Project practitioners help execute the U.S. government’s largest hospital merger and realign modern military healthcare
VOICES ❘ In the Trenches
Project practitioners help execute the U.S. government's largest hospital merger and realign modern military healthcare.
Daniel Messinger; Capt. Elizabeth Booth Myhre, Nurse Corps, U.S. Navy; Col. John Bulick, U.S. Air Force; and Robert Silverman
DRIVEN BY THE NEED to provide world-class care for wounded warriors and military personnel, the U.S. military has been consolidating its healthcare facilities around the world for over a decade through the Base Realignment and Closure (BRAC) process. The BRAC process is designed to close excess military installations to increase efficiencies in line with U.S. Congressional and Department of Defense objectives.
In the Washington, D.C., USA region, such an undertaking required US$2.7 billion and included the relocation of more than 160 clinical services, construction of more than 3 million square feet (278,709 square meters) of new or renovated facilities, and the realignment of nearly 10,000 healthcare and support staff.
The central effort of the program was the transition of patients and staff from Walter Reed Army Medical Center (WRAMC) in Washington, D.C., which was being closed, to new joint facilities at the former National Naval Medical Center (NNMC) in Bethesda, Maryland, USA (now renamed Walter Reed National Military Medical Center) and a new hospital in Fort Belvoir, Virginia, USA.
The six-year program succeeded through a choreographed combination of managing change, engaging a “megacommunity” of stakeholders, and using both standard and innovative project and program management techniques.
A 2007 Washington Post series that criticized the housing conditions for wounded warriors receiving medical treatment at WRAMC added considerable complexity to this program. The U.S. Secretary of Defense took a multipronged approach, including establishing the Joint Task Force National Capital Region Medical (JTF CapMed) to oversee the transition, consolidation and realignment of military health care.
The project management and transition planning required the careful consideration of options across all factors associated with the design, construction, outfitting, workforce planning, clinical practice, operations, and staff and patient moves. Early in the planning, JTF CapMed united military experts with program management experts from consultancy Booz Allen Hamilton, a PMI Global Executive Council member, to establish a program management office (PMO). The PMO was tasked to identify and track hundreds of milestones, develop a risk register, and establish a performance dashboard to communicate key metrics to stakeholders to ensure that there would be no decrement in service to the patients and wounded warriors receiving care throughout this transition.
The PMO and JTF CapMed also needed to drive organizational culture change. In this case, staff and patients were transitioning from service-specific facilities, such as those dedicated to the Army or Navy, to joint facilities.
The team addressed cultural integration through:
- Consistent communication to staff about change
- Orientation for new perspectives and the newly established organizational culture
- Strong messages, communicated from the JTF Commander, aimed at unifying, alleviating concerns and promoting inclusion
In addition to JTF CapMed's PMO managing the overall program, the four major medical centers in the area established program offices of their own to manage transition activities. The labor categories of staff were also standardized to ensure a baseline of skills and to address cultural differences. Execution milestones helped the JTF CapMed Commander identify risks and communicate risk management actions to the Secretary of Defense during daily conference calls leading up to the deadline.
Building a Community
In the case of most large programs that greatly affect public citizenry, not one sector—government, business or civil society—can solve project challenges alone. Using “megacommunity” concepts developed by Booz Allen, the JTF CapMed engaged a myriad of stakeholders, including:
- Wounded warriors and their families
- U.S. Congress members
- Other local patients in the U.S. Military Health System
- Multiple military services and units impacted by the closure of WRAMC
- More than 9,000 hospital clinicians, administrators and staff members
- Senior leaders in the U.S. Department of Defense
- Neighbors surrounding all three facilities
One technique for driving multiple stakeholders to a common goal is “war gaming” (also referred to as a “strategic simulation”). Over the course of several war games, the JTF CapMed team brought together hundreds of stakeholders from related but distinct communities—such as Commanders, administrators, staff, patients, wounded warriors and families—to identify courses of action for the transition of Walter Reed to the new medical facilities.
More than 10 clinical, logistics and lessons-learned summits engaged subject-matter experts in identifying critical integrated-delivery system requirements, transition challenges and next steps. These summits provided the blueprint for how key departments would operate in the new hospitals with new staff working alongside each other in a new environment.
The project included more than 3 million square feet (278,709 square meters) of new or renovated facilities.
Setting the Standards
Project leaders relied on the Knowledge Areas in A Guide to the Project Management Body of Knowledge (PMBOK® Guide) to create a baseline of project management practices used on the project:
- Integration: The master transition plan detailed how JTF CapMed would migrate clinical services from the existing hospitals to the new facilities.
- Time management: The PMO‘s 10,000-line integrated master schedule captured 135 mission-critical milestones, which enabled JTF CapMed to effectively identify and manage the critical path and control project scope.
- Quality management: Quality management policies and procedures ensured that PMO processes and deliverables met the associated requirements and would endure long after the BRAC transition.
- Communications: The PMO's communications plan focused on effective inbound and outbound communication in support of the transition mission. The central theme of the plan was “right message, right time, right audience.”
- Risk management: The PMO employed a systematic risk framework for JTF CapMed's decision-making process, addressing more than 100 significant risks with detailed risk responses.
With this big-budget program successfully completed, the military is applying similar techniques and lessons learned from the JTF for additional consolidation projects and the construction and transition of new facilities. PM
Daniel Messinger is a Booz Allen Hamilton lead associate and was the JTF CapMed program management office governance lead. Capt. Elizabeth Booth Myhre, Nurse Corps, U.S. Navy, was the JTF CapMed PMO director. Col. John Bulick, U.S. Air Force, is the JTF CapMed facilities director. Robert Silverman is a vice president of Booz Allen Hamilton and the original Booz Allen program manager supporting JTF CapMed.
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