Grounded in Nature: A New Patient Pavilion as Unique as its Context

Dartmouth Health’s Dartmouth Hitchcock Medical Center is located on a picturesque 225-acre campus in the Upper Connecticut River Valley and serves as the main centre of care for a large rural population throughout New Hampshire and Vermont. Bounded by the White Mountains to the north and the Connecticut River to the east, the new Patient Pavilion anchors the north end of the existing structure, providing a fresh take on the campus vernacular. The building form, massing and materiality are inspired by the natural context: sunlight between the trees, stone within the mountains, and the flow of rivers and streams. Elements of nature are pulled inward through the mindful placement of wood features and fractal patterns that mirror those of tree branches and leaves.

The five-story inpatient tower takes advantage of its elevated site and forest-enclosed, natural setting with large windows that allow plenty of daylight to enter and views outward over the landscape. The building’s curved form defines a welcoming arrival sequence and optimizes views to nature from the patient rooms. The V-shaped floor plate connects to existing buildings while creating new usable spaces and exterior courtyards that serve as areas of respite. 

Natural Materials Enhance the Healing Environment

A base of regionally quarried stone grounds the building into the landscape creating an instinctive relationship with the changing palette of the seasons. The base houses the main entrance and public amenities. Its materials — natural stone and glass — create a comfortable, bright, and cheerful environment and extend the calm of the natural environment indoors. The Patient Pavilion is clad in a vertically ribbed, rain-screen panel system, with window openings that create a dynamic pattern across the façade, emphasizing the movement and flow of staff and patients. A projected metal border frames the tower and extends out to separate private from public spaces.

Interior materials were evaluated and selected based on health, durability, and cleanability criteria, starting with the 50-year palette of neutral materials that remain for the life of the building and layering in opportunities for warm bright accents in the furniture, art and wayfinding. Accents of reclaimed wood extracted from local New England barns were used to highlight destination points and bring warmth to the space. Lighting and form were used to create movement, reinforce wayfinding, and direct views to the outside and reinforce circadian rhythm all to promote healing.

Flexible and Ready for the Future

The new Patient Pavilion will accommodate 64 adaptable inpatient beds on opening day, with the capacity to add 64 beds in the future. Flexibility in the future is a key operational concept for the new pavilion. Patient rooms provide appropriate clearance, power, and medical gasses to convert to critical care without renovation, with proper infrastructure redundancies to remain resilient in any emergency situation. The inpatient floors are likewise sized to meet critical care requirements for equipment storage, medication rooms and staff support space. Each 32-bed floor is divided into identical pods of 16-beds, with clinical support space provided for each pod. These pods provide flexibility in dividing the floor by patient type, if required.

Separation and optimization of clinical flows is a second key concept. Public elevators are separate from service elevators, and public circulation space is clearly defined and separated from non-public circulation. Each floor connects horizontally into the existing campus, providing multiple options for patient flow to and from the diagnostic & treatment areas.

Multidisciplinary team-based care is the third key operational concept. Team Hubs provide open but private areas for caregivers to work, meet and collaborate. Modelled on the idea of a ‘kitchen island,’ these hubs are intended to be used by all providers, residents and nursing students that visit the floor and contain the array of central monitoring equipment. In addition to Team Hubs, charting workstations are provided at every two patient rooms.