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.
2.
3.
4.
5.
Imperative for “World Class” Military Healthcare
Overview of the BRAC Program
Coordination with Project Stake Holders
Case Studies
Audience Q & A
Introductions
 Andrew Gutberlet, Naval Facilities Engineering
Command (NAVFAC)
The Imperative for
“World-Class” Military Healthcare
Andrew Gutberlet
Public Works Department Washington
Walter Reed National Military Medical Center Bethesda
BRAC Program
Where the Nation Heals Its Heroes
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 President’s Hospital
BRAC Commission 2005
Tertiary Care + Non Tertiary Care
Non-Tertiary Care
Subspecialty and Complex Care
Primary and Specialty Care
Walter Reed National Military Medical Center Bethesda
Ft. Belvoir Community Hospital
Deadline of 15 September 2011
WRNMMCB BRAC Program Evolution
TODAY
• On/off Base Traffic Mitigations Costs
>2.8 million sf
$1.3 billion
• ~ 3,000 additional personnel
• Recover Funding Shortfall for Garage #2
• Additions to Phase 1
As of 26 September 2007
• 2.5 million sf
• $939.6 million
• ~ 2,500 additional personnel
• Enlisted Barracks with Dining Facility
• Fitness Center
• Warrior Care Clinic, Admin, Parking
• Warrior Care Wing
• Update Price Factors
• Accelerate MILCON
• Realign Service Regions
• Update Commission Data Set
• Update Price Factors
• Joint Space Analysis
As of 24 May 2007
• 1.057 million sf
• $697.5 million
• ~ 1,400 additional personnel
Business Plan July 2006
• 837,000 sf
• $493 million
• 731 additional personnel
Commission Report - September 2005
• Add/Renovate 509,000 sf
• $246.3 million
• ~ 776 additional personnel
NSA Bethesda
BRAC Construction Projects
Building 17: Consolidated Complex Admin/Fitness
Facility/Parking Garage; 415K sqft
CBB
Traffic Mitigation Gate #5
ECD: Aug 2011
Traffic Mitigation Gate #4
ECD: Jun 2012
W-T
RMA Land
Construction
Palmer Brown
Intersec./Perimeter Road
ECD: Aug /Nov 2011
Donated
Multi-Use Parking
Structure; 1200 Spaces
Traffic Mitigation Gate #3
ECD: Dec 2012
Fisher Houses
60 Units in 3 Houses
Building 62: Barracks/Dining/Admin ;
295K sqft
National Intrepid Center of Excellence
2 floors; 72K sqft
Hospital Renovations;
390K sqft.
Patient Parking Garage
944 Spaces; 335K sqft
Traffic Mitigation Gate #1
and Pass / ID Office
Blgd A: Outpatient
6 Floors; 560 sqft
Blgd B: Inpatient
4 Floors; 162K sqft
Traffic Mitigation
Gate #2
Renovation – Making the Pieces Fit
Phased approach focused on:
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


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.”
Challenges…
Making the Pieces Fit
E-Room
Ortho/Podiatry
B
P
S
S
11
Challenges…
Making the Pieces Fit
MSS = 35,000 sf
PSS = 12,000 sf
12
WRNMMCB Facility
13
WRNMMC Bethesda Stakeholders
NCPC
JTF Cap Med
BP 169 and 173E
Regional Health Care
Montgomery
County
TMA
Possess Financial
Resources
NNMC Bethesda
Patients
NAVMED NCA
Navy Regional Health Care
Navy MTFs w/in the Region
Realign by September
2011
BUMED
U.S. Property
Congress
Card
NAVFAC
Construction/Renovation
Agent
National
Institute
Of Health
Holders for NNMC
Bethesda
Resource Sponsor
Media and the Public
White House
Executive Medicine
WRAMC
Close September 2011
Staff
OASD(HA)
State of
Maryland
Homeowners
Assns.
Project Delivery
This large, complex project required:
 Speed of Delivery
 Schedule Certainty
 Budget Certainty
 Flexibility for Program Changes
… Design-Build Delivery offered this solution
NSA Bethesda
BRAC Construction Projects
CY 2008
CY 2009
CY 2010
CY 2011
Award Contract (03 Mar)
Design
4 months
Ground Breaking (03 Jul)
Ambulatory Care
(Jul)
(15 Aug)
25 months
In Patient Pavilion
(Aug)
BRAC Deadline !
(15 Sep)
25 months
Patient Parking Structure
(Nov)
15 months
Multi-Use Parking Structure
15 months
Gates Improvement Project
10 months
Renovations Bldgs 1-10
(Jan)
Concurrent with New Construction 25 mo
(31 Jul)
7 months
17
Renovations Schedule
Department
Construction Duration
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Main Radiology Phase I
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Commencing in November 2010, approximately onethird of the existing medical center will be under
renovation with more contractors that patients on the
facility
Cardiology (phase 1)
Penthouse
Medical Surgery Phase I
Dental Readiness (phase 2)
Clinical Pathology Phase IB
Anesthesiology
Main Radiology Phase II
PACU
Cardiac Rehab
Sleep Lab
3D Modeling
Medical Surgery Phase II
Medical Surgery Phase IV
Infectious Diseases
Laser Eye/Optometry
Cardiology (phase 2)
Pulmonary
Transplant
Pain Block
Stone Center
Pain Clinic
Peds Sedation/ OV Med Surg
Plastic Surgery
Hospital Dentistry
Neurosurgery
Clinical Pathology Phase II
Clinical Pathology Phase III
Main OR
Medical Surgery Phase III
Behavioral Health (Phase II)
Prev. & Cons. Services
GME On-Call
APU Check-in
Women's Clinics
Investigational Research
Nephrology (phase 2)
Total Area Under Renovation (SF)
244k
55k
53k
50k
50k
Jun-10
Jul-10
Aug-10
Sep-10
239k
240k
230k
237k
228k
217k
217k
May-11
Jun-11
185k
75k
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
17
Apr-11
Jul-11
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
Involvement by
multiple
government
stakeholders
Architect of Record
Design Integration
Electrical Design
and Construction
Mechanical Design
and Construction
Commissioning
Agent
Interior
Finishes
Sprinkler
System
Concrete
Excavation
and Tunnels
Challenges and Solutions
1. Complexity and Scope of the Project
2. Fast-Track Design and Approval
3. Change and Scope Management
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)
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
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 Bethesda
BRAC Program
Questions?
Where the Nation Heals Its Heroes