Walter Reed National Military Medical Center, Bethesda
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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

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Discussions

Walter Reed National Military Medical Center, Bethesda Construction ExecutionPresented toSAME Washington D.C. Post 31 July 2008

1


Discussions

Discussions

  • BRAC Law

  • Bethesda History

  • Program Overview

  • Related Projects

  • Construction Site and Logistics Plan…what’swhere

  • Construction Timeline…key events

  • Work-in-Place & On-site Labor Force

  • Command Relationships

  • Communications


Bethesda history

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

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


Discussions

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: 8,000Projected 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

Scope of Clinical Work:

- 682,000 sqft of new construction

- 320,000 sqft of renovation (60% of existing clinic)

Scope of Non-Clinical Work:

- 327,000 sqft of new construction (parking structure)

- 96,000 sqft of renovation

Major Projects:

- 6-story, 520Ksqft Outpatient Facility

- 4-story, 162Ksqft InpatientFacility

- 947 space Patient Parking Garage

- Clinic and Administration Renovation

- 1200 space Staff Parking Garage (Option)

RFP #2 Work … finalizing

Major Projects:

- Gym w/pool

- Administration Facility (new and renovate)

- Barracks (300 plus rooms and galley)

- Parking, Utility and Traffic Mitigation…TBD

Program: ~$200 M

Scope of Work… all non-clinical:

- 533,000 sqft of new construction

- 41,000 sqft of renovation


Discussions

Program Overview

N

3. WTU BEQ

4. Gym

5. Parking

2. WTU Admin

1. Outpatient Care

Bldg A

1. Non-Clinical

Admin Space

RFP #1: $650M

5. Bldg 17 Admin Renovations

2. Inpatient Care

Bldg B

= New Construction

4. Patient

Parking

= Renovation Work

2. Fisher Houses

RFP #2: $200 M

3. Bldgs 1-10

Renovations

6. Staff Parking

= New Construction

= Renovation Work

1. TBI/PTSD NICoE

Private Funding: ~ $60 - 80M


Discussions

FDR’s Concept

1963-1980

Vision


Discussions

Joint Warrior Care Wing

  • 4th Floor, Bldg 10

  • 66 State-of-the-art Rooms

  • Start Spring 2010

  • Complete May 2011

Aerial View

P

P

A

C

B

Ambulatory Care Center

  • Six stories plus basement

  • 533,000 gsf

  • Start July 2008

  • Complete September 2010

Inpatient Care Addition

  • Four stories plus basemen

  • Complete October 2010


National intrepid center of excellence nicoe

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

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

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)


Discussions

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


Discussions

Site Logistics Plan


Construction timeline key events

Construction TimelineKey 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)

(30 Sep)

Building B (In patient facility)

(Aug)

(30 Oct)

Patient Parking Garage Structure

(30 Oct)

(Nov*)

Renovations Bldgs 1-10

(30 Jul)

(Jul)

Renovation Bldg #17 (Time-line TBD)


Work in place and on site labor

Work in Place and On-site Labor

Work in Place (WIP):

  • Average Monthly WIP: $15M

  • Highest Monthly WIP: $26M…Apr and May 09

  • Jan 09 to Sep 09: Monthly WIP > $20M

  • Concerns: Supervision, incremental funding timeline and availability of contingency

On-site Labor:

  • Cumulative Total: 20,000 person workforce

  • Monthly Average: 472 personnel per day

  • Peak Workforce: 1,336/day in Oct 09

  • Jul 09 to Mar 10: Workforce at 1,000+ per day

  • No on-site Parking

  • Concerns: Transportation, access, messing, safety and security.

Avg.


Discussions

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 Concrete:

34,000 cubic yards

..or enough to build

The Washington

Monument

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

RFP #1 Work

Amount of Work Hours:

3,500,000

Or

the effort to play

53,000 NFL football games

Or

103 Seasons

Amount of Flooring:

Over 1 million sq ft

Or

This is nearly 25 Acres

Or

17 football fields

Rate of Work Produced:

$641,400,000

in 40 Months

Or

An average of $527,178 per day

RFP #2 Work

16


Relationships and touch points

Relationships and Touch-points

BUMED

OSD (HA)

NMNCA

NNMC

JTF

Top Priorities:

  • Patient Care and

  • Medical Operations

  • Safety

  • - On Site

  • - Throughout Campus

  • Communications

  • - Unity of Effort

  • Construction

  • - Quality, Time and Costs

  • Security

Commissioning

Agent

Sprinkler

System

Mechanical Design

and Construction

Excavation

and Tunnels

Interior

Finishes

Electrical Design

and Construction

Architect of Record

Design Integration

Concrete


Discussions

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…

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

Level

External

  • 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.

  • 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.

Formal

Partnering

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…

  • 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.


Questions

Questions ??

1


Discussions

Site Map

PPG

A

B


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