Walter Reed National Military Medical Center Bethesda Delivering High-Quality Healthcare In a...
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Walter Reed National Military Medical Center Bethesda Delivering High-Quality Healthcare In a war-time environment Within the BRAC Deadline Using Design-Build
Walter Reed National Military Medical Center Bethesda
Delivering High-Quality Healthcare In a war-time environment Within
the BRAC Deadline Using Design-Build Delivery
Slide 2
Todays Agenda 1.Imperative for World Class Military Healthcare
2.Overview of the BRAC Program 3.Coordination with Project Stake
Holders 4.Case Studies 5.Audience Q & A
Slide 3
Introductions Andrew Gutberlet, Naval Facilities Engineering
Command (NAVFAC)
Slide 4
The Imperative for World-Class Military Healthcare Andrew
Gutberlet Public Works Department Washington
Slide 5
Walter Reed National Military Medical Center Bethesda BRAC
Program Where the Nation Heals Its Heroes
Slide 6
Naval Support Activity Bethesda National 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 Presidents Hospital
Slide 7
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
Slide 8
WRNMMCB BRAC Program Evolution Commission Report - September
2005 Add/Renovate 509,000 sf $246.3 million ~ 776 additional
personnel 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 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 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 Update Commission Data Set Update
Price Factors Joint Space Analysis Warrior Care Wing Update Price
Factors Accelerate MILCON Realign Service Regions Warrior Care Wing
Update Price Factors Accelerate MILCON Realign Service Regions
TODAY >2.8 million sf $1.3 billion ~ 3,000 additional personnel
TODAY >2.8 million sf $1.3 billion ~ 3,000 additional personnel
Enlisted Barracks with Dining Facility Fitness Center Warrior Care
Clinic, Admin, Parking 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 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 On/off
Base Traffic Mitigations Costs Recover Funding Shortfall for Garage
#2 Additions to Phase 1
Slide 9
NSA Bethesda BRAC Construction Projects Fisher Houses 60 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 Excellence 2 floors; 72K sqft
Traffic Mitigation Gate #3 ECD: Dec 2012 Traffic Mitigation Gate #5
ECD: Aug 2011 Traffic Mitigation Gate #4 ECD: Jun 2012 Palmer Brown
Intersec./Perimeter Road ECD: Aug /Nov 2011 Multi-Use Parking
Structure; 1200 Spaces Hospital Renovations; 390K sqft. Patient
Parking Garage 944 Spaces; 335K sqft Blgd A: Outpatient 6 Floors;
560 sqft Blgd B: Inpatient 4 Floors; 162K sqft Traffic Mitigation
Gate #1 and Pass / ID Office Traffic Mitigation Gate #2 CBB W-T RMA
Land Construction Donated
Slide 10
Renovation Making the Pieces Fit Phased 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 Nations 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.
Slide 11
11 Med Swing Space Challenges Making the Pieces Fit
Ortho/Podiatry E-Room B PSSPSS
Slide 12
12 Challenges Making the Pieces Fit MSS = 35,000 sf PSS =
12,000 sf
Slide 13
13 WRNMMCB Facility
Slide 14
Staff Patients WRNMMC Bethesda Stakeholders JTF Cap Med BP 169
and 173E Regional Health Care WRAMC Close September 2011 NNMC
Bethesda Realign by September 2011 BUMED Property Card Holders for
NNMC Bethesda Resource Sponsor Montgomery County National Institute
Of Health National Institute Of Health NCPC State of Maryland
Homeowners Assns. OASD(HA) Media and the Public NAVMED NCA Navy
Regional Health Care Navy MTFs w/in the Region NAVFAC
Construction/Renovation Agent White House Executive Medicine TMA
Possess Financial Resources U.S. Congress
Slide 15
Project Delivery This large, complex project required: Speed of
Delivery Schedule Certainty Budget Certainty Flexibility for
Program Changes Design-Build Delivery offered this solution
Slide 16
NSA Bethesda BRAC Construction Projects In Patient Pavilion
Patient Parking Structure Renovations Bldgs 1-10 CY 2008CY 2009CY
2010CY 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 mo25 months 7 months25
months15 months 10 months BRAC Deadline !
Slide 17
17 Renovations Schedule Commencing in November 2010,
approximately one- third of the existing medical center will be
under renovation with more contractors that patients on the
facility 17
Slide 18
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
Slide 19
Relationships and Stakeholders Architect of Record Design
Integration Electrical Design and Construction Mechanical Design
and Construction Commissioning Agent Interior Finishes Sprinkler
System Concrete Excavation and Tunnels Involvement by multiple
government stakeholders
Slide 20
Challenges and Solutions 1.Complexity and Scope of the Project
2.Fast-Track Design and Approval 3.Change and Scope Management
Slide 21
Complexity and Scope of the Project Challenge 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)
Slide 22
Fast-Track Design and Approval Challenge 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
Slide 23
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
Slide 24
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
Slide 25
Walter Reed National Military Medical Center Bethesda BRAC
Program Where the Nation Heals Its Heroes Questions?