Hi-tech Hospitals rise in the East

HDHiTec HD Hospital Development January 1995

Most new Japanese hospitals have adopted an international style, a hybrid where modern multi-floor office meets western hotel. Graham Cooper reports on four of the latest.

Japan's homogeneous population of 125m is crammed into four islands, which together are approximately the size of Britain. Japan is a volcanic rnountainous country where only a quarter the land is habitable. It has high densities of people in an urban megapolis, which stretches from Tokyo along the seaward corridor west to Osaka and Kobe. The long hours the Japanese work to pay exorbitant rents takes their toll on the nation's health. High rents and a shortage of land mean that new hospital developments have to use land efficiently. Every inch of soil is at a premium, particularly in Tokyo and horizontally greedy concepts such as the British Nucleus model have made little impact. Modern hospital developments tend to incorporate urban characteristics, and high-rise accommodation is common.

In Japan public hospitals are either national (well funded) or they are financed locally by the city or prefecture. Commonly, National Insurance pays for 90% of the charge, with the patient paying the remainder. Private hospitals are independent institutions funded by rnedical schools, church organisations and charities, and are for all patients, not just private account customers. During my brief field study I visited a range of recent developments. This article concentrates on four hospitals each completed in the last two years and each with its own innovation in healthcare provision. The hospitals visited were Tokyo Metropolitan Health Plaza, Juntendo University Hospital, St Luke's Hospital and the Hyogo Rehabilitation Centre.

Tokyo Metropolitan Health Plaza, Hygeia Architects: Nihon Sekkei inc
The Hygeia hospital plaza is located in the busy central Shinjuku- Ku district of Tokyo, and combines the Tokyo Metropolitan Ohkubo Hospital with the Metropolitan Health Promotions Centre. It is a public facility, funded by the Shinjuku-Ku district. The hospital and the centre are linked by a bridge across an immaculate public gallery. The Ohkubo Hospital is a 20-floor block, with 40 beds in a simple ward plan on the outer perimeter of a racetrack Rooms have up to four beds, with washrooms and utility spaces located in the central service zone The four-bed rooms enjoy clear views across the roofscapes and abundant daylight from large windows. Each person is allowed two walls and a corner for their own personal space

The Purpose Health Promotions Centre was opened on Tokyo Citizens Health Day in July 1993 before the economic bubble burst in Japan. It is a community facility, which actively supports health promotion for the local working population an ambitious experiment, it is designed to prevent expensive visits to hospitals. The centre's literature gives out the message that all Tokyo citizens must take responsibility for their own health. The centre promotes practical health plans, which balance nutrition, exercise and relaxation as part of daily life. It has a swimming pool and training room, but is by no means a recreation facility; rather it advises on how the pressures of modern living can damage your health and concentrates on illness prevention. The users are those whose bodies have already signalled cause for concern, who are referred by their own doctor or local hospital.

Within the centre there are three main areas: health examination; instruction; and information/research. The facility employs state-of-the-art physical training equipment synchronised to analogue computer systems. Health examination has numerous spaces with diagnostic and monitoring equipment, including a high-tech fitness assessment corner. The examination rooms provide ECGs and blood and exercise tests. The instruction area contains a circuit training room, a treadmill and nutrition education space. There is also a relaxation room where those under stress can listen to soothing music as sound therapy.Compared to the enormous ground rents in Tokyo, building and equipment costs are minor. It is common for inner city hospitals to add to their income from on-site commercial development. Hygeia for example includes a 15-floor office development for this purpose.

Juntendo University Hospital, Tokyo Architects: Makoto ITOH, Design Division, Shimizu Corporation
Tokyo's Juntendo University Hospital was established in 1838 and is one of the oldest hospitals in Japan. The new main acute building has been in operation since October 1993 but is yet to be finished. It is housed in an imposing 14-storey block, which accommodates 600 beds. The plan is square with 40-bed ward units on the upper eight floors, and two nursing stations at opposite corners of each level. In the absence of centralised health service design guidance, the development brief and functional plan was drawn up by the Medical School consultants. My visit focused on the out- patient department, which plans to treat a massive 4500 visitors a day. This futuristic facility has the latest smart card information electronics to distribute an enormous throughput of patients on to the tiers of a giant atrium.

Unlike the British referral system, hospitals in Japan also cater for clients straight off the street. At Juntendo patients carry plastic identification cards the size of a cheque card. They are offered a bank of validation machines instead of queuing at a reception counter. The machine takes the card and places the patient into a queuing order at an appropriate waiting station. It then questions the database fields, which allow the assessment of current medical record status during consultation. After examination patients take their turn in the main atrium for the pharmacy to package their prescription. Patients are then prompted by the accounts department when it is their turn to pay. These two processes are presented on a giant video screen, which alerts the viewer from a corner of the main waiting space.

St Luke's Hospital Consultants: MPA Planners, architect
St Luke's is a private hospital, established by the American Pentecostal Church in 1902. The new acute building replaces the old 1933 colonial art deco hospital, which survived the war. The latter is famous and is to be preserved and refurbished for use as a medical college. The new hospital is a majestic building. It opened in May 1993 as the first major single bed hospital in Japan. All 521 beds benefit from a large window view and all St Luke's rooms have en suite facilities. The bedrooms are relatively small, but encapsulate the comfort of a quality western hotel. Each room is fitted with the latest remote controls for the patient's convenience and has a cosy ambience. Although open to the general public, ward accommodation for an average 11-day stay is prohibitively expensive.

Based on American planning principles, the ward layouts are triangular. All inpatient floors have 33 beds with three streamlined nurse stations located at each apex. Unfortunately a shortage of professional nursing staff in Japan means it will be difficult to staff all three nurse-bases on each floor at night. In the tradition of the original building, the facade and fenestration of new ward blocks are a distinguished expression of the single bedrooms and triangular wards. The two 10-storey triangular ward blocks are mounted on a large rectangular podium. Day surgery, A&E, out- patients and diagnostics are all arranged in the lower hospital. St Luke's is a well-designed healthcare facility. There is much to learn from the lighting, signage and landscaping, which reflect the Japanese concern for total quality design. The attention to detail established in the earlier hospital is continued in a contemporary but tasteful style. Adjacent to the hospital is a pair of tall quayside towers, whose upper floors will be developed into the St Luke's Hospital Patient Hotel.

Hyogo Rehabilitation Centre Consultants: Department of Architecture, Kyoto Institute of Technology; Architects: Urban & Housing Dept, Hyogo Prefectural Government.
The Hyogo Rehabilitation centre is an innovative and bespoke campus facility, which won this year's Nippon Hospital Architecture Award. It was set up in 1969 to rehabilitate the physically and mentally handicapped, so they could lead fulfilling lives. This 300-bed healthcare service offers a total rehabilitation programme, which includes medical, psycho- social and vocational rehabilitation services. The new centre is comprised of six different units: a medical rehabilitation hospital; psycho-social rehabilitation, vocational rehabilitation; nursing home; education centre, and the technology R&D institute. The centre offers the most up-to-date clinical and rehabilitation treatment. It also serves the physically handicapped in the community with a mobile rehabilitation team, which visits welfare centres and patients' homes.

The Hyogo centre recognises Japan's most pressing problem - an ageing population. By the turn of the century a quarter of the population will be over 65 years old. The centre applies the principle of normalisation for older people to participate fully in the community and to stop them from becoming dependent on a reduced working population. An assurance of mobility, safety and of independent living is a basic citizen's right, according to the centre's policy. This policy is informed by the philosophy at government level. With an ageing population it is imperative that the streets, public transport and houses are enhanced to provide adequate services to every citizen.

The most striking features of this spacious hospital are the purposeful atmosphere and the enormous therapy hall, which is located on the ground floor behind the reception zone. The hall is the size of an Olympic gymnasium and its generous open plan is extremely well equipped and attended. Patients of varying degrees of disability compete enthusiastically to acquire mobility. An atmosphere of positive group dynamics and friendly competition encourages a camaraderie, which stimulates patients to try harder. The services include exercise facilities and equipment, specially designed toilets, lifts, hoists and simulated home surroundings. The move from a wheelchair to a tatami mat floor can be made gracefully thanks to the lifting devices at the centre. The Hyogo Centre also offers specialist ward facilities and a spectacular communal bath from which a view of the surrounding scenery can be enjoyed. It even supplies a ward with a traditional shoji screened which provides an atmosphere, albeit at a price The medical rehabilitation hospital has an open and civilised entrance area with a specially designed low reception counter to accommodate non-ambulant users. The main common activity spaces are lavishly dressed in Italian marble.

Summary Japan poses a cultural challenge to most visitors. During their long period of isolation the Japanese developed a sophisticated and richly woven society. The country's architecture developed from the teahouse culture, creating settings that encouraged contemplation, reflection and relaxation. With such valued assets, it is disappointing that Japan's new hospitals seem to have abandoned this rich Sukiya tradition in favour of a modernist style. Most modern Japanese hospitals have adopted an international appearance, a hybrid where modern multi-floor office meets western hotel. Like the interior typical office building they are designed from the general to the particular. An exception is the Hyogo Rehabilitation Centre, which was designed the other way round, starting with the patient's needs. This philosophy is closer to the Japanese tradition. Close attention to detail is also a very Japanese concept, and forms the basis of total quality. This was very evident in the facilities toured. Hopefully Japan will retain its rich cultural and social identity; traditional Japanese architecture has rnuch to teach budding hospital designers here in the west.

Thanks go to Atsushi Sasaki, assistant professor at the Kyoto Institute of Technology, and Masahiro Ikawa, JIA, senior architect with Nihon Sekkei, for their help and support in preparing this article.


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