[Justlovemy]

A Congressional mandate to ensure the new Walter Reed National Medical Center will be a “world-class” medical center has turned into a war of words between the deputy secretary of defense and an independent review board charged with checking the military’s progress.

The new Walter Reed medical center is scheduled to open in 2011 at the campus of the Bethesda Naval Hospital in Bethesda, Md., under BRAC policy that will shutter Walter Reed Army Medical Center that is six miles away in Washington, D.C.

According to the Defense Health Board’s Base Realignment and Closing Health Systems Advisory Subcommittee, the Pentagon still needs:

• A master plan for the region’s medical centers as well as for the new Walter Reed facility itself.

• Continued budget funding for construction on the project.

• To determine who will be in charge of the joint facility.

• To make changes to fit the definition of “world class,” such as larger operating facilities and single-patient rooms.

Those findings come from a report submitted to the Defense Department on July 2 called “Achieving World Class: An Independent Review of the Design Plans for the Walter Reed National Medical Center and the Fort Belvoir Community Hospital.”

Pentagon officials overseeing the project “have to figure out who’s in charge; the authority issue has to be straightened out,” said Ken Kizer, chairman of the Base Realignment and Closing Health Systems Advisory Subcommittee, an advisory group for the Defense Health Board. “That and the budget and the master plan are the three paramount issues.”

On Oct. 15, Deputy Secretary of Defense William Lynn III wrote a letter to members of Congress stating that he concurred with the board’s findings. But, according to Defense Health Board members, Defense officials seemed to have misinterpreted the intent of the report.

“The key findings in the report indicate that construction should continue at both the Bethesda and Fort Belvoir sites while a comprehensive master plan for [Walter Reed] and a [National Capital Region] Integrated Delivery System is developed,” Lynn wrote.

Defense Health Board members say that’s not what the report means at all, and that they were “dismayed” that Defense Department officials felt the operations as they stand now are “sufficient” after seeing the report. They sent their own letter in response to Lynn’s letter to Congress:

“To be clear, the committee did not suggest that either the new construction or the total design plan as presently laid out would result in a world class medical facility,” states the letter from Kizer. “The committee clearly stated that the current plans were not those of a world class medical facility.”

According to the 2010 National Defense Authorization Act, the Secretary of Defense “shall develop and implement a comprehensive master plan to provide sufficient world class military medical facilities and an integrated system of health care delivery for the National Capital Region.”

But Lynn seemed to disagree that this is an immediate requirement.

“While Congress has specified that the new [Walter Reed] and [Fort Belvoir Community Hospital] should be designed as world-class military medical facilities, this is not an underlying requirement of the BRAC 2005 recommendations,” Lynn wrote. “Instead, the development of these facilities as world-class medical centers … will be an ongoing process, requiring continuous improvement and benchmarking to commercial best practices.”

Though the report was not officially released until July, Defense Department officials have known about the recommendations since late 2008, Kizer said. They responded in October.

Kizer expressed concerns that the Pentagon may have misunderstood his subcommittee’s recommendations in a letter to the vice president of the Defense Health Board, Wayne Lednar, on Nov. 13. The board endorsed the letter, which was been forwarded to Lynn.

“The committee appreciates the [Defense Department’s] general agreement with its findings and the department’s candor in acknowledging that the current plans for the [hospital] will not produce a world-class medical facility,” Kizer wrote. But the letter continues, stating that the Defense Department lacks the “sense of commitment to correcting the identified deficiencies and organizational problems that were identified by the committee.”

Congress asked the Defense Health Board, an independent advisory group to the Pentagon, to conduct the review of the new facility, which will combine existing buildings with new structures. The board also worked to determine what “world-class” means, including details of a facility above and beyond what’s available at a typical hospital. But part of the problem, Kizer said, is that BRAC money may only be used for new structures. However, the master plan must include the site as a whole.

“The two processes have to come together,” Kizer said. “It’s one facility. That’s not rocket science, but it hasn’t happened.”

Some of the report’s findings included that surgeons would be required to travel two floors through public areas from the operating room to gain access to tissue specimens — forcing patients to spend more time anesthetized and surgeons to have to scrub in twice.

Kizer said the 17 existing operating rooms are about half the size of what they need to be because they were built according to old standards, and that only the three new operating rooms could be considered not just “world class,” but reaching the “state-of-the-art” standards most hospitals require.

In part, Walter Reed Army Medical Center is moving from its current digs because of old infrastructure — everything from faulty heating and air conditioning to rough plumbing — and because of what the new facility can offer: a 354-bed center with equipment to treat brain injuries and post-traumatic stress disorder, as well as equipment to help service members with amputations recover.


Article: http://www.militarytimes.com/news/20...rreed_111709w/

[Trissinas]

As construction proceeds briskly on the $2.4 billion “world-class” hospital Congress approved to replace Washington, D.C.’s Walter Reed Army Medical Center, a watchdog panel’s review of the project cites serious shortcomings in the planned facilities.

The new 354-bed Walter Reed National Medical Center is slated to open in September 2011, several months ahead of schedule, at the campus of the National Naval Medical Center in Bethesda, Md. Under base realignment and closure policy, the old hospital will be shuttered once the new medical center is in operation.

In September 2008, just a couple of months after construction began, Congress asked the Defense Health Board to conduct a review of the design plans for the new joint medical center. The board, an independent advisory group to the Pentagon, formed the BRAC Health Systems Advisory Subcommittee for that purpose. The subcommittee submitted its report on July 2.

The report found several problems that demonstrate design plans fall far short of Congress’ mandate to build a “world-class” medical center, including:

• Not enough operating rooms.

• Operating rooms too small to accommodate current and future advancements in surgical technology.

• A bed plan that does not include enough single-patient rooms — important for minimizing airborne and contact infections.

• Some nursing stations located too far from patient care areas.

• Uncertainty over whether the plan addresses technological needs such as fiber-optic cabling and wireless services.

Ken Kizer, subcommittee chairman and former Veterans Affairs Department undersecretary for health, said the project — which includes multiple military branches and agencies at local, state and federal levels — lacked a cohesive master plan and clear lines of leadership.

He said Pentagon officials overseeing the project “have to figure out who’s in charge; the authority issue has to be straightened out.”

“That and the budget and the master plan are the three paramount issues,” he said.

Part of the problem, the subcommittee found, is that BRAC money may be used only for new structures, but the plans for the new national medical center also include redesign and renovation of existing structures.

“The two processes have to come together,” Kizer said. “It’s one facility. That’s not rocket science, but it hasn’t happened.”

The subcommittee’s report, titled “Achieving World Class: An Independent Review of the Design Plans for the Walter Reed National Medical Center and the Fort Belvoir [Va.] Community Hospital,” cited lack of clarity by Congress on precisely what “world class” meant in terms of hospital design and construction. “World class” indicates the intentions of Congress, the report said, but “does not provide operational or functional details.”

In part, Walter Reed Army Medical Center is moving from its current digs because of old infrastructure — everything from faulty heating and air conditioning to rough plumbing — and because of what the new facility can offer: a 354-bed center with equipment to treat brain injuries and post-traumatic stress disorder, as well as equipment to help service members with amputations recover.

The long need for a new and improved medical center to replace the more than 100-year-old hospital got sudden attention in 2007, after media reports exposed the squalid conditions and sometimes substandard care wounded Iraq and Afghanistan vets were forced to endure there.

On Oct. 15, Deputy Defense Secretary William Lynn III wrote a letter to members of Congress stating that project design and progress for the new medical center were “sufficient.”

“While Congress has specified that the new [Walter Reed] and [Fort Belvoir Community Hospital] should be designed as world-class military medical facilities, this is not an underlying requirement of the BRAC 2005 recommendations,” Lynn wrote. “Instead, the development of these facilities as world-class medical centers … will be an ongoing process, requiring continuous improvement and benchmarking to commercial best practices.”

The subcommittee responded in a letter to Congress that it was “dismayed” that those conclusions could be made after viewing the report.

Kizer expressed concerns that the Pentagon may have misunderstood his subcommittee’s recommendations in a Nov. 13 letter to the vice president of the Defense Health Board, Wayne Lednar. The board endorsed the letter, which has been forwarded to Lynn. A Defense Department spokeswoman said Nov. 19 that Lynn had not yet received the letter, and therefore had no response.


Article: http://www.armytimes.com/news/2009/1..._reed_113009w/


Walter Reed Army Medical Center
The Walter Reed National Military Medical Center, scheduled to
open in 2011, is shown in an artist's rendering.

[chinesemedicine]

Everyone agrees that the new Walter Reed National Military Medical Center won’t meet Congress’ definition of a “world-class facility” by its scheduled completion in September 2011.

But military officials say a finished campus will be a good starting point for working toward a world-class facility.

Or, as military planners put it: “Development of a world-class medical facility is not a destination, but rather a journey of continuous improvement.”

An independent board that was asked to review the military’s progress said that’s the wrong place to start: If the Pentagon does not immediately make needed changes, it will waste money and time and disrupt care to wounded service members when the facility is inevitably renovated later.

Lawmakers at a Dec. 2 hearing seemed to agree.

“‘World class’ is most decidedly a destination — one that Congress expects the new facility to arrive at before [it] opens its doors,” said Rep. Susan Davis, D-Calif., who chairs the House Armed Services Committee’s personnel panel.

Rep. Solomon Ortiz, D-Texas, chairman of the armed service’s committee’s readiness panel, lamented the fact that four years after the process of creating a new facility began, “we still have a disorganized medical command, a disjointed funding authority and an inconsistent construction design in support of a $2.5 billion effort.”

The new Walter Reed medical center is scheduled to open in 2011 on the campus of the National Naval Medical Center in Bethesda, Md., under base closure decisions that will shutter the old Walter Reed Army Medical Center, located six miles away in Washington, D.C.

According to the Defense Health Board’s Base Realignment and Closing Health Systems Advisory subcommittee, the military is still struggling with basic tasks, such as a master plan for the capital region’s medical facilities, continued funding for construction on the new Walter Reed project, a determination of who is in charge of the facility as well as who will provide staffing for it, and coming up with fixes for a variety of problems.

Specifically, more than a dozen operating rooms at the new Walter Reed facility do not meet modern standards for size, service members would have to share rooms, and surgeons would have to walk through public areas to reach tissue-specimen storage areas, forcing them to scrub in more than once during a procedure.

Allen Middleton, the Pentagon’s acting principal deputy assistant secretary for health affairs, explained that the process of combining the existing facility in Bethesda with a new world-class facility is complicated, in large part because a major hospital still operates at Bethesda as construction continues around it.

Building such a major facility in a comparatively short period of time in the Washington, D.C., region “is certainly one of the most difficult undertakings in the history of the Military Health System,” Middleton said.

Vice Adm. John Mateczun, head of the National Capital Region Joint Task Force Medical, said construction is 60 percent done, though most of the features that would make the new Walter Reed “world class” will not be complete until after the September 2011 deadline.

Still, Dorothy Robyn, deputy undersecretary of defense for installations and environment, said the facility “will be superior to what we have now.”

Mateczun said the military plans to “evolve operating rooms as we go,” which will leave the hospital with a shortage of operating rooms in the near term.

He proposed extending the workday so doctors could continue with a full patient load.

Mater plans also are being drafted that will guide future funding decisions, Robyn said.

The new facility’s original cost estimate of $800 million has shot to $2.4 billion due to expansion of the project and improvements.

Ken Kizer, chairman of the Defense Health Board’s National Capital Region Base Realignment and Closure Health Systems Advisory Subcommittee, said he is concerned that adjustments are not being made now even as basic construction moves ahead of schedule.

“It means that the window of opportunity to take corrective action is even less than it was several months ago when the [Defense Health Board] completed its report,” he said.

“We have had concerns about the plans for the Walter Reed National Military Medical Center at Bethesda from the beginning,” Davis said. “In hearings and meetings we have had Vice Adm. Mateczun tell us, in effect, ‘Don’t worry — everything is on track.’ We have yet to be convinced this is true. In fact, we have yet to be convinced that the department takes our concerns seriously.”


Article: http://www.militarytimes.com/news/20...gress_120309w/