Supporting Our Nation’s Veterans

TME: Share the mission of the Office of Construction & Facilities Management within the Department of Veterans Affairs.

FIOTES: The Office of Construction & Facilities Management (CFM) advances the Department of Veterans Affairs (VA) mission in support of our nation’s veterans by planning, designing, constructing, and acquiring major facilities. CFM is responsible for major construction project management; real property acquisitions, disposals and management; major lease and build-to-suit project management; and design and construction standards for health care facilities.

Through its construction and real property programs, CFM delivers to veterans, high-quality buildings, additions, large-scale renovations, and structural enhancements. Additionally, CFM manages facility sustainability, seismic corrections, physical security, and historic preservation of VA facilities, and while providing policy and support to departmental officials in these areas.

TME: What are some of the priority projects that the department has recently finished or has in development.

FIOTES: We have a number of new projects, through new construction and build-to-suit leases, that are pushing the envelope in health care technology and innovation—both in how they are built and what they offer to our veterans.

New Orleans VA Medical Center. Having been built in the wake of Hurricane Katrina, the new facility includes design and structural features that will not only ensure its resiliency in the event of a future catastrophic event, but will allow it to remain operational for up to a week and be available to serve the emergency needs of the broader community. The facility covers 1.6-million-ft² (gross) and has 200 beds, an outpatient clinic, a community living center, research facilities, patient and staff parking garages, and a central utility plant. It saw its first patient in December 2016 and will be fully operational by the end of 2017. Veterans Served: approximately 72,000.

Orlando VA Medical Center. The facility is 1.2-million-ft² (gross) and includes 134 inpatient beds, an outpatient clinic, a 120-bed community living center, a 60-bed domiciliary, parking garages, and a central energy plant. It also has a National Simulation Learning Center. The facility saw its first patient in 2015. Veterans Served: approximately 105,000.

Las Vegas VA Medical Center. At 1.1-million-ft² (gross), the facility includes 90 inpatient beds, a 120-bed nursing home care unit, an ambulatory care center, primary and specialty care, surgery, rehabilitation, geriatrics, extended care, a women’s health clinic and an administration/education complex. Veterans Benefits Administration offices are collocated. The final phase of construction, the expansion of the Emergency Department, was finished in March 2016. Veterans Served: approximately 64,000.

Polytrauma Rehabilitation Center – Tampa, Fla. The 189,188-ft² (gross) facility includes 56 private inpatient rooms, day rooms, a relaxing lobby and deck, and state-of-the-art therapy areas consisting of a climbing wall and an aquatic center. The space is designed to support physical and emotional rehabilitation to assist patients in their return to society. This facility is one of five in the country designed to return veterans, with traumatic brain injury or polytrauma, to the least restrictive environment in the community with meaningful daily activities including return to active duty, work and school, independent living, or supported living. The facility opened in April 2014. Veterans Served: approximately 93,000.

Ambulatory Care Center – Omaha, Neb. VA entered into an agreement in April 2017 with a non-profit partner to construct a new 156,000-ft² (gross) Ambulatory Care Center on VA’s Omaha campus. The facility will provide primary care, radiology and surgery services. This first-in-its-kind project resulted in significant savings to the VA, while partnering with donors to help fund the facility. The private sector’s use of best practices and industry standards will help the VA deliver this facility more quickly and economically. This is the first of five pilots authorized under specific legislation last December. Veterans served: approximately 37,900.

Health Care Center – Monterey, Calif. VA formally accepted the 168,000-ft² (net) center as substantially complete in February 2017. Activation began and its first patient visit was scheduled for August 2017. This is a shared facility between the VA and the Department of Defense that will ease the transition of active servicemembers to VA care. Veterans Served: 10,000, and 5,000 dependents.

Health Care Center – Charlotte, N.C. The use of design-build and innovative technologies helped deliver this 295,000-ft² (net) health care center ahead of schedule and under budget. The facility, constructed through a build-to-suit lease, saw its first patient in April 2016. Veterans Served: 37,000.

Outpatient Clinic – Tallahassee, Fla. The 142,000-ft² (net) outpatient clinic, constructed through a build-to-suit lease, saw its first patient in October 2016. Veterans Served: 15,000.

Health Care Center – Butler, Pa. This facility will be operational ahead of the standard design and construction timeframe for a project of this size. The 168,000-ft² (net) health care center will see its first patient in September 2017. Veterans Served: 25,000.

TME: Can you give insight into some of the recent changes that have taken place in your design and construction program?

FIOTES: Over the past few years, we have made significant changes targeted to improve design and construction management, promote cost controls, and limit schedule growth. Design and construction is a lengthy process, and while the efforts may take time to be realized, we are confident the results will be to the benefit of veterans we serve and our partners in the industry.

• CFM recognizes that improvement of the design and construction process is iterative. We are committed to continuous process improvements and are seeing the impact of several already.
• Integration of full-time medical planners from the project start is helping the coordination of design with medical equipment, resulting in reduced time and cost and fewer re-works.
• CFM’s efforts to streamline change order approvals have reduced processing time, and we are seeing the results in positive feedback from our contractors. Our ability to keep the contract current (modifications approved in a timely manner) demonstrates a commitment to our contractors that helps improve relationships.
• VA issued guidance on Framework Principles for the Delivery of Major Construction Projects. This guidance establishes clean lines of authority for execution of design and construction, and established the CFM Executive Director as the responsible authority for changes to the design of projects. This provides clear governance of the construction process.
• CFM issued guidance on Foundation of Project Design Principles that lays the framework to assure construction projects are functional and that elaborate and unnecessary design features are not driving up costs.
• VA implemented a rigorous requirements control and change management process to improve management controls and contain out-of-scope requests.
• CFM mandates that constructability reviews of major construction projects be completed by a private construction management firm throughout the design and before final bid documents are prepared.

Over the past few years, we have made significant changes targeted to improve design and construction management, promote cost controls, and limit schedule growth. Design and construction is a lengthy process, and while the efforts may take time to be realized, we are confident the results will be to the benefit of veterans we serve and our partners in the industry.

TME: What benefits have you seen from your partnership with the U.S. Army Corps of Engineers?

FIOTES: The VA has entered into a new and expanded partnership with the U.S. Army Corps of Engineers to help deliver some of our largest projects. While the operations and governance of this teamwork are still evolving, the Corps has brought many experts and best practices to these projects and we expect that we will be able to enhance our own program as we learn from new or better delivery methods.

Specifically for the Denver replacement hospital project, VA has seen the benefits of being able to reestablish trust and to complete construction of the project so we can deliver a new medical center to our veterans. The collaborative VA/Corps program management team working at the headquarters level enables oversight of all projects in the portfolio. Best practices and lessons learned from one project can be applied to another for more expedient and thorough issue resolution.

TME: How do you foresee changing demographics and evolving technology changing your approaches to medical facilities?

FIOTES: VA is at a crossroads. We have an inventory of over 6,200 buildings and 155 million-ft². The average age of facilities is approaching 60 years. More than 2,200 buildings are historic. We have a backlog of deficiencies and modernization requirements exceeding $40 billion. And with changing demographics and shifting populations, VA must approach its facilities planning and delivery in a new way.

The Secretary of Veterans Affairs has made it one of his top priorities to modernize VA infrastructure. For us, that translates into world-class facilities: the right project, in the right place, at the right time, serving veterans needs. At the same time, VA recognizes that resources are finite and capital modernization efforts must be prioritized. Consequently, we want to focus our priorities on facilities providing access to “foundational services” for our veterans—primary care, mental health and overall care coordination—and, services that address military-related conditions/disorders for which the VA is uniquely positioned to deliver exceptional care.

The Secretary of Veterans Affairs has made it one of his top priorities to modernize VA infrastructure. For us, that translates into world-class facilities: the right project, in the right place, at the right time, serving veterans needs.

Where VA might not have the required infrastructure, resources, or volume to meet appropriate care standards, we will explore opportunities for partnering as well as broader use of technology.

Recently, the secretary rolled out plans for expansion of telehealth across the VA system—an effort intended to dramatically increase the use of this technology and provide improved access to healthcare for veterans, particularly in rural or remote areas. Ultimately, VA’s intent is to determine an optimal service alignment and a capital investment strategy in every market we serve. Our goal is to ensure our nation’s veterans have easy access to high-quality health care—whether in state-of-the art VA facilities or in collaboration with the Department of Defense, our academic affiliates, other community providers for the provision of care within a high-performing integrated health care network.

TME: Where can organizations like SAME best support your agency’s mission and needs?

FIOTES: Professional organizations like SAME provide impact by bringing industry and owners together in a collaborative environment for education and relationship-building.

Additionally, there is a real opportunity to bring government agencies together to support the sharing of lessons learned and best practices in order to help tackle the challenges facing delivering facilities across the public sector.

[Interview originally published in the September-October 2017 issue of The Military Engineer.]