Built To Serve: Carl R. Darnall Army Medical Center
A five-piece bronze display of statues, by Brodin Studios of Kimball, Minn., sits at the main entrance of Carl R. Darnall Army Medical Center at Fort Hood, Texas, and depicts a World War II veteran shaking the hand of a soldier who’s accompanied by his family.
Clinic waiting areas are located adjacent to a courtyard, allowing guests to step outside or enjoy natural daylighting inside.
Nurses’ charting stations are located outside of the patient rooms for recordkeeping and allow staff to maintain a direct view inside to patients. Materials such as quartz, selected for their ease of maintenance and long-term durability, compose all of the writing surfaces and countertops.
The labor and delivery rooms include family zones located next to the windows as well as hospitality-like amenities, such as wood floors, sleeper sofas, workspaces, and storage areas.
Covered outdoor balconies offer staff members an opportunity for fresh air while protecting them from the Texas sun.
Within the double-height atrium, patients can access the second floor via a staircase or elevators located behind the main information desk.
A large open dining area is located off the main concourse and showcases the wood and stone materials used throughout the medical center.
A memorial garden dedicated to the medical center’s namesake, Brig. Gen. Carl Rogers Darnall, is located in an enclosed courtyard by the clinics and has an active water feature that cascades water down a memorial wall.
An exterior brick system inlaid in precast insulated panels pays homage to the original hospital’s architecture, while Texas quarried limestone is used at the entries and on the signage walls to create continuity between the interior and exterior as well as connect with the local geography.
When Darnall Army Community Hospital at Fort Hood, in Killeen, Texas, opened in 1965, it was supporting one division of 17,000 troops. Today, the hospital serves more than 42,000 active duty personnel from the 1st Cavalry Division, 3rd Calvary Regiment, and specialized brigades, as well as more than 100,000 beneficiaries, including family members and veterans.
Leaders tried to make do with the original structure, adding a new ED and a women’s health clinic in the early- and mid-2000s and expanding outpatient services into modular structures around campus over the years. But the result was a disjointed care experience. Furthermore, the decades-old hospital didn’t meet the Department of Defense’s (DOD) standards for care, housing semiprivate inpatient rooms and too-small exam rooms. Meanwhile, military missions and tactics changed, too, and soldiers returning to the post were facing different types of injuries or healthcare needs than before, which required additional service lines, such as orthopedic rehabilitation and behavioral health.
In 2006, Fort Hood announced a master plan to build a replacement hospital, which became one of the largest DOD contracts funded by the American Recovery and Reinvestment Act. Groundbreaking began in 2010 and the 947,000-square-foot facility—renamed the Carl R. Darnall Army Medical Center—opened in November 2015 with a six-story hospital tower, three outpatient specialty clinic buildings, and three parking garages.
Lt. Col. Robert Schultz, program manager, U.S. Army Health Facility Planning Agency, Health Facility Program Office-Central at Fort Hood, says it was important that the project didn’t take a cookie-cutter approach or try to replicate another post’s hospital. “There are different missions, different service members, and potentially different types of injuries or things that [patients] experienced that affect what’s provided,” he says. “It has to be unique and match the folks and the types of services [offered].”
A new setting
The design/build team of HKS Inc. (architecture and interior design), Balfour Beatty (construction), McCarthy (construction), and Wingler & Sharp (design in association with HKS) didn’t have to look far to find a location for the replacement, identifying a 65-acre site across the street. Rupert Brown, associate principal and senior vice president at HKS (Dallas), says the team next developed a design concept based on health and healing. “The strength of soldiers is defined by physical, spiritual, and mental fitness—body, heart, and mind. It’s also shaped by the health and well-being of the Army family,” Brown says. “Providing a world-class medical center for the people in the Fort Hood community ensures the continuation of the mission of Army medical care in providing the very best healing and care for soldiers and their families.”
The new medical center is 60 percent larger than the previous facility and has three major care areas, “bones, brains, and babies,” to support the primary care needs of its patients. For example, many soldiers stationed at Fort Hood are involved in overseas operations that require the use of large vehicles that they’re constantly jumping on and off of, leading to a prevalence of chiropractic and joint injuries. The focus also reflects the medical center’s growing behavioral health service line and the volume of babies delivered at the medical center, which averages 250-300 deliveries a month.
Services, or “portals of care,” are categorized as clinic-based or hospital-based. The clinic-based portals include primary care, orthopedics, rehabilitation, surgery, and behavioral health. Inpatient portals supported by the 122-bed hospital include intensive care, general medicine, and surgery, with an ED and imaging department also housed there. This approach guided the adjacencies created in the campus’ three clinic buildings and inpatient tower. For example, chiropractic, occupational therapy, and pain management departments are housed together on the first floor of one of the clinic buildings. “It allows [patients] to get care from different service lines without having to traverse the entire building,” says Brent Willson, associate principal and senior vice president at HKS.
All of the women’s services, including outpatient care, OB/GYN, labor and delivery, and neonatal care, are located in the women’s health clinic that’s on the hospital side of campus. The idea behind the solution was that a woman would use the clinic to access prenatal care, take tours of delivery rooms, and visit with doctors. “So when she comes in for delivery, she’s already familiar with the facility, the labor and delivery unit, and she can come in the same door,” Willson says. “It’s focused on complete care of mothers and women, from prenatal care all the way through delivery and postnatal care.”
The arrangement also benefited the behavioral health unit, specifically for patients being treated for post-traumatic stress disorder, depression, or trouble reintegrating with society after deployment. While space at the existing hospital had been repurposed to support care as awareness of mental health needs grew, the design of the replacement hospital offered an opportunity to consider what would define the optimal care environment.
The answer was locating all behavioral health services on the third floor of the hospital and adjacent clinic building, with room for a range of services, from individual and group therapy (for squads and families) to inpatient treatment. Bridging the two areas together allows cross-staffing between outpatient and inpatient care. There’s also access to a secured outdoor area with a basketball court that’s dedicated to behavioral health patients. “Giving patients access to nature for fresh air and sunshine is beneficial to the healing process,” Schultz says.
A sense of place
Recognizing that a nearly 1 million-square-foot building could be intimidating to navigate, the team worked to create a design that’s intuitive. “Especially the first-time visitor or that person new to Fort Hood, their access and orientation to the facility needed to be simple and clear,” Willson says. The clinic and hospital buildings are organized linearly, with a single connecting concourse that runs the length of the medical center and is anchored by parking garages on both ends.
A two-story atrium with floor-to-ceiling windows serves as a dividing point on the concourse; hospital-based services are on the left side and the three outpatient clinics are on the right side. There’s also an information desk, cafeteria, outdoor dining area, and pharmacy located on the ground floor off the atrium, creating a centralized gathering spot and orientation point.
Wayfinding themes were established in each care portal through the use of accent colors and nature icons, including wetlands, grasslands, and woodlands for the three clinics; bluffs for the hospital; and wildflowers for the women’s center, says Jamie Castillo, vice president and director of health interiors at HKS. “Subtle details within the composition of graphics, imagery, textiles, and paint accents are altered within each portal of care.” For example, the women’s building features a periwinkle accent color and floral artwork and fabrics.
On the exterior, Brown says the building was oriented to maximize daylight and create views, giving the facility a “sense of openness with glazing”—this, along with the addition of multiple outdoor spaces, helps break down the scale of the medical center. The campus offers landscaped courtyards near the entrance and clinic buildings, rooftop gardens, and outdoor balconies, including one for staff off a sixth-floor c-suite, where the post commander and his staff have offices and a conference center.
In the details
The project team took a personalized approach to interior design, providing a supportive, healing environment that’s as comfortable for returning soldiers as it is for family members. “We wanted to create a space that was going to give them the ability to relax and come into a better state, whether they were entering a patient room or the main lobby,” Castillo says.
The materials palette reflects the natural landscape and includes native limestones, quartz, wood veneers, and metal banding details in the glazing, millwork design, and terrazzo flooring. A combination of maple wood and limestone provides a contrast at feature walls within the main entry, dining area, and concourses at each level, connecting the clinic waiting areas to their respective elevator lobbies.
In the private patient rooms, wood tones appear again on the headwall and footwall millwork, along with dimmable lighting, views to the outdoors, and a sleek quartz desktop that transitions from a writing surface into a bench in one fluid design, providing additional seating for family members. “It automatically elevates the ambience of the patient room to an environment where patients and their families are naturally more comfortable and, thus, are better able to rest and to be receptive to care,” Castillo says.
The design team also took into account future growth needs, configuring the site to accommodate expansion to the south and adding interstitial floors in the buildings to facilitate HVAC upgrades with minimal disruption. The facility was designed to achieve LEED Gold certification with such features as drought-resistant landscaping that’s irrigated using condensate from the mechanical system, a mechanical system that uses 100 percent outside air, and a high-performance building envelope.
Walking paths wind around the campus, including a therapeutic pathway with alcoves for rest and contemplation connecting the medical center to a future Warriors Transition Unit located on campus. “Military families are on the go a lot so the idea of making this facility about its region and location, it was trying to help tell the story of community and home for all those who use this facility,” Willson says.
Anne DiNardo is executive editor of Healthcare Design. She can be reached at firstname.lastname@example.org.
• Completion date: November 2015
• Owner: Carl R. Darnall Army Medical Center
• Total building area: 947,000 sq. ft.
• Total construction cost: $561 million
• Cost/sq. ft.: $592
• Architecture: HKS Inc.
• Interior design: HKS Inc.
• Contracting: Chief administrator: Lt. Col. Robert Schultz
• Engineering: Halff Associates Inc. (civil engineer, landscape architect), Cagley & Associates (structural engineering), Southland Industries (mechanical and plumbing engineer), M.C. Dean (electrical engineer)
• Construction: Balfour Beatty, McCarthy
• Commissioning: The Ranger Group
• Art/pictures: Healthcare Graphics Consulting (signage and graphics consultant)
• AV equipment/electronics/software: McDean, Optimal Solutions Inc., Panelcrafters, Liberty AV Solutions
• Carpet/flooring: Interface Flor (carpet), Johnsonite (sheet vinyl), Tajima (luxury vinyl plank), Armstrong (vinyl composition tile), Dal-Tile (porcelain tile), American Olean (quarry tile)
• Ceiling/wall systems: USG (acoustical tile and grid), Armstrong Woodworks Access (custom ceiling), Modernfold (operable partitions)
• Doors/locks/hardware: Performance Door (supplier); Steelcraft (hollow metal door and frame); Eggers (wood door); Ingersoll Rand, Glynn Johnson, LCN, Ives (hardware); Schlage (locks)
• Fabric/textiles: HBF (tack board fabric), ArCom (cubicle curtain), Maharam (cubicle curtain), DesignTex (acoustical wall fabric)
• Furniture seating/case goods: Herman Miller Healthcare (furniture), Hallmark Industrial Supply (casework), ISEC (millwork)
• Handrails/wall guards: Johnsonite (resilient post), C/S Acrovyn (corner guards, handrails, sheet wall protection)
• Headwalls/booms: Interspec (NICU, exam, prep, recovery), Hill-Rom (ICU/CCU), ISEC (patient rooms), Stryker (OR booms)
• Lighting: Cooper Lighting
• Signage/wayfinding: Healthcare Graphics Consulting, Bob Oudin
• Surfaces: Sherwin-Williams (paint), Wilsonart (plastic laminate), Panolam (fiber-reinforced plastic paneling), LG Hi-Macs (solid surfacing), LG Viatera Quartz (stone)
• Wallcoverings: Maharam (vinyl wall covering)
• Other: Mecho-Shade (roller shade), GRT Glass Design (decorative glass)