Even with the challenges of the COVID-19 pandemic, UC San Diego Health continued to innovate ways to reduce waste, increase procurement of local, sustainable food and other products; reduce energy and water demand; and increase engagement across the organization. UC San Diego Health sustainability milestones in 2021 included developing a Green Clinic/Unit Certification program (GCC), initiating a Greening the OR (GOR) working group, and growing waste reduction and single-use medical device (SUD) reprocessing programs. GCC development included beta-testing and pilots, working with two student Carbon Neutrality fellows, the Sustainability Committee, and staff from the Hemophilia and Thrombosis Treatment Center, Sulpizio Cardiovascular Center and postpartum women and infant services. GOR made tremendous progress on priority actions in the first year due to the tenacity and dedication of physicians, nurses, and staff involved in environmental health and safety, sterile processing, procurement, environmental services, energy management and other areas. Successful GOR metrics included eliminating 18,000 Bair Paws disposable gowns from landfill, saving $170,000 annually; increasing SUD reprocessing education, collection and buy-back, with $450,000 in annual savings; benchmarking greenhouse gas impacts from anesthesia gases and eliminating desflurane from the formulary; and replacing over 2,500 operating room lights with LEDs for $65,000 in annual energy savings.