feasibility, infection control concerns, and staff buy-in must be balanced for success in this category already limited by current waste streams.

Experts noted that reusable alternatives to high-volume disposables, such as drapes and gowns, were promising, with effort and feasibility dependent on local availability. Behavioral strategies, from limiting glove use or reassessing sterile mask usage to something as simple as reducing printing, were cited as impactful with minimal effort. Anesthetic waste management in veterinary medicine emerged as the section with great potential impact, often with only moderate initial effort. Anesthetic protocols present opportunities for improving both sustainability and quality of care, with SMEs noting that lowest safe flow can have large impact. While several SMEs noted that greener anesthesia may improve care, it must be implemented safely and with evidence-based practices. Changes require staff training and careful implementation to avoid compromising patient outcomes. While resources for more sustainable veterinary anesthesia exist (16), there remains opportunities for learning, as many veterinary professionals are unaware about the impact of veterinary anesthesia (17). Other sections prompted discussion, such as aquamation where some experts noted the possible significant emission savings while others expressed concern about gaps in current evidence, as well as potential ecological impacts. Overall, experts emphasized the need for stronger evidence-based guidance for waste reduction practices.

3.2.3 Water

Water focuses on minimizing water use with behavioral changes as well as equipment efficiency. Within the Water category, there were 16 actions and 3 themes (Table 8; Figure 2C). These included simple, but impactful, interventions. SMEs noted that laundry is a primary driver of water use in most clinics, reinforcing its relevance as an area for reassessment of sustainable protocols. Bedding choice was brought up as a concern due to differences in water use and production impact between cotton and recycled synthetic fabrics. Beyond total water use, there were additional comments about the impacts of sustainable protocols related to water, such as installing filters to minimize microplastic pollution from laundering. Experts again emphasized that reducing water use is dependent on geographic location. Water reduction actions may have mild impacts on carbon footprints, but there were many low effort, easy “wins” to significantly reduce water pollution and bring attention to sustainability.

3.2.4 Procurement

Procurement focuses on making sustainable choices in clinic supplies and suppliers. The Procurement category had 25 actions and 2 themes (Table 9; Figure 2D). SMEs described procurement as an area where actions are often conceptually low effort with high impact, yet they are difficult in practice due to real-world constraints. Product availability, lack of supplier transparency, and managing purchasing in a clinic setting all emerged as challenges. Procurement decisions may also lie beyond the individual clinics’ control. A major source of discussion was Life Cycle Assessments (LCA), a tool for tackling Scope 3 emission. Scope 3 emissions are the indirect emissions generated across a clinic’s value chain, including the supply chain. While some experts mentioned the utility of LCAs, as well as emphasized the importance of asking suppliers to provide them, there remains minimal infrastructure for reliable LCA data and manufacturers can be unmotivated to reduce product-level impacts or provide LCAs. Still, actions for improving inventory management were highlighted for their waste-reducing potential. Even procurement choices were seen as impactful to help signal market demand and spark shifts in supply chains, even if individual impacts were moderate in the short term.

Table 9

Table 9. The list of actions in the Procurement category of the Clinic tier, grouped by theme.

3.2.5 Transportation

Transportation focuses on using and promoting low emission transportation for the clinic, staff, and clients. The Transportation category had 14 actions and 2 themes (Table 10; Figure 2E). SMEs identified employee community and client transportation as significant contributors to veterinary-related emissions, accounting for an estimated 15% each of total footprints. Potential interventions are highly context dependent. Experts were skeptical about the feasibility of widespread carpooling or public transit use, especially in regions with limited infrastructure. Providing electric vehicle charging was seen as helpful to encourage transitions and showcase commitment to sustainability, but also limited by the number of charging stations to benefit staff charging and by the time required to benefit client charging. While shifting to electric vehicles and promoting public transit or cycling are important, infrastructural and behavioral barriers remain. There was noted discussion on the potential impact of telehealth. SMEs acknowledged limitations of current infrastructure and associated regulations, while noting facets of telehealth opportunities, for example reducing the number of recheck visits with phone calls or pictures. Overall, experts emphasized that transportation improvements are incredibly important, as the major contributor to a vet clinic’s carbon footprint, however deeply challenged by infrastructure limitations, as well as behavior changes, and may require supportive policies.

Table 10

Table 10. The list of actions in the Transportation category of the Clinic tier, grouped by theme.

3.3 Community

The Community tier focuses on engaging clients, staff, and the broader public in sustainability initiatives, leveraging education, partnerships, and advocacy to extend environmental impact beyond the clinic’s operations. Our final list of actions in the Community tier was 46 (Figure 3) across the five categories. Health had 13 actions and 3 themes (Table 11; Figure 3A), Stories had 8 actions and 2 themes (Table 12; Figure 3B), Connections had 6 actions and 3 themes (Table 13; Figure 3C), Policies had 9 actions and 2 themes (Table 14; Figure 3D), and Nature had 10 actions and 3 themes (Table 15; Figure 3E).

Table 11

Table 11. The list of actions in the Health category of the Community tier, grouped by theme.

Table 12

Table 12. The list of actions in the Stories category of the Community tier, grouped by theme.

Table 13

Table 13. The list of actions in the Connections category of the Community tier, grouped by theme.

Table 14

Table 14. The list of actions in the Policies category of the Community tier, grouped by theme.

Table 15

Table 15. The list of actions in the Nature category of the Community tier, grouped by theme.

SMEs highlighted actions within the broad community category with the lens of veterinarians as a profession uniquely positioned as climate communicators with a shared concern for animal health. However, turning this potential into real impact was seen as difficult when requiring training and leadership support for climate conversations. Efforts to increase community access to care or offer low-cost services were noted to face significant constraints, especially in hospital models where economic pressures may conflict with sustainability goals. Preventive care was identified as the area with the maximal impact; however, experts again noted the lack of low-impact evidence-based diagnostic and treatment recommendations. Experts emphasized that engagement can be more impactful than specific environmental actions themselves. Finally, while national and global sustainability efforts were seen as valuable, most SMEs recommended focusing locally to maximize impact within the community. Veterinarians hold a trusted voice in their communities and have a unique opportunity to start climate action conversations with clients. Community highlights the unique role of veterinarians as trusted messengers and the complexity of embedding sustainability within practice culture. Veterinarians’ role as educators and advocates for environmental and public health must be within the clinic and beyond its walls. Community engagement is a promising, yet emerging, avenue for advancing sustainability in veterinary clinics.

4 Discussion

The results of this project provide veterinary clinics and teams with a practical starting point for engaging in environmental sustainability. By offering a range of nearly 200 actions, from highly visible and impactful to small zero-cost changes, clinics can choose where and how they want to start their sustainability journey. The actions provide sustainability teams ideas for paths forward for their clinic, or ways to connect people to sustainable opportunities. Even actions with moderate impact can be entry points to spark interest and get people in the sustainability door. Quick wins can help create buy-in and momentum for longer-term change. Our goal was to provide sustainable resources to those who want them and allow clinics to get involved with sustainability immediately. Clinics can choose the initiatives that fit their goals and their resources, increasing their impact over time. Every veterinary clinic can start somewhere, and having accessible, evidence-informed resources on hand empowers veterinary professionals to take immediate, meaningful steps toward embedding sustainability into practice.

Beyond informing veterinary professionals in practice, the findings from this project can inform the advancement of educational programming on environmental sustainability in veterinary schools and provides the opportunity for teaching institutes to model best practices. In 2023, the American Association of Veterinary Medical Colleges released a position statement on climate change, encouraging member institutions to integrate climate change and related topics into their curricula (18), and an AAVMC working group has since been formed to support educators in rapidly developing and embedding relevant content. The themes and actions identified in this study provide a practical starting point for creating educational resources that both highlight the breadth of possible interventions and emphasize those with the greatest impact. These materials could be incorporated into veterinary curricula, continuing education, and professional development programs focused on practice management. As sustainability is a relatively new focus in the profession, more senior veterinary professionals are less likely to have been introduced to the topic during their training (3), making continuing education particularly important. Such programming should also be accessible to veterinary paraprofessionals, a group with demonstrated interest in the topic and a track record of championing and implementing these changes in clinics (6). Integrating these best practices into teaching hospital operations in both the U.S. and Canada would immerse trainees in sustainable workflows from the outset, fostering not only the adoption of environmentally responsible behaviors but also positioning veterinary professionals as credible advocates for sustainability within their communities (5, 19). These resources may also support building a foundation for veterinarians to play a more active role in science communication. All veterinary professionals deserve to have access to continued learning on sustainability and communication on veterinary sustainability throughout their careers.

This project could also shape change in the broader veterinary industry. These actions provide a clear roadmap for environmentally sustainable clinic operations and could serve as a foundation for developing a third-party certification for veterinary clinics. Third-party certifications, awarded by independent organizations, verify that products, services, or facilities meet established standards. In human healthcare, non-profit organizations exist to provide guidance, progress assessments, and recognition to providers that have decarbonized their operations (9, 10). Although veterinary-specific certifications or awards exist in other countries (20, 21), to our knowledge, no comparable certification exists for veterinary practices in the U.S. or Canada. This gap is notable given that more than 65% of surveyed U.S. veterinary clients indicated they would value a certification identifying clinics that have reduced their carbon footprint (8). A veterinary-specific certification would also promote further research for vet clinics to minimize carbon emissions (22). The list of actions developed in this study could guide a certifying body in establishing such a program. Like existing models, certification could be tiered (e.g., bronze, silver, gold, platinum), allowing clinics to progress stepwise. Lower tiers might reward “easy wins” requiring minimal resources, while higher tiers would recognize more resource-intensive, higher-impact measures. Such a certification would be mutually beneficial to both clinics and clients. Public recognition can appeal to environmentally conscious clients, thereby attracting additional business. Additionally, the certification process can serve as a structured framework for clinics to measure progress and identify goals for continued improvement.

While this study establishes a foundation of best practices for environmental sustainability in veterinary medicine, significant opportunities remain for further research. All our SMEs highlighted the lack of objective data on the actual environmental, economic, and operational impacts of these actions when implemented in veterinary settings. In some cases, evidence can be extrapolated from human healthcare (e.g., anesthesia) or related sectors; however, there is a need for veterinary-specific information in other cases (e.g., companion animal aquamation). More broadly, robust, veterinary-specific data would strengthen the case for adoption, allow prioritization of high-impact interventions, and inform cost–benefit analyses relevant to diverse practice types. Equally important is research on behavior change in the veterinary profession, identifying the social, cultural, and organizational factors that facilitate or hinder the uptake of sustainable practices. This includes exploring effective communication strategies, incentives, and leadership models that can shift norms and embed sustainability into routine clinical operations. Such work would not only close key knowledge gaps but also provide the evidence-based needed to drive measurable, lasting change in the profession.

Continued research will be important to address the limitations of this study. Our literature review was restricted to freely accessible, English-language resources, which may have excluded relevant actions described in subscription-based publications or in other languages. Likewise, all members of our SME panel were native English speakers, introducing the possibility of similar language bias in the expert review process. Our SME panel represented primarily small animal practices, limiting the scope of practice type represented. While we believe our SME panel was highly qualified, the emerging nature of veterinary sustainability means that the current pool of experts is small, potentially limiting the diversity of perspectives represented. As the evidence base expands and the field matures, it will be important to revisit and refine the list of themes and actions presented here, using this initial framework as a foundation for incorporating new information, experiences, and stakeholder input.

5 Conclusion

Through a multi-phase, expert-informed process, we collaboratively developed practical actions for environmental sustainability best practice in veterinary hospitals and clinics in the US and Canada. Environmental sustainability in veterinary medicine is influenced by a range of factors, including geographic location, resource availability, and clinic-specific goals. Despite this variability, we identified hundreds of actions that clinical teams can adopt to reduce the environmental impacts associated with veterinary care delivery. These actions reflect the nuanced challenges and opportunities identified by SMEs and ground each recommendation in real-world clinic contexts. Importantly, these actions are not a one-size-fits-all prescription, but rather a flexible framework that clinics can adapt based on their size, location, resources, and sustainability goals. Additionally, the effort and impact matrix supports clinics beginning their sustainability journey by providing low-cost, high-visibility actions, while facilitating progression toward more resource intensive actions that have higher impact measures. By integrating clinical practice with environmental stewardship, this list supports veterinary teams in delivering high-quality care while contributing meaningfully to planetary health. We hope it serves as both a roadmap and a catalyst for action to help clinics start, sustain, and scale their sustainability journeys.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

CK-A: Writing – original draft, Writing – review & editing. DS: Writing – original draft, Writing – review & editing. KC: Writing – original draft, Writing – review & editing. CD: Writing – original draft, Writing – review & editing.

Funding

The author(s) declare that no financial support was received for the research and/or publication of this article.

Acknowledgments

We thank the subject matter experts who generously contributed their time, expertise, and insight. Their thoughtful feedback and discussion of opportunities and challenges of implementing sustainable practices, as well as passion for advancing sustainability in veterinary medicine, helped ensure this project is both practical and impactful.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The authors declare that no Gen AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher’s note

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Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fvets.2025.1690485/full#supplementary-material

References

1. UNEP. Making peace with nature: a scientific blueprint to tackle the climate, biodiversity and pollution emergencies. Nairobi: UNEP (2021).

Google Scholar

2. Lenzen, M, Malik, A, Li, M, Fry, J, Weisz, H, Pichler, P-P, et al. The environmental footprint of health care: a global assessment. Lancet Planet Health. (2020) 4:e271–9. doi: 10.1016/S2542-5196(20)30121-2,

PubMed Abstract | Crossref Full Text | Google Scholar

3. Kramer, CG, McCaw, KA, Zarestky, J, and Duncan, CG. Veterinarians in a changing global climate: educational disconnect and a path forward. Front Vet Sci. (2020) 7:613620. doi: 10.3389/fvets.2020.613620,

PubMed Abstract | Crossref Full Text | Google Scholar

4. Mair, TS, Janska, S, and Higham, LE. Sustainability in equine veterinary practice: a survey of opinions and practices amongst veterinary teams in the United Kingdom. Equine Vet Educ. (2021) 33:e445–8. doi: 10.1111/eve.13565

Crossref Full Text | Google Scholar

5. Schiavone, SCM, Smith, SM, Mazariegos, I, Salomon, M, Webb, TL, Carpenter, MJ, et al. Environmental sustainability in veterinary medicine: an opportunity for teaching hospitals. J Vet Med Educ. (2022) 49:260–6. doi: 10.3138/jvme-2020-0125,

PubMed Abstract | Crossref Full Text | Google Scholar

6. Scott, D, Davis, L, and Duncan, C. Environmentally sustainable management practices support veterinary staff wellbeing. Front Vet Sci. (2025) 12:1614496. doi: 10.3389/fvets.2025.1614496

Crossref Full Text | Google Scholar

7. Halfacree, Z, and Stonehewer, J. Vet professionals want to make sustainability changes. Vet Rec. (2021) 189:157. doi: 10.1002/vetr.860

Crossref Full Text | Google Scholar

8. Deluty, SB, Scott, DM, Waugh, SC, Martin, VK, McCaw, KA, Rupert, JR, et al. Client choice may provide an economic incentive for veterinary practices to invest in sustainable infrastructure and climate change education. Front Vet Sci. (2021) 7:622199. doi: 10.3389/fvets.2020.622199

Crossref Full Text | Google Scholar

9. Joint Commission (2025). Sustainable Healthcare Certification. Available online at: https://www.jointcommission.org/en-us/certification/sustainable-healthcare (Accessed October 15, 2024).

Google Scholar

10. Practice Greenhealth. (2018). The greenbeat blog Available online at: https://practicegreenhealth.org/about/news/environmental-excellence-awards (Accessed October 15, 2024).

Google Scholar

11. Koytcheva, MK, Sauerwein, LK, Webb, TL, Baumgarn, SA, Skeels, SA, and Duncan, CG. A systematic review of environmental sustainability in veterinary practice. Top Companion Anim Med. (2021) 44:100550. doi: 10.1016/j.tcam.2021.100550,

PubMed Abstract | Crossref Full Text | Google Scholar

12. Christopoulos, D. Peer esteem snowballing: a methodology for expert surveys. Brussels: Eurostat. (2007).

Google Scholar

13. Parker, C, Scott, S, and Geddes, A. Snowball sampling. London: Sage Publications Ltd (2019).

Google Scholar

14. Trubetskaya, A, Scholten, PBV, and Corredig, M. Changes towards more sustainable food packaging legislation and practices. A survey of policy makers and stakeholders in Europe. Food Packag Shelf Life. (2022) 32:100856. doi: 10.1016/j.fpsl.2022.100856

Crossref Full Text | Google Scholar

15. Kern-Allely, CM, McGimsey, MR, McAdam, TS, Cortes, VL, Baumgarn, S, Griffenhagen, GM, et al. Waste not want not: piloting a clinical waste audit at a United States university veterinary teaching hospital. J Am Vet Med Assoc. (2023) 261:584–91. doi: 10.2460/javma.22.11.0495,

PubMed Abstract | Crossref Full Text | Google Scholar

16. Jones, RS, and West, E. Environmental sustainability in veterinary anaesthesia. Vet Anaesth Analg. (2019) 46:409–20. doi: 10.1016/j.vaa.2018.12.008,

PubMed Abstract | Crossref Full Text | Google Scholar

17. Viola, L, Quintana, J, Sanchez, V, Scott, D, Griffenhagen, GM, and Duncan, C. Veterinary anesthesia: an opportunity to reduce the environmental footprint of clinical care. J Am Vet Med Assoc. (2024) 262:1271–8. doi: 10.2460/javma.24.01.0059,

PubMed Abstract | Crossref Full Text | Google Scholar

18. AAVMC AAVMC position statement on climate change. VetSustain (2023).

Google Scholar

19. Duncan, C, Scott, D, Kern-Allely, C, and Yager, R. Embedding sustainability in veterinary education: a model for the future at Colorado State University. J Am Vet Med Assoc. (2025) 263:1060. doi: 10.2460/javma.25.06.0374,

PubMed Abstract | Crossref Full Text | Google Scholar

20. RCVS. (2025). Practice Standards Scheme (PSS) awards. Available online at: https://www.rcvs.org.uk/setting-standards/practice-standards-scheme/pss-awards/ (Accessed August 13, 2025).

Google Scholar

21. VetSustain. (2025). A sustainable approach to clinical veterinary practice. Available online at: https://learn.vetsustain.org/courses/ASACVP-part1 (Accessed August 13, 2025.

Google Scholar

22. Watson, JA, Klupiec, C, Bindloss, J, and Morin, M. The path to net zero carbon emissions for veterinary practice. Front Vet Sci. (2023) 10:1240765. doi: 10.3389/fvets.2023.1240765

Crossref Full Text | Google Scholar

23. Saha, K, Yarnall, M, and Paladini, S. Sustainable practices in the animal health industry: A stakeholder-based view. Bus Strategy Environ. (2023) 33:3356–82. doi: 10.1002/bse.3633

Crossref Full Text | Google Scholar