Walter Reed National Military Medical Center, Bethesda
Construction Execution
Presented
to
SAME
Washington D.C. Post
31 July 2008
1
Discussions
• BRAC Law
• Bethesda History
• Program Overview
• Related Projects
• Construction Site and Logistics Plan…what’s where
• Construction Timeline…key events
• Work-in-Place & On-site Labor Force
• Command Relationships
• Communications
Bethesda History
1939
• FDR: “It is the healing pool of Bethesda!”
• Design from the heartland (Omaha, NEB)
• BLDGs 1-6 commissioned 31 AUG 1942
• 2,464 beds
1943-2000
• “The President’s Hospital”… “Serving our Nation’s leaders”
• Academic Center (USUHS founded 1972)
• Rivalry with Walter Reed
• New construction:
–BLDGs 7 and 8-- 1963
–BLDGs 9 and 10– 1980
• Despite growth, a place of natural beauty
and serenity
• NNMC - a focal point for the nation’s anxieties
–Recurrent crises (note periodicity):
• Forrestal suicide (1949)
• JFK autopsy (1963)
• Billig affair (1985)
BRAC Law
•Establishment of the new Walter Reed
National Military Medical Center (WRNMMC)
•Realignment of WRAMC functions to
Bethesda and Ft Belvoir
•Tertiary Services to Bethesda
–specialty and subspecialty care
–specialized facilities for most serious war injured
–Cancer CoE
•All services relocated by 15 Sep 2011
Program Overview
General Information
Program: ~$1B over 3 yrs…2 major contracts (RFP #1 and RFP #2)
Scope: ~2M square feet of new construction and renovation
Current Base Population: 8,000
Projected Population Increase: 10,200
Current Number of Patients/visitors:
Projected Patient/visitor Increase:
- 1,860 per day
- Double per day
RFP #1 Work
Program: ~$650 M
Major Projects:
Scope of Clinical Work:
- 6-story, 520K sqft Outpatient Facility
- 682,000 sqft of new construction
- 4-story, 162K sqft Inpatient Facility
- 320,000 sqft of renovation (60% of existing clinic)
- 947 space Patient Parking Garage
- Clinic and Administration Renovation
Scope of Non-Clinical Work:
- 1200 space Staff Parking Garage (Option)
- 327,000 sqft of new construction (parking structure)
- 96,000 sqft of renovation
RFP #2 Work … finalizing
Program: ~$200 M
Scope of Work… all non-clinical:
- 533,000 sqft of new construction
- 41,000 sqft of renovation
Major Projects:
- Gym w/pool
- Administration Facility (new and renovate)
- Barracks (300 plus rooms and galley)
- Parking, Utility and Traffic Mitigation…TBD
Program Overview
N
3. WTU BEQ
4. Gym
5. Parking
2. WTU Admin
1. Outpatient Care
Bldg A
1. Non-Clinical
Admin Space
5. Bldg 17 Admin Renovations
2. Inpatient Care
Bldg B
RFP #1: $650M
= New Construction
4. Patient
Parking
= Renovation Work
2. Fisher Houses
3. Bldgs 1-10
Renovations
RFP #2: $200 M
6. Staff Parking
1. TBI/PTSD NICoE
= New Construction
= Renovation Work
Private Funding: ~ $60 - 80M
FDR’s Concept
1963-1980
Vision
Aerial View
Joint Warrior Care Wing
• 4th Floor, Bldg 10
• 66 State-of-the-art Rooms
• Start Spring P
2010
• Complete May 2011
P
A
Ambulatory Care Center
• Six stories plus basement
• 533,000 gsf
• Start July 2008
• Complete September 2010
B
C
Inpatient Care Addition
• Four stories plus basemen
• Complete October 2010
National Intrepid Center of Excellence
(NICoE)
Smithgroup Concept
• 65,000+ sf facility
•Cost =~$50M+
•Built and Equipped by FHF
Related Projects (Parking, Traffic Mitigation etc)
– Exercise Contract Option for Staff Parking Garage FY 10
– On-site Traffic Mitigation FY 10/11
• Entry Control Points at five gates
• Widen Roads
• Pass & ID Office
– Off-site Traffic Mitigation FY 11
• Elevator access to Medical Center Metro Station
– Utility Upgrades ISO NICoE project FY 10
– MDOT: $43M for intersection improvement
Evidence-Based Design (EBD)
•Effects of design features on clinical outcomes
•Keys for WRNMMC:
–Single rooms (50% decr. morbidity)
–Infection control (HEPA, sink placement)
–Noise control and light
–Ergonomics (ceiling lifts, etc.)
–Green design
–“Healing environment” (nature, arts, spirituality)
The Evidence - > 700 studies have demonstrated value –
Citations - Ulrich and Zimring, Role of the Physical Environment in the 21st Century Hospital (2004); available at www.healthdesign.org
• Planetree ward: Decreased staff walking patterns
(29% nurse work minutes)
• Decreased noise: Decreased readmission rate CCU; ▼BP; ▲pt satisfaction
• Clean air (HEPA): Decreased infection and death rates patients
• Bright light: Decreased pain meds; decreased
• Single Patient Rooms - Single patient rooms: Decreased infection rates, falls,
noise, self-reported stress
• Increased confidentiality (HIPAA), family presence, satisfaction with care
• Gardens: Increased overall satisfaction rate with hospital
• Patients report decreased stress and less depression
• Art - Decreased pain med requirements in ICU
• Decreased length of stay surgical patients
Site Logistics Plan
Construction Timeline
Key Events
CY 2009
CY 2008
CY 2010
CY 2011
Award Contract (03 Mar)
Start Design (04 Mar)
Integrated Design Service
Sign ROD (06 May)
Contractor Mobilization (10 May)
Mobilize NAVFAC/CBB Trailers (12 May)
*NCPC Review of Design (5 Jun)
Ground Breaking (03 Jul)
Building A (Out patient facility)
(Jul)
(Aug)
(Nov*)
(Jul)
(30 Sep)
Building B (In patient facility)
Patient Parking Garage Structure
(30 Oct)
(30 Oct)
Renovations Bldgs 1-10
Renovation Bldg #17 (Time-line TBD)
(30 Jul)
Work in Place and On-site Labor
Work In Place
Work in Place (WIP):
700
- Average Monthly WIP: $15M
600
$ Millions
500
- Highest Monthly WIP: $26M…Apr and May 09
400
- Jan 09 to Sep 09: Monthly WIP > $20M
300
200
100
Jun-11
Apr-11
Feb-11
Dec-10
Oct-10
Aug-10
Jun-10
Apr-10
Feb-10
Dec-09
Oct-09
Aug-09
Jun-09
Apr-09
Feb-09
Oct-08
Dec-08
Aug-08
Apr-08
Jun-08
Feb-08
0
Concerns: Supervision, incremental funding
timeline and availability of contingency
Time
On-site Labor:
Labor Force
1,600
- Cumulative Total: 20,000 person workforce
- Peak Workforce: 1,336/day in Oct 09
- Jul 09 to Mar 10: Workforce at 1,000+ per day
Total Personnel
- Monthly Average: 472 personnel per day
1,400
1,200
1,000
800
600
Avg.
400
200
Time
Aug-11
Apr-11
Jun-11
Feb-11
Oct-10
Dec-10
Jun-10
Aug-10
Apr-10
Feb-10
Oct-09
Dec-09
Jun-09
Aug-09
Apr-09
Feb-09
Dec-08
Oct-08
Aug-08
Apr-08
Jun-08
Concerns: Transportation, access, messing,
safety and security.
0
Feb-08
- No on-site Parking
Project Facts…
General Information
Amount of Soil Removed:
228 million pounds
Or
More than the displaced weight of
a Nimitz Class Aircraft Carrier
Amount of Flooring:
Over 1 million sq ft
Or
This is nearly 25 Acres
Or
17 football fields
16
Amount of Concrete:
34,000 cubic yards
..or enough to build
The Washington
RFP #1 Work
Monument
Rate of Work Produced:
$641,400,000
in 40 Months
Or
RFP #2ofWork
An average
$527,178 per day
Amount of Steel Needed:
2 million pounds
Or
Enough steel to make
9 miles of railroad tracks
The distance between
NNMC & the U.S. Capital
Amount of Work Hours:
3,500,000
Or
the effort to play
53,000 NFL football games
Or
103 Seasons
Relationships and Touch-points
Top Priorities:
Patient Care and
Medical Operations
Safety
- On Site
- Throughout Campus
Communications
- Unity of Effort
Construction
- Quality, Time and Costs
Security
Architect of Record
Design Integration
Electrical Design
and Construction
Mechanical Design
and Construction
Commissioning
Agent
Interior
Finishes
Sprinkler
System
Concrete
Excavation
and Tunnels
Communications…
Presentations
& Site Tours
• As Required
• Key Players: OICC, TMA, JTF
NMNCA, NNMC, Clark-BB
• Focus: Central brief with current,
consistent, and coordinated project
information maintained
by OICC.
Executive
External
Level
• Every 3-4 Months
• Key Players: JTF CDR, LANT CDR
NNMC/NMNCA CDR, WRAMC CDR,
Clark-BB VP, NFWASH CO
• Focus: Project Status, Contractor
Performance, Issues and Way-ahead.
On-Site
• Weekly
• Key Players: ROICC, PMs,
MFDO, Construction Superintendent,
HFPPO, NNMC Facilities, etc…
• Focus: Safety, Construction
Scheduling, Medical Operations,
Design Status Review, Equipment
Delivery, etc…
• As Required…JTF/NNMC Lead
• Key Players: OSD, JTF, NNMC,
NAVFAC, OICC, Clark-BB, PAOs
• Focus: Consistent, updated, well
coordinated information for open
dissemination to public or
targeted audiences.
Formal
Partnering
• Quarterly
• Key Players: OICC, Clark-BB, A&E,
MFDO, PAO, HFPPO, NMNCA,
NNMC, ROICC Leadership, Facilitator
Focus: Concerns and impediments
to construction, internal and external
communications and construction
disruption to patient care.
Senior
Leadership Forums
• Monthly
• Key Players: OICC, Clark-BB,
TMA, JTF-J4, MFDO Director,
BUMED, NNMC PM, WRAMC
• Intent: Safety, 3-month outlook,
performance, impacts to medical
operations, quality, lessons learned,
etc…
Questions ??
1
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