Pioneering projects get a lot of press when they first open, becoming the touchstone and inspiration for the design of other projects.  After we explore the cutting edge, perhaps it’s even more important to understand how a project has performed after years of use—the consequences, intended and unintended, of design.

The American College of Healthcare Architects (ACHA) created the Legacy Project Award program in 2013 to do just that. Representing the highest honor that can be bestowed on a project by the ACHA, the Legacy Project Award recognizes projects in operation 15 years or longer whose concepts have stood the test of time and gracefully accommodated change without compromising the integrity of their design principles.

The 2016 ACHA Legacy Project Award was given to Northwestern Memorial Hospital (Chicago) earlier this year.  Opened in 1999, the $580 million project was a replacement facility for inpatient and ambulatory care facilities, consolidating delivery of care and enabling operational efficiencies.

The hospital chose a design and delivery model that was a precursor to what we know today as integrated project delivery. Three firms, Ellerbe Beckett, HOK and VOA, formed a joint venture for the project and delivered a high-rise that seamlessly fit into Chicago’s Streeterville neighborhood.

David Allison, alumni distinguished professor and director of graduate studies in architecture and health at Clemson University and a lead juror on the Legacy Award, says the hospital enriched Streeterville rather than create a “medical slum.” For example, the first three floors of the building are accessible to the public and include retail and dining.

Another reason that the project is deserving of this year’s award is the clear and effective organizational framework that has preserved circulation and front/back of house relationships even as needs have changed.

Northwestern’s vision was not immediately appreciated. Dubbed “the mistake on the lake,” the project constructed 500 inpatient beds when trends indicated a move away from these types of facilities. In fact, the new building experienced a 16 percent growth in admissions in its first year of operation and even needed to add more inpatient beds.

Since the hospital can’t grow horizontally because of its urban location that growth was accommodated within the footprint by converting three floors of physician office space into inpatient beds for ICU, a med/surg unit focused on cardiac care, and an inpatient psychiatry unit.

The same planning fundamentals of circulation and building zoning have been maintained and applied to the renovation work. This includes public circulation that runs along the north edge of the building providing constant views and visual orientation; zoned elevators; separation of front- and back-of-house traffic noted with finishes such as carpeting in public corridors and resilient flooring in clinical areas; and maintaining the first three floors for public uses such as a conference center, food court, health learning center, and chapel.

Patient-centered design strategies considered cutting edge at the time, such as private patient rooms, accommodation of family overnight stays, and ease of wayfinding, were also introduced at Northwestern Memorial and have become common practice today.

“These are fundamental rules of the building that have not changed and some of the key parts, such as gracious entries, retail, and ease of navigation have become hallmarks that are implemented in all our large facilities,” says Kristina Hedley, director of special affairs at Northwestern Memorial HealthCare.  “What is surprising is that we get the same reaction today as when we opened it 17 years ago. People use the same words and have the same connection to the building even though we have changed things.”

This year’s Legacy Project Award winner made bold moves toward patient-centered design, community inclusion, and a collaborative, team-based approach to building that have now become givens of healthcare design.

The familiarity of these concepts can cause us to fail to appreciate them as revolutionary. By celebrating design legacy, we see more than just the design; we learn from its vision and are able to innovate even further because of it.

Angela Mazzi is a senior medical planner at GBBN Architects in Cincinnati.