A healing garden at the Fort Belvoir Community Hospital, a tree-lined facility in Virginia less than 20 miles south of Washington, D.C., bears little resemblance to the sterile, airless courtyards of other hospitals. With geometric paving patterns, varied plantings, and zen-garden-like pebble paths, this is just one of several distinct areas of the new facility that are designed to blur the lines between building and nature.

The almost-1.3-million-square-foot hospital was developed in response to the 2005 Base Realignment and Closure (BRAC) Commission Report and the Defense Base Closure and Realignment Act of 1990. These necessitated the closure of the Walter Reed Army Medical Center, whose capabilities were then split between the National Naval Medical Center in Bethesda, Md., and Fort Belvoir. The new facility at Fort Belvoir, completed last summer, has 120 beds and is roughly four times the size of the DeWitt Army Community Hospital, the former medical facility on site. Because of its immensity, reducing the facility’s environmental impact was a goal from the outset, with the project on track for LEED Gold certification.

Designed by HDR in a joint venture with Fairfax, Va.–based Dewberry, the hospital is the first military hospital in the country to combine evidence-based design (EBD) and a sustainable return on investment (SROI) analysis. In this case, the EBD process examined how elements of the physical environment—elements chosen by the project designers—affect building inhabitants or patient outcomes, according to Jeff Getty, the project’s lead architectural designer and a senior vice president at HDR. The building design is based on scientific research and takes a more holistic approach than traditional medical design, he says.

The SROI analysis takes into account relevant social, economic, and environmental effects, both immediate and long-term, of the project’s energy- and water-conservation measures. “It provides measurable metrics for sustainable features and helps to justify our decisions,” Getty says. This, coupled with the EBD research, helped the team to choose elements that would achieve a variety of desired results, such as reductions in utility bills or air-pollutant emissions.

“The business of evidence-based design was interwoven with our aspirations for sustainability features,” Getty says. “For example, the mechanical filtration of air [in portions of the building] is done with HEPA filtration. It cleanses the air of contagions that imperil patients in particular. That is one of the things that is shown by research to have negative impacts on patient outcomes.”

Treatment of the site, which previously had been a nine-hole golf course, was particularly important, Getty says. The team preserved or restored 62 percent of the natural environment with native and adaptive plants and installed curbless parking, which naturally drains water into bioretention areas. Bioswales on either side of the building absorb stormwater and surface drainage. Getty says that the team planted two trees for every one removed during construction.

Rather than be one colossal monolith, the building is divided into five distinct wings, graduated in height from the six-story main building down to a pair of two-floor buildings. “The concept of the building was derived from the idea of trying to preserve a single stand of old trees,” Getty says, “so we kind of wrapped the building around that.” Getty calls the building “crenellated,” with walls and edges that cut in and out to offer more views and opportunities for daylight.

Several elements that came out of the EBD process will assist hospital staff. Reducing hospital-acquired infections through the installation of easily accessible hand-washing sinks in patient and exam rooms is a major EBD element. At Fort Belvoir, these spaces include floor tiling that directs staff to these stations. Most inpatient rooms also have a patient lift to limit hospital-staff injuries, a common problem in hospitals.

“Our staff members love the new hospital and are awestruck the moment they see the facility,” says Army Col. Alan B. Shoupe, the hospital’s deputy commander for healthcare operations and strategic planning. “Our staff commonly talks about how easy it is to get around the facility, how the technology that is in place helps them complete their jobs more quickly, and how the facility helps them provide safe, quality, compassionate care to patients.”

The most distinctive building feature may be the swooping roofs that channel rainwater into underground cisterns where it is kept for reuse in irrigation on site. (“The swoops also pay homage to Fort Belvoir’s large bald eagle population,” Shoupe says.) Getty asserts that this system, paired with the condensation saved from the HVAC system, will save the facility 1.6 million gallons of potable water every year over a comparable building. A vegetated roof, visible from patient rooms, also captures stormwater and reduces the heat-island effect.

Mechanical and lighting systems are designed to be as energy efficient as possible, including a heat-recovery chiller system. The result of HDR’s green strategy is an estimated 27 percent energy reduction, a savings of nearly $500,000 on annual energy costs, and an estimated savings of 4,000 tons in CO2 emissions—all compared to a standard-design hospital, according to Getty.

Finally, the team created a series of reflective and distinct garden spaces around the hospital, each developed for a particular constituency—soldiers, children, chapel visitors, and others. “Indoor air quality, views to the outside, access to nature—these all provide positive psychological benefits, but go hand in hand with sustainability,” Getty says. “Our goal was to get this whole building closer to the landscape.”

Kim A. O’Connell writes about historic preservation and sustainable design from Arlington, Va.