A Chicago hospital shows us time and again that good design saves—and improves—lives

These patients tend to be weakened by sleep deprivation, malnutrition, deconditioning, and other negative consequences of their hospital stay—all factors that can be significantly improved through good design.
For an example of how design can help, one need look no further than the Rush University Medical Center Hospital Tower in Chicago, Illinois. Completed in 2012, a year before Krumholz published his theory in the prestigious New England Journal of Medicine, Rush has proven that it offers a better hospital stay and can handle a major emergency like a pandemic.

In 2006, when architects and designers began working on the transformation of Rush, they were charged with implementing the best practices for patient care. “We weren’t just building a building,” says Mick Zdeblick, the former vice president of hospital operations at Rush and now the CEO of Community Memorial Health System in Ventura, California. “We were using an $800 million-dollar investment to redesign our care models, create flexibility for future medical innovations, and add to the Chicago skyline.”

The building is indeed an eye-catching addition to the skyline. Its iconic “butterfly” shape, which garnered a national design award from the American Institute of Architects, along with several other awards, is also grounded in extremely practical considerations. The floor plan’s four triangular wings, each with its own nursing station and supply rooms, mean that nurses don’t have to go far to reach a patient. “The triangular layout shortens the travel distances between any two rooms and the support functions,” explains professor David Allison, director of the graduate program in architecture and health at Clemson University, who uses Rush as a case study in classes. “Rush isn’t the first to come out with this layout, but what’s distinctive is how efficient and compact it is—the staff have visibility and quick access to a lot of patients.”

The triangular wings also reduce sound transmission. Instead of facing each other across a corridor, the patient rooms are staggered, preventing sound from traveling directly between them. Noise pollution is a major issue in hospitals; it causes sleep disturbances, raises heart rates and blood pressure, and is generally correlated with deleterious effects. Hence, creating a quiet environment for rest, healing, and recovery was a priority for the design team. Among other noise-dampening measures, they carpeted the hallways on the top three floors. “This was a controversial step, but it had a big impact,” says Jerry Johnson, one of the architects who designed Rush. “In the end, the units are generally very quiet.” Operational changes also made a difference. The hospital switched from an overhead paging system to a decentralized call system where nurses carry pagers on them. All that attention paid off. Patient surveys show that Rush ranks as one of the quietest hospitals in the country. “It’s a machine for healing,” says Francis Fullam, professor of health systems management at Rush University Medical Center, who has been analyzing the patient experience at Rush for more than two decades.

Another key idea was to standardize the patient rooms so that everything is located in the same place. “It just makes it mentally easy for the caregiver. You walk into the room and the only variable is the patient,” says Mic Dwyer, former director in the office of transformation at Rush and previously the hospital’s director of interventional nursing. “You’re focusing on the patient, you’re not focusing on ‘Where’s this? And where’s that?’ I can’t emphasize enough how stressful that is in any care environment.”

Disaster preparedness is also designed into the hospital, which was already known for its emergency care, allowing it to spring into action in 2020 during the worst pandemic in the country’s history. The first-floor emergency department was the nation’s first to be designed specifically for a major disaster, including a terrorist attack, an industrial accident, or a viral outbreak. The design team configured the ambulance bay so it could become a decontamination area in case of a chemical exposure, with a mass shower system and a large underground tank to hold contaminated runoff. All 60 emergency treatment rooms are enclosed, with doors instead of curtains. And each unit of 20 beds can be placed under negative pressure, preventing germ-laden air from escaping. A separate wing of the hospital can be placed under negative pressure for additional capacity, too.

By April 2020, 25% of critically ill COVID patients in the state were being treated at Rush. It quickly expanded its intensive care unit five-fold, a relatively straightforward process because of the standardization of its room design. The ambulance bay became a triage center, with chairs spaced six feet apart, to screen 100 people a day. Meanwhile, other ER patients were directed to the building’s main atrium, which was specifically designed to double as a backup medical bay: Its columns contain panels for accessing oxygen and other medical gases, as well as power and data. “Rush has emerged as a national leader in the face of this crisis,” wrote Dr. Omar Lateef, CEO of Rush University Medical Center, in a December 2020 report. “Our innovative Tower hospital facility has been lauded for its ability to safely handle a mass contagion event.”

Seventeen years after he started working on Rush, designer Jerry Johnson is overjoyed that the building has worked out as planned.