Walter Reed National Military Medical Center Bethesda Delivering

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 Healthcare 2. Overview of the BRAC Program 3. Coordination with Project Stake Holders 4. Case Studies 5. 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 Cap. Med, § AFRRI, Naval Postgraduate Dental School § Campus includes Navy Lodge, NEX, Mc. Donalds, gas station, other services Home of the President’s Hospital

BRAC Commission 2005 Tertiary Care + Non Tertiary Care Subspecialty and Complex Care Non-Tertiary 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 • Recover Funding Shortfall for Garage #2 • Additions to Phase 1 • 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 >2. 8 million sf $1. 3 billion • ~ 3, 000 additional personnel As of 26 September 2007 • 2. 5 million sf • $939. 6 million • ~ 2, 500 additional personnel 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; 415 K sqft CBB W-T RMA Land Construction Donated Palmer Brown Intersec. /Perimeter Road ECD: Aug /Nov 2011 Traffic Mitigation Gate #5 ECD: Aug 2011 Traffic Mitigation Gate #4 ECD: Jun 2012 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 ; 295 K sqft National Intrepid Center of Excellence 2 floors; 72 K sqft Hospital Renovations; 390 K sqft. Patient Parking Garage 944 Spaces; 335 K sqft Traffic Mitigation Gate #1 and Pass / ID Office Blgd A: Outpatient 6 Floors; 560 sqft Blgd B: Inpatient 4 Floors; 162 K sqft Traffic Mitigation Gate #2

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 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 “Building a hospital early 2011 in a hospital while continuing to operate the hospital. ”

Challenges… Making the Pieces Fit E-Room Ortho/Podiatry B P S S g in w S e ed pac M S 11

Challenges… Making the Pieces Fit MSS = 35, 000 sf PSS = 12, 000 sf 12

WRNMMCB Facility 13

NCPC WRNMMC Bethesda JTF Cap Med TMA Stakeholders Montgomery BP 169 and 173 E Possess Financial Regional Health Care County 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 Staff OASD(HA) State of Maryland Media and the Public White House Executive Medicine WRAMC Close September 2011 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 25 months (Jul) (15 Aug) 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 Concurrent with New Construction 25 mo (Jan) (31 Jul) 7 months

17 Renovations Schedule Commencing in November 2010, approximately onethird of the existing medical center will be under renovation with more contractors that patients on the facility 17

Overcoming Key Challenges § OICC Bethesda managing multiple programs § Evolving programmatic and scope needs driven by multiple stakeholders in highprofile 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

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

Walter Reed National Military Medical Center Bethesda BRAC Program Questions? Where the Nation Heals Its Heroes