The U.S. Navy Bureau of Medicine and Surgery (BUMED) is the headquarters command for Navy Medicine, providing high quality, cost-effective health care to beneficiaries in wartime and in peacetime. Highly trained Navy Medicine personnel deploy with Sailors and Marines worldwide, providing critical mission support to over 700,000 active-duty Navy and Marine Corps members aboard ship, in the air and on the battlefield. At the same time, Navy Medicine’s military and civilian health care professionals provide care for 2.6 million uniformed services’ family members and retirees at military treatment facilities while continuing to support contingency, humanitarian and joint operations around the world.
The historic BUMED headquarters campus in Washington, D.C. previously served as the U.S. Naval Observatory, Washington Naval Hospital, and a medical and nursing school. Today, the campus is the site where the strategic planning and policymaking is both crafted and managed to achieve that Navy Medicine vision.
In support of its mission to safeguard the health of Navy and Marine Corps personnel, BUMED directs medical and dental services worldwide and provides management of the facilities owned by the Department of the Navy. BUMED’s Real Property Inventory includes 319 medical buildings totaling 14-million-ft2, 551 supporting buildings totaling 62-million-ft2, and 629 additional assets.
Managing New Challenges
In the last several years, BUMED has been challenged to comply with several new mandates, including:
- GAO/NSIAD 99-100 “Real Property Management Needs Improvement”
- GAO-03-274 Report “Changes in Funding Priorities and Strategic Planning Needed to Improve the Condition of Military Facilities”
- SECNAV FM Panel Report “Enhancing Naval Readiness Through Effective Facility Management”
- Medical Treatment Facility Inspection Checklist Annual survey of Medical Treatment Facilities for conformance with Navy standards.
More recently, Congress and the Office of the President have issued new standards for sustainability of federally-managed infrastructure. New and evolving standards for achieving world-class medical facilities demand constant, real-time knowledge of assets in support of the mission of the Navy Medicine and the Military Health System.
BUMED recognizes that its infrastructure is crucial in supporting its mission. The Command was challenged by how to keep decision-support information current in order to fully understand facility requirements, and then allocate funding against new mandates to ensure mission readiness.
Historically, the prioritization of funding for special project requests was performed somewhat inconsistently. Projects went through a series of prioritization phases that were not based on needs matched to BUMED’s mission or organizational criteria. Assessment processes and standards varied between projects and from building to building, with no standard method of estimating costs associated with repairs. The information compiled in each audit was reported, tracked and managed on paper. Each document became out-of-date as soon as a repair was completed or a new problem was discovered. Decisions for funding were based on inconsistent and anecdotal information, not real-time, fact-based, comparative analysis.
BUMED directs medical and dental services worldwide and provides management of the facilities owned by the Department of the Navy. BUMED’s Real Property Inventory includes 319 medical buildings totaling 14-million-ft2, 551 supporting buildings totaling 62-million-ft2, and 629 additional assets.
Determined to have its portfolio become more mission-ready, BUMED decided to take a more proactive approach to managing and maintaining its facility assets. It sought an efficient and consistent process for assessing building conditions and estimating the cost of repairs, and a method of ensuring that data remained up-to-date and accurate. Ultimately, BUMED also wanted this data to feed directly into its capital budgeting decision-support process.
A Reengineered Approach to Capital Asset Management
In 2003, BUMED began working with an external contractor to systematically assess the condition of its portfolio and implement a new capital planning system that includes real-time, market-based cost data from RSMeans and enables users to create “what-if” funding scenarios, generate reports and easily access, analyze and update large amounts of facility data. BUMED has also enabled fact-based, standardized communication tools among the Navy Medicine sites and improved the accuracy of estimated costs of facility repair and maintenance projects.
Over the past seven years, using results from its capital planning system, BUMED has significantly reengineered and matured its approach to capital management. For example, BUMED has shifted its approach to assessing capital assets, moving to a just-in-time, risk-based assessment approach. Rather than unnecessarily assessing assets that are modern and running well, the organization has the information available to focus on risk areas and their impact on Navy mission. This approach was a departure from the more traditional, baseline approach BUMED originally used to continually assess all assets and conditions. It has helped BUMED better optimize limited capital funds by focusing on high risk, highly mission-critical areas. Ultimately, this strategy has enabled BUMED to plan and spend most appropriately for the greatest impact on mission.
BUMED also has found innovative ways to use its capital planning system to streamline and automate many capital management processes. It has incorporated Department of Defense (DOD) and Navy business processes into the system and tailored the system to meet Navy and DOD requirements for capital asset reporting. These include the DD1391 Project Request forms for Command approval, Automated Information System reporting and Navy accounting standards.
In addition, an automated annual survey of its Medical Treatment Facilities (MTFs) for mission readiness by BUMED’s onsite facilities managers provides a way to quickly determine if a building is performing to the standards set by BUMED and enumerates the work required to close any identified gaps. Because the survey is web-based, data from a completed survey is automatically fed back into the central repository to further ensure that building data is up-to-date and accurate. BUMED has also integrated facility data with the Internet Navy Facilities Assets Data Store database, the official record of the Navy’s real property assets.
BUMED recently undertook an evaluation of the processes it uses to prioritize capital projects, and as a result is refining its approach to better focus on mission criticality. A two-day stakeholder seminar led to the formulation of a multi-year action plan, qualifying and validating assessment findings with a specific and consistent methodology.
Recognizing the importance of implementing consistent cultural process improvement, BUMED also has worked hard to build consensus among the facilities managers by educating its workforce on changes in capital planning and management methods, both for facility assessment and ranking requirements.
Inherent in the military is personnel turnover due to deployments, re-assignments and usual turn-over. As a result, BUMED needed a way to elevate their assessment solution within the organization and to get greater exposure of the data stored in its capital planning system. This resulted in the development of an Executive Dashboard and information portal for use at all levels of the organization. Staff throughout BUMED gained a new recognition of the additional value of the unique facilities intelligence available in the system.
Achieving Mission Readiness
BUMED’s enterprise-wide capital planning system has resulted in optimization of limited funding for capital improvements, as well as significant productivity gains for its very limited management staff. For example, it previously took 13 people four weeks to produce a Project Request form to approve release of funds from Military Construction. With the automated DD1391 form, one person can produce this report in half a day. The Executive Dashboard has enabled transparency throughout the organization so that anyone from the BUMED Headquarters down to the facility manager of a particular building can quickly access facility condition data, facility requirements, and project status updates. With each assessment cycle, updated information is fed into the planning and prioritizing process. As projects are completed, project data is updated in the system to reflect the new conditions and close out requirements, and the new information is reflected in the next planning cycle.
BUMED has implemented more than just a database; it has created a foundation for their asset management processes by providing consistent, credible facility data to help ensure mission readiness.