Big In Japan

HDJH HD Hospital Development June 1999

Describes some of the outstanding examples of recent acute hospital design in Japan, and notes some of the design and planning details that may provide lessons for designers in the UK.

In the Autumn I visited a range of healthcare facilities across central and western Japan. They included specialist facilities such as ambulatory care (OPD) and elderly residential care, but most were large 'regional core hospitals' or municipal hospitals for cities like Yokoharna and Osaka. A number of the hospitals were recommended by the Japan Institute of Hospital Architecture JIHA.

It was especially interesting to gain an insight into current health service issues in Japan during the visit; in a mountainous country the majority of the 120 million population live in increasingly overcrowded urban conurbations. Due to pressures on contemporary family life and the reduced space in the home the average stay in a Japanese hospital is 20 days. Patients are not speedily discharged and sent home to cramped conditions, rather they expect to make a full recovery before leaving hospital. Hospitals are healing environments, which respond to social demands to provide respite for patient's families.

In Japan there are more than 9500 hospitals with more than 20 beds, and more than 85000 clinics with up to 19 beds managed by physicians. As with most other developed countries many hospitals in Japan are obsolete, with inadequate accommodation for modern treatment. The quality and circumstances of hospitals described here should therefore not he considered typical. All are supported by state of the art technology and all enjoy surprisingly good location.

Sanda City Hospital District General Hospital Kobe Prefecture Architect Nikken Sekkei
Designed by the architectural practice with the largest hospital portfolio in Japan, and located in Kita Sanda town a new town development that has the highest rate of increase in Japan, the 300-bed Sanda City Hospital is an impressively palatial modern hospital. Situated in a commanding location the six-storey design exploits different site levels offering good views of Mount Rokko. A striking form with a slender ward configuration and well-vented balconies suggest a large landmark hotel resort. The streamlined ward slab mounted over the diagnostic plinth provides a very distinctive profile. With the aim of both function and comfort the hospital is characterised by a one-floor concept for OPD, including diagnostic and radiotherapy. The point at which the wards bridge the main entrance forms an imposing symbolic gate which cuts a deep access into the core of the hospital circulation and frames the visual space through and beyond the building's mass itself.

Two entrances are provided, one at ground for public transport and taxis drop off, and the first floor bridge access to the car park. Both routes converge on the first floor and the remainder of the circulation is punctuated with distinguishing features such as the as diagonal elevations and saw tooth ceiling over the main OPD waiting spaces. The ward plan is deceptively simple with bedrooms offset and stepped creating a displaced inner area for staff and services. Day rooms fit elegantly into the central corners created by the sliding floor plan of the bed- rooms. The hospital looks efficient and impeccably clean, however giving a sanitised appearance that feels suffocating. The pale pastel finishing and indirect lighting provide a softness which is relieved by some traditional landscaping particularly through the barrel-shaped lightwell. Such spaces for contemplation and relaxation that offer exposure to the elements are all too rare within hospitals but are particularly conducive to longer stay institutions.

Toyonaka Municipal Hospital Architect K. Ito Architects and Engineers.
Located near Osaka airport within a long, narrow and sloping wooded site, this dynamic eight-storey wedge-shaped building was designed by a distinguished firm of hospital specialists to compliment the natural characteristics of the site. The brief was to design a comfortable and welcoming environment that exploited surrounding greenery. To successfully create a comfortable healing environment the topos and surroundings were clearly important factors in the choice of site. A dual triangle and diamond shape 619-bed ward block mounted on a mitred base podium presents a large form of 50m wide by 400 m in length. Following a dramatic approach from a monorail station featuring a landscaped lake incorporating a water sculpture by Susumu Shingu, the front door and information desk are surprisingly modest. Progressing from the mean reception space with its low ceiling the visitor enters a cavernous and highly glazed main concourse. This voluminous conservatory contains a cafeteria which spills onto the patio facing the wooded garden within the university grounds. The diagonal route of the main street unwinds its way into the outpatients department. The lower OPD service located deep in the podium generally lacks daylight with the exception of the toplit central waiting space. The triangular ward blocks contain a mixture of single private or post-operation rooms and the more social four bed spaces. The wards feature generous double height bay windowed day rooms. The interior accommodation appears overloaded resulting in an abundance of closed private spaces that are unresolved and disorientating. The affirmative geometry of the exterior with its extrovert well-defined colour profiles encloses a poorly orchestrated internal arrangement lacking clarity.

Keiyu Hospital Regional Core Hospital, Yokohama. Architect.. K Ito Architects
Located on a rectangular and compact site within the harbour regeneration district of Yokohama, the 351-bed hospital claims to be an 'international hospital resort'. Entry is through a tall wedge-shaped central atrium in which waiting and day rooms allow maximum open space, avoiding the tension and intensity of a traditional medical institution. The 13-storey half-drum ward block provides wide vistas eastward over the harbour. The single and four-bed spaces radiate seaward and the restricted view along the curving ward disguises the actual length of the corridor and presents a sequential and graduated layer of privacy. Bridges link the semicircular ward area to the orthodox examination sector to the rear, across the tilting glazed atrium

Other features include an integral wayfinding system, healing art, and informal areas for communication between staff and patients. Orientation within the hospital is simple and visitors are able to sense the layout upon entering the hospital. Artistic elements include a domed earthen lavender-covered berm overlooking the entrance to the underground car park and ceramic floor features with a sun motif. Star constellations have been sandblasted on to the glazed elevator and painted stucco enlivens the plaster walls of the cafe. The double height day rooms which face west to the city are found to the rear of the wards. These generous lounges offer clear views through large round windows to the herb gardens planned for the top of the OPD wing.

Kameda Clinic Kamogawa Chiba Prefecture, Ambulatory Care Service. Architect.. Hawaii Ltd and Nihon Sekkei.
The Mayan-styled outpatients building at the Kameda Clinic in the Bossa Peninsula resort of Kamogawa was created by collaboration between American and Japanese architects. A private medical centre with a range of the latest services from Chinese herbal medicine to laser surgery, its principal objective is patient-centred care. With full digital electronic medical records patients have full access to the practitioners' notes. The Kameda compares performance indicators and data with prestigious Australian and American hospitals. Examination and treatment rooms, located around the four-storey atrium, face the sea across the promenade. The ceremonial main stairway in the image of a lavish American lobby may well be a little too ostentatious for contemporary Japanese taste. All the diagnostic services are however only a floor away from the consultant examination spaces. By combining the western principle of the atrium with the Japanese custom of perimeter planning the architects have effectively managed to separate the clinical services from the experience of the patients. Separating the trolley traffic ensures a restful and calming atmosphere. Surrounding the building with this layer of service access tends however to reduce the access to natural daylight from within the clinic's waiting rooms. The hospital management's policy of creating a "comfortable and unrestrained setting" by incorporating natural themes from the neighbouring seas and mountain range extends to the art project coordinated by Keiko Anagriu's Design Office. Hence each floor features different natural elements found in the surrounding environment. The annual Tanabata festival is celebrated in each ward using decorated bamboo, and art auctions are held twice a year towards the provision of local elderly care.

Studying alternative plans and spatial solutions can lead to improvements in hospital design. Yet it is difficult to compare benchmark standards of different nations due to different social and political priorities, and the expectations and circumstances of the local population, patients and medical staff. There however remains a great deal to learn from the design solutions to the differing service requirements and the physical and geographical characteristics. Whilst long abandoned in the UK, slab and podium arrangements for hospitals remain common in Japan. We can observe how service requirements such as hotel accommodation and diagnostic visits are expressed in their own distinct building forms. The public amenities and circulation core are carved out of the interstitial spaces between the resulting forms. The Kameda Clinic for instance presents a symbiotic solution to two different programmatic functions allowing patient priority and service traffic to co-exist under one roof. With an average stay of 20 days extra amenities for the patients and their visitors become increasingly important. Double height day rooms and comfortable four bed wards offer more potential social space. The external courtyard room at Sanda provides a compelling case for the introduction of tranquil spaces where patients are able to experience the elements and nature in a creative and harmonious setting. By taking a fresh view and examining a broader perspective designers in the UK could learn a great deal from their counterparts in Japan.

The opportunity for the above study was made possible due to the sponsor GB Sasakawa Foundation, my benign and generous host Dr Kisho Kurokawa, and the kindness of Tadao Ando during my time in Western Japan.


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