Over the past decade of conflict, tens of thousands of America’s wounded have been injured in combat. One of the success stories of battlefield medicine advances is the increased rate of survival from injuries that, in previous conflicts, resulted in death. The survival rate for U.S. service members wounded in Iraq has reached 90%, higher than in any previous war, according to www.miltary.com.

New life-saving procedures, such as injury training, buddy aid, rapid battlefield evacuation, and the presence of ICU capabilities aboard long-haul aircrafts, have allowed more of our nation’s heroes to return home for care and rehabilitation. Unfortunately, as a result, amputations and post-traumatic stress disorder are the most visible signature injuries.

Growing numbers of returning wounded, often with catastrophic injuries, tested the health response of the Department of Defense (DoD) facilities infrastructure. Many military hospitals began to recognize that their facilities were outdated and incapable of dealing with advancements in medical care and technology. Although continuing to operate safely, many of the facilities required significant additional investment. This is one issue on which the DoD, Congress, and the president agreed.

A perfect storm of demand and available funding has created a watershed moment in military hospital design and construction. In 2005, the Base Realignment and Closure Act (BRAC) directed the closure of Walter Reed Army Medical Center and the establishment of Walter Reed National Military Medical Center, expanding the capabilities of the Bethesda National Navy Medical Center and constructing the DoD’s largest community hospital at Fort Belvoir.

In response to the increased casualty rate, Congress not only added funds to these projects, but also to the 2008 DoD Medical Military Construction budget. The American Recovery Act funded more than $1.3 billion in new military hospital construction, and the DoD increased its overall investment rate for future budgets. All told, more than $5 billion of medical treatment facilities are currently being constructed and designed to support wounded warriors and their families.

During this same time period, based on a mandate by Congress, subject matter experts developed both world-class facility design and acquisition standards for the DoD that enabled appropriated funds to be used wisely and effectively. The DoD adopted the principles of evidence-based design (EBD), family-centered care, and alternative delivery models, including design-build, into all new and renovated military healthcare facilities.

So, what do our new healthcare facilities for wounded warriors look like as a result of the convergence of these events? Here are some of the newest models of military hospital design and construction.


Walter Reed National Military Medical Center

Opening Date: November 10, 2011

November 10, 2011, marked the formal opening of Walter Reed National Military Medical Center (WRNMMC) at Bethesda, Maryland. Created through BRAC of 2005, WRNMMC consolidated the services of Washington, D.C.’s Walter Reed Army Medical Center to the campus of the National Naval Medical Center. Now the nation’s flagship military healthcare platform, the project enhances the delivery of outstanding healthcare and treatment services to military personnel and their families in a safe, functional, and sustainable environment.


WRNMMC was successfully delivered by the design-build team of Clark/Balfour Beatty, A Joint Venture and designer-of-record HKS Architects, with the initial concept design developed by AECOM and HOK Architects. The $826 million project included approximately 750,000 square feet of new construction, 450,000 square feet of renovations, and infrastructure improvements. The design-build team completed all BRAC-related work six weeks prior to the mandatory September 15, 2011, completion deadline.

WRNMMC now stands among the nation’s premier military health facilities for wounded warriors recovering from traumatic brain injury or loss of limb. The design-build team created numerous custom spaces to allow the facility to offer a complete range of medical services, including surgery, critical care, musculoskeletal, neuroscience, cardiovascular/invasive procedures, cancer treatment, endoscopy, imaging, children’s health and emergency care.

Specific attention was placed upon creating comprehensive environments for the rehabilitation of patients with amputation and brain injuries, a Vision Center of Excellence, and wards specifically designed for wounded warriors and brain injury patients.


Fort Hood Replacement Hospital

Opening Date: May 2014

The Balfour Beatty | McCarthy joint venture, with HKS Inc./ Wingler & Sharp as design partners, was selected by the U.S. Army Corps of Engineers to provide design-build services for the Fort Hood Replacement Hospital project at Fort Hood, Texas. The 944,000-square-foot facility will replace the existing 45-year-old Carl R. Darnall Army Medical Center and provide a new state-of-the-art healthcare facility for service members and their families.

Funded by the American Recovery and Reinvestment Act, the $534 million Carl R. Darnall Army Medical Center replacement hospital will reinforce and promote the mission of Fort Hood medical care in providing world-class healthcare within an innovative and modern healing environment.

The replacement hospital seeks to reflect on “what makes the Army strong” to provide the best medical care possible. It is the belief that simple organization and highly efficient planning is the basis for such a facility.

Circulation is a central design theme and touchstone, organizing all elements of the medical center. Circulation links the community (on- and off-post) to the campus, parking, associated garages, building, and clinical functions in a logical cascade. The functional groupings of services are efficiently organized into “portals of care”—maximizing patient-centered care. The concourse, which runs the length of the facility, provides a clear, orienting element.

The exterior design is simple and appealing, promoting efficiency in design and construction, and establishing a desirable healing environment. The building orientation works in harmony with the site, its natural topography, views, access, and solar orientation. The hospital evokes Fort Hood pride— responding to and reflecting upon local geographical features, such as topography, natural materials, rock formations, plateaus and ridges, wetlands and lakes, vegetation, and wooded areas.


Camp Pendleton Hospital

Opening Date: 2014

Naval Facilities Engineering Command Southwest awarded Clark/McCarthy a $394 million contract to design and construct a new hospital a
t Marine Corps Base Camp Pendleton. With modifications and an option, the value of the contract will increase to $451 million. Included in the team are HKS, executive architect, and Wingler & Sharp, associate architect. The initial concept design was completed by HDR Inc.

The 500,000-square-foot, multilevel medical hospital project is located on a 70-acre site at Camp Pendleton in Southern California. The completed project will include inpatient medical facilities with a maximum of 67 patient beds, emergency care, primary care, specialty care clinics, surgery, intensive care, and support spaces.

Additional work includes adding a central utilities plant; a 1,500-space, multilevel parking structure; surface parking; and site development. The hospital will be designed and constructed in line with California’s seismic safety standards and to receive LEED Gold certification.

The Naval Hospital replacement project at Camp Pendleton is one of the largest American Recovery and Reinvestment Act (ARRA) of 2009 projects within the DoD and is the largest ARRA project awarded in the Department of Navy.


Ireland Army Community Hospital

Opening Date: 2016

HKS/Wingler & Sharp was selected to design a new hospital at Fort Knox, Kentucky, working with the U.S. Army Corps of Engineers Louisville District, Health Facilities Planning Agency, and Medical Facilities Center of Expertise and Standardization.

Pending allocation of federal funding for construction of this hospital, the project would replace Fort Knox’s Ireland Army Community Hospital and would feature a 280,000-square-foot, 30-bed hospital, 245,000 square feet of outpatient clinics, a 28,000-square-foot logistics building, a 2,100-square-foot ambulance garage, and a new central utility plant.

The hospital design draws from the historic and established vernacular of Fort Knox. Kentucky red brick combined with prominent white columns and expansive glass complements the existing buildings on the campus, while providing a modern, timeless, and progressive architectural statement for the expanding campus.

The hospital is sited to tie into the fabric of the region with healing elements, such as water features, walking trails, indigenous landscaping, scenic courtyards, outdoor dining, and access to nature. Inside, the facility supports the latest in forward-thinking clinical practices.

Designed to achieve LEED Silver certification, the facility would showcase numerous innovative, sustainable, and world-class features in a hospital and clinic environment that utilizes EBD concepts that promote wellness and healing.


Continual process improvement

In another major step toward world-class healthcare environments for the country’s wounded warriors, retirees, and their family members, the DoD retained the joint venture of HKS and Wingler & Sharp to assist them in developing a set of capabilities, protocols, and operational standards for conducting rigorous research and innovation studies into healthcare planning, design, technology insertion, and operations.

This initiative will focus on developing: (1) a common framework, foundation, and guidelines for evolving and addressing design solutions; (2) a unified theme and solutions that could be applied across all medical treatment facilities; (3) healing environments that propose solutions that look at care in a holistic manner for the staff, patients, and family members; (4) EBD principles within a world-class facility; and (5) an understanding of patients’ needs and expectations for their care requirements.

According to Tom Harvey, FAIA, director of HKS’s Center for Advanced Design, Research and Evaluation (CADRE), HKS/Wingler & Sharp will develop a business plan to establish and operate this center, which will be used by the Portfolio Planning and Management Division of the Assistant Secretary of Defense for Health Affairs, all three U.S. military health services, construction agents such as the Corps of Engineers and Naval Facilities Engineering Command, and the Veterans Health Administration System.

“This effort will have a direct impact on the entire military healthcare system associated with facility development. It will apply to all medical healthcare facility planning, design, construction, and operational systems,” Harvey says.

The joint venture, through the expertise and experience of its not-for-profit research group, CADRE, will establish a research framework and protocols as they relate to the study of facility design. The research will focus on improving patient safety and outcomes; operational efficiency; cost containment; patient, family, and staff satisfaction; and education and training efficacy.

Potential long-term savings to the Military Health System include implementation of EBD principles and world-class tested features, reduction in design and construction errors, diminished operation and maintenance costs, improved standardization in criteria and other design tools, enhanced understanding of facility limitations, and justifiable programs for design. 

This project also will demonstrate the benefits of simulation and modeling to build and sustain consensus on layout and spacing factors, from the room to the facility level. A platform for standardization, experimentation, integration with academia, and industry and process development will evolve.

“The one-year study will culminate in the description of what this center can and should be capable of accomplishing, as well as the human and physical resources required to deliver on its goals,” Harvey says. “The result of this effort will set the stage for programming, design, and construction of the world’s premier EBD research center supporting the U.S. military’s goal to provide world-class healthcare facilities to its constituents.”

HKS/Wingler & Sharp will deliver the research center business plan by spring 2012.

As the government looks to the future, the care and treatment of the country’s wounded warriors remains a priority. This will be evidenced by not only brick and mortar investments, but also by advanced healing, caring facilities open around the country to serve military beneficiaries for years to come. HCD


Richard L. Bond, AIA, is Associate Principal, Federal Healthcare Strategy Leader, at HKS Inc. He can be reached at rbond@hksinc.com.