An affiliate of Massachusetts General Hospital, Nantucket Cottage Hospital has been serving residents and tourists in Nantucket, Mass., since the 1910s. The organization’s most recent facility was built in 1957 and lacked the amenities, robust technology network, and resiliency features desired to meet the care and patient expectations of today. “There had been no medical facility of any kind built on the island in 60 years,” says Jocelyn Stroupe, principal and director of health interiors at CannonDesign (Chicago). So in 2011, the hospital’s board gave approval to explore a replacement hospital that would provide a modern healthcare setting while conforming to the island’s historic aesthetic.
To help guide this journey 30 miles out at sea, a committee was formed that included residents and staff (many of whom are islanders themselves) to work with CannonDesign, which provided architecture and interior design services. Together, they toured a variety of buildings on Nantucket to understand the island’s historic architecture and building materials as well as the community’s relationship with the hospital. “In the winter, when a lot of things are closed, there are limited restaurants open, so people go to the hospital and dine there. It’s a very interesting component in terms of its place in the community,” Stroupe says. “A lot of other hospitals don’t have that same type of relationship.”
In fact, the project’s $120 million capital campaign was met entirely with private donations by residents so that no taxpayer dollars had to be used. As a result, Stroupe says there was a lot of interest in making sure that the new hospital was designed specifically for Nantucket. “They wanted us to be sure to capture the essence of the island and its culture,” she says.
Building character
Input from the community wasn’t the only guiding force on the project, however. With the entire island designated as a historic district, the new hospital design required the approval of Nantucket’s elected architectural review board, which weighed in on everything from building materials to lighting to signage and more. “They are very particular about what goes on and how it looks to maintain that Nantucket charm,” says Brian McKenna, health region leader at CannonDesign (Boston). “We were asked to apply scale and measurements and proportions that are traditionally used for houses to a healthcare institution.”
For example, the same pitched roof standard for houses on the island had to be applied to the two-story 110,000-square-foot hospital building. Other iconic building elements, including weathered gray shingles with white trim, were a must-have in the design vernacular of the hospital, as well. “It’s really a beautiful community because of that consistent character that it has, but at the same time, it’s also a unique challenge applying that character to a healthcare setting,” Stroupe says.
The project team had to overcome another host of challenges specific to the locale, as well. To begin, the new hospital was being built adjacent to the existing facility that remained operational until the new building opened in January 2019—at times, construction was taking place just 8 feet away. A phased construction plan included relocating a few of the old buildings to help clear the site and using a remote laydown area for materials and transporting them as needed. Additionally, with the island accessible only by boat or plane, daily weather disruptions, including storms and fog, had the potential to cancel travel, thus impacting the ability of work crews as well as supplies and materials to arrive on-site. This meant the project team had to plan for a number of “assumed weather delays” during scheduling. “It certainly makes you realize how isolated they are and what that means for life on an island,” Stroupe says.
The seasonal fluctuation of tourists—which increases the community’s population from 10,000 in the winter months to 60,000 during the summer—was another dynamic that impacted planning and design. During the off-season, McKenna notes that it’s not unusual for the hospital to have a couple of patients spread between the inpatient and emergency departments and only three to four staff to deliver care. In the former hospital, these departments were apart from each other, so one of the goals for the new facility was to increase efficiencies by creating a core of primary care services, including housing the ED next to imaging and near inpatient beds, to allow staff to move easily between areas. “They do a lot of cross-training of staff with multiple services, so operationally there was a big focus on efficiencies,” he says.
Alternately, the hospital also had to be designed to flex up to handle summer patient surges. One solution was to design the 16 prep/recovery bays in the second-floor interventional suite to be universal. For example, if the hospital experienced high demand for endoscopy services in one day, all the spaces would be equipped to handle them rather than limiting the number of procedures that could be performed. “There’s a lot of flexibility that way in how they utilize the space,” McKenna says.
Simple touches
To guide decisions about the interior design, Stroupe says the project team visited island homes, hotels, and restaurants to get an understanding of local styles, materials preferences, and color palettes. One common feature that was noted, she says, was that most houses on the island utilize light colors to help reflect available light and brighten interior spaces on cloudy or foggy days. In response, the hospital features a predominately white color palette with touches of blues in key areas, such as the registration desk in the physician office space or near patient doorways in the inpatient unit.
When selecting materials, designers took a simplified approach that was inspired by the island’s natural elements, including porcelain tile and white oak wood. Nantucket’s history of craftsmanship, including the weaving of lightship baskets, which tie back to the whaling industry, were also incorporated into the project and represented through decorative elements such as hanging light fixtures in the dining area and a wood wall in the lobby. “We ended up with maybe five materials on the project, which is pretty unusual,” Stroupe says. “A lot of times when we look at how to approach a healthcare project, certainly we’re trying to figure out how can we use color to help people understand where they’re going or to provide interest in the space, but it felt inappropriate for this particular setting. It really needed to be more about the simplicity and using materials in an elegant way, celebrating the craftsmanship, and not doing anything that was applied and unnecessary.”
Rather than add clutter to the environment with overhead signage or traditional wayfinding, the team relied on the architecture to help guide people throughout the space. For example, the main entrance leads to an open first-floor lobby with all major programs accessible from this space, including the adjacent ED (which also has a separate entrance) and inpatient rooms on one side of the building and an ambulatory wing with an outpatient clinic and conference space on the other. The second floor utilizes the same open central-lobby concept to serve as the main waiting area for the labor and delivery suite, interventional department, and surgery. A cafeteria and administrative area for executives are also located there.
Island fortress
Resiliency was also a priority in delivering a modern facility, with the project team incorporating hurricane design specifications established by Florida’s Miami Dade County. The new hospital is built to withstand winds in excess of 158 mph thanks in part to a double-hulled exterior building shell composed of fire- and impact-resistant drywall, metal studs, and 5-by-5-foot concrete footings fortified by mesh—all of which are covered with traditional cedar shingles that look at home on the island. In case of severe flooding, the hospital’s mechanical systems are located on the top of the building and hidden behind a mansard roof. Other resilient features of the building include hurricane-resistant doors and windows, dual electrical and water supplies to provide backup redundancy, and operable windows for ventilation if the air handling systems lose power.
While the hospital’s resilency features prepare it for the next weather-related event, many of its other modern features have proven beneficial throughout the coronavirus pandemic, says Gary Shaw, president and CEO at Nantucket Cottage Hospital (Shaw joined the hospital in December 2019). Specifically, when COVID-19 hit the island in spring, the medical staff was able to create hot and cold zones to separate infected and noninfected patients thanks to the flexible care environment. The facility’s robust new telemedicine capabilities, originally intended to support communications between clinicians on the island and specialists at the system’s mainland facilities, enabled clinicians to easily respond to the rise in demand for telehealth services and supported communication between patients and staff and their families via mobile devices. “By the nature of how modern structures are built with current codes, airflow, lighting, and technologies, these buildings are highly adaptable to various focused events,” he says.
Anne DiNardo is executive editor of Healthcare Design. She can be reached at anne.dinardo@emeraldx.com.
