Access Denied


Comparing the access to nature given to patients in the UK and Japan, and finds some similarities as well as some differences. HD Hospital Development Mangazine May 2002

The 'Recent Health Care Architecture in Japan' symposium, held at the RIBA and CUBE (Manchester) in September was a most important event in the year-long Japan 2001 festival. The occasion brought together many practitioners in hospital design from both Japan and the UK and established official links between the Japan Institute of Healtheare Architecture and Architects for Health (see HD, November 2001, p9). During a recent debrief visit to Japan it was my privilege to be invited to present a lecture to the Department of Architecture at the Tokyo University. The subject was 'Engaging Nature - A proposal to bring natural phenomena nearer to the inpatient's experience'.

As a result of extensive advocacy in the last decade, more artists have been commissioned in the UK's health service than in any other sector considerably raising awareness of the aesthetic agenda. In both Japan and the UK healtheare arts are used as a vehicle to promote a positive image and to enhance the corporate profile as so much of the art dimension remains concentrated in the public domain of the facilities. The typical hospital arts programme however remains largely independent of the building fabric and the spatial context of the patient with its specific demands and requirements. The theme of my Japan lecture was how to introduce the delights of nature to the hospital users and in particular the inpatient. In the UK there have been a limited number of landscape successes, amongst which the gardens and courtyards at St Georges Tooting and the West Dorset Hospital can be included. Similarly in Japan the roof gardens at St Luke's Tokyo and the Gamagori Hospital are exceptional. The quality of light and tree planting in the main entrance concourse and the outpatients' mini lightwells at Gamagori are particularly well regarded.

The quality of the environment clearly impacts on the patient's perception, their well-being. and ultimatiely their recovery rates. The Tokyo lecture was focused predominately on the delicate subject of inpatients' personal comfort. personal space and the immediate surroundings. As a benchmark, some of the best ward accommodation in Japan were presented for illustrations. The single room only wards at the exclusive St Luke's and the semi circular Keiyu Hospital suites in Yokohama with superb sea views over Tokyo Bay were selected from the new larger hospitals. It is however the smaller-scale clinics where the humanitarian criteria and nature have the most chance of meeting and merging. The Dobtai Clinic in Kamakura by Norihiko Dan and the Seaward Stress Care Centre by Itsuko Hasegawa promised new possibilities in planning new forms of ward space.

Hasegawa (labelled 'the listening architect') is primarily concerned with how well the building performs its duties beyond the construction phase. Locating the stress care unit next to the harbour estuary overlooking the Shiranui Sea means the inpatients are able to benefit from a wash of reflected light off the tidal river, In this diaphanous building patients become subliminally orientated to the natural rhythms of the special location, which has resulted in reduced length of stays. It is said looking up to the clouds on a sunny day is perhaps the most beautiful visual experience available, and the patients at the Seaward centre can observe and enjoy such views through the roof lights in the ceiling. directly above their headboards. Hasegawas was able to radically relocate the new stress care unit next to a tidal river but of course this is an exceptional case. However designers can learn a great deal from the Seaward centre about how to improve the patient's experience by realigning the ward space to interact with the natural elements.

The interface between inside and out needs attention - otherwise how do we connect the floor to the ground, and the ceiling to the sky? Their immediate surroundings is the critical mediation space, and this requires careful landscape attention .An adjoining garden can be animated for instance by pools and running water, rocks and shrubs - the water will reflect sunlight into the space and onto the ceilings. In larger ward areas introduce roof lights or even more desirable, mini- gardens in lightwells. The patient must however be empowered to control and to orientate themselves in order to enjoy their environment, and be also able to interact with the new social common activity spaces described earlier (see HD, March 2002,p48).

Generally the inpatient experience is one of being highly restricted. bermetically scaled and isolated in artificial and controlled conditions, and protected against the outside elements. This means that access, contact and interaction with nature is denied. Today's ward accommodation often suffers from institutional conformity, is repetitive, shabby and utilitarian, and cluttered with ugly, non-functional furnishings. Although clinical functionality is often dispiriting for patients and staff, such service priorities would appear to prevail. There is a growing need to re-address the situation in favour of the comfort. perception and interaction of the inpatient. The physical surroundings of the bed space are important to the spiritual well-being of the patients, and engaging with natural ecology offers a solution. Maybe the 21st century will see a move away from the clinical white cube clones to the 'eco-ward', a patient-focused space which connects to the local culture, topography and natural habitation. The 'eco-ward' however suggests a fundamental reappraisal of the bed space, offering a fresh challenge for hospital design of the future.

The author would like to hear about any outstanding examples of ward spaces which invite in the natural elements and surrounding landscape. Contact him via HD.


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