Harborview Medical Center required a specialized operating room (OR) to integrate bi-plane imaging technology with neurosurgical procedures like craniotomies and cardiovascular surgery. Ankrom Moisan and Aldrich partnered to design a flexible, 2,000 sq. ft. hybrid OR capable of adapting quickly for emergency cases. Our design process was shaped by continuous feedback from Harborview’s medical team. We focused on space optimization, ensuring efficient transitions from patient prep to surgery, while supporting multiple clinicians and accommodating a wide range of equipment. A custom ceiling system integrates diffusers, lighting, and booms to support various procedural configurations. The design allows for various procedural layouts while maintaining a clean, efficient flow of equipment and staff. Before finalizing the design, we collaborated with Harborview to create a detailed equipment plan and used 3D virtual reality to allow staff to immerse themselves in the space. To fully understand the OR’s needs, two of our designers shadowed a craniotomy procedure, ensuring the layout supported the real-world demands of equipment, staff, and space. The result is a highly functional, adaptable OR that integrates technology and workflow seamlessly to support Harborview’s advanced surgical needs.