1 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 ,464 beds “The President’s Hospital”… “Serving our Nation’s leaders” Academic Center (USUHS founded 1972) Rivalry with Walter Reed New construction: –BLDGs 7 and –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 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, 520K sqft Outpatient Facility - 4-story, 162K sqft Inpatient Facility space Patient Parking Garage - Clinic and Administration Renovation space Staff Parking Garage (Option) RFP #2 Work … finalizing Program: ~$200 M Scope 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: ~ $ M Program Overview 2. WTU Admin 3. WTU BEQ 4. 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 N 1. Non-Clinical Admin Space 5. Bldg 17 Admin Renovations = Renovation Work

FDR’s Concept Vision

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 4 th Floor, Bldg 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 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

Site Logistics Plan

Construction Timeline Key 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 Labor Work in Place (WIP): 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. - 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 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 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 Or This is nearly 25 Acres Or 17 football fields Amount of Work Hours: 3,500,000 Or the effort to play 53,000 NFL football games Or 103 Seasons 16

Relationships and Touch-points Architect of Record Design Integration Electrical Design and Construction Mechanical Design and Construction Commissioning Agent Interior Finishes Sprinkler System Concrete Excavation and 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 Executive Level 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.

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