Today’s Agenda

Walter Reed National Military Medical Center Bethesda

Delivering High-Quality Healthcare

In a war-time environment Within the BRAC Deadline Using Design-Build Delivery

Today’s Agenda

1. Imperative for “World Class” Military Healthcare2. Overview of the BRAC Program 3. Coordination with Project Stake Holders4. Case Studies5. Audience Q & A

Introductions Andrew Gutberlet, Naval Facilities Engineering

Command (NAVFAC)

The Imperative for “World-Class” Military Healthcare

Andrew GutberletPublic Works Department Washington

Walter Reed National Military Medical Center BethesdaBRAC Program

Where the Nation Heals Its Heroes

Naval Support Activity BethesdaNational Naval Medical Center

NNMC: 600,000 patients annually 4,100 staff

NSA Bethesda: 8,000 personnel 245 acres Historically significant buildings Major Tenants: USUHS, JTF CapMed, AFRRI, Naval Postgraduate Dental School Campus includes Navy Lodge, NEX,

McDonalds, gas station, other services

Home of the President’s Hospital

BRAC Commission 2005

Non-Tertiary Care

Primary and Specialty Care

Walter Reed National Military Medical Center Bethesda Ft. Belvoir Community Hospital

Tertiary Care + Non Tertiary Care

Subspecialty and Complex Care

Deadline of 15 September 2011

WRNMMCB BRAC Program Evolution

Commission Report - September 2005• Add/Renovate 509,000 sf• $246.3 million• ~ 776 additional personnel

Business Plan July 2006• 837,000 sf• $493 million• 731 additional personnel

As of 24 May 2007• 1.057 million sf• $697.5 million• ~ 1,400 additional personnel

• Update Commission Data Set• Update Price Factors• Joint Space Analysis

• Warrior Care Wing• Update Price Factors• Accelerate MILCON• Realign Service Regions

TODAY>2.8 million sf $1.3 billion• ~ 3,000 additional personnel

• Enlisted Barracks with Dining Facility• Fitness Center• Warrior Care Clinic, Admin, Parking

As of 26 September 2007• 2.5 million sf • $939.6 million• ~ 2,500 additional personnel

• On/off Base Traffic Mitigations Costs• Recover Funding Shortfall for Garage #2• Additions to Phase 1

NSA BethesdaBRAC Construction Projects

Fisher Houses60 Units in 3 Houses

Building 62: Barracks/Dining/Admin ; 295K sqft

Building 17: Consolidated Complex Admin/Fitness Facility/Parking Garage; 415K sqft

National Intrepid Center of Excellence2 floors; 72K sqft

Traffic Mitigation Gate #3ECD: Dec 2012

Traffic Mitigation Gate #5ECD: Aug 2011

Traffic Mitigation Gate #4ECD: Jun 2012

Palmer Brown Intersec./Perimeter RoadECD: Aug /Nov 2011 Multi-Use Parking

Structure; 1200 Spaces

Hospital Renovations;390K sqft.

Patient Parking Garage944 Spaces; 335K sqft

Blgd A: Outpatient6 Floors; 560 sqft

Blgd B: Inpatient4 Floors; 162K sqft

Traffic Mitigation Gate #1and Pass / ID Office

Traffic MitigationGate #2

CBBW-TRMA LandConstructionDonated

Renovation – Making the Pieces FitPhased approach focused on:

Maintaining patient + staff safety, continuity, quality and quantity of care Preserving vital residency and training programs Maintaining Joint Commission Certification Protect ability to provide secure healthcare services to Nation’s leaders

Dependent upon: Critical path timeline that preserves lab, pharmacy, radiological services Availability of swing space Maintaining phased schedule; availability of new buildings in early 2011

“Building a hospital in a hospital while continuing to operate the hospital.”

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Med S

wing

Space

Challenges…Making the Pieces Fit

Ortho/PodiatryE-Room

B

PSS

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Challenges…Making the Pieces Fit

MSS = 35,000 sf

PSS = 12,000 sf

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WRNMMCB Facility

Staff

Patients

WRNMMC Bethesda StakeholdersJTF Cap Med

BP 169 and 173E Regional Health Care

WRAMCClose September 2011

NNMC Bethesda

Realign by September 2011

BUMEDProperty Card

Holders for NNMC Bethesda

Resource Sponsor

Montgomery County

NationalInstitute

Of Health

NCPC State of Maryland

HomeownersAssns.OASD(HA)

Media and the Public

NAVMED NCANavy Regional Health Care Navy MTFs w/in the Region

NAVFACConstruction/Renovation

Agent

White HouseExecutive Medicine

TMAPossess Financial

Resources

U.S. Congress

Project DeliveryThis large, complex project required: Speed of Delivery Schedule Certainty Budget Certainty Flexibility for Program Changes

… Design-Build Delivery offered this solution

NSA BethesdaBRAC Construction Projects

In Patient Pavilion

Patient Parking Structure

Renovations Bldgs 1-10

CY 2008 CY 2009 CY 2010 CY 2011

Award Contract (03 Mar)

Ambulatory Care (15 Aug)

(Jan) (31 Jul)

(15 Sep)

(Nov)

(Aug)

(Jul)

Ground Breaking (03 Jul)

Design

Multi-Use Parking Structure

Gates Improvement Project

4 months

Concurrent with New Construction 25 mo

25 months

7 months

25 months

15 months

15 months

10 months

BRAC Deadline !

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Renovations ScheduleDepartment Construction Duration

Main Radiology Phase ICardiology (phase 1)PenthouseMedical Surgery Phase IDental Readiness (phase 2)Clinical Pathology Phase IBAnesthesiologyMain Radiology Phase IIPACUCardiac RehabSleep Lab3D ModelingMedical Surgery Phase IIMedical Surgery Phase IVInfectious DiseasesLaser Eye/OptometryCardiology (phase 2)PulmonaryTransplantPain BlockStone CenterPain ClinicPeds Sedation/ OV Med SurgPlastic SurgeryHospital DentistryNeurosurgeryClinical Pathology Phase IIClinical Pathology Phase IIIMain ORMedical Surgery Phase IIIBehavioral Health (Phase II)Prev. & Cons. ServicesGME On-CallAPU Check-inWomen's ClinicsInvestigational ResearchNephrology (phase 2)

55k 53k 50k 50k75k

244k 239k 240k 230k 237k 228k 217k 217k185k

Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11

Total Area Under Renovation (SF)

Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11

Commencing in November 2010, approximately one-third of the existing medical center will be under

renovation with more contractors that patients on the facility

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Overcoming Key Challenges OICC Bethesda managing multiple programs Evolving programmatic and scope needs driven by

multiple stakeholders in high-profile environment Active engagement by stakeholders in design Coordination with other government contractors

Relationships and Stakeholders

Architect of Record Design Integration Electrical Design

and ConstructionMechanical Design and Construction

CommissioningAgent

InteriorFinishes

SprinklerSystem

Concrete Excavationand Tunnels

Involvement by multiple government stakeholders

Challenges and Solutions1. Complexity and Scope of the Project

2. Fast-Track Design and Approval

3. Change and Scope Management

Complexity and Scope of the ProjectChallenge

Manage a large, complex project within a fast-track schedule

Solution Divided Project Into Pieces within

the New Work and Renovation Scopes Each Piece was Tied to a Design Package Each Design Package had its Own Team

(Ownership/Accountability)

Fast-Track Design and ApprovalChallenge

Validate the program and complete the design within a fast-track project schedule involving multiple government stakeholders

Solution Produced a comprehensive Program Validation package

within four (4) months of NTP Validated every room for size, layout, function, flow and

equipment Held numerous departmental review meetings with owner Advanced multiple other design packages concurrently

Change and Scope Management Challenge

Manage changes and scope increases while staying on schedule

Solution Developed process for managing multiple changes (RFPs) during

design – rapid scoping, concept/design, pricing, approval, CDs Facilitated timely decisions for changes during design development

– used tracking sheet and met weekly Implemented fast-track design review and approval process for

changes post-IFC documents Implemented Functionality Walks – End User Input

WRNMMC Successes Early Turnover of Patient Parking Structure and

Multi-Use Parking Structure

Delivery of Ambulatory Care and In-Patient Buildings ahead of schedule

On-Time Completion of Renovated Spaces

Successful Relocation of WRAMC Staff and Patients

Staff / Clinician and Patient Feedback

Site Surveyed Twice by The Joint Commission and Full Accreditation

Walter Reed National Military Medical Center BethesdaBRAC Program

Where the Nation Heals Its Heroes

Questions?