This chapter explains the key aspects of operating department design that facilitate a highly skilled multidisciplinary team to provide essential care to a vulnerable group of patients. It is important that the surgical facilities are designed to support the smooth flow of patients from admission to discharge. Surgical activities are broad ranging from scheduled or unscheduled, complex, to routine day surgery. Theatre services are central within the hospital system and rely on interdependant relationships with other hospital departments. This presents organisational, planning, and design challenges, as healthcare providers seek to improve services and utilise existing infrastructure to offer facilities that meet demand in a fast-paced and progressive field. Patients are entitled to receive high-quality healthcare, which is provided safely and effectively, and theatre teams should expect to deliver those high standards of care in an appropriate workspace. Theatre design is an essential component of the perioperative pathway, allowing surgical interventions to be carried out safely and efficiently to enable the best possible patient outcomes.