The Military Health System (MHS) is a worldwide network of healthcare facilities and personnel. The healthcare facility inventory is aging and requires extensive facility management, renovations and replacement construction to maintain the environment of a high quality of care. Recent developments in sustainability and evidence-based design (EBD) have created additional requirements for the design and construction of facilities. These areas of design emphasis, sustainability and EBD, are developing best practices according to the respective theory. Existing facilities in the MHS have been directed to undergo restoration and modernization by Department of Defense (DoD) civilian leadership. Governmental directives have mandated that these restorations and new construction complies with current building codes and that EBD design features be included in healthcare facility planning. The hospital building type has changed over history due to innovations in building technology, such as HVAC and steel frame construction, as well as healthcare initiatives, such as treatment of tuberculosis and the mentally ill. The design concepts of environmental sustainability and EBD are currently altering the hospital typology. Building professionals have found significant differences in facilities that are categorized as evidence-based and those noted as sustainable. The future of successful healthcare designs relies on a balance of these concepts. The hospital building type has one of the highest energy intensities out of all commercial building types. Hospitals have become more energy intense due to the evolution of the deep-plan hospital. The design of the building envelope is the most lasting feature affecting the energy use of a hospital, due to its service-life typically equaling the life of the facility. The building envelope design consists of the shape of the building, material selection, as well as its orientation. This research demonstrates the relationship between incorporating positive building occupant features, such as increased day lighting and views of nature, and efficient energy design choices. The use of energy simulation software and early design collaboration between multiple professional disciplines is recognized as critical to optimal design solutions
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