1. 1 Original contractual date Current planning and contractual dates** June 2015 Dec 2015 Jan 2016 Feb 2016 June 2015 DEC 2016 Sept 2016 **Goal: See first patient by December 2016** DEC 2016 9 months to activate 3 months to activate Draft – September 2015 CEPInpatient Pt. Garage Transitional Living Outpatient D&TSite Concourse CEP Pt. Garage Inpatient Concourse D&TSite Outpatient Phased Turnover Timeline Changes Jan 2016 May 2016 Apr 2016 Transitional Living **SLVHCS, CFM & CMHP are actively discussing the possibility of a phased turnover of the D&T building

2. 2 1/16 CEP, Inpatient, & Patient Garage First obligation date (approx) Total Furniture10/15/15 $1.1M$6.0M $10.0M$4.0M $ 21.1M Equipment10/23/15 $12.5M$17.5M$27.5M$50.5M$108.0M FTEE10/1/15$4.2M $6.3M $5.9M $6.3M $22.7M Contracts11/15/15$17.1M$3.0M$4.4M$2.7M$27.2M Other10/1/15 $3.8M$2.5M $0.7M $0.1M$7.1M Total$38.7M $35.3M$48.5M$63.6M$186.1M 5/16 Outpatient 6-9/16 D&T (phased turnover) 4/16 Transitiona l Living FY16 Q1 FY16 Q2 FY16 Q3 FY16 Q4 Building Turnover Dates Dollars are estimates to be finalized by bids to procurement packages9/8/15 Replacement Medical Center FY16 Budget

3. 3 Principles of activation of new medical center No interruption of current clinical services while transitioning to a new hospital in a way that is seamless to Veterans Employees will be familiar with standard operating procedures and physical layout of new environment Assure effective and reliable service for medical operations through interventions such as simulation prior to opening Compliance with all relevant VHA Directives (e.g. Facility Infrastructure Requirements to Perform Standard, Intermediate or Complex Surgical Procedures 2010-018, 2010) related to clinical programs 3

4. 4 Proposed timeline for early activation 4 Phase 1 (starting by end of 2016) Current non-procedural SLVHCS clinical services (e.g., outpatient clinics, diagnostic imaging, prosthetics, phlebotomy, pharmacy, sleep laboratory, C&P program). Phase 2 (mid-2017) Ambulatory procedures unit and other procedures (e.g., endoscopy) not expected to require inpatient admission. Phased-in activation of inpatient mental health, then Emergency Department, acute care (medicine/surgery) and critical care simultaneously, followed by inpatient rehab, hospice, and palliative care. It is estimated to take approximately three months to activate limited beds across all types of units. Number of beds per unit will be phased as well, e.g. 12 ICU beds (6 medical and 6 surgical) and 24 acute care med/surg beds. Phased-in activation of inpatient admissions of Veterans limited to lower severity of illness scores for both acute care and critical care using conventional scoring tools whenever available.

5. 5 Proposed timeline for early activation 5 Phase 3 (late 2017) Expansion in number and complexity of ambulatory procedures that may potentially require inpatient admission. Opening of hybrid operating rooms to allow intermediate and then high complexity surgery. Programs such as interventional radiology, cardiac electrophysiology and catheterization laboratories.

6. 6 January 2016 – November 2016 October 2016 PM&R admin. Prosthetics admin. November 2016 Primary Care admin. Mental Health admin. C&P Dermatology admin. Medicine admin. Social Work admin. Rev. 9/11/2015 March 2016 Full warehouse operations April 2016 Facilities – shops May 2016 HAS Fiscal Chaplain January 2016 Police Facilities Logistics – limited warehouse operations Environmental Management Service Phasing Plan of Support Services Based on current planning and contractual dates Note: SLVHCS, CFM & CMHP are actively discussing the possibility of a phased turnover of the D&T building, which would positively impact services planned for May 2017 and after.

7. 7 December 2016 – February 2018 Initial Service Activation August 2017 IP Med/Surg/ ICU & Discharge Lounge IP Dialysis Pulmonary & GI Proc. Surgery – Standard Complexity Emergency September 2017 IP – Rehab, Hospice, Palliative Care & Respite October 2017 Hybrid OR Interventional Radiology/EP Lab Interventional Cardiology & Pain Clinic Surgery – Intermediate complexity February 2018 Surgery - high complexity Rev. 9/11/2015 January 2017 Clinics Primary Care Women’s Infusion Pulmonary Surgery Cardio, GI General Med Neurology Oncology ------------------------- February 2017 PERC May 2017 Radiology Gen Radiology CT/MRI/US Nuclear Med PET CT Path & Lab Core Labs Ext Clinic Labs Micro & Chem SPS ------------------------- June 2017 Nutrition – Food Production IP Pharmacy July 2017 IP MH On Call IP SWS Path & Lab Histo/ Cyto Blood Bank Morgue Autopsy December 2016 Check-In OP Phlebotomy OP Pharmacy Prosthetics Sleep Lab Clinics Mental Health PM&R Eye C&P ENT Derm Audiology Speech Dental Phasing Plan of Clinical Services for Patient Care Based on current planning and contractual dates **Goal: See first patient by December 2016** Note: SLVHCS, CFM & CMHP are actively discussing the possibility of a phased turnover of the D&T building, which would positively impact services planned for May 2017 and after. Phase 1Phase 2 Phase 3

8. 8 8 CY 2015 12/16 First patient seen 12/16 First patient seen 9/16 D&T, concourse, employee garage & site turned over, begin activation 9/16 D&T, concourse, employee garage & site turned over, begin activation 4/16 Transitional Living building turned over, begin activation 4/16 Transitional Living building turned over, begin activation 5/16 Outpatient building turned over, begin activation 5/16 Outpatient building turned over, begin activation 1/16 CEP, Inpatient bldg. and patient parking garage turned over, begin activation 1/16 CEP, Inpatient bldg. and patient parking garage turned over, begin activation CY 2016 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 29 new FTEE 29 new FTEE 40 new FTEE 35 new FTEE 35 new FTEE 21 new FTEE 7 new FTEE 7 new FTEE 22 new FTEE 22 new FTEE 1 new FTEE 1 new FTEE 26 new FTEE 1 new FTEE 1 new FTEE 50 new FTEE 50 new FTEE 25 new FTEE 25 new FTEE 41 new FTEE 41 new FTEE 59 new FTEE 59 new FTEE 120 new FTEE 120 new FTEE EOY FY16 Total Projected Activation FTEE = 625.875 EOY FY15 Approved Activation FTEE = 368.875 Activation FTEE Projection Based on current planning and contractual dates

9. 9 Renderings

10. 10 Training 10 Chartered Integrated Project Team specifically focusing on training for the new medical center. - Involves collaboration with subject matter experts, including National Simulation Center. - Under development are: - Overall campus orientation - Service and unit specific training including equipment, flow, processes - Identification and development of specific mock training scenarios for each unit - Use of one inpatient unit as a simulation unit specifically for team training In Fy15 we added new training and developmental programs: - Hudson Thomas Project (GS1-5, WG equivalent) - Buddy Program for new employees - Three-phase Supervisor Institute - Revised new employee orientation and service level orientation based on feedback from new employees In Fy16 we are developing new training programs: - MSAs - AOs - internships for administrative and technical positions, including engineering and health care management.

11. 11 For concerns and questions please contact at any time 24/7 : Fernando Rivera, FACHE, Interim Network Director, VISN 16 Email: Fernando.Rivera@va.govFernando.Rivera@va.gov Cell Phone: 202-834-7893