Q1: Why is the Navy building a new hospital on Guam?
A1: The purpose of this project is to provide a replacement hospital facility that serves the current and anticipated Department of Defense (DoD) population on Guam. The new hospital is needed to provide efficient, modern hospital infrastructure which meets all current building, electrical, mechanical, and structural seismic codes and standards.
The existing 1954 hospital has exceeded useful life expectancy and its layout is larger than needed. The current facility generates high energy and operating costs due to inefficient design and degraded infrastructure. The current layout consists of several large medical/surgical wings tied to a central circulatory spine which creates an inefficient use of space and less than optimal patient flow between clinics. Medical clinics and ancillary services are dispersed on four levels of the facility. The non-functional arrangement of departments into wings along with the lengthy connecting corridor system results in poor patient staff and supply circulation due to the intermixing of patient, staff, and service traffic throughout the facility. It is out of date with the current ambulatory outpatient model of care.
Action: The Navy Bureau of Medicine and Surgery (BUMED) approved construction of a new hospital to replace the existing Naval Hospital which will be demolished and turned into a parking lot. Existing ancillary support buildings associated with current operations of the existing hospital that will be retained include the helicopter pad, and medical warehouse. The replacement hospital is located on Navy property within the existing Naval Hospital compound.
Q2. Why can’t the Navy just renovate the existing hospital?
A2. Alternatives were considered to include renovation options and a no action alternative. The Renovation Alternative would not deliver a modern hospital due to structural limitations of the existing hospital facility and would require a significant degree of construction phasing over an extended period that would potentially disrupt healthcare delivery within the existing facility. Potential construction activities spread over five or more years would have a negative impact on patient care within the existing facility. For this reason, the Renovation Alternative was not selected as a viable option.
Under the No Action Alternative, the existing 56-year old Naval Hospital would not provide the necessary modern environment of healthcare required to serve beneficiaries over the next 50 years and would not meet current seismic standards. For this reason, the No Action alternative was rejected.
See A1 for more information on the decision and need for a new facility in order to retain operational readiness for Navy and Marine Corps service members, as well as continuity of care for beneficiaries.
Q3: Where is the new hospital located?
A3: The new U.S. Naval Hospital Guam is located in Agana, and is being built on land adjacent to the current facility, on U.S. Navy property. Agana is a central location for both the U.S. Navy and U.S. Marine Corps bases.
Other military treatment facilities on the island of Guam include:
The U.S. Air Force already has an outpatient facility and dental clinic at Andersen AFB, located in the north eastern area of Guam. The Veterans Administration Community Based Outpatient Clinic is located near the Naval Hospital Guam.
Q4: What is the scope of the replacement hospital project?
A4: The new hospital provides a modern design for efficient healthcare delivery. The new hospital, awarded in September FY10 for $158M will be 281,000 GSF. The new hospital will improve patient life safety and increase efficiencies in hospital operations, while accommodating projected beneficiary growth. The new hospital will provide modern facilities for inpatient medical/surgical/obstetrical services, outpatient specialty services, ancillary services and medical logistics. The completed hospital will provide 42 beds, four operating rooms, two C-Section rooms, and improved diagnostic and ancillary capabilities to include MRI and CT scanning suites.
The advantage of the replacement hospital is in its modern design based on current DoD criteria which reflects today's model of healthcare. The compact, nearly square footprint of the replacement facility will improve flow between medical services and increase staff efficiency.
Patient travel distances within the hospital and facility congestion will be reduced by the organization of high traffic clinic and ancillary areas in closest proximity to the main entrances and circulation spines, with other clinic and inpatient activities located on the upper floors. The flexibility to adjust to changing workload and operations is an extremely important benefit of the replacement facility design that will improve NH Guam's capacity to provide care. All of the inpatient functions are on one level on the west side of the second floor.
The inpatient beds in the Medical/Surgical Unit, the Intensive Care Unit, and the Obstetrical Unit are adjacent to each other so that the bedrooms at their borders can be used as acuity adaptable beds to allow one unit to overflow into the next if the need arises. The Medical/Surgical Unit has flexibility in that its bedrooms are proportioned for contingency operations so a one patient bedroom can be converted into a two patient bedroom. The placement of acuity adaptable rooms within the unit adjacent to the ICU allows for the unit to ebb and flow with the needs of the ICU.
Currently, Services USNH Guam provides:
Thirty-eight beds including six ICU beds; two OR; one C-Section operatory room; Family Practice; Internal Medicine; General Surgery; Pediatrics; Dermatology; Mental Health; Orthopedics; OB-GYN; Ophthalmology/Optometry; Urology; Oral Maxillofacial Surgery; Otolaryngology (ENT); Emergency Department; Audiology; Anesthesiology; Physical Therapy; Nutrition Services; Laboratory; Pharmacy; Radiology; Dental; Occupational Health, and Occupational Therapy.
**Note: All services currently available at USNH Guam will continue to be provided at the new facility and/or its affiliated clinics.
Services the new U.S. Naval Hospital Guam will offer:
The replacement facility is 281,000 GSF with 42 Beds Total: four OR plus two C-Section Rooms; six-bed ICU (plus six Acuity Adaptable); Family Practice; Internal Medicine; General Surgery; Pediatrics; Dermatology; Mental Health; Orthopedics; OB-GYN; Ophthalmology/Optometry; Urology; Oral Maxillofacial Surgery; Otolaryngology (ENT); Emergency Department; Audiology; Anesthesiology; Physical Therapy; Nutrition Services; Laboratory; Pharmacy; Radiology; Occupational Health; Dental, Podiatry, Occupational Therapy.
Q5: Where will the medical care for the new hospital come from?
A5: The current medical staff will remain in place. Additionally, Navy Medicine West, comprised of 10 Military Treatment Facilities (MTFs) in the Pacific Region, has the ability to cross level medical personnel to meet the needs of the staffing for USNH Guam. Navy Medicine West can adjust manning within the region to support the anticipated population shifts.
The U.S. House passed a stop gap spending bill that includes projects that were postponed in the 2013 National Defense Authorization Act. Because of these delays, billet requirements needed in the future are uncertain due to the need to reassess the needs of Guam (which will now involve fewer Marines and family members) through such measures as a Supplemental Environmental Impact Statement (SEIS) and Health Care Requirements Analysis (HCRA). Currently there are 771 billets Off- 179; Enl-384; GS- 105; Con- 103) at NH Guam, which includes: doctors, nurses, hospital corpsmen, and various administrative support staff.
Since NHG will significantly increase outpatient care capabilities, leadership is planning for some internal redistribution of physicians, HM support staff, and nursing staff. NHG does not anticipate a need to significantly increase administrative staff, galley staff, etc. However, in areas where there is an expected increase of services, such as lab and radiology, we have planned accordingly and increased specialty staff to meet those demands.
Q6: What is the timing of the move?
A6: The new hospital is scheduled to be open and available by the summer of 2014.
Q7. Which company was awarded the project?
A7. The construction contract was awarded to Watts Webcor Obayashi A JV of Honolulu, Hawaii in September 2010 in the amount $158 Million. (Current modified value of this contract is $165MIL.
Refer any additional questions to NAVFAC, Guam, POC: Willian Austin, Public Affairs Officer
NAVFAC Marianas, Office: 671-349-4053, William.Austin@fe.navy.mil Web: www.navfac.navy.mil
Q8: Who is funding the move?
A8: Funding from Defense Health Agency for U.S. Naval Hospital Guam.
Q9: Will TRICARE benefits change?
A9: Eligibility for care at the Naval Hospital and eligibility for TRICARE will remain unchanged with the replacement hospital. For more information visit: http://www.tricare.mil/tma/pacific/
Q10: Ambulance services? MEDEVAC services ?
A10: MEDVAC services will remain the same, which is to provide a streamlined aeromedical evacuation process which ensures patient safety and the most efficient use of resources to accomplish the transfer of care.
Q11: Environmental approach/improvements are being made for the replacement hospital?
A11: The replacement hospital will be built on Navy land adjacent to the current facility, which is located at the Naval Hospital base. Environmental Analysis for the hospital was completed August 9, 2010 with a Finding of No Significant Impact.
The hospital and will seek Silver level Leed Certification. Sustainable principles and concepts for energy efficient environmental design as outlined in the U.S. Green Building Council (USGBC) LEED for New Construction (LEED-NC) manual are being incorporated to the fullest extent possible. Selection of each LEED credit is based on client requirements, applicability, cost effectiveness, and budgetary constraints. (See link)
During the design development credits were evaluated for possible achievement. Each LEED credit is reviewed for its affect on life cycle costs, operational efficiency and worker productivity. The highest priority has been placed on credits that meet the project and client requirements and are economically justifiable. The sustainable design goal for this project is to incorporate a minimum of 50 credits, equivalent to the LEED v3 “Silver” level.
LEED is an internationally recognized green building certification system, providing third-party verification that a building or community was designed and built using strategies aimed at improving performance across all the metrics that matter most: energy savings, water efficiency, CO2 emissions reduction, improved indoor environmental quality, and stewardship of resources and sensitivity to their impacts.
Developed by the U.S. Green Building Council (USGBC), LEED provides building owners and operators a concise framework for identifying and implementing practical and measurable green building design, construction, operations and maintenance solutions.
Q12: What will be the dimensions of the new hospital?
A12: The facility will feature two stories of clinical functions with a third story containing administration functions and air handler rooms. The replacement hospital will be 281,000 Gross Square Feet and will have:
• 42 Beds (6 ICU, 22 MSU, 14 L&D) these inpatient beds are laid out in a manner that allows each nursing unit to flow into the next during times of high census. For example, the ICU can expand into acuity adaptable rooms in the Multiservice Unit.
• 4 ORs (3 general operating rooms and 1 orthopedic operating room) as well as 2 dedicated C-section rooms.
• This project will add the new capability of MRI.
• More efficient patient, staff and supply circulation.
• Improved survivability from earthquake and typhoon damage.
• The functional concept of the Replacement Hospital is straightforward in its organization, with high traffic clinic and ancillary areas in closest proximity to the main entrances and circulation spines. And lesser clinic and inpatient activities located on the upper floors.
• The building features a 3-story skylight (clerestory) atrium space that serves as the principal circulation and orientation space within the facility. The clerestory windows high in the atrium will admit additional day lighting in the center areas of the building. A major advantage of this straightforward design is the ability of the patient to quickly see all of his or her destinations upon entering the building.
• On the east side of the atrium are outpatient clinics and on the west side of the first floor are the hospital ancillary functions including Pharmacy, Pathology, Radiology and Emergency Services. The Pharmacy is located near the main front entrance, which makes it easy for patients to pick up their prescription on leaving the facility and allows patients to return for refills without having to penetrate deeply into the facility circulation. The Master-At-Arms, Medical Records, Patient Administration, Reception, Health Benefit Advisors, and Cashier are located at the main entrance to assist patients entering the facility.
• All of the inpatient functions are on one level; each patient room is designed as a private room.
• The inpatient beds in the Medical/Surgical Unit, the Intensive Care Unit, and the Obstetrical Unit are adjacent to each other so that the bedrooms at their borders can be used as acuity adaptable beds to allow one unit to overflow into the next if the need arises.
• The Medical/Surgical Unit has flexibility in that its bedrooms are proportioned for contingency operations so that the single patient rooms can become a two patient bedroom. The placement of acuity adaptable rooms within the unit adjacent to the ICU allows for the unit to ebb and flow with the needs of the ICU.
• Mother-Baby Unit LDRPs are located along the exterior wall with two Nurses’ Stations centrally located to cover the corridor. Flexibility is provided by having the Medical/Surgical Unit beds adjacent to the unit, which allow these bedrooms to serve as acuity adaptable beds for the OB unit.
• Outpatient clinic areas for Surgery and Surgery related clinics are located on the same floor and in proximity to their inpatient counterparts making it easy for the staff to move from the outpatient area to the inpatient area when needed.
• The administrative areas are designed into open office landscaped, which provides the maximum flexibility for changing the layout of the clerical office work area and space assignments.
Q13: What business opportunities will the new MTF bring to Guam?
A13: The economic impact to Guam is unknown at this time; however, Navy Medicine West anticipates employment opportunities for medical staff, medical technicians, medical maintenance, technical support and construction/contract opportunities during the demolition and building transition phases.
Q14: What will happen to the old hospital?
A14: The current hospital will be demolished and turned into parking. Anticipate approximately 900 parking spots.
Q15: Why can’t the local Guam hospital move into the current Naval Hospital?
A15: The current hospital will be turned into a parking area. In addition, the USNH Guam is a Naval Installation, so only eligible beneficiaries with approved CAC/I.D. cards are allowed access for security purposes. Finally, it has been determined that the cost to maintain such an old facility not a viable option.
Q16: Some local lawmakers requested to allow the government of Guam to assume any of the "old" medical equipment or parts of the facility (for that matter), that will not be used once the new facility is built, is that possible? Why has the local community been denied access to any leftover medical equipment from the old hospital?
A16: Since there will be no "old" facility remaining because it will be demolished to make room for a parking lot, there will not be remaining parts of the facility available for reuse.
Regarding medical equipment, Per DoD 4160.21-M (Aug. 1997) Defense Material Disposal Manual, (encl. 2) and Navy Medicine Equipment Management Manual (NAVMED P-5132 ):
"DoD controls the disposition of foreign and domestic excess property under Navy control. This is accomplished through the services provided by the Defense Reutilization Marketing Service (DRMS.) Navy activities do not have the authority to donate excess personal property; this authority is vested in DoD and exercised by the DRMS. The DoD Humanitarian Assistance Program (HAP) is the conduit for donating excess DOD medical property to foreign countries. HAP coordinates efforts among the donating command, DRMS, and the State Department.”
Detailed guidance on the disposal of Navy property, including donations, is provided in the Defense Materiel Disposition Manual, DOD 4160.21-M" (attached.)
"Medical" equipment that is still in good and serviceable condition, will be advertised to other MTFs through TRIMEDS for 45 days. Other MTFs may request those items at no cost. All remaining "medical" and "other" (i.e. equipment and furniture, to include unclaimed items from TRIMEDS), will be disposed of through the Defense Logistics Agency Disposition Services (commonly referred to as "DRMO").
Those items traverse through a 49 day cycle, and are available to DoD first, Other Federal Agencies (OFA) second, and finally can be donated to authorized recipients of donations (GovGuam, Humanitarian Assistance Program, etc.). There are specific points in the 49 day cycle items become available to the various entities. If unclaimed at the end of the 49 days, it is transferred to their liquidation service (governmentliquidators.com), where it is typically grouped into lots and auctioned off as surplus to any buyer.
Prior to transfer to the DLA, non-medical gear and equipment can be transferred to other DoD entities by the hospital at any time, but when NHG transfers excess gear and equipment to DLA, it no longer belongs to the hospital and has no influence on where it goes from there. NHG will be transferring all excess gear and equipment to DRMO in phases that are affected by hospital use and DRMO’s ability to absorb the volume.
Q17: The new Naval Hospital will be much more advanced than the local civilian hospital on Guam, can civilians opt to have their medical care at the Naval Hospital instead?
A17: Active duty military personnel, retirees and their family members throughout Joint Region Marianas are eligible for health care at military treatment facilities on the island including the U.S. Naval Hospital, the Navy Branch Health Clinics and the 36th Medical Group at Andersen Air Force Base. U.S. Naval Hospital Guam collaborates with Guam Memorial Hospital and the local first responders to accept and treat any patient for emergency care including Department of Defense beneficiaries and local civilian residents.
Q18: What is happening with the VA clinic?
A18: A new VA Community Based Outpatient Clinic (CBOC) was constructed (completed October 2010) adjacent to the Naval Hospital base, Agana Heights. For more information on the VA clinic, please contact: Bernadette Santos, Community Based Outpatient Clinic (CBOC)
Staff FAQ's About the New Hospital
Q) Will there be a Subway (or other fast food restaurant) in the galley area? Or somewhere else in the hospital?
A)The hospital is currently in negotiations with vendors to solicit proposals for food options. Space is very limited to do something like this, because the ventilation plumbing and electrical needs. We are going to do our best to come up with a solution that works best for the largest amount people.
Q) When and where will the sample patient room be set up so that nurses can learn the room layout? This is a patient safety concern. Everything in the new building will be different. Ward nurses need to know how to run the equipment before they have live patients. (Where's the oxygen, how does the bed work, where are the electric outlets? Where should the infusion pump be located? Where will the hand washing sink be? Etc.)
A) There are no plans to set up a sample patient room. Staff will undergo several training opportunities to orient them to the new hospital. Staff should be on the lookout for hospital all hands calls that can further address these concerns.
Q) Will there be a separate elevator for staff/housekeeping? So patients/visitors don't overhear PHI conversations or get mop water slopped on them?
A) There are several elevators located throughout the building. Most patients will be using the main elevators near the front entrance and most staff will be using the other elevators located deeper in the facility. At least one of those elevators will be reserved strictly to transport patients, but there may be occasions where patients and visitors will have opportunity to mix. As always, we will respect patient's rights by not having conversations in the hallways or the elevators that may be overheard by others. As for the mop water, we had not heard of any issues!
Q) Are there janitor closets on all 3 floors and where are they located?
A) There are many closets and utility rooms located throughout the facility.
Q) Will there be a staff gym, and where will it be located?
A)There are no plans for a staff gym in the new building.
Q) Where will the ATM machine be located?
A) There are no plans for an ATM machine to be located in the new building.
Q) Will there be seating when there are long corridors? They help debilitated patients avoid falling, but very few corridors in the current hospital have safe places for debilitated patients to rest. Will the new building be safer?
A) There is no additional seating plan in long corridors for patients to sit down and rest. However, there are multiple places to sit down in the main atrium on the first floor, which is where most patients will be most of the time. There is a reception desk near the main entrance where patients may request assistance with wheelchairs or escorts from the Red Cross volunteers.
Q) Will there be handrails in all the corridors? They help debilitated patients avoid falling, but they have been removed from many corridors in the current hospital. Will the new building be safer?
A) The new building will be equipped with handrails in any corridor accessible by patients, consistent with any modern healthcare facility.
Q) Where will the chapel & chaplain's offices be in the new building? I hear the chapel is going to be taken down. Where will the new chapel be built, and what about the classroom?
A) The chapel and the chaplain's office will be located on the second floor near the main entrance in the new building. There are no plans to demolish the chapel that is standing across the street from the new building. There are no plans to continue using it as a chapel either. It may be used occasionally as extra classroom space, and we will continue to do so in the future.
Q) What will substitute for the auditorium for staff All Hands meetings/training?
A) There is no auditorium planned for the new building. Instead large classes and gatherings will be held in the dining room, which will be outfitted with cameras, movie screens, and television displays.
Q) Where will the computer classroom (currently K-3 classroom) be located?
A) There is a small computer lab planned for the new hospital. It will be located in the library space on the third floor.
Q) Besides the Staff Education & Training Department classrooms, what small classrooms will be available on a regular basis for meetings and classes?
A) There are numerous conference rooms located throughout the hospital, as well as small conference tables located in staff lounges. There will be three large classrooms in the staff education space on the third floor. We will be entering a new paradigm; hospital staff is going to have to get used to the concept of shared space. We may have to work a little harder at coordinating schedules to ensure that all of our needs are met. However, we believe that there is adequate space for meetings and gatherings. And we still will have access to the chapel building across the street if necessary.
Q) Where will video teleconferences (VTC) be held? (Currently held in XO's Board Room.)
A) There are six locations throughout the hospital where video teleconferencing capability will be present. Additionally, the network will be robust enough to support desktop videoconferencing at several locations as well. In order to access this technology, there must be a need for it. Interested users should contact information management for more details.
Q) Will there be a Wardroom? A Chief's Mess?
A) There will be no wardroom and no chief's mess facilities in the galley.
Q) How will way finding work in the new hospital?
A) We will employ Red Cross volunteers as way finders and concierges and there will also be touch screens available with way finding maps.
Q) Where will COD be located?
A) The chief of the day desk will be located at the after-hours entrance to the hospital, which is located adjacent to the emergency department.
Q) Where will I be able to eat? Will there be a galley open to the staff? What hours/days will it be open? How many seats will it have? Will there be a snack bar (like the current Subway)? How about geedunk machines?
Q) Where will the Guard Mail Room be?
A) There is no guard Mail room planned for the new facility.
Q) Will there be a post office in the new building (like there is in the current building)? If not, where will departments receive their mail (including boxes)? Where will they mail items? Will there be mail boxes for staff?
A) There will not be a post office in the new building. All departmental mail will come to the Materials Management department. Departmental representatives will need to go to the warehouse daily to check their mail.
Q) While waiting for the old building to be turned into a parking lot, where will staff park? Where will patients park?
A) Our leadership is currently looking at plans to mitigate parking problems. These plans may include obtaining golf carts to transport patients and visitors from remote parking if necessary.