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 CapMed,  AFRRI, Naval Postgraduate Dental School  Campus includes Navy Lodge, NEX, McDonalds, gas station, other services Home of the President’s Hospital

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

WRNMMCB BRAC Program Evolution Commission Report - September 2005 Add/Renovate 509,000 sf $246.3 million ~ 776 additional personnel Commission Report - September 2005 Add/Renovate 509,000 sf $246.3 million ~ 776 additional personnel Business Plan July ,000 sf $493 million 731 additional personnel Business Plan July ,000 sf $493 million 731 additional personnel As of 24 May million sf $697.5 million ~ 1,400 additional personnel As of 24 May million sf $697.5 million ~ 1,400 additional personnel Update Commission Data Set Update Price Factors Joint Space Analysis Update Commission Data Set Update Price Factors Joint Space Analysis Warrior Care Wing Update Price Factors Accelerate MILCON Realign Service Regions Warrior Care Wing Update Price Factors Accelerate MILCON Realign Service Regions TODAY >2.8 million sf $1.3 billion ~ 3,000 additional personnel TODAY >2.8 million sf $1.3 billion ~ 3,000 additional personnel Enlisted Barracks with Dining Facility Fitness Center Warrior Care Clinic, Admin, Parking Enlisted Barracks with Dining Facility Fitness Center Warrior Care Clinic, Admin, Parking As of 26 September million sf $939.6 million ~ 2,500 additional personnel As of 26 September million sf $939.6 million ~ 2,500 additional personnel On/off Base Traffic Mitigations Costs Recover Funding Shortfall for Garage #2 Additions to Phase 1 On/off Base Traffic Mitigations Costs Recover Funding Shortfall for Garage #2 Additions to Phase 1

NSA Bethesda BRAC Construction Projects Fisher Houses 60 Units in 3 Houses Building 62: Barracks/Dining/Admin ; 295K sqft Building 17: Consolidated Complex Admin/Fitness Facility/Parking Garage; 415K sqft National Intrepid Center of Excellence 2 floors; 72K sqft Traffic Mitigation Gate #3 ECD: Dec 2012 Traffic Mitigation Gate #5 ECD: Aug 2011 Traffic Mitigation Gate #4 ECD: Jun 2012 Palmer Brown Intersec./Perimeter Road ECD: Aug /Nov 2011 Multi-Use Parking Structure; 1200 Spaces Hospital Renovations; 390K sqft. Patient Parking Garage 944 Spaces; 335K sqft Blgd A: Outpatient 6 Floors; 560 sqft Blgd B: Inpatient 4 Floors; 162K sqft Traffic Mitigation Gate #1 and Pass / ID Office Traffic Mitigation Gate #2 CBB W-T RMA Land Construction Donated

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

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

13 WRNMMCB Facility

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

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 In Patient Pavilion Patient Parking Structure Renovations Bldgs 1-10 CY 2008CY 2009CY 2010CY 2011 Award Contract (03 Mar) Ambulatory Care (15 Aug) (Jan)(31 Jul) (15 Sep) (Nov) (Aug) (Jul) Ground Breaking (03 Jul) Design Multi-Use Parking Structure Gates Improvement Project 4 months Concurrent with New Construction 25 mo25 months 7 months25 months15 months 10 months BRAC Deadline !

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 17

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

Relationships and Stakeholders Architect of Record Design Integration Electrical Design and Construction Mechanical Design and Construction Commissioning Agent Interior Finishes Sprinkler System Concrete Excavation and Tunnels Involvement by multiple government stakeholders

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 concurrently

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 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

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