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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

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  1. Walter Reed National Military Medical Center, Bethesda Construction ExecutionPresented toSAME Washington D.C. Post 31 July 2008 1

  2. 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

  3. 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)

  4. 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

  5. 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 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

  6. 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

  7. FDR’s Concept 1963-1980 Vision

  8. 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

  9. National Intrepid Center of Excellence(NICoE) • Smithgroup Concept • 65,000+ sf facility • Cost =~$50M+ • Built and Equipped by FHF

  10. 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

  11. 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)

  12. 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

  13. Site Logistics Plan

  14. 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)

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. Questions ?? 1

  20. Site Map PPG A B

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