Clinic O is an extension and renovation of a 40-year-old clinic located in Mie Prefecture, Japan. The existing reinforced concrete building, constructed in 1984, houses a dental clinic on the ground floor and a residence on the second floor. At the time of its construction, concepts of universal design were not yet widely recognized. The surrounding area was more rural and tranquil than it is today, and the appearance of this pure white RC clinic must have made a strong impression on the landscape. Its elevated plinth, dignified stance, and geometric composition based on strict horizontality and verticality created a sharp contrast with the surrounding fields, reflecting an era when medical architecture was expected to possess a strong sense of symbolism and autonomy.
Courtesy of Takayuki Kuzushima and Associates
The project began when the clinic was passed on to a second-generation director. Along with the expansion of medical services, functional deficiencies in the existing building had become apparent, prompting both a spatial reorganization and an update of the clinic’s public image. Key issues included the lack of a children’s waiting area, insufficient back-of-house space, and limited accessibility at the approach and restrooms. As the existing floor area could not accommodate these requirements, an extension was proposed.
Courtesy of Takayuki Kuzushima and Associates
To the east, along the neighboring site boundary, part of the existing plinth was removed to create a slender, corridor-like volume. This new addition contains the waiting area and children’s space, while the reduced waiting area in the original building allowed the back-of-house functions to be expanded and circulation to be clarified.
Courtesy of Takayuki Kuzushima and Associates
The extension was conceived as a buffer that mediates between the existing building and its surroundings. By carefully designing this buffer—particularly the approach space—the sequence of visiting the clinic, receiving treatment, and completing payment was reimagined as a smoother, more integrated experience within everyday life. At the same time, the added volume was intended to soften the strong sense of independence that characterized the original building.
Courtesy of Takayuki Kuzushima and Associates
Level differences between the existing floor level and ground level were resolved through wide steps and gently sloping ramps, creating an approachable entrance. Structurally, the extension was built with a steel rigid frame to respond delicately to the robustness of the existing RC structure. Columns were positioned to avoid openings, while ground-supported columns were carefully placed to clear the road boundary and the existing concrete foundations. Although conceptually simple, the design required precise site surveys and construction due to the curved road, level changes, and structural integration near the existing parapet.
Courtesy of Takayuki Kuzushima and Associates
The wall along the gently sloping road was made entirely of glass, allowing views of both the interior spaces and the existing building from the outside. This glass screen extends to the stair porch, abstracting the façade and welcoming visitors. Where the extension meets the existing building, exterior walls were converted into interior surfaces: protective white paint was removed to expose a bush-hammered finish, and existing window openings were reused as reception counters. Without altering opening positions or adding new interior walls, elements of the existing building were reinterpreted as components of the new architecture. The corridor-like interior is shaped by the rural landscape outside and the textured surfaces that bear the traces of 40 years.
Courtesy of Takayuki Kuzushima and Associates
Rather than opting for complete demolition and reconstruction—which would have imposed a heavy burden and disregarded the existing environment—the project explores an alternative approach. By carefully calibrating the scale and presence of the extension, continuity was established between old and new interior spaces, as well as between the existing building and its surrounding landscape.
Project Info:
Architects: Takayuki Kuzushima and Associates
Country: Inabe, Japan
Area: 47 m²
Year: 2024
Photographs: Courtesy of Takayuki Kuzushima and Associates
Lead Architects: Takayuki Kuzushima
Engineering & Consulting > Structural: Komatsu Structural Design
