When the founders of the Cleveland Clinic decided to build an inpatient hospital in Cleveland 100 years ago, they had a backup plan. The healthcare organization told project architect Thomas Ellerbe of then Ellerbe & Co. (St. Paul, Minn.), which later became part of AECOM, to design the building so that if the hospital failed, it could be converted to apartments.

The firm did so by equipping each patient room with a private toilet and lavatory, which was revolutionary at the time, according to the firm’s archives, The Ellerbe Tradition: Seventy Years of Architecture and Engineering, published in 1980. Building and equipping the hospital cost $600,000.

“In 1922, only deluxe suites in a few major hospitals had such conveniences,” Ellerbe wrote. “With plumbing facilities already available in each room [of the original hospital], kitchenettes and bathrooms could be installed at minimum expense.”

That original 1924 hospital building, now known as the “M Building,” never was converted to apartments—and today continues to operate on the health system’s main campus, housing operating rooms, clinical spaces, specialty services, and patient rooms. “We’ve been changing things for 100 years,” says Randy Geise, senior healthcare facility planner at the Cleveland Clinic.

Cleveland Clinic hospital’s evolution

When it opened in June 1924, the original hospital housed 184 beds, almost all in semiprivate rooms, and four operating rooms on seven floors. Over the years, Cleveland Clinic expanded the facility to meet evolving care and service needs, including a standalone research building in 1928, another wing in 1929, and a 1947 building that connected them. Further success led to new wings in 1955 and 1965. Today, the M Building houses 203 patient beds (32 of those are in the original 1924 building shell).

“We’ve just changed things out of necessity; we’ve made the best we can of the footprint we have with this building,” Geise says. “Not knowing what the future holds, the founders wanted the building to be as flexible as possible. Well, [the hospital] never failed.”

Hospital renovations and expansions

The first floor originally housed an ambulance entrance and the morgue side by side, along with kitchen facilities and other back-of-house areas, such as mechanical. The hospital’s main kitchen is still there today and has been expanded.

The building also houses an inpatient cancer care unit on the seventh floor, bariatric center on the sixth floor, general clinical research on the fifth floor, pediatric congenital heart outpatient clinic on the fourth floor, neonatal intensive care unit (NICU) on the third floor, and surgical space on the second floor.

One of the more recent renovations was to the seventh floor, which originally housed the surgical suites and intensive care unit (ICU), including operating rooms (ORs) with skylights. In 1993, the floor was converted to palliative care and carpet, a lounge, and piano room were added to create a homelike space for patients and families. In 2023, the space was renovated again, updating finishes to the organization’s standardized palette (white walls, gray floors, and abundant artwork), and expanding the nurses’ station and workspaces.

Healthcare design that stands test of time

Some things in the building haven’t changed for a century, and Geise says that’s good. For example, the patient rooms on the fifth-floor clinical research unit are the same size, though they’ve been updated to private rooms. And the terrazzo flooring in the stairwell “is still as good as it was 100 years ago,” he says.

There’s a downside to at least one immutable aspect of the building. The ceiling height of the first six floors is only about 10 feet, 9 inches from floor to slab, which limits what type of services can be offered there, Geise says. “If you wanted to put imaging equipment in there, you’d need more headway. But they didn’t need it then,” he says.

Future proofing a hospital campus

As the Cleveland Clinic continues to build and expand, specialty services and departments housed in the 1924 hospital and other older buildings are being moved to new, purpose-built facilities. For example, a wing in the M Building dedicated to inpatient care for pediatric epilepsy—part of the 1929 addition to the original hospital—will relocate and expand to a new approximately 1-million-square-foot neurological institute, which is under construction and set to open in 2027 on the main campus.

There will come a day when the 1924 hospital is no longer useful, Geise says, but that it has remained so for 100 years—and still is used to treat some of the most critical patients—is remarkable. The founders “who feared not being successful in 1924 … would be amazed,” he says.

Robert McCune is senior editor of Healthcare Design and can be reached at robert.mccune@emeraldx.com.