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.

Though Health Technology Assessment (HTA) has steadily grown over the past decades, less attention has been paid to the way HTA may prove more responsive to the broader economic, social, and environmental challenges that health systems are facing today. In view of climate change, chronic diseases, an aging population, inequalities, and workforce issues, the HTA community’s unique set of skills nonetheless holds great potential to help decision-makers strengthen many publicly funded health systems around the world.

This article adopts an integrated system-wide perspective guided by the Responsible Innovation in Health (RIH) framework to explore how the HTA community may not only adapt to the speed of innovation but also consider its direction.

Because RIH aims to steer innovation toward a more sustainable pathway, it can help HTA agencies anticipate decision-makers’ informational needs regarding four systemic challenges: (1) equitable access; (2) workforce issues; (3) accountable policy trade-offs; and (4) environmental sustainability. We clarify how key elements of the RIH framework may be used by HTA agencies to: (1) supplement their evaluation process; (2) align their priority-setting or strategic planning activities with their health system challenges; or (3) inform the production of early HTAs, horizon scans, or reports that are broader in scope than a single technology review.

The article concludes with three practical implications that were identified by the Institut National d’Excellence en Santé et Services Sociaux (INESSS) (Québec, Canada) and may inspire other HTA agencies.