NAGASAWA Yasushi Dr. Engr. (PhD)

Transcription

1 PHOTO NAGASAWA Yasushi Dr. Engr. (PhD) Professor Emeritus, The University of Tokyo and Kogakuin University

2 Healthcare System in Japan Architectural Planning and Design Theory 1. Block Plan : Composed by five functional units 2. Departmental Relationship : Based on various movement of people 3. Material Handling : Logistics of various materials 4. Safe and Security Planning : Ordinary and Unordinary situation 5. Master planning / Development Control Planning 6. Informatics Planning : Introduction of computer Direction in design for future hospitals Innovative healthcare infrastructure planning

3 Healthcare System in Japan Statistics of Japanese Hospital Operation Total number of hospitals is around 8,540, including 1,000 mental hospitals 18% of which is public hospitals. Total number of hospital beds are around 1,570,000 including 340,000 mental hospital beds 30% of which is public hospital beds. Average number of beds/hospital is around 180, ranging from 20beds to 1000 beds.

4 Healthcare System in Japan Statistics of Japanese Hospital Operation Total Medical Expenditure is 40 trillion Japanese yen, 40% of which is for inpatient care and 35% of which is for noninpatient care. 36% of which is for the care of the elderly over 75 years old. Average number of physicians and nursing staff per unit population is not differ from other Western nations, but when it comes to per 100 hospital beds, it is very much few compared with other Western nations, because of tremendous number of hospital beds per unit population in Japan.

5 Healthcare System in Japan Statistics of Japanese Hospital Operation Average length of stay in general hospitals is around 20 days which is rather long compared with the situation in developed countries. It is decreasing rapidly from 25 days in the year 2000, Average bed occupancy is around 75% in general hospitals.

6 Healthcare System in Japan 1961 National Insurance System Everyone is covered by one of the various insurance schemes. According to increasing National Medical Expenditure, the amount of own money each patient have to pay has been changed from 0% to utmost 30% of actual medical expenses which each hospital asks to gain from insurance body.

7 Healthcare System in Japan Accessibility Free Access to any hospitals all over the nation, showing insurance card OPD consultation has been carried out without any appointment until some years ago, when it is decided for new OPD patients to secondary and thirtial hospitals have to pay certain amount of money as initial consultation fee, if they have not reference letter from local physicians.

8 Healthcare System in Japan Hospital Construction Hospitals could be built any places because of big demand of hospital medical services after establishing National Insurance System in 1961 until 1990s when Regional Hospital Plan was set up in each medical region. Regional Hospital Plan After establishing maximum number of hospital beds per each medical region, new hospital construction and increase of existing hospital bed is restricted.

9 Healthcare System in Japan Hospital Operational Cost National/Local Government Hospitals were provided some part of operational cost as National/Local Government subsidiary. Non-Government Hospitals have to provide their own operational cost asking each medical insurance organizations based on the agreement of unit price which is revised every 2 years for each medical procedure.

10 Healthcare System in Japan DPC (DRG) System - Some of the hospital medical services cost are counted on the based of the DPC : Diagnosis Procedure Combination (DRG : Diagnosis Related Group) System which shows pre-fixed amount of each medical procedure group. National Database (NDB) As National Database (NDB) which is composed by the report of all the medical services receipt, is now allowed in use by the Ministry of Health, better health information in each medical region is now available.

11 Healthcare System in Japan Hospital Construction Cost National/Local Government Hospitals were provided some part of construction cost as National/Local Government subsidiary. PFI (Private Financing Initiative) is also available. Non-Government Hospitals have to owe their construction cost by themselves or loan money from banks/funding organizations. In other words, it is needed to earn construction budget from daily income of hospital services

12 Healthcare System in Japan Return of Investment (ROI) Modal After ROI model was introduced in 2004 to hospital accounting system, hospital managers started to consider ROI concept to hospital operation, eg. staff training. According to 2006 Report on Improvement of Hospital Management, both Judgement and Reason Index are important to improve Profit, Security and Function of hospital operation. Any actual performing/outcome data is not available yet.

13 Architectural Planning and Design Theory Evidence Based Design (EBD) Late Professor Yasumi Yoshitake, the University of Tokyo evidence-based design studies since the 1950s. based on the field surveys conducted in hospitals The first field survey was carried out in several wards of a couple of hospitals, observing movement of nurses during day duties in The movement between staff station and patient bed rooms are most frequent.

14 Architectural Planning and Design Theory Evidence Based Design (EBD) Method : POE POST OCCUPANCY EVALUATION A number of field surveys in hospital buildings Problem findings Small number of detailed field surveys Finding out contradiction of building in use Development of planning principle In design stage five groups of patients were intended to be cared by nursing team but in operational stage seven groups of patients are cared by each nurse.

15 Architectural Planning and Design Theory Evidence Based Design OPD

16 Architectural Planning and Design Theory Evidence Based Design OPD

17 Architectural Planning and Design Theory Evidence Based Design Wards 40% of duty hours of each nurse is allocated to writing/discussion. They were walking 2.5 km during their evening/night duties. On average 11 times of washing hands / hour were observed.

18 Architectural Planning and Design Theory Design evidences have been shared in national and international organizations. JIHA : Japan Institute of Healthcare Architecture UIA/PHG : Public Health Group HEAJ : Healthcare Engineering Association of Japan IFHE : International Federation of Hospital Engineering IFHE Executive Committee members JIHA President : 2006~2010 IFHE President : 2010~2012

19 1. Block Plan : Composed by Five Functional Units / Space Planning Wards OPD Diagnosis & Treatment Administration Logistics 2. Departmental Relationship : Based on various movement of people Inpatients, out-patients / hospital staff : Physicians, Nurses, Pharmacist, Radiological technician, Path-lab technician, PT, OT, ST, etc. / Visitors, patients family members etc. 3. Material Handling : Logistics of various materials Medical Equipment, Pharmaceutical materials, D&T materials, Sterilized materials, Linens, Nursing tools, Stationaries, Specimen, Food, Wastes, Deceased persons etc. 4. Safe and Security Planning : Difference between Safety and Security Daily Hazard:Fall, Fall to the ground, barn, Robbery, etc Natural Disaster and Man made Disaster 5. Master planning / Development Control Planning To cope with Growth and Changes in the 6. Informatics Planning : Introduction of computer Electrical patients record, On site ordering, Booking of consultation, PACS (Picture Achieving and Communication Systems), etc.

20 1. Block Plan : Composed by Five Functional Units / Space Planning Wards OPD Diagnosis & Treatment Administration Logistics

21 1. Block Plan : Composed by Five Functional Units / Space Planning - Space Planning of Hospitals in Japan (JIHA) Analysis of Functional Units Area in Japanese Hospitals Built in the 2000's Newly built hospitals from 2001 to 2007, - A series of statistics on functional units floor area in Japanese hospitals have been reported each decade since 1960s m2/bed Composition Ratio

22 1. Block Plan : Composed by Five Functional Units / Space Planning - Space Planning of Hospitals in Japan - Space measurement of bedside nursing activities m is needed. -

23 1. Block Plan : Composed by Five Functional Units / Space Planning - Space Planning of Hospitals in Japan - Analysis of bedside nursing activities in ICU m is needed

24 2. Departmental Relationship : Based on various movement of people 3. Material Handling : Logistics of various materials Evidence Based Design Creating centralized functional units in hospitals, which promoted efficient and effective hospital management resulted in causing various movement of people and goods. Five functional units/departments, Wards, OPD, Diagnosis/Treatment, Supply and Administration are defined. Movement of people and materials were surveyed and summarized in the diagram.

25 2. Departmental Relationship : Based on various movement of people Patients: Inpatients, Out-patients Hospital staff: Physicians, Nurses, Pharmacist, Radiological technician, Path-lab technician, PT, OT, ST, etc. Others: Visitors, patients family members, Material providers, etc.

26 2. Departmental Relationship : Based on various movement of people OPD in Tokyo University Hospital Not irritated by lengthy waiting time Specialized cell phone for patients Easy to be orientated. Corridors are faced to windows so as to find their way easily by patients.

27 2. Departmental Relationship : Based on various movement of people Easy to be orientated. See through rift in hospital street in Ashikaga Red Cross Hospital One stop reception for patients in order to reduce unnecessary movement. Space Syntax Survey John Repons, UK Photo by Nikken Sekkei

28 3. Material Handling : Logistics of various materials Medical equipment Pharmaceutical materials Diagnosis & Treatment materials Sterilized materials Linens Nursing tools Stationaries Specimen Food Wastes Deceased persons -----

29 3. Material Handling : Logistics of various materials Centralized functional units caused various transportation of goods and materials Automatic transportation system : University of Tokyo Teaching Hospital Robot transportation system : Stanford University Hospital

30 3. Material Handling : Logistics of various materials Material Handling System : Decentralized storages in wards. Based on SPD : Supply/Processing /Distribution System SPD staff are checking the storage utilized bar chart system COPYRIGHT OSP OSHC University of Tokyo Teaching Hospital

31 4. Safe and Security Planning : Ordinary and Unordinary situation Ordinary situation : Daily Hazard Fall, Fall to the ground, barn, Robbery, etc Unordinary situation : Natural Disaster and Man made Disaster

32 Safe and Security in hospitals suffered from Earthquake - Structure/Non-structure - Equipment/Engineering - Planning/Operation: - BCP (Business Continuity Planning Anti-seismic non-structural element : KOBE Earthquake 1995

33 Safe and Security in hospitals suffered from Earthquake Structure/Non-structure Shaking table after KOBE Earthquake Foor height life size Mockup of Hospital building equipped with medical instruments at E-Defense laboratory in Kobe Fig.1 shaking table tests on a Fig. 2. Section o f model (base

34 Safe and Security in hospitals suffered from Earthquake Triage space is provided in front of OPD in Ashikaga Red Cross Hospital Blue(Black) Red Yellow Green Each triage tag color colour Black, Red, Yellow and Green Wind power generators Photo by Nikken Sekkei

35 5. Master planning / Development Control Planning To cope with Growth in the future Site for extension and rebuilding Multi wings type Hospital Street type To cope with Changes in the future Space for maintenance and renovation Interstitial Space type (ISS)

36 5. Master planning / Development Control Planning Site for extension and rebuilding Chiba Cancer Center Northwick Park Hospital Ise shrine is rebuilt every 20 years. Multi wings type Hospital Street type

37 orthwickpark Hospital, London Hospital Street type Northwick Park Hospital UK

38 5. Master planning / Development Control Planning Site for extension and rebuilding Multi wings and Hospital Street type Ashikaga Red Cross Hospital Photo by Nikken Sekkei

39 5. Master planning / Development Control Planning Space for maintenance and renovation Interstitial Space type (ISS) Internal Universal Space Flower height 4.8m = 2.7m + ISS 2.1m McMaster Hospital, Canada Greenwich District General Hospital, London Photo by Nikken Sekkei

40 5. Master planning / Development Control Planning From Tailored Suits Type Buildings to Loose Fit Type Buildings Ample floor space and Floor height

41 6. Informatics Planning : Introduction of computer Electrical patients record On site ordering Booking of consultation PACS (Picture Achieving and Communication Systems

42 6. Informatics Planning : Introduction of computer Change of communication tools Voice wards photos telephone video internet From wired to wireless

43 6. Informatics Planning : Introduction of computer PACS (Picture Achieving and Communication Systems) will make hospitals from concentrated one to de-concentrated one.

44 6. Informatics Planning : Introduction of computer Easy to communicate Simple information I m OK. 平安 card in Chinese elderly home in San Francisco. Revers expression from PLEASE DO NOT DIDTURB in hotel rooms. Visual information is better than described information.. Signage of operating theatre department in a hospital, Sweden..

45 Direction in design for future hospitals Green Hospitals Reducing LCC (Life Cycle Cost), esp. operating cost, 80% of LCC Reducing CO2 emission Passive and Active way to save energy Global capacity is limited Solar Energy 2,000t Heat Strage Tank (Underground Pit Space) Photo by Nikken Sekkei

46 Direction in design for future hospitals Green Hospitals Reducing LCC (Life Cycle Cost), esp. operating cost, 80% of LCC Reducing CO2 emission Aim the smart hospital Passive and Active way to save energy Prevent from Sun & Birds For human & earth - Next Generation Green Hospital - Eco Information Photo by Nikken Sekkei

47 Direction in design for future hospitals Healing Environment Healing environment for patients Prof. Roger Ulrich, TAMU 1984 It is statistically proved the length of stay after the surgery was shorter for patients staying in the room facing to green than facing to brick wall. Private-room-like multi-bed room in Japan Trial to get private window for each patient

48 Direction in design for future hospitals Healing Environment Healing environment for patients Improve staff working environment All single bed room for the first time of Japanese Red Cross hospitals AAR : Acuity Adaptable Room USA

49 Innovative healthcare infrastructure planning Rapid of aging population in Japan - The years moving from aging society (65+ = 7%) to aged society (65+ = 14%) 125 years in France / 65 years in USA / Only 25years in Japan Increasing elderly inpatients in hospitals Quite high medical expenditure. - Ageing in place is critical. Continuing Care Retirement Community project - The Elderly living in the community.

50 Thank You 多謝