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Last fall I was asked by Maryland Senator Benjamin Cardin to join a group evaluating whether the new Walter Reed National Military Medical Center [WRNMMC], when completed in a few years, would be “world class.” The group, a subcommittee of the Defense Health Board, met multiple times to learn about the plans and develop a report for Congress. The report is now available at http://www.health.mil/dhb/meetings/NCR%20BRAC%20HSAS%20Report%20-%20Final.pdf . Here is a brief summary. The Base Realignment and Closure Commission [BRAC] determined five years ago that the current Walter Reed should be closed and the functions moved to two facilities. One would be a community hospital and outpatient facility at Fort Belvoir, VA just south of Mount Vernon. It would give primary and secondary care to active and retired military that live in the southern half of the national capital area. The other would be on the grounds of the current National Naval Medical Center in Bethesda, MD just northwest of Washington. This conjoined facility would be renamed the WRNMMC and would have multiple functions. Primary and secondary care for those military personnel who live in the northern half or the capital area; tertiary care to those from throughout the region and total care for the wounded warrior.
We found that the Fort Belvoir facility was well designed but that the new WRNMMC had some definite deficiencies. Here is a summary. There was never a master facility plan for the campus which currently houses multiple functions and has many older buildings that over time should be replaced in an orderly manner. There was not a “demand analysis” completed to determine what the needs would be in to the future. For example, with the wars in Iraq and Afghanistan, would there be need for more, less or different OR configurations? With a growing retired military population in the area, what would be the new needs? Instead, a static approach was used, shifting the current functions at Walter Reed to the two future facilities. We also found that there would be no in-house simulation laboratories for learning OR procedures, cardiac cath or GI endoscopy techniques. In a modern hospital these are critical and must be immediately adjacent. The campus has externally mandated constraints on parking, logical from a local roadway perspective but not recognizing that staff from one shift cannot leave until the staff from the next shift has arrived – this means more spaces, not fewer. There is a METRO stop at the corner but in the winter it is a long walk to the hospital – some type of tunnel or people mover is needed to encourage ridership.
The report just went to Congress and to date the following has occurred:
House -- FY10 Defense Appropriations
“Medical care in the National Capital Region - The Committee continues to be concerned over the impact of care in this area with the consolidation of WRAMC and Bethesda Naval. Congress’ independent evaluation of DoD’s comprehensive plan was positive, for the most part. They await DoD’s 30-day assessment of that review’s findings and recommendations.”
Senate -- FY10 Defense Appropriations - Amendment by Senator McCain “Requirement for a master plan to provide world class military medical facilities in the National Capital Region” - agreed to by unanimous consent.
It is encouraging that Congress is taking the report seriously.
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Praise for Dr Schimpff
The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.
-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).
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