1 walter reed national military medical center, bethesda construction execution presented to same...
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Walter Reed National Military Medical Center, Bethesda Construction Execution
Presented to
SAME Washington D.C. Post
31 July 2008
Discussions
• BRAC Law
• Bethesda History
• Program Overview
• Related Projects
• Construction Site and Logistics Plan…what’s where
• Construction Timeline…key events
• Work-in-Place & On-site Labor Force
• Command Relationships
• Communications
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
•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
General Information
Program: ~$1B over 3 yrs…2 major contracts (RFP #1 and RFP #2)Scope: ~2M square feet of new construction and renovationCurrent Base Population: 8,000 Projected Population Increase: 10,200Current Number of Patients/visitors: Projected Patient/visitor Increase:
- 1,860 per day - Double per day
RFP #1 Work
Program: ~$650 MScope 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, 520K sqft Outpatient Facility - 4-story, 162K sqft Inpatient Facility - 947 space Patient Parking Garage - Clinic and Administration Renovation - 1200 space Staff Parking Garage (Option)
RFP #2 Work … finalizing
Program: ~$200 MScope of Work… all non-clinical: - 533,000 sqft of new construction - 41,000 sqft of renovation
Major Projects: - Gym w/pool - Administration Facility (new and renovate) - Barracks (300 plus rooms and galley) - Parking, Utility and Traffic Mitigation…TBD
Program Overview
RFP #1: $650M
RFP #2: $200 M
Private Funding: ~ $60 - 80M
Program Overview
2. WTU Admin
3. WTU BEQ4. Gym
1. Outpatient Care Bldg A
4. Patient Parking
5. Parking
2. Inpatient Care Bldg B
3. Bldgs 1-10 Renovations
1. TBI/PTSD NICoE
6. Staff Parking
2. Fisher Houses
= New Construction
= New Construction
N
1. Non-Clinical Admin Space
5. Bldg 17 Admin Renovations
= Renovation Work
= Renovation Work
Aerial View
P P
Ambulatory Care Center • Six stories plus basement• 533,000 gsf• Start July 2008• Complete September 2010
B
Inpatient Care Addition • Four stories plus basemen• Complete October 2010
C
Joint Warrior Care Wing • 4th Floor, Bldg 10• 66 State-of-the-art Rooms• Start Spring 2010• Complete May 2011
A
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)
– 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)
•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)
• 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
• 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
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
• Single Patient Rooms - Single patient rooms: Decreased infection rates, falls, noise, self-reported stress
• Increased confidentiality (HIPAA), family presence, satisfaction with care
• 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
• 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
• Art - Decreased pain med requirements in ICU• Decreased length of stay surgical patients
Construction TimelineKey Events
Building B (In patient facility)
Patient Parking Garage Structure
Renovation Bldg #17 (Time-line TBD)
Renovations Bldgs 1-10
CY 2008 CY 2009 CY 2010 CY 2011
Award Contract (03 Mar)
Mobilize NAVFAC/CBB Trailers (12 May)
Sign ROD (06 May)
Contractor Mobilization (10 May)
Building A (Out patient facility) (30 Sep)
(30 Oct)
(30 Jul)
Start Design (04 Mar)
*NCPC Review of Design (5 Jun)
(30 Oct)
Integrated Design Service
(Jul)
(Nov*)
(Aug)
(Jul)
Ground Breaking (03 Jul)
Work in Place and On-site LaborWork In Place
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Work in Place (WIP):
On-site Labor: Labor Force
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- 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.
- 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
Avg.
General Information
RFP #1 Work
RFP #2 Work
Project Facts…
Amount of Soil Removed:228 million pounds
OrMore 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
OrEnough steel to make
9 miles of railroad tracks
The distance between NNMC & the U.S. Capital
Rate of Work Produced:$641,400,000
in 40 Months Or
An average of $527,178 per day
Amount of Flooring:Over 1 million sq ft
OrThis is nearly 25 Acres
Or17 football fields
Amount of Work Hours:3,500,000
Orthe effort to play
53,000 NFL football gamesOr
103 Seasons
16
Relationships and Touch-points
Architect of Record Design Integration
Electrical Design and Construction
Mechanical Design and Construction
CommissioningAgent
InteriorFinishes
SprinklerSystem
Concrete Excavationand Tunnels
Patient Care and Medical Operations
Safety - On Site - Throughout Campus
Communications - Unity of Effort
Construction - Quality, Time and Costs
Security
Top Priorities:
Presentations& Site Tours
External ExecutiveLevel
• 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.
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…
Formal Partnering
• 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.
• 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…
Senior Leadership Forums
Communications…
• As Required• Key Players: OICC, TMA, JTF NMNCA, NNMC, Clark-BB • Focus: Central brief with current, consistent, and coordinated project information maintained by OICC.
• 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.