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Today’s Agenda

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. Imperative for “World Class” Military Healthcare Overview of the BRAC Program

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Today’s Agenda

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  1. Walter Reed National Military Medical Center BethesdaDelivering High-Quality HealthcareIn a war-time environment Within the BRAC Deadline Using Design-Build Delivery

  2. Today’s Agenda • Imperative for “World Class” Military Healthcare • Overview of the BRAC Program • Coordination with Project Stake Holders • Case Studies • Audience Q & A

  3. Introductions • Andrew Gutberlet, Naval Facilities Engineering Command (NAVFAC)

  4. The Imperative for “World-Class” Military Healthcare Andrew GutberletPublic Works Department Washington

  5. Walter Reed National Military Medical Center BethesdaBRAC Program Where the Nation Heals Its Heroes

  6. Naval Support Activity BethesdaNational 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

  7. BRAC Commission 2005 Tertiary Care + Non Tertiary Care Subspecialty and Complex Care Non-Tertiary Care Primary and Specialty Care Ft. Belvoir Community Hospital Walter Reed National Military Medical Center Bethesda Deadline of 15 September 2011

  8. Commission Report - September 2005 Add/Renovate 509,000 sf $246.3 million ~ 776 additional personnel Business Plan July 2006 837,000 sf $493 million 731 additional personnel WRNMMCB BRAC Program Evolution TODAY • >2.8 million sf • $1.3 billion • ~ 3,000 additional personnel • On/off Base Traffic Mitigations Costs • 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 As of 24 May 2007 • 1.057 million sf • $697.5 million • ~ 1,400 additional personnel • Update Commission Data Set • Update Price Factors • Joint Space Analysis

  9. NSA BethesdaBRAC Construction Projects Building 17: Consolidated Complex Admin/Fitness Facility/Parking Garage; 415K sqft Traffic Mitigation Gate #5 ECD: Aug 2011 Traffic Mitigation Gate #4 ECD: Jun 2012 CBB W-T Palmer Brown Intersec./Perimeter Road ECD: Aug /Nov 2011 RMA Land Construction Multi-Use Parking Structure; 1200 Spaces Donated 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 B: Inpatient 4 Floors; 162K sqft Blgd A: Outpatient 6 Floors; 560 sqft Traffic Mitigation Gate #2

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

  11. Challenges… Making the Pieces Fit Ortho/Podiatry B E-Room PSS Med Swing Space 11

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

  13. WRNMMCB Facility

  14. WRNMMC Bethesda Stakeholders JTF Cap Med BP 169 and 173E Regional Health Care TMA Possess Financial Resources NCPC Montgomery County State of Maryland U.S. Congress NNMC Bethesda Realign by September 2011 Patients Media and the Public White House Executive Medicine NAVMED NCA Navy Regional Health Care Navy MTFs w/in the Region BUMED Property Card Holders for NNMC Bethesda Resource Sponsor NAVFAC Construction/Renovation Agent WRAMC Close September 2011 Staff National Institute Of Health Homeowners Assns. OASD(HA)

  15. Project Delivery This large, complex project required: • Speed of Delivery • Schedule Certainty • Budget Certainty • Flexibility for Program Changes … Design-Build Delivery offered this solution

  16. NSA BethesdaBRAC Construction Projects CY 2008 CY 2009 CY 2010 CY 2011 Award Contract (03 Mar) Design Ground Breaking (03 Jul) Ambulatory Care 4 months (Jul) (15 Aug) In Patient Pavilion 15 months 15 months 10 months BRAC Deadline ! (Aug) (15 Sep) Concurrent with New Construction 25 mo 25 months 25 months 7 months Patient Parking Structure (Nov) Multi-Use Parking Structure Gates Improvement Project Renovations Bldgs 1-10 (Jan) (31 Jul)

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

  18. 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

  19. Relationships and Stakeholders BUMED OSD (HA) NMNCA NNMC WRAMC JTF Involvement by multiple government stakeholders Architect of Record Design Integration Commissioning Agent Sprinkler System Mechanical Design and Construction Excavation and Tunnels Interior Finishes Electrical Design and Construction Concrete

  20. Challenges and Solutions • Complexity and Scope of the Project • Fast-Track Design and Approval • Change and Scope Management

  21. 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)

  22. 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

  23. 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

  24. 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

  25. Walter Reed National Military Medical Center BethesdaBRAC Program Questions? Where the Nation Heals Its Heroes

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