PN99822_FP_Misawa Hospital Addition and Alteration_V2.0 (22 Feb 21).pdf

TEMPLATE 20201021

Facility Planning Functional Program

Hospital Addition and Alteration

PN99822

Misawa Air Base

Aomori Prefecture, Japan

Version 2.0 Final Date: 18 Feb 21

Version Date Prepared by Reviewed by Comments

1.0 20 Oct

Capt. Springer Deb Mortland Correlates to final CIDM documents

2.0 18 Feb

Capt. Springer Deb Mortland Correlates to Initial DA

3.0 Correlates to 35% design

4.0 Correlates to 100% design

Table of Contents

PREFACE

FUNCTIONAL PROGRAM UPDATES

PART 1 STRATEGIC OVERVIEW

1.1 Summary

1.2 Required Capabilities - Direct Care Facility

1.2 Required Capabilities - Non-Direct Care Facility .................... Error! Bookmark not defined.

1.3 Current State/Current Operating Environment

1.4 Future End State

1.5 Contributing Issues

1.6 Facility Alternatives Considered

PART 2 DESIGN REQUIREMENTS

2.1 Project Overview

2.2 Key Site Considerations

2.3 Facility Adjacency Matrix

2.4 Design Requirements

2.5 General Equipment Requirements

2.6 Departments/Functional Areas

2.7 Facility Support Services

FACILITY PLANNING FUNCTIONAL PROGRAM

PREFACE

A series of key artifacts must be completed for each capital project executed on behalf of the Military Health System (MHS). This Facility Planning Functional Program (Functional Program), formerly known as the Concept of Operations, is one of those artifacts and it is intended to serve two main purposes.

A key purpose of the Functional Program is to provide information to those who are responsible for the design, construction, transition, and operation of a facility that is benefiting from capital investment funding. In other words, the Functional Program enables project execution and informs facility operations.

The second principal purpose is to document the history of each project by capturing in one place the planning assumptions, design intent, and operational expectations. Typically, an MHS capital investment project requires 7 to 10 years to transition from planning to construction completion. During that time, turnover of key personnel associated with the project occurs with great frequency. The Functional Program enables those joining the project at any time to have a common understanding of its rationale, key design considerations, and expected contribution to the mission of the MHS.

The Functional Program is a living document that evolves as project milestones are achieved, it consists of two main parts, and each part builds on the next. The detail of the information varies depending on the size and scope of the project.

1. Part 1 – Strategic Overview describes the requirements specific to an identified facility requirement. It summarizes the Military-specific environment, current conditions, related problem(s), the proposed future state, and the basic operational assumptions. Part 1 includes the vision, mission, population, staffing, workload, operating hours, and overall scope of services to be provided at a facility and summarizes the requirements planning performed specific to a proposed facility action. Part 1 is prepared by Capital Strategy Management personnel in preparation for prioritization through the Capital Investment Decision Model (CIDM) process.

2. Part 2 – Design Requirements expands and updates planning assumptions and provides guidance and elaboration of the functional/operational-based requirements that align with the Program for Design (PFD). Part 2 informs the Design and Construction Agents, the facility staff, the Designer of Record, and the Design and Construction team. It is a design-focused document that describes departmental and area-specific services, delivery models, the “flow” of people, equipment, and materials within the facility, a functional description of the spaces, special requirements specific to those spaces, adjacency requirements, and design requirements. Part 2 is prepared by Capital Strategy Management personnel during requirements planning.

As the project evolves, the Functional Program plays a role in the facility transition plan and addresses how staff will function in the new environment. Using Parts 1 and 2 as a foundation, project delivery team members develop the detailed guidance that enables facility staff to maximize utilization of facility capabilities. Operational content will be developed and added to the Functional Program, amplifying Part 2. Optimally, the Operational Plan documents service changes and/or changes in the built environment that drive operational changes, and advise and inform Post Occupancy Evaluations. Maintenance of the Operational content within the Functional Program becomes the responsibility of the facility after transition.

The figure below depicts the construct of the Functional Program as it evolves through the lifecycle of the portfolio management and project development.

NOTES:

1. The use of “will” in the Functional Program Part 2 Design Requirements represents a mandatory requirement that the Integrated Portfolio Design Team (IPT) must comply with during Phases 4 through 8.

2. Black non-italicized font represents standard content elements that are required in the

Functional Program and will not be deleted.

3. Blue non-italicized font represents content elements that are modified in the Functional Program based on the project specific requirements.

4. Italicized purple font represents a Hyper link within the document.

5. Italicized font provides “examples” of content for a specific section and/or direction to the author; the examples or direction text will be deleted on final version of this Functional Program.

6. Within the Functional Program, only subtitle text will be numbered. Bullet text within sections will not be numbered.

FUNCTIONAL PROGRAM UPDATES

Substantive updates to this Functional Program will be documented with each version.

Table of Updates

Date Author Version

Section

Description of change and justification

4 Aug

Capt.

Springer

0.1 Initial creation of artifacts for administrative review.

2 Sep

Capt.

Springer

0.2 Adjusted for Team Lead comments

Sep

Capt.

Springer

0.3 Adjusted for QRB 1 comments

Oct

Capt Springer

1.0 Prepared for CIDM

Jan

Capt.

Springer

1.1 Prepared artifacts for QRB3

2 Feb

Capt.

Springer

1.2 Adjusted for QRB3 Comments

Feb

Capt.

Springer

2.0 Adjusted for QRB 4 Comments

PART 1 STRATEGIC OVERVIEW

This section of the Functional Program details findings and considerations used to plan and validate the requirements of a capital asset investment. It includes the facility-specific vision, mission, clinical, administrative, and operational planning elements, and the benefits of the project to the MHS integration of readiness and health to deliver the Quadruple Aim: improved readiness, better health, better care, and lower cost.

Part 1 Reference Documents:

Builder Facility Report (3 Aug 20) Data Analysis Report Program for Design (PFD) Version 2.0-2.0 (18 Feb 21) DD 1391 – (18 Feb 21) Economic Analysis (20 Oct 20)

In developing the Facility Planning Functional Program, please use a bulleted format for a concise presentation that is easy to read.

1.1 Summary

The summary focuses the reader’s attention on the most important aspects of the current state, problem, and final recommendation. The summary briefly conveys the facility location; the installation mission including location, strategic importance, and or military value; market alignment; facility identification; facility mission; problem statement; and benefits/value of the recommended capital investment, and the identification of any deviations from regulatory requirements and/or service policies, i.e. Patient Centered Medical Home, The Joint Commission, and ABA etc.

1.1.1 Abstract:

• The Misawa AB Hospital was completed in 1994 but cannot meet life-safety requirements related to HVAC, fire protection, and electrical systems as well as having unmet spatial requirements within dental, sterile processing department (SPD), and Pharmacy.

• Provide repairs and a minor addition that meet mission requirements to include NFPA requirements for mass communication and fire protection, Pharmacy USP compounding, SPD, Dental, and Food Service alterations.

1.1.2 Location:

• Base / Installation Name: Misawa AB

• Country: Japan

• Market: Defense Health Region (DHR) Indo-Pacific

1.1.3 Installation Mission:

• Misawa AB is a force projection installation tasked with protecting US, Japan and ally interests in the Pacific region.

• Military units supported include:

• US Air Force o Supports two Squadrons of F-16CJ Fighting Falcons.

• US Navy o Patrol and Reconnaissance Wing with P-3C Orion, EP-3 Aries and P8-A Poseidon

• Japan Air Self Defense Force (JASDF) o 3rd Tactical Fighter Squadron with F-2A/B, T-4, and F-35 Lightning II o Airborne Early Warning Wing with E-2C Hawkeye o Air Rescue Wing with CH-47J Chinook

• Misawa is the only joint service installation in the Western Pacific.

1.1.4 Market Alignment:

• Misawa AB falls under the Indo-Pacific DHR.

• The Hospital is the primary point of service for DoD beneficiaries enrolled at Misawa AB, as well as Navy/Marines porting during deployments for dental/healthcare beyond ship-board capabilities.

• Investment supports the Hospital’s military mission.

• Investment is viewed as a long-term action.

1.1.5 Facility Mission:

• Misawa AB Hospital is a 12-bed inpatient facility with surge expansion capability to 23-beds providing primary and specialty care to approximately 7,000 eligible beneficiaries.

• DMIS IDs associated with this facility are 0639 for the hospital and 1106 for dental services.

• No known mission changes, mission is expected to remain stable.

• The Hospital is the sole provider of healthcare to the beneficiary population. Patients whose care exceeds the Hospital’s capabilities are sent to host nation medical services or are medically evacuated.

• JASDF forces receive care at a separate Japanese hospital on installation. Healthcare mission is conducted primarily out of building 99, with Mental Health and Education and Training services conducted out of building 96. Only building 99 is impacted by this scope.

1.1.6 Impacted Buildings:

Table 1. Buildings

Building Number

Name RPUID Size

(BGSF)

Year Built

FCI BCI

99 Hospital 490915 155,488 1994 81 64 Source: DMLSS Date: July 2020

1.1.7 Strategic Drivers/DHA Initiatives:

• No MOUs/SAs exist for this facility impacting the facility alternative.

• The hospital is not a site for any GME or Phase II training.

• Quality Improvement / Process Improvement (QI/PI) initiatives impacting planning are:

o Dental Treatment Rooms (DTRs) will be right-sized to meet standard practices of care.

o Pharmacy will be brought to compliance with USP 797 and 800 standards.

o Mass notification, and fire alarms will be made NFPA and base compliant.

o The mechanical room supporting the Operating Rooms (ORs) and SPD will be expanded to allow for future phasing capability.

• No support agreements, visiting providers or circuit riders exist with other facilities.

• To meet USINDOPACOM mission requirements, Misawa Hospital supports operational readiness missions and provides contingency operational capability through surge capability and readiness support for deployed forces through dental and medical specialties.

1.1.8 Problem Statement:

• Existing Hospital-wide fire alarm system does not meet UFC, NFPA 101, NFPA 72, or

Architectural Barriers Act (ABA) requirements. Fire alarm systems and mass notification systems are not compatible with base-wide system requirements.

• Hospital Electrical system is currently configured to a single access point with long leads connecting multiple systems with no access panels create long downtimes in multiple departments when repairs are required.

• Current distribution equipment, automatic transfer switches, feeders, panels, circuits, transformers, do not meet NFPA requirements and accessible to staff, creating safety issues.

• HVAC system has zoning and temperature control deficiencies negatively impacting the mission and creating risks to patients due to lack of humidity control, fresh air exchange, and temperature control. Multiple exhaust fans, built for an abandoned contingency response mission, lack volume control creating pressurization issues throughout the hospital.

• Hospital mechanical rooms are constrained and lack space to replace AHUs without extended mission degradation.

• Sterile Processing Department (SPD) is substantially undersized and has an obsolete, two-room layout, creating high risks of cross-contamination. HVAC system is unable to maintain required pressurization.

• Inpatient Pharmacy is non-compliant for USP 797 (sterile compounding) and 800 (hazardous compounding) guidelines.

• Dental department has undersized patient care and support spaces. DTRs have original casework that is outdated and deteriorating. Waiting room is inadequately sized to accommodate current requirements.

• Food Service was originally designed as a full service kitchen for a contingency response, and oversized and mismatched to meet the current mission.

1.1.9 Recommendation/Benefits - Value:

• The recommended alteration/addition course of action will:

o Correct hospital wide NFPA deficiencies of the nurse call, mass notification, fire alarm systems, and departmental HVAC deficiencies within the facility.

o Expand Inpatient Pharmacy to accommodate USP 797 and 800 compounding requirements.

o Correct spatial shortfall and outfitting within the dental department.

o Correct malfunctioning HVAC and spatial shortfall within the SPD.

o Resolve Food Service mission mismatch that no longer requires food preparation.

• The benefits/value of the recommended capital investment in relation to the Quadruple Aim Performance Plan are as follows:

o Better health and quality are achieved by removing cross contamination risks in the SPD, meeting USP requirements for Inpatient Pharmacy, and meeting NFPA requirements for mass notification across the hospital.

o Military Readiness is improved by supporting dental facilities updated to meet both contingency mission requirements and support of deployed Sailors and Marines.

1.2 Required Capabilities - Direct Care Facility

This section describes the baseline projected future population served, services to be provided, and the corresponding administrative and support activities, workload, staffing, and other key information pertaining to operating assumptions, Information Management / Information Technology (IM/IT) operating assumptions and the outputs of the project.

1.2.1 Population Served:

Table 2. Population

Beneficiary Category FY17 FY18 FY19 Projected

FY29

Explanation of the factors for projecting future population

Active Duty Eligible 2,853 2,900 2,966 2,906

3-Yr Avg

Enrolled 2,853 2,900 2,966 2,906 Active Duty

FM

Eligible 2,584 2,594 2,317 2,498 Enrolled 2,751 2,669 2,575 2,665

Retiree Eligible 119 121 126 122 Enrolled 89 85 90 88

Retiree FM Eligible 294 289 284 289 Enrolled 124 118 120 121

Reliant Eligible 1,200 1,200 1,200 1,200 Total Eligible 7,050 7,104 6,893 7,016 Total Enrolled 5,817 5,772 5,751 5,780

Source: MTF Profile Date: Mar 20

• Active Duty FM Enrolled population exceeds Eligible related to both non-command sponsored dependents and rotating AD forces.

1.2.2 Services:

Ground Floor

• General Dentistry

• Oral Maxillofacial Surgery

• Orthodontics

• Periodontics

• Pediatric Dentistry

• Inpatient Pharmacy

Lower Level

• Medical Records (End-State)

• SPD

• Food Service

• No service or product lines will be removed as a result of the facility capital investment.

1.2.3 Operating Assumptions:

• The facility operates 365 days a year 24 hours a day.

• Operational requirements dictate that only one operating room may be down at a time, and that the SPD may not be down for any length of time.

1.2.4 Workload:

Table 3. Dental Workload Data

Job Description Year

Year

Year

Projected Year

Explanation of the factors for projecting future workload

Dentist 12,158 11,496 11,569 11,741

3-Yr Avg Orthodontics 930 1,018 - 974 Oral Maxillofacial

- - 188 188

Pediatric Dentist - - 368 368 Periodontics 50 - - 250 Perio authorization slated to be filled in near future.

Dental Hygiene 4,827 4,692 4,433 4,651 3-Yr Avg Dental Imaging 1,664 1,727 1,458 1,616 Total 17,965 17,206 16,558 18,172* *Excl. Imaging

Source: M2 Date: Aug 20

Table 4. Pharmacy Workload Data

AFSC

Description

Year

Year

Year

Projected Year

Explanation of the factors for projecting future workload

Outpatient Pharmacy

40,316 38,601 41,318 40,078 3-Yr Average

Inpatient Pharmacy

35,640 37,915 37,348 36,968

Total 75,956 76,516 78,666 77,046 Source: PDTS Date: Aug 20

Table 5. Inpatient Workload Data Service FY 17 FY 18 FY 19 Projected

Year

Explanation of the factors for projecting future workload

Disp ADPL Disp ADPL Disp ADPL Disp ADPL Medical 228 - 152 - 214 - 198 -

3-Yr Average

Surgical 47 - 34 - 78 - 53 -

OB 485 - 461 - 511 - 486 -

Newborn 160 - 154 - 162 - 159 - Mental Health

92 - 44 - 36 - 57 -

Total 1,012 2.77 845 2.32 1,001 2.74 953 2.61 Source: MTF Profile Date: Aug 20

1.2.5 Staffing:

• Staffing table represents a total for the hospital.

Table 6. Staffing Type by Category Number

Skill Type Category Number Classification

MIL CIV Contractor Total Provider 1 & 2 59.5 0.5 - 60

RN 3

38.1 0.3 2.6 41

LPN/Technician/Nursing Assistant 4

136.7 6.3 7 150

Administrative/Others 5

88.4 16.6 40 145

Totals 322.7 23.7 49.6 396 Source: MTF Profile (Available FTEs) Date: Aug 20

1.2.6 Information Management (IM) / Information Technology (IT) Operating Assumptions:

Refer to DHA Low Voltage (LV) and IT Planning Workbook

Included systems:

• Intrusion Detection System (IDS)

• Access Control

• Audio/Visual Systems

• Nurse Call Systems within Medical/Surgery, OR, and Labor and Delivery

• Video Surveillance System (VSS)

• VOIP Phones

• Wireless Local Area Network

• Television

• Public Address Systems (PAPD)

• Mass Notification/Fire Alarm

• Telecommunication Rooms

1.3 Current State/Current Operating Environment

This section describes the current state of the facility and ability to meet the current, or changing, mission; conveys facility capacity and infrastructure condition, including the building age, design, space, allocation, and the deficiencies, from an infrastructure and service delivery perspective, that are the impetus for requesting a capital investment, and defines the problem and any gap analysis.

1.3.1 Current State:

• Misawa AB Hospital is located in a rural area of Northern Japan with the closest

MHS/federal agency over 400 miles away. Originally designed with a self-sufficient/contained contingency and collapse capability, most departments built were below ground with engineered soil between levels. The facility has not had any significant functional department repairs or upgrades.

• The SPD provides all instrument processing for the hospital and is substantially undersized.

Non-redundant equipment causes excessive delays when they require repair, and a functionally obsolete two-room layout creates risks of cross-contamination.

o Electrical feed to the SPD is unable to meet power requirements.

o Current HVAC system serves the SPD, part of the surgical area, and two ORs. Diffusers lack VAV boxes, required air changes and pressurization requirements are not met.

• The Pharmacy is a combined inpatient/outpatient service that is undersized.

o Pharmacy is non-compliant for USP 797 (sterile compounding) and 800 (hazardous compounding) guidelines. No anteroom or buffer rooms exist for the compounding functions.

o Inpatient compounding is conducted in outpatient pharmacy storage.

• Dental department has undersized Dental Treatment Rooms (DTRs) and support spaces.

DTRs have original casework. The internal Dental Instrument Processing Center (DIPC) was deemed deficient and has been closed, sending all dental workload to the SPD. The existing DIPC has not been re-purposed, becoming non-functioning space.

• Food Service was originally designed for full service during a contingency mission, and is now mismatched to the current mission. Obsolete fixtures and equipment are unable to meet sanitation requirements.

• Existing fire alarm system was built to Japanese standards, has exceeded useful life, and does not meet UFC, NFPA 101, NFPA 72, or ABA requirements. Fire alarm and mass notification systems are not compatible with base-wide system requirements.

o Building notification is provided via a manual activation of the existing PA system that must be activated by an operator in the Control Center located the main facility entry.

Additionally, no visual notification systems are installed anywhere in the facility, either alarm or mass notification.

• Nurse Call systems are isolated to single department.

• Electrical system access is currently unprotected from patient/staff. Distribution equipment, automatic transfer switches, feeders, panels, circuits, transformers, do not meet NFPA requirements.

• HVAC systems within defined departments have major deficiencies in zoning and temperature control negatively impacting the mission and creating risks to patient care.

o The majority of air diffusers lack volume control o Pressurization control in critical areas of the facility (ORs and SPD) are difficult to maintain.

o Existing outside air intake louvers do not meet ATFP height requirements.

o Hard ceilings throughout the facility with limited access points, make servicing HVAC system components extremely difficult.

1.4 Future End State

This section explains the desired end state for the enterprise and the market impact in alignment with the problem statement at the beginning of this document. It briefly conveys how the proposed capital investment ‘solution’ supports achieving the desired end state, which may be a larger context than just proposed project scope, and provides the measurable/quantifiable outcomes that will be supported by data, the high level cost, the Building Gross Square Footage (BGSF), and parking requirements per the UFC 4-510-01.

1.4.1 End State Concept:

• The proposed capital investment will replace entire mass notification, fire alarm systems to include manual fire alarm boxes, smoke detection for new AHUs, fire alarm panels, and a visual notification system for building 99.

• The nurse call systems will be replaced with a system capable of hospital wide notification.

• Alteration and repair of Dental, SPD, Food Service, Inpatient Pharmacy, and Medical

Records will include HVAC and electrical upgrades.

o Dental is expanded to enable contingency response, and right-sizing of patient care areas.

o SPD is enlarged to meet dental and surgical sterilization requirements.

o Food Service is aligned to meet mission.

o USP 797 and expansion of USP 800 capability will be added to the Pharmacy.

o Medical Records is moved to the basement to allow for Pharmacy expansion.

o Logistics warehouse will be impacted by a mechanical room expansion, requiring an update to their high-density shelving.

• HVAC repairs extending beyond areas of alteration include the construction of catwalks, and an additional mechanical room that support future HVAC repair not within the scope of this project.

o Mechanical room expansion within Logistics enables a future capital investment to repair hospital wide HVAC deficiencies not resolved within this scope.

• Due to the isolated location of Misawa AB, and limited local host nation medical network capabilities, non-facility alternatives do not exist within the network.

• The project will repair and renovate 17,447 BGSF of the hospital and construct a 1,830 BGSF addition to the Dental Clinic. Costs are based upon AE parametric estimates resulting in an approximate cost of $22.9M. Hospital wide infrastructure upgrades are included in the parametric estimate.

• Parking requirements are not affected by this capital investment.

• Temporary facilities are required for this project, and are not included in the parametric estimate as they will be procured under a separate contract.

1.5 Contributing Issues

This section explains any concerns or gaps not captured in any of the other sections that impact capital investment cost or risk (e.g. Mission location, force re-stationing, site identification, and additional cost items).

• Neither USACE nor NAVFAC has representation in this area. With agreement from USACE, and Wing involvement, base Civil Engineering, with coordination through base Contracting, has agreed to operate as execution agent for FY21. Further coordination will be required to meet any other future year execution of remaining HVAC repair.

• This project is an FY20 AF Health Facilities Division (HFD) roll-over project. A 100% Issued for Construction (IFC) design set has been released to Base Contracting and pre-solicited to local contractors.

o Dental administrative addition was programmed based upon supporting structural grid versus space planning criteria guidelines.

o To ensure dental operations, a five phase transition plan has been detailed out to ensure full mission capability at all stages without requiring a phasing facility.

• SPD does not have the capability of shutting down operations for any period of time. No local equivalent exists that can work as an interim solution. A specialized temporary SPD would be required to ensure continued operations. To reduce government risk, an SPD trailer will be funded under a stand-alone initial outfitting contract, as no equivalent is available from the host nation.

• HVAC volume control and pressurization issues exist throughout the facility. AF HFD has contracted out a 95% design solution to design a complete hospital HVAC master plan to be executed through FOB-ED at a later date.

• To meet local service restrictions as well as surge and contingency requirements, additional oral surgery and orthodontics capabilities have been programmed.

• Site location has one of the largest annual snowfalls of any DoD installation, greatly impacting construction times.

• The project site is not located in a 100-year flood plain

• The central utility plant and generator will not be impacted as a result of this effort.

1.6 Facility Alternatives Considered

This section briefly describes the facility alternatives considered (Operational, Status Quo, Lease, Full or Partial Replacement, Alteration, and/or Addition); the advantages and disadvantages of each.

1.6.1 Status Quo:

• Description: Current hospital remains in its current condition, without correcting the discrepancies described above. (NPV: $85,392,662)

• Advantages: Least cost alternative.

• Disadvantages:

o Dental program shortfall and outdated equipment not addressed.

o Cross-contamination in SPD and Pharmacy compounding not addressed o Pharmacy would remain non-compliant for compounding.

o NFPA life safety, mass notification, fire alarm system, LVS systems are left unaddressed

• Alternative is not recommended as it does not meet mission and regulatory requirements.

1.6.2 Lease:

• This alternative is non-viable as it is located in a host nation.

1.6.3 Replacement (Full or Partial):

• Description: This alternative would replace the existing facility with a new, updated hospital.

(NPV: $444,215,403)

• Advantages: Replacement would provide state of the art facility, right-sized to meet current requirements.

• Disadvantages: Alternative is the most costly. Replacement would require submission to the

Japanese Facility Improvement Program, a lengthy and complicated process.

• Alternative is not recommended, as a replacement is the highest cost alternative considered.

1.6.4 Alteration:

• Description: Renovate facility to align to current mission requirements and applicable regulatory governance. (NPV: $89,671,865)

• Advantages: Addresses space shortfalls in SPD and Inpatient Pharmacy, meets mission alignment requirements, and addresses USP and NFPA deficiencies.

• Disadvantages: Undersized DTR are not addressed.

• Alternative not recommended. This alternative meets all regulatory requirements, and addressed some mission requirements but fails to address space shortfalls in the Dental Clinic.

1.6.5 Addition and Alteration: (Recommended)

• Description: Renovate and expand facility to align to current mission requirements and applicable regulatory governance. (NPV: $106,103,593)

• Advantages: Addresses space shortfalls, mission alignment requirements, USP and NFPA deficiencies.

• Disadvantages: None identified.

• Recommended alternative meets all mission and regulatory requirements within scope.

PART 2 DESIGN REQUIREMENTS

This section of the Functional Program details additional findings and considerations used to refine the requirements, the Program for Design (PFD) and Project Room Contents (PRC). It includes department or service-specific narratives and adjacency graphics to inform planners, designers, architects, and engineers of the functions inside this facility as well as how the departments and services were envisioned to operate for patients, visitors, staff, and materials flow. The contents of Part 2 help to inform the design process, and correlate to the intended services and operations of the facility.

Part 2 Reference Documents:

Project Room Contents Report (PRC) Version 2.0-2.0 Low Voltage and IT Planning Workbook

2.1 Project Overview

This section describes the project and explains key characteristics and context. This information articulates why the project/facility is important to DHA and conveys to the Agent and the A/E key features, i.e., safety, sustainability. Describe what the end result will look like and what it will be expected to provide to the enterprise.

• The project provides alterations to SPD, Pharmacy, Food Service, and Dental Clinic, necessary to meet mission objectives. Additionally, a Dental Clinic addition provides administrative space displaced by the Dental alteration. SPD will be expanded to correct a functionally obsolete two room setup that provides sterilization for both Dental and Surgical departments. Food Service will be right-sized to meet its current mission. Inpatient Pharmacy will be expanded to enable non-hazardous and hazardous compounding. Medical Records will be moved to the lower level of the hospital. Additionally, this project delivers hospital wide mass notification, nurse call, fire alarm systems, and public address systems that meet NFPA, ABA, and installation criteria. Finally this project will correct HVAC deficiencies within the defined departmental areas.

2.2 Key Site Considerations

This section includes relevant details of how the facility is to be located in reference to other facilities, limitations or constraints on how staff, patients, logistics support and fire department/emergency vehicles access the facility, and the roadways or other geographical features that impact access to, or the function of the facility.

• The building’s lower level extends past the exterior wall of the upper level. Most of the grade around this level is built up on top of the roof over the lower level. The Dental Clinic expansion will be built on top of the existing structural grid of the lower level.

• On the west side of the building in the direction of the proposed expansion, there are seven exhaust towers. The tallest tower is for the generator exhaust. The remaining short towers are for general building exhaust. Some of these towers will have to be modified to redirect exhaust.

• The entire lower level sits on top of a tall crawl space that is broken up with a grid of thick concrete walls. Holes have been casted in these walls to allow access through them. This crawl space is used for plumbing but due to the structural slab above, no new recessed flooring will be allowed on the lower level.

• Minor walkway removal and approximately four parking spaces will be affected by the west side expansion proposal. Patient/Visitor/Staff walkways will be required for entry to the new main Dental Clinic entry.

• The below grade drive lane used for ambulances and logistics delivery prevents phasing facilities to be placed on the lawn adjacent to the south side of the Hospital. The sterile processing trailer will be required to be placed in the parking lot adjacent the command suite off-stage entry.

2.3 Facility Adjacency Matrix

This section includes an adjacency matrix and a relationship legend at the highest facility level.

Detail for departments will be provided in respective department sections.

Departmental Adjacency Matrix No departmental matrix is provided as all departments, with exception of Medical Records, will remain within their existing areas of the hospital.

2.3.1 Departmental relationship strengths:

● Critical: Identifies the strongest relationship for inter-related functions between two departments. Their locations with respect to each other must be carefully considered in the design and take precedence over non critical functional relationships. This relationship can be achieved by either vertical and, or horizontal circulation paths.

♦ Critical - same floor: Same strength of functional relationship as “Critical” but must be achieved through horizontal circulation paths only.

▲ Important: Identifies a strong relationship for inter-related functions between two departments as well as their locations with respect to each other. Their locations with respect to each other must be carefully considered in the design and take precedence over those with “No Relationship”. This relationship can be achieved by either vertical and or horizontal circulation paths.

Preference: Indicates a desire for two departments to be adjacent to each other, but is not a requirement.

Δ Keep Separate: Indicates a need for separation between specific departments.

Blank box: Indicates no preferred relationship.

2.3.2 Adjacency definitions: used to clarify locations or adjacency relationships

Directly Accessible: connected to the identified area or room through a doorway, pass-through, or other opening without going through an intervening room or public space

Adjacent: located next to but not necessarily connected to the identified area or room

Immediately Accessible: available either in or adjacent to the identified area or room

Readily Accessible: available on the same floor as the identified area or room

Accessible: available horizontally or vertically to the area

2.3.3 Interdepartmental Adjacency Relationships:

The Dental Department has a close relationship with Sterile Processing. Staff will traverse to and from each department to deliver instruments for processing, and restock dental central supply.

2.4 Design Requirements

This section includes design requirements which pertain to the entire facility, and to multiple departments or services in the PFD. These requirements are addressed here and do not need to be repeated in the applicable individual department sections of this Functional Program.

2.4.1 General Design:

• Signage and way finding will provide clear directions from roadways and parking areas to entrance(s) of the facility, and from entrance(s) to all departments or services within the facility.

• Walking distances from parking areas to dedicated entrances will be minimalized.

• Natural Light will be used to the greatest extent possible in all areas of the facility, with lobbies, lounges, waiting rooms, and Dental Treatment Rooms having highest priority.

• Conference Room will be equipped to support briefings, presentations, classes and group meetings. Coordination of furniture, equipment, data and power will occur during design after award. Conference Rooms will have VTC capabilities and VTC will connect to NIPR;

the Government will specify and approve make/model of software versions.

• Separate flows will be created between patients/visitors (on-stage) and staff (off- stage) to optimize privacy, safety and patient/staff satisfaction. “On-Stage” is defined as the Public /Reception Area and the General and Special Dentistry/Radiography Area in all Departments.

“Off-Stage” is defined as the Staff/ Administration Area and the Support Area in each department.

2.4.2 Public/Reception Area: On-Stage

• A Main Dental Waiting Area will be immediately accessible to the primary Dental entrance of the facility.

• A Reception area will be easily identified as a point of access to the associated department.

Speech privacy will be enhanced by the use of furniture spacing and placement in relation to the reception desk and between Waiting room seating groups.

• Reception desk will be located to avoid congestion during the check-in or check-out process and to maximize speech and visual privacy. Coordination of staff workstations at the Reception Desk to support privacy will occur during design after award.

• Reception staff workstations will have direct visibility of the check-in kiosk and the waiting room that is part of their assigned department.

• Reception desk will require coordination of phones, workstations and copier(s) during design after award.

• Dental Records will be located immediately accessible to the associated Reception Desk.

Access to the Records Room for non-Reception staff will be via a path that does not require them to pass through the Reception Desk workstation area.

• The Copy/Office Supply Room will be located adjacent to the Dental Records Storage and be immediately accessible to Reception staff.

• Waiting room seating will be configured into small groupings and allow visibility of the television. Data and power for the television(s) will be coordinated during design after award. Seating placement will support speech privacy between each of the groupings and from groups to Reception.

2.4.3 Patient Care/Treatment Area: Escorted, Off-Stage

• Off-stage corridors and elevators will be utilized as much as possible to transport patients from the Patient Care/Treatment Area to an ambulance or to other departments/services.

Off-stage elevator access control will be integrated with the electronic security system.

2.4.4 Staff and Administrative Area: Off-Stage

• The Staff Lounge(s) will be designed to encourage staff respite and will be located in an off-stage area to facilitate sharing between staff from adjacent departments/services.

• The Staff Toilet(s) will be located adjacent to a Staff Lounge.

• Staff lockers will be located in, or adjacent to a Staff Lounge.

2.4.5 Support Area: Off-Stage

• The rooms in the Support Area will be located directly accessible to the services that are supported to minimize staff travel distances.

• The Soiled Utility will be located adjacent to the Dental Treatment Room(s) in the General and Specialty Dentistry area and it will be accessible via an off-stage corridor.

• The Clean Linen Alcove will be located adjacent to the Dental Treatment Rooms in the

General and Specialty Dentistry area.

2.5 General Equipment Requirements

Rooms will be equipped per the PRC List and this Functional Program and will require coordination during design after award. DoD Space Templates will be referenced for standardization of function and flow of select rooms, as applicable.

Rooms that require data, power and telecom outlets will require coordination during design after award for the placement of these outlets to achieve optimal access for the number of staff assigned per the PFD and the equipment per the PRC List.

2.6 Departments/Functional Areas

The order of departments in this section correlates to the Misawa Hospital Alteration and Addition PFD, which is composed of four departments.

2.6.1 DEPARMENT 1, Food Service

2.6.1.1 SCOPE OF SERVICE:

Provide appropriate nutrition to patients in the Hospital, as well as readily available delivered meals for patients from the installation Dining Facility. The Dietician provides Nutrition Management services and counseling to patients referred from clinical providers.

2.6.1.2 WORKLOAD / PRODUCTION WORKLOAD:

Nutrition Management encounters are assumed to be included in Medical and Surgical Nursing (MSU), Labor and Delivery, and Surgical encounters.

2.6.1.3 STAFFING:

Food Service MIL CIV Contractor Total

4d0x1 – Diet Therapy Technician 3 3 43d3 - Dietician 1 1

Totals 3 1 4 Source: Unit Manning Document Date: Mar 20

2.6.1.4 PATIENT/VISITOR FLOW:

Patients will arrive at the Dietician’s office following clear wayfinding from patient parking through the main lobby space and public circulation. Height/Weight are taken in the Consult office. Upon completion of their appointment, they will exit the same way they entered. Other than for Nutrition appointments, patients will not regularly access Food Services as patient meals are delivered to the patients.

2.6.1.5 STAFF FLOW:

Food Services staff will use staff entry(s) from staff parking and use off-stage circulation to their workspace. Flow will consider walking distances that staff repeat throughout the day to ensure efficiency of layout.

2.6.1.6 LOGISTICS / MATERIALS FLOW:

Food products will be received directly to the department and stored in the Cubicle area.

Generally supplies and provisions are picked up at the installation Dining Facility and delivered via a Government Owned Vehicle by Food Service staff. The staff will deliver patient meals by off-stage corridors.

2.6.1.7 SECURITY REQUIREMENTS:

• The Food Service department will be controlled access.

2.6.1.8 INTRADEPARTMENTAL RELATIONSHIPS:

• Include a refrigerator and freezer in the meal preparation of the Kitchen Space.

• The Dishwashing area will be separate from the meal prep area.

• The Dietician Office will be accessible to a public corridor but adjacent to the Kitchen area.

• Technician cubicles will be adjacent to the Kitchen Space and grouped together with access to the off-stage area corridor.

2.6.2 DEPARMENT 2, Sterile Processing

2.6.2.1 SCOPE OF SERVICE:

• Sterile Processing provides sterile processing for supplies and instruments for inpatient, surgical, and dental services.

2.6.2.2 WORKLOAD / PRODUCTION WORKLOAD:

• Sterile Processing supports the workload from 23 Dental Treatment Rooms that includes specialty dentistry as well as two operating rooms.

2.6.2.3 STAFFING:

Sterile Processing

MIL CIV Contractor Total 4n0x1 – Aerospace Medicine Technician 3 3

Totals 3 Source: Unit Manning Document Date: Mar 20

Note: No staff are assigned to Sterile Processing. Staff supporting General Surgery, and MSU provide manning from their staffing.

2.6.2.4 PATIENT/VISITOR FLOW:

Not applicable.

2.6.2.5 STAFF FLOW:

Staff will use staff entry(s) from staff parking and use off-stage circulation to their workspaces.

Staff will use existing changing/locker area located in the non-sterile portion of the surgical suite on their way to the SPD. Once in SPD, staff flow will be throughout the area. Flow will consider walking distances that staff repeat throughout the day to ensure efficiency of layout.

2.6.2.6 LOGISTICS / MATERIALS FLOW:

Any materials and supplies will be processed through Logistics and be supplied to the Sterile Processing spaces through off-stage access. Any biomedical waste, trash and recycling will use off-stage access to be collected in the existing location in Logistics for contract disposal. Service for equipment and replacement equipment is a key Logistics flow and proper access (width and turning radius) for the largest anticipated item must be validated for the full length of the off-stage circulation.

2.6.2.7 SECURITY REQUIREMENTS:

Access Control System is required at entry to Sterile Processing.

2.6.2.8 INTRADEPARTMENTAL RELATIONSHIPS:

Decontamination (Soiled Work Area)

• Decontamination requires access control from the corridor into the Soiled Transition/Drop

Off.

• A visual/audio intercom providing two-way communication and visibility will be provided and located in clear sight of the entrance to Decontamination and to Clean Pick up.

• A Soiled Transition Vestibule will be located at the entrance of SPD. Soiled Transition

Vestibule will be directly accessible to the Decontamination Work Area. A handheld device for scanning bar codes and a computer will be provided in this area to support equipment tracking.

• The Decontamination Work Area will be directly accessible to the Automatic Cart Washer and directly accessible to the Janitors Closet.

• An Automatic Cart Washer will be provided. Case carts are staged and placed in the washers for decontamination and pass through the washer to the Case Cart Assembly room located in the Receiving, Storage, and Dispatch Area.

• A pass-through window will be provided from Decontamination to Clean Workroom, Instrument Set Assembly for items requiring manual decontamination prior to being passed into Assembly and Preparation.

• A Neptune detergent and water treatment Storage Room will be located in Decontamination and be directly accessible to the staff.

Preparation and Assembly (Clean Work Area)

• A pass-through from Decontamination to the Clean Workroom, Assembly will be provided.

Instruments are assembled into sets or case carts, placed in sterilization containers or packs and prepared for the sterilization process.

• Preparation and Assembly will be adjacent to Sterilization.

Sterilization Area

• The Sterilizers will be directly accessible to the Sterile Storage Instruments and Supply.

• Adequate clearance around the sterilizers and maintenance access doors will be provided.

• Sufficient queuing space will be provided to maneuver and park carts that are being stocked or carts that are ready. Wall-mounted storage and space for mounted racks and enclosed vertical cabinets and/or peg boards will be provided.

Receiving, Storage and Dispatch

• Cart Holding, Clean will have sufficient space to stage and assemble case carts for distribution. Completed case carts await dispatch for the next day surgery cases, prepared for storage, or for distribution to departments or clinics via dedicated clean routes. An alert system (buzzer) will be provided outside the door to Storage, Sterile Instruments to alert staff when supplies are delivered or when a staff member presents to pick up an item or cart.

• Storage, Sterile Equipment and Sterile Supply will be adjacent to each other and immediately accessible to the Cart Holding, Clean.

2.6.3 DEPARMENT 3, Dental Clinic

2.6.3.1 SCOPE OF SERVICE:

Provide Dental Services to include General Dentistry, Hygiene, Orthodontics, Pediatric Dentistry, Periodontics and Oral and Maxillofacial Surgery for beneficiaries. Services also include Dental Radiography and Prosthodontics lab and ceramics.

2.6.3.2 WORKLOAD / PRODUCTION WORKLOAD:

Dental General Dentist 11,741

Orthodontist 974

Oral and Maxillofacial Surgery 188

Pediatric Dentist 368

Periodontics 250

Dental Hygiene 4,651

Dental Imaging 1,616

Source: M2 Date: Aug 20

2.6.3.3 STAFFING:

Dental Clinic MIL CIV Contractor Total

47b3 – Orthodontist 1 1 47g3 – Dentist 2 2 47g3a – Dentist, Comprehensive 2 2 47g3b – Dentist, Advanced Clinical 1 1 47g3c – Dentist, General Clinical 2 2 47h3 – Periodontist 1 1 47k3 – Pediatric Dentist 1 1 47s3 – Oral and Maxillofacial Surgeon 1 1 4y0x1 – Dental Assistant 31 3 34 4y0x1h – Dental Hygienist 1 1 4y0x2 – Dental Laboratory 4 4

Totals 43 3 46 Source: Unit Manning Document Date: Mar 20

2.6.3.4 PATIENT/VISITOR FLOW:

Patients will arrive at the Dental Clinic following clear wayfinding from patient parking through the lobby, vestibule and public circulation. Upon arrival, patients will sign in at reception and have a seat in waiting. Techs will escort them to the services required for their appointment.

Flow will typically be from waiting to Dental Radiography area to General Dentistry or Specialty Dentistry areas. Upon completion of their appointment, patients will stop at reception to arrange any follow up appointments and exit the same way they entered.

2.6.3.5 STAFF FLOW:

Dental staff will use off-stage access to enter the clinic and will change into scrubs in the Dental Clinic Locker/Changing rooms prior to arriving in the patient care area. Once in the dental clinic patient care area, dental staff flow will be throughout the clinic to include patient care areas, support and staff spaces Flow will consider walking distances that staff repeat throughout the day to ensure efficiency of layout. When staff leave the clinic, they will pass through the Locker/Changing Room to change into street clothing.

2.6.3.6 LOGISTICS / MATERIALS FLOW:

Dental is a very large customer for material. The flow from main clinic Logistics to Dental Central Supply will be efficient through vertical and/or horizontal off-stage travel. From Central Supply, materials will be loaded to the individual DTRs on a regular basis as items are depleted.

Dental also has a significant biohazardous waste that must be transported to existing Logistics through off-stage corridors.

2.6.3.7 SECURITY REQUIREMENTS:

• All supply and storage rooms will have access control.

2.6.3.8 INTRADEPARTMENTAL RELATIONSHIPS:

Reception

• Dental Records, Storage will be directly accessible to Reception.

• Waiting and Playroom may be combined, and should maintain a visual connection with each other.

• Toilet, Public Female and Male will be directly accessible to Waiting.

General Dentistry

• The General Dentistry area will be adjacent to Waiting.

• General DTRs will be single chair rooms, grouped together and located to take advantage of natural light.

• Hygiene DTRs will be single chair rooms, located to the front of the clinic due to high volume of visits. Hygiene DTRs have a lower priority for natural light than General DTRs.

• Pediatric DTRs will be near waiting to reduce walking distance.

Specialty Dentistry

• The Specialty Dentistry area will be adjacent to waiting but does not need to be adjacent to

General Dentistry.

• Specialty DTRs will be adjacent to one another and co-located by DTR specialty.

• Crash Cart alcove will be located immediately accessible to Specialty DTRs.

• Wheelchair alcove will be immediately accessible to Oral Surgery.

• Patient toilet should be off the common corridor in the Specialty Dentistry area.

Dental Radiography

• Dental Radiography will be a suite area located between General Dentistry and Specialty

Dentistry.

Dental Laboratories

• Dental Prosthodontics Laboratory will be an open concept with, shipping and receiving cubicle, CAD/CAM and storage in one space.

• The lab area will be adjacent to Prosthodontics DTR in Specialty Dentistry and located in an off-stage area.

• Natural daylight is required in the Lab.

• CAD/CAM scanner alcove will be located near the Dental, Prosthodontic Laboratory and available for all DTRs.

• Lab NCOIC will be located adjacent to/inside the lab.

Support

• Dental Instrument Storage will be centrally located among all DTRs with…