[2] Initially, the setting was just going to be a hospital, but the team elected to add the resort and morgue in order to make it more surprising for players.
They went to lengths to ensure that the different areas felt like they made sense to be connected to one another, justifying the presence of a resort being that a rich patient would want to recuperate or the staff room having a dance mat game because it's set in Japan.
When describing the level archetype Hokkaido fits into, Christensen called it a spiral, due to how they wrap around and interconnect with stairs and slopes.
[2] They had to avoid potentially confusing players, which they accomplished by having an early area require them to learn the gimmick, as well as through signposting the access levels on the doors and the clothing.
Rowe wanted something that was both "industrial and clunky" yet moved unnaturally fluidly, finding those two themes working in concert "very disturbing.
He was partly designed in response to a mission in the Sapienza level, where Agent 47 has to eliminate a virus in an underground seaside cave.
[4] The level takes place in an exclusive hospital located in Hokkaido, the northern most prefecture of Japan, featuring three main areas.
During the main mission, Situs Inversus, this area is under a state of extreme security due to the patient being Erich Soders, the Head of the ICA.
"[9] PC Gamer writer Phil Savage praised it for how it made the systems and level design work together so thoroughly as well as how "confident and experimental" it was.
[10][13] Push Square writer Sam Brooke felt that, while it wasn't the perfect ending to Hitman, it was a "nice swansong," calling it the most "atmospheric and creative" of all the episodes.
He discussed how the level is strange and challenging due to how much information certain NPCs have, citing a moment when he was disguised as a patient and a guard caught him wandering outside.
[13] Paste Magazine writer Hamish Black ranked it as the fourth best level in the game, praising the variety of strategies you could employ as well the atmosphere.
[16]Hardcore Gamer writer Adam Beck ranked Hokkaido as the second best mission in Hitman 2, feeling that the size was just right and that Japan is a good choice for a level.