Japan Study Tour Summary

Katta Katta General Hospital

Schedule November 6th-12th 2005

Day 1 St. Luke's Case Study

Day 2 University of Tokyo Workshops and Hospital Visit

Day 3 Aichi Centre for Childrens Health and Medical centre.

Day 4 Hospex and Tokyo Rinkai Hospital

Day 5 Saitama Prefecture University, National Child Center and Kawasaki Municipal Hospital.

Day 6 Katta General Hospital and Joint AfH/JIHA Forum

Day 7 Yokohama City Minato Red Cross Hospital

Day 1

St Luke's International Hospital and Life Sciences

Consultants: MPA Planners, Designers Nikken Sekkei architect & engineers

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 is preserved and refurbished for use as a medical college.

The new hospital 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 and fitted with the latest remote controls for the patient's convenience. 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. 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.

The landscaping incorporated has earned the hospital an important urban regeneration award. The large strolling roof garden provides much needed fresh air and exercise space in a dense inner-city district. The gardens provide a welcome extra tier of city habitation and offers temporary outdoor display space.

Adjacent to the hospital is a pair of tall quayside towers, whose upper floors contain the St Luke's Hospital Patient Hotel and the St Luke's Residence, sheltered accommodation for the elderly. Western style furnished luxury apartments with magnificent views along the Sumida River. With an average age 72 years old St Lukes residence is for tenants who have no serious impairments or diseases and are capable of looking after their own needs,. Alarm buttons are generously distributed in all the main rooms and life cycle monitors are installed over the doorways.

Day 2

Presentations and Hospital visit, The University of Tokyo

Introduction to JIHA and The University Tokyo Hospital. Professor Yasushi Nagasawa Health Care System ; Japan Dr Atsuo Kakehi, National Institute of Public Health

Hospital Architecture in Japan - Ruka Kosuge

Visit to University of Tokyo Hospital. Designed Shinichi Okada & Associates

First built in 1877 the UTH was the first University Hospital in Japan it was based on a German medical system. Following the war a US administration system was established and the hospital was rebuilt by architect Yoshitake. The Nagasawa studio commenced the Hospital Geography masterplan in 1982. Designed by architects Shinichi Okada & Associates the new ward tower completes the 20 year redevelopment of the Hospital. In accordance with the system masterplan, the central diagnostic centre was built in the first phase, the OPD Treatment centre second, and finally the ward tower The new large scale highly advanced hospital with 1046beds has a staff of 7500 with 2800 professors and was completed in September 2001. The OPD completed January 1994 has some 200 consultation booths and receives 3000 patients a day. The University introduced a voluntary appointments system, medical information ordering system, auto revisit reception and patient beeping system. The visit commenced with an introduction by Chief Executive Ryozo Nagai MD

Day 3

Aichi Children's Health and Medical Centre Designers Yasui Architects & Engineers

Located in Oobu, on a hillside in southern suburbs of Nagoya, the aim is to help children and families return back to their homes with assurance. The medical centre has a department for health maintenance which supports mothers and children in their communities. A three story atrium called main street facilitates staff collaboration between different units and easy way-finding for visitors. ACHEMEC contains 200 beds within 6 wards and ICU with 6 beds. The visit proceeded with an introduction by the hospital chief executive Masami Nagashima MD. (see Appendix notes.)

Nagoya University Hospital Health Consultants: Dept of Architecture Nagoya University

Visit to the Treatment Centre

Day 4

Hospex Exhibition and Robotic Lecture Big Site Exhibition Hall Tokyo

Tokyo Rinkai Hospital Project (formally Shitaya Hospital.) Designer AXS Satow. Inc.

Built on a landfill area in the Tokyo Edogawa waterfront district it rises 8 stories and contains 400 beds. It features a distinctive triangular ward floor housing 3 nursing units each with 33 beds. The vertical circulation core with support rooms is separated from the patients area by deep light wells providing "a quiet and comforting environment " Single rooms have been increased to 40%. Project architects from Satow Inc and a hospital executive introduced the background to the project.

Day 5

Saitama Prefecture University

Department of Medical Science and Nursing Studies

This giant joint nursing school and medical university campus is designed by Rikken Yamamoto an architect of considerable social awareness who has designed 'Care Plazas' for the elderly but is famous for his radical housing projects. Yamarnoto takes his bearings from the historical Japanese residencies with their transparent walls and a fluid transition between indoors and out. He exaggerates dimensions and creates eccentric designs, such as his elaborate roof structures.

The key element ordering and unifying the individually designed units is a covered gallery with public staircases. The main theme of the institution is to establish greater links between the trainee therapists and nursing profession, to break down barriers and explore ways to promote co-operation towards improved quality practice and patient care. The building itself consist of two main extended parallel academic blocks which like a stadium surround the communal inner recreation ground. Sandwich between the teaching blocks are shared experimental laboratories, examination and treatment suites. Above are landscaped roof gardens containing a performance hall with sliding doors which open onto the grassed arena.

Kawasaki Municipal Hospital Designer Nihon Sekkei Architects - Engineers

Originally established in 1936 for infection control, later medical developments led to a sprawling general hospital which lacked rationality. Full re-construction whilst maintaining services on an incremental redevelopment basis would have taken ten years. A further challenge was to dramatically reduce transportation distances and the hospital footprint to a quarter of the site. In order to reduce disruption a huge T structure was created containing the whole of the new 700-bed ward specification cantilevered over the existing low rise accommodation.

Finally the outpatient accommodation, administration and central diagnostic department where completed in the spaces under the new elevated wings. The whole redevelopment was completed in 5years and was opened in March 2000. The wards between the seventh and fifteenth floors are supported by four giant Herculian posts and to prevent overturning moments at the time of earthquakes the structure is jacked on each side and anchored to a concrete reinforcement wall.

National Center for Child Health & Development Ministry of Health & Welfare Architects

Founded in 1965 the original National Childrens Hospital has grown into the National Center for Child Health & Development NCCHD is a unique dedicated paediatric and maternal health care facility funded directly by the Japanese Ministry of Health, Labour and Welfare. Formerly known as the Okura Hospital the NCCHD has a imposing and formidable thirteen-story presence in the Setagaya a fashionable western suburb of Tokyo. Opened in March 2002 with a total of 500 beds the centre strives for outstanding patient care sensitive to the holistic needs of the child and family. Concerned with the well-being of the generation to come, it is an international centre offering women's reproductive health, maternal fetal medicine, gene therapy and stem cell research.

Day 6

Katta General Hospital Designer Taro Ashihara + Architecture Workshop

The low table profile sleekly slots easily into the slopes of the mountain resort it occupies a deep plateau with small ward units distributed horizontally above the upper platform. A medium size 300 bed hospital serving Shiroishi Zao City it is designed by

Architecture Workshop, a collective made up of Koh Ishiyama, Hideto Horiike and Taro Ashihara. Conceived as a porous plate the departments have been cleverly modeled into the simple envelope providing a well articulated sequence of spatial experiences. The visitor enters between the pilotis into a generous double height volume and proceeds through a checkerboard of rooflight courtyards and terraces. With its white walls awash with sunlight the inpatient care area is arranged as a quiet roof garden village with open vistas which borrow the surrounding mountain range. From the bed space the patient has direct access to the patios blissfully unaware of the noise and rush beneath their rooms. The timber board floors and sliding doors are reminiscent of traditional Japanese homes. Viewed from the patients care area above, a round lawn with undulating grass ripples the southerly rehabilitation garden assist patients to mend themselves. A freestanding curved wall has a portal to the town, a symbolic "hope wall" it screens a highway, gives scale and contrast the mountain scenery.

Note This hospital has three levels and is a rectangle measuring 120 meters by 140 meters in plan. The top floor is the ward, which was conceived as a porous plate. Each sickroom has a courtyard so that patients can get sunlight, ventilation, and a view of a garden. The pilotis under this porous plate accommodates on two levels the diagnostic, treatment and administrative departments. The outpatient, emergency and examination facilities, which are most frequently used, are on the first floor, and the operating rooms and administrative offices are on the second floor.

Joint JIHA and AfH Seminar

National Institute of Public Health Forum Tokyo

Day7

Yokohama City Minato Red Cross Hospital Design K. Ito Architects & Engineers.

Following the kind invitation of Architect Kazuaki Ito, Nigel and Graham spend a memorable afternoon in Yokohama visiting two of the hospitals designed by his company.

Visiting on a sunny Saturday afternoon we arrived over the harbour bridge with exhilarating views into the historic docklands across Tokyo Bay. Descending the ramp into the underground car park the hospital architect Kazuaki Ito informs us of the changing ownership of the hospital. He explains his original client was the City Health Authorities but it appears the stringent economic reforms led to the sale of the hospital to the non profit making Japanese Red Cross Hospitals. Although in principle it remains a municipal hospital for the central Minato district prior to its opening it was faced with a new set of priorities and programme.

Enroute Ito san had explained his office's design ethos for the new Yokohama hospital was restraint and quietness. Refreshing ourselves in the visitors restaurant the subtlety of the materials; the marble, the exquisite tiny tessera tiling. the watery pale blue veined stone used in the public areas were immediately apparent. Proud of his spatial and surface finish qualities the architect quickly distance himself from the choice of interior furnishing and seating which were acquired after completion by the Red Cross.

Meeting our hosts the hospital management representatives in the main concourse, the place was strangely idle, Saturday being a quiet non-consultation day. Within the double height reception with its landmark crescent ceiling we imagined it fully operational during the weekday rush hour. We were immediately struck by the extraordinarily effective stretched silky fabric screen ceiling lighting which was indistinguishable from daylight. The routine day care facilities as a whole are spread in a grid pattern across the ground floor, both ends of the hospital visible through the main street. Above the remaining accommodation including 584 beds, rise eight stories within the H plan formation. (See plans above.)

For orientation our guides were eager to show us the impressive helipad and their top floor private suite. The finely fitted exclusive en-suites with their splendid bay views revealed little of their clinical purpose. From the penthouse we strolled the elegant routes and lift lobbies to the hospice and courtyard on the second floor.

Entered discretely from the rear entrance the L shaped palliative care unit wraps itself round the two quay -side elevations. A string of comfortable single rooms converge at a communal lounge with its remarkable port views. We were unfortunately unable to visit the regular wards with their echelon four bed bays which generate the distinctive upper deck frieze around the main wings. Nor did we visit the psychiatric care wards, its 50 beds due to open in spring 2006. Our tour concluded back on the ground floor in the main street looping through the consultation and examination suites. Although familiar clinical territory the usual institutional surroundings were relieved by natural daylight from the occasional top lit space. General fittings, the signage layout and corner trims display a modest but confident design ethos, the specialist hospital architects benefiting from many years of accumulated experience.

The Yokohama City Minato Red Cross hospital's muscular liner-profile exterior belies the gently refined internal finishes. The robust plan appears able to facilitate the ongoing changes in ownership and care regimes. What is abundantly in evidence in Yokohama is the Japanese assured capability for accommodating multiple programmes simultaneously under the same roof.

Keiyu Hospital Regional Core Hospital,

Following a break to see the recently completed Yokohama International Ferry Terminal designed by Foreign Office architects we made a brief visited the Keiyu Hospital an earlier "louder" hospital by K.Ito architects. The 351bed hospital is located on a rectangular and compact site within the harbour regeneration district of Yokohama. 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 graduated layer of privacy. Bridges link the semicircular ward area to the orthodox examination sector across the tilting glazed atrium to the rear. 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 roof top of the OPD wing.

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