This article was originally published on April 25, 2014, and is among Healthcare Design's Top 10 most-read articles of 2014. To see a full list, click here.

From its stunning façade to its project delivery process, the new Naval Hospital at Camp Pendleton, located at the major West Coast base of the U.S. Marine Corps near San Diego, represents a standard for military healthcare facility design. Delivered six months ahead  of schedule (completed in November 2013 and opened in December) and more than $100 million under budget, this 500,000-square-foot facility is a welcome replacement for a hospital that was designed and built in the early 1970s. It’s also one of the first federal projects to be funded under the American Recovery and Reinvestment Act of 2009 and the largest recovery act project in the Navy.

The design goal was to create a world-class, timeless, landmark facility fitting of a prominent site overlooking the Pacific Ocean. More important, it had to reflect the values of the U.S. Navy and Marine Corps while accommodating the latest evidence-based design practices. The project was led by the joint venture design-build team of Clark Construction Group LLC and McCarthy Building Cos. Inc., joined by HKS Architects Inc. (Los Angeles) as the project architect-of-record and HDR Architecture Inc. (San Diego) as the architectural designer. Young + Co. Inc. (San Diego), HDR Architects, and HKS Architects collaborated on the interior design.

Designing a landmark
Providing emergency, primary, intensive, and specialty care, the new hospital (on a 1 million-square-foot campus) has 96 outpatient procedure rooms and 205 exam rooms, as well as 54 patient rooms that accommodate up to 60 beds for nonambulatory patients who require stays in excess of 24 hours. Reflecting the mostly young military population it serves, the hospital also has eight labor and delivery rooms, together with 16 postpartum suites. Outpatient care alone is expected to reach around 2,000 visits per day.

The interior design is modern yet familiar, with warm colors and materials, soft curves, and natural light used to communicate a sense of caring and compassion for the 70,000 active-duty and military veterans and their families who use the facility. Each patient floor has a theme inspired by nature—ocean, earth, sun, and sky—with fabrics, materials, colors, signage, and artwork that reflect those organic elements.

Evidence-based design features include 200- to 220-square-foot single-patient rooms with space for family members, patient lifts, and views to the outdoors. A few of the patient rooms, however, are semiprivate, according to Carlos Gonzales, the leader of the design-build joint venture who is now a vice president at Clark Concrete Contractors, a subsidiary of Clark Construction Group. “Anecdotal information from staff indicated that multiple marines injured in a single event heal faster and have better attitudes when they’re with their buddies,” he says.

Artwork and access to outdoor spaces/gardens provide positive distractions, while the ICU has decentralized nurses’ stations to enhance safety and reduce staff travel distances. A central atrium and courtyard open up the middle of the building, providing natural light and supporting intuitive wayfinding to reduce stress. Rubber floors, carpet, and acoustical ceiling panels help mitigate noise.

“There are also plenty of spaces for visitors to gather away from patients,” says Laura Thielen, vice president at HKS, citing the outdoor gardens, atrium waiting areas, and a private meditation space on one of the patient floors that has views of the ocean.

Great effort was also made to ensure that movement from the street into the clinical areas was smooth, by putting high-volume clinics and the pharmacy on the first floor, near the main entrance. “The staff likes the way the building functions and flows,” says Capt. Mark A. Kobelja, commanding officer of the Naval Hospital Marine Corps Base Camp Pendleton. “They’re not fighting the facility like they were in the old hospital. They love the natural light and views.”

Outside, “the materials and massing of the building reflect the coastal environment of California with its distinctive rocky bluffs,” says Thomas Todd, vice president and healthcare principal at HDR Architects. “The design is clean, classic, and strong, with a sense of order and discipline–very much like the military.”

Enhancing design-build
Sustainable design features include green roofs, healing gardens, and an atrium open to the sky. The building’s energy performance is 30 percent better than baseline standards set by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). The team achieved all five of LEED’s “Innovation in Design” credits by using more than 20 percent recycled content, reducing water usage by more than 50 percent, restoring vegetative open space that’s more than twice the footprint of the building, and implementing a campus-wide education program that highlights the hospital’s sustainability.

The scope of work also included construction of a central utilities plant with 3,100 tons of cooling and redundant utility systems, to allow the hospital to remain independently and fully functional for three days in the event of a power outage, as well as construction of a 1,500-space parking structure and 1,000-space surface parking area.

In addition to the design-build team’s $394 million base contract, the Navy adopted two contract modifications, which were added because the Navy wasn’t yet authorized to appropriate the funds when the base contract was signed. The first contract modification included the purchase of conservation banking credits to increase the amount of endangered coastal sagebrush within the project boundary to preserve and protect the natural environment. “Overall, the campus includes 73 acres of land that was developed as part of the project,” Gonzales says. “It includes landscaped areas, healing gardens, ceremonial outdoor spaces, and habitat restoration of an existing waterway that’s environmentally protected.”

The second contract modification incorporated roughly $42 million worth of medical equipment, furniture, and artwork—items that the government requires to be appropriated prior to the year they go into use. In collaboration with the Naval Facilities Engineering Command (NAVFAC) and the Navy Bureau of Medicine and Surgery, the design-build team developed a medical equipment package utilizing basis-of-design specifications and user group feedback to select more than 20,000 pieces of equipment, provide input on furniture and artwork, and coordinate the building design and infrastructure to accommodate it. The process of “best value determination” was used for every item, allowing the Navy an opportunity to compare models, options, maintenance contracts, and lifecycle costs.

“This later modific
ation was a first for the Department of Defense and NAVFAC, and significantly added to the typical design-builder requirements by calling for a team that was well-versed in medical equipment planning, procurement, installation, and training,” Gonzales says. Besides saving time, the turnkey procurement of equipment also saved money. The Navy didn’t have to spend its contingency because equipment was purchased under one umbrella, which eliminated costly change orders.

To develop the interior concepts, including the furniture and artwork specifications, Clark/McCarthy teamed with Young + Co. and HDR. Their documents were turned over to HKS for final execution.

Streamlining delivery
The design team fully integrated with the construction team from the beginning, working closely with members on each design submittal and package to ensure constructability, expedite work, and control quality and costs. No major construction was started until 65 percent of the design was finalized. “We worked with HDR to establish a detailed program and advanced design,” Gonzales says. “There were very few unknowns.”

The construction team also implemented a process to work simultaneously in multiple areas, which also streamlined the process. Each of the six design packages were sequenced and planned for an approval date that would expedite construction, including early utility relocation; site planning, civil engineering, and landscape architecture; structural and mechanical, electrical and plumbing engineering; hospital exterior envelope and interior build-out; central plant; and parking structure.

HDR and Young + Co. were initially contracted by the Navy to develop the architecture and interiors concepts and provide bridge documents to the design-build team. According to Jean Young, president of Young + Co., in a typical government indefinite delivery/indefinite quantity (IDIQ) contract, which provides for an indefinite amount of supplies or services during a fixed period of time, the interiors team assigned to work on the design concept would deliver bridge documents  without any specific specifications for finishes and furniture—approximately 35 percent of the total scope.

“However, in this case, the scope extended to 90 percent, all the way to complete finish specifications and furniture specifications, with pricing included,” Young says. “This is highly unusual.”

Because the Navy met with HDR and Young + Co. as part of the IDIQ contract and made all the decisions up front (including a request for proposals for artwork selection), it helped with the success of the project and shortened the schedule by two years from than the typical six. The design build-team didn’t have to create new design concepts or artwork specifications, allowing pieces to go to bid accordingly and be executed shortly after contracts were awarded.

A place to help
The practice of medicine has changed a lot in the 40 years since Camp Pendleton’s last hospital was built. Like other organizations, the Navy recognized a shift toward providing more outpatient services. “We didn’t need a facility with 500 beds,” Kobelia says. “The design-build team did a great job of integrating the inpatient and outpatient services in one facility.”

Members of the project team also emphasize that this hospital is tangible proof of the deep commitment the Navy has to the Marine Corps. “I’ve been designing hospitals for 31 years,” HDR’s Todd says, “and every project has community support and is dedicated to serving patients. But it’s an extra special experience to be able to contribute to a project like this, especially when we have so many service people oversees right now.”

The hospital opened in December 2013 and has been well received by patients and families, who like its open spaces and access to nature. “People have told me that they find it very relaxing,” Kobelja says, “that they don’t feel like they’re in a scary hospital—they’ve arrived at a place where people can help them.”

Sara O. Marberry, EDAC, is a contributing editor for Healthcare Design. She is a writer, blogger, speaker, and strategic marketing and business consultant in Evanston, Ill., and the former executive vice president of The Center for Health Design. She can be reached at

Sidebar: Quick facts

  • Schedule: The hospital was turned over six months ahead of the Navy’s target schedule
  • Budget: The design-build team delivered the hospital more than $100 million under budget
  • Quality: There was no re-work due to noncompliance with government standards/specifications
  • Safety: There were zero lost-time incidents for the duration of the project, which included more than 2.6 million man-hours
  • Small business: 75 percent of all contracts were awarded to small business subcontractors, including more than 45 percent to Service Disabled Veteran Owned Small Businesses

For a source list relating to this project, see “Camp Pendleton Replacement Hospital: Project Breakdown