VA Constantly Revising Construction Strategies to Better Meet Veterans’ Needs

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Stella-Fiotes-thumbStella Fiotes, Executive Director, Office of Construction and Facilities Management

The Department of Veterans Affairs is tasked with the responsibility of providing services for all U.S. veterans, especially when it comes to their healthcare.

Managing existing facilities and building new care locations involves the efforts of multiple departments within the VA working together. The Office of Construction and Facilities Management, led by Executive Director Stella Fiotes, oversees all major construction projects estimated to cost $10 million or more.

A registered architect with a master’s degree in architecture and urban planning, Fiotes has worked for the federal government, primarily in agencies focused on science or healthcare, since the 1990s.

Her current projects include a $600-million hospital in Orlando, Fla., an $800-million hospital in Denver, Colo., and a $900-million replacement hospital in New Orleans, La., as well as major renovations, improvements, and additions to existing facilities.

Fiotes’ total construction portfolio consists of over 50 active major construction projects across the nation totaling about $13 billion.

Setting priorities on a grand scale

With such a wide range of responsibilities, the department has a heavily data-driven process for determining which projects receive funding every year. Fiotes said the department looks at gaps and requirements about 10 years out and ranks projects according to priorities. Top-ranking projects are those related to safety and security, fixing existing structures, and right-sizing the inventory.

From the hundreds of projects that make the list, the department develops a design program that will support construction funding requests. Once a project reaches 35 percent design, it is considered for construction funding and included in the department’s budget request. As medical needs are continually evolving, the evaluation of new projects is conducted each year.

“We try to strike a balance between new or replacement facilities, additions, renovations, and ancillary and support facilities such as parking garages, utility plants, and other infrastructure needs,” Fiotes said.

Once projects are assigned, the challenge of execution begins. Programs under $10 million are overseen by one of three administrations at the local level. Individual hospitals also fund their own maintenance projects such as roof repairs, boiler replacements, or other needs.

Good planning makes great projects

Fiotes said the number-one key to having any successful project is proper planning, and by proper planning, she means an intensive process of preparation and consultation.

Her planning office includes planners, architects, and engineers who handle planning issues, standards for hospital construction, and the Technical Information Library. Actual management of design and construction is accomplished through her operations staff, which is located across the nation.

With so many stakeholders involved, coordination with all parties throughout the process is vital.

“I have to coordinate with local offices and medical centers to make sure we are not stepping over their planned maintenance projects,” Fiotes said. “We start with the strategic capital investment planning, then use the Veterans Integrated Service Networks to plan across multiple medical centers with the goal of ultimately developing physical master plans for each individual facility.”

Fiotes said it is important to go through all of the steps methodically, from identifying the right requirements to implementing the right solution, so the project is launched correctly the first time. Many lessons, though, have been learned through trial and error.

“In the past we haven’t always had such a structured planning process,” she said. “We have had projects that would start as one thing and over several years of implementation and additional funding, requests would morph into something bigger and more expensive.”

To help limit those changes in scope, the department brings in medical-equipment planners right from the start. Fiotes said in the past, medical-equipment planners would be brought in around the commissioning or activation stage. Because healthcare is constantly changing both in care models and in technology and most projects start four to five years before the equipment is going to be moved into a space, those planners have to be present early on in order to keep everyone aligned with what is needed.

Sometimes, changes are unavoidable, as happened recently when the facilities transitioned to a patient-aligned care team (PACT) model of care. In that case, Fiotes said the change was significant enough that some designs needed to be stopped midstream and redesigned to support the new model.

“Healthcare doesn’t stand still,” she said. “Some changes are unavoidable, so we have to be adaptable. But that comes at a cost.”

Another key at the early planning stage is to ensure consistency throughout projects, including having one project management software system that everyone uses and consistent processes for certain elements.

Supporting the mission in a changing environment

“Our mission speaks for itself,” Fiotes said. “Being part of an organization that provides healthcare facilities for veterans to receive the care and attention they have earned and deserve is immensely satisfying.”

In the future, Fiotes said telehealth will become more important to the VA in providing quality care. While the department distributes the healthcare system as much as possible, such as through the use of community-based clinics, the population is so spread out, the VA sees a need to use technology and other means of delivery to provide greater access to care.

“But bricks and mortar will not go away anytime soon,” Fiotes said, “and we will continue to enhance and adapt our construction delivery methods to meet the emerging facility needs.”

by Patricia Chaney

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