Toward managing a sustainable hospital

“In Japan, there has always been a culture of mottainai, or reusing what can be used, but this has not been adapted to hospitals,” says Shunsuke Terasaka, MD chairman and president of Kashiwaba Neurosurgical Hospital, a 144-bed facility in the city of Sapporo, capital of Japan’s northernmost main island of Hokkaido. “At Kashiwaba, we attach great importance to the United Nations’ Sustainable Development Goals (SDGs),” says the veteran brain surgeon. Together with his staff, he set concrete goals to bring the mottainai culture to their healthcare facility. 

The COVID-19 pandemic was one of the factors that forced change. When supplies were scarce, Kashiwaba’s logistics center began using bar codes on all medical supplies to ensure they were used before their expiration date, minimizing waste. In addition, Kashiwaba only orders the necessary supplies when it needs them, reducing the strain on the supply chain. The hospital makes use of medical equipment, consumables, and logistics with a mindful footprint – inside and outside the facilities. They also support medtech companies’ efforts of reusing or refurbishing materials in the lifecyle.

In 2018, the hospital experienced hard times when an earthquake – a constant threat in Japan – struck. It caused a three-day blackout and affected the food supply lines. “At the time, our hospital had a contract with a food service company in Honshu and was unable to provide satisfactory meals to patients until transportation was restored. Local residents delivered vegetables and other items to the hospital, but we were hampered by the contract and were unable to deliver their kind donations to our patients,” Terasaka recounts. 

Hokkaido is the only place in Japan that can achieve 100 percent food self-sufficiency,” says Terasaka. “It’s generally said that hospital food is not tasty, but we want to prove that wrong. Now, products from local fishermen and farmers are included in meals for patients and staff, and some are sold at a kiosk in the hospital’s reception area.

To make the facility even more resilient and sustainable, Terasaka announced in 2018 a project to build a next-generation hospital with cutting-edge equipment. With its distinctive offset circular architectural design, Sapporo Kashiwabakai Hospital will be a 167-bed, seven-story facility in the city’s Minami-hiragishi district with a total floor area of 13,000 square meters. 

When it opens in December 2024, it will offer the latest advances in neurosurgical imaging, neurological disease treatment and rehabilitation, as well as a large green space for outdoor therapy and healing. The hospital has partnered with Siemens Healthineers, aiming to provide high-quality medical care in the field of neurosurgery and advanced acute care in Hokkaido. 

The goal is to realize SMART (Seamless Multi Access for Reliable Treatment) OR / SMART ER – a ‘seamless’ operating room and emergency room that will contribute to urgent endovascular treatment and advanced cerebrovascular surgery. One of the leading causes of death, and the leading cause of long-term care needs in Japan, are cerebral infarctions - an urgent stroke requiring intravenous tPA therapy within 4.5 hours after onset or catheterization within 8 hours. 

The new hospital will introduce CT, angiography, and MRI equipment from Siemens Healthineers, and will improve the workflow of advanced endovascular treatment by arranging equipment and designing patient flow lines to reduce patient travel time and the burden associated with travel. Live video feeds that integrate multidimensional information and surgical images will connect the operating room to the outside world, providing opportunities for developmental discussions and education.