Being in the U.S. Army Corps of Engineers, you realize that nothing happens in a vacuum. Every new project begins with a need or desire for improvement, a lack of infrastructure or environmental requirement concern. This is true of the newly opened Naval Family Branch Clinic, located at Marine Corps Air Station Iwakuni, Japan.
“The genesis of the project was the relocation of Carrier Air Wing Five from (Naval Air Station) Atsugi to Iwakuni,” said Richard A. Davis, deputy chief, Programs and Project Management Division, Japan Engineer District. “The existing clinic at Iwakuni was undersized and unable to accommodate the increase in population.”
The newly opened 12,374 square meter medical dental clinic is a world-class, state of the art medical facility constructed entirely by the Government of Japan. The crown jewel of this facility is two surgical suites and six suites that can deliver babies and allow the mother to recover.
The successful opening of this facility did not come easy.
“A medical facility is the most difficult to build in the host nation program,” said Davis. “There are many conflicts between U.S. and Japanese criteria, especially medical gas, life safety and mechanical requirements. The Japanese criteria is just a little bit different. Part of the emphasis on meeting U.S. criteria is The Joint Commission, which accredits medical facilities, including military hospitals and clinics, worldwide.”
As the designated DoD construction agent for Japan, JED is responsible for the execution of Host Nation programs, including the Japan Facilities Improvement Program, Special Action Committee on Okinawa, and Defense Policy Review Initiative and various other host nation relocation projects. These programs are designed, constructed, and funded by the Government of Japan.
“The Iwakuni (Resident Office) team and the (JED) engineers spent a lot of time in the first few months during construction to resolve more than 300 incomplete or deficient design details after the Government of Japan finished its design,” said Davis. “While the foundation work was being done, JED’s Engineering and Construction Divisions worked through all of these issues and came up with agreeable solutions.”
A key aspect for this project was commissioning the new facility. For medical facilities, commissioning is a long and detailed process that ensure the facilities are up to standard before the first patient visit occurs.
“Complex facilities like hospitals want a robust commissioning plan to test all the medical gas systems, life safety systems, fire alarms, sprinklers, alarm systems, elevators and mechanical systems,” said Davis. “Many rooms have very specific air change requirements, pressurization requirements, and temperature control, especially operating suites and isolation rooms. We worked with the Government of Japan to develop a plan to commission the facility and found out there were a lot shortfalls with the commissioning plan and execution.”
Japanese and U.S. commission standards are different in how and what they test.
“The Government of Japan went through their commissioning effort, but it is not to the same rigor as the U.S. requires,” said Justin S Gay, chief, Navy/Marine Corps Branch, JED. “For instance, fire alarm pull devices require 100 percent verification, whereas Japanese commissioning only requires 10 percent to be tested. JED worked closely with the Navy to ensure that we would deliver the facility operational.”
Trust between the Navy and JED was vitally important during the acceptance and commissioning process.
“We worked with Iwakuni DPRI and Naval Facilities to accept the facility by the U.S. government from the Japanese government,” said Gay. “Acceptance would allow the U.S. to commission the building per U.S. requirements vs. our limited access while under Japanese control. Iwakuni accepted the building with agreement by both the Navy Facilities owner and Navy Medicine who is the occupant user.”
“Navy Medicine had to delay movement of their personnel slated to come from Yokosuka and other hospitals and clinics throughout the region, while we commissioned the facility,” said Gay. “In order to accomplish this, I utilized international contracting vehicles provided through the Huntsville Center.”
The U.S. Army Engineering and Support Center, Huntsville is a major element of the U.S. Army Corps of Engineers that supports Department of Defense and other government agencies worldwide. More than 1,000 employees from various program and project management, engineering and support disciplines work at the Huntsville Center headquarters in Huntsville, Alabama, and its offices in Omaha, Nebraska, and Alexandria, Virginia.
The relationship and teamwork that were cultivated between JED, the Navy, the Marine Corps, GOJ and Team USACE was a big factor in the successful opening of the facility.
“We used the MFAES (Medical Facilities Architectural and Engineering Services) Indefinite Delivery/Indefinite Quantity contract at Huntsville,” said Gay. “Huntsville provides a qualified group of architectural and engineering firms who specialize in medical facilities both CONUS and OCONUS. HNC was quickly able to support JED by issuing a task order to support our commissioning effort.”
“This was a total USACE effort,” said Davis. “In addition to the entities that Justin talked about, USACE has a medical center of expertise. We involved them throughout the design, but it was a learning process for them, too. Trying to build a medical facility to U.S. criteria that also meets host nation criteria. Because it was a Japanese designed and constructed facility, they learned a lot of lessons that will benefit future design and construction.”
“We requested the MX (US. Army Corps of Engineers’ Medical Facilities Mandatory Center of Expertise and Standardization) to tour the nearly complete facility” said Gay. “Multiple team members representing numerous disciplines from the MX toured the facility. Their review demonstrated their expertise. The MX team identified points for technical improvement and compliance, which we were able to better socialize with our Japanese counterparts due to their input. Our goal was to provide the Navy with the world-class medical facility they anticipated instead of a burden that would require many post-occupancy corrections and create a significant impact to patient care. The commissioning contractor provided by HNC enabled JED to better understand the deficiencies and positioned JED to better present the concerns with the GOJ for correction. The information was factual, based on UFC (Unified Facilities Criteria Program) criteria. Fast forward to today, Iwakuni is an occupied medical facility. They successfully delivered the first baby and performed the first inpatient surgery in June of 2018. The facility is currently occupied and Navy Medicine team has made their preliminary Joint Commission inspection.”
The partnership with the with our alliance partners was a large part of the success of this project.
“The Government of Japan understood the importance of patient care in Japan and was fully committed to supporting the Sailors, Marines, and their families at Marine Corps Air Station Iwakuni,” he added.
“Based on our experience with the hospital in Okinawa and the clinic in Iwakuni we are able to turn over a more complete facility quicker than we were able to before,” said Davis.
“I think this definitely is a success story,” said Davis. “From where we were at the end of construction to having the first birth, first surgery in June is definitely a big success.”
“Our commitment was not just to deliver the facility, but a commitment to maintaining medical capability on a long-term basis,” said Gay.
Japan Engineer District’s host nation projects like the Iwakuni Medical Dental Clinic are designed and built by our alliance partner. Our military construction programs are designed and supported both in the District and across the USACE enterprise for our fellow military services here in Japan. Nothing is done in a vacuum; we all work together and successfully build together.