Good bones are as important to appropriate architecture as they are to good health. When I was part of the design team for Dartmouth-Hitchcock Medical Center (DHMC) over 25 years ago, we were rigorous in organizing the 1.4 million square foot complex along a three-story sky lit spine. Today, the central campus contains about 2 million square feet (plus DHMC’s satellite facilities in other cities) yet the complex’s straightforward organization makes it easy to navigate and pleasant to maneuver. DHMC was one of the first ‘medical mall’ facilities in the country, and is still among the best. Nevertheless, the design shortcomings we argued about years ago – that the main stair was too narrow and didn’t descend to the lowest level – are still the first complaints I hear. Reinforcing Frank Lloyd Wright’s observation that, “A doctor can bury his mistakes, an architect can only advise his client to plant vines.” A plant wall might be a more fitting terminus to DHMC’s mall than a stair that no one can use.

I’ve visited DHMC several times since it opened in 1991, but wanted to visit with the perspective of ‘How will we live tomorrow.’ Charlie Welch, Director of Operational Services; Dave Stiger, Director of Project Management and Construction, and Marianne Barthel, Arts Program Coordinator; met with me to discuss how the facility has adapted and changed, and what they see for tomorrow.

Charlie explained with within ten years of opening, DHMC needed to expand clinical, diagnostic and treatment capabilities. The ‘Project for Progress’ opened in 2003 and 2004, adding MR’s, OR’s and other diagnostics, as well as increased outpatient treatment, cancer care, and cancer research capacity. More recently, growth has been beyond the central campus, with outpatient facilities in Keene, Manchester, Concord, Nashua, and St. Johnsbury, VT. Now, with population growing, and aging, DHMC has the complementary pressure of too few inpatient beds.

They have managed to add 40 beds through creative space juggling, but there is no easy way to add a significant number without building the third inpatient wing envisioned in the original master plan – at today’s cost of about $200 million.

Chris described how DHMC responds to changes in resource availability. The original campus was powered by oil. They were on the cusp of switching over to wood chip incineration when the natural gas boom occurred. So, they switched to compressed natural gas. They are investigating switching over to liquid natural gas, possibly sharing a central distribution facility with nearby Dartmouth College. Dave’s group investigates renewables like wind and solar on every project, but to date, they have not demonstrated acceptable payback periods.

While Charlie and Dave keep people warm and dry, Marianne’s focus is on elevating everyone’s experience – staff, patients and visitors alike. She oversees a program of performances, permanent and rotating art. The day I visited, the extensive Audubon print collection (gift of Mary and Laurance Rockefeller) shared the main lobby with a display of staff art and Frank Logan, a volunteer pianist for over twenty years, filled the space with piano standards.

How will we live tomorrow?

“In healthcare, it will be a challenge as we get older and our expenses rise to accommodate end-of-life care. We are designing a 12-bed palliative care (hospice) facility. Visiting nurses, aging in place, are encouraging steps. We do not need to be the end all here on this campus. We are starting telehealth programs that link doctors to patients for routine care from their homes, and also support more acute patients in smaller hospitals. Our Link Transfer Center will allow EMS teams to identify a regional hospital with the appropriate care and bed space. Hospital census will be spread across the region.” Charlie Welc

“The cost of solar is decreasing. It may be viable on future projects.” Dave Stiger

“Aesthetics and art in all of its forms are integral to tomorrow. We have an extensive art collection, but it is all in public areas. If you’re an inpatient here for weeks, you may not enjoy any of it. We want to bring art to the patient room. We’re looking at digital frames with a rotating collection of images. Patients will also have the option to personalize them if they have pictures of family or friends they want to see.” Marianne Barthel