The Ann & Robert H. Lurie Children’s Hospital of Chicago resolves a unique set of technical engineering challenges emerging from the vertical reorganization of conventionally horizontal spaces, the demanding integration of engineered systems and structural strategies, and an aggressive fast-track schedule – within the already complex equation of safety, reliability, and efficiency in a sensitive healing environment for children. Lurie Children's is ranked number one in almost every major pediatric specialty and serves over 110,000 children each year. The new 23-story facility provides 288 beds, 22 ORs (4 hybrid), expandable imaging facilities, offices that convert into additional patient rooms, and a fully flexible clinical BSL-3 laboratory. AEI's role began in pre-design, identifying opportunities for incorporating compatibility, efficiency, and flexibility into the design. Mock-up rooms for natal and pediatric ICUs, acute care, trauma, and ambulatory care facilitated staff input on patient scenarios and optimal technology and utility configurations.