Several Health Technology Assessment (HTA) agencies have shown an interest in the environmental impacts of drugs, technologies, and health services, and some have begun work in this area. However, few agencies have published a strategy for integrating environmental considerations into their core activities. Defining a strategy matters since it makes explicit where an organization aims to go and how it intends to get there. To help bridge the gap, this article aims to describe the strategy developed by the Institut national d’excellence en santé et services sociaux (INESSS) (Québec, Canada), its implementation process, and the lessons learned.

The strategy was informed by the scientific and grey literature and consolidated through a consultation process with multiple stakeholders, including experts in environmental sciences, HTA agencies, patients, caregivers, citizens, clinicians, sustainable development officers, and health and social care civil servants.

The strategy articulates the means to meet three operational objectives: (a) knowing when to integrate environmental considerations into HTA knowledge products; (b) knowing which environmental considerations to integrate; and (c) knowing how to integrate these considerations into a growing number of knowledge products and improve over time.

Navigating through the novelty and uncertainty associated with environmental sustainability requires scientific humility as well as an organizational ability to learn and continuously improve. The tools and implementation process described in this paper could inspire and benefit other HTA agencies interested in advancing the inclusion of environmental considerations into their core activities.