Base Realignment

1
2008 MHS CONFERENCE Caring for Americas Heroes

• Base Realignment Closure (BRAC) Clinical
  Actions Update

2
Agenda

• Clinical BRAC Scope Overview Schedule
• SAT Overview Update
• NCR Overview Update
• Fisher Intrepid Center of Excellence Update
• BRAC / Evidence Based Design (EBD) Integration
• Q A

3
Clinical BRAC Scope Overview
Clinical BRAC Scope All hands-on patient care
facilities affected by Base Realignment and
Closure law.

• Business Plan 169 includes the realignment of
  Walter Reed Army Medical Center.
• Business Plan 171 realigns McCord Air Force
  Base, Washington, medical facilities with those
  of the Madigan Army Medical Center.
• Business Plan 172 is associated with the
  conversion of Wilford Hall Medical Center to a
  large clinic and the enhancement and renovation
  of Brooke Army Medical Center.
• Business Plan 173 includes the conversion of
  eight inpatient medical centers to community
  hospitals or clinics across the country.

4
Clinical BRAC Scope - Continued
Fort Belvoir Community Hospital
Walter Reed National Military Medical Center,
Bethesda Aerial Perspectives (concept)
San Antonio Military Medical Center (left)
Fort Sam Houston Health Clinic (right)
5
Clinical BRAC Execution Schedule Overview

6
Clinical BRAC Average Monthly Burn Rate by FY
NCR
SAT
100,000
88,811,000
83,115,000
16,595,000
80,000
28,756,000
60,000
Thousands of
72,217,000
40,000
54,358,000
27,704,000
13,646,000
20,000
14,058,000
Average Burn/MonthFY08
Average Burn/MonthFY09
Average Burn/MonthFY10
To place the BRAC monthly burn in perspective,
our normal medical MILCON burn rate per month is
approximately between 6.6M to 25M
7
Clinical BRAC Average Monthly Burn Rate by FY
269M
100,000
300,000
135M
200,000
46M
8
San Antonio Overview Update
9
Impact on Ongoing Operations
240 Moves
WHMC
BAMC

• SAMMC South
• Location Lackland AFB
• Current Budget 51M MILCON
• Scope Complete functional realignment of BAMC
  and Wilford Hall including the renovation and
  conversion of Wilford Hall Medical Center to a
  clinic

• SAMMC North
• Location Brooke Army Medical Center SAMMC
  North
• Current Budget 630M MILCON
• Scope New Tower is over 700,000 sq ft
  approximately 50 increase of current hospital
  as well as approximately 100 increase in
  operational beds and 200 increase in parking
  spaces

240 clinical moves, which started in 2007, are
planned across BAMC WHMC
10
SAT Facilities Ft. Sam Houston Primary Care
Clinic
11
SAT Construction Phasing Transition Schedule
Transition Period Redistribution of services
between SAMMC-North and SAMMC-South Jun 2007
thru Sep 2011
12
National Capital Region Overview Update
Enhance Accelerate
13
NCR Construction Phasing Transition Schedule
Transition Period Redistribution of services from
WRAMC May 2010 thru Sep 2011
National Environmental Policy Act
14
NCR Facilities Enhance AccelerateFt. Belvoir
Hospital Clinical Facilities Scope/Schedule

• Enhancement Highlights
• Ambulatory Care
• Substance Abuse, Family Advocacy, Patient
  Services
• Blood Donor Center, Red Cross
• Occupational Health, Community Health
• Graduate Medical Education, Hospital Education
• Private Sector Space Standards Adjustment
• Enhancement to Equipment Budget
• Construction Acceleration
• Ft. Belvoir Inflation Price Adjustment
• Current Working Estimate 747M MILCON, 1.2M
  Square Feet

Central Utility Plant Summer 2009
Garage(South) Fall 2009
C
D
E
B
Garage (North) Aug 2010
A

15
NCR Facilities Enhance AccelerateWRNNMC
Clinical Facilities Scope/Schedule

• Enhancements for Warrior Care Center
• Enhanced scope provides all new ICU beds
• Original BRAC scope provided 20 new beds and 30
  existing ICU Beds
• Acceleration funds gets this addition done
  faster
• Ambulatory Care Center
• Part of original BRAC scope
• 66 Single Patient Beds (renovate existing space
  in Bldg 10)
• Original Scope provided zero private patient
  rooms
• Private rooms are the industry standard speeds
  healing and improves outcomes
• New scope to augment Family Support Space
  throughout

A
B
1
B
9
10
C
A
C
Pending EIS review and Record of Decision
A
1
B
9
C
10
16
Bethesda Preliminary Construction Phasing
Timeline
Key
Construct., Reno., Commission., Equip., Punch
Design Activity
Design Fabrication
Dept. Moves
Modular Unit
EIS
Approval
Milestone
17
NCR Facilities Bethesda BRAC Program Support
FacilitiesScope and Schedule
Clinical BRAC
Enhanced and Accelerated
Original PresBud

4.5. JEH
2. WT Housing
Hospital Add/Alt Parking (FY08)
8 .Parking
7. Fitness
Support Facilities
6. MEDCEN Support

• Warrior in Transition Clinic (FY09)
• Warrior in Transition Housing (FY09)
• Tri-Service Warrior in Transition Unit (FY08-09)
• Expanded Mess Facilities (FY09)
• MEDCEN Jr. Enlisted Housing (FY09)
• Non-Clinical MEDCEN Support (FY08)
• Fitness Center (FY09)
• Parking Structure (FY09)

3. WT Unit
1. WT Clinic
Renovation
2. Fisher Houses
1. CoE
Non Appropriated

• Center of Excellence for Traumatic Brain Injury
  and Psychological Health (CY08)
• New Fisher Houses (2x15 units) (CY08)

18
Fisher Intrepid Center of Excellence Update

• DoD accepts generous gift from Intrepid Fallen
  Heroes Fund
• Provides 60,000 Sq Ft building for advanced
  research and treatment valued at approximately
  60M (of which 20M for imaging equipment)
• DoD providing site preparation which includes the
  demolition of Building 12 as well as utilities
• Demolition will commence upon the signing of the
  ROD on 9 May 08
• Estimated completion Dec 09

19
Clinical BRAC Scope - Continued
Fort Belvoir Community Hospital
Walter Reed National Military Medical Center,
Bethesda Aerial Perspectives (concept)
San Antonio Military Medical Center (left)
Fort Sam Houston Health Clinic (right)
20
BRAC / Evidence Based Design Integration
21
Evidence-Based Design (EBD) for Healthcare

• The application of design principles and building
  features that have been scientifically studied
  and proven to make a positive difference in
• Outcomes
• Safety
• The bottom line

22
Theres More to EBD than Just Buildings
Trans-formational Leadership Culture
Healing Environment
Research
Research
Re-engineered Clinical Administrative Processes
Facility Design
Research
23
EBD Principles and Goals for the MHS

• Improve the Quality and Safety of Healthcare
• Reduce
• Hospital-acquired infections (airborne, contact
  and water transmissions)
• Medication errors
• Noise stress and improve speech intelligibility
• Room transfers
• Prevent patient falls
• Create a Patient- and Family-Centered Environment
  
• Increase social support
• Reduce spatial disorientation
• Improve patient privacy and confidentiality
• Provide adequate and appropriate light exposure
• Support optimal patient nutrition
• Improve patient sleep and rest
• Decrease exposure to harmful chemicals
• Maximize patient control of his/her environment

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EBD Principles and Goals for the MHS (contd)

• Enhance Care of the Whole Person by Providing
  Contact with Nature Positive Distractions
• Decrease patient and family stress
• Create a Positive Work Environment
• Decrease back pain and work-related injuries
• Reduce staff fatigue
• Eliminate noisy and chaotic environments
• Increase team effectiveness
• Design for Maximum Standardization, Future
  Flexibility and Growth
• Facilitate care coordination and patient service
• Expand public space utility

25
Challenges to EBD Implementation

• EBD increases pressures on tight construction
  budgets!
• Up front vs. life cycle costs
• Nice to have vs. essential to quality
• Military culture may diminish enthusiasm for EBD
• We save lives in tents in a war zone
• Single patient rooms vs. the buddy system
• A legacy of minimally adequate but austere
• Change threatens aggressive schedules
• Use existing design criteria to save time!
• Silos impede multidisciplinary approach to EBD
• Many players, most focused only on their piece
• Knowledge of EBD is not sufficiently dispersed
  throughout the MHS and the construction community

26
EBD in BRAC Facilities