This paper aims at positioning organizational design as an important phenomenon in the field of project management with a high potential of contributing to organizational theory. While organizational design has been neglected by scholars of management and organizational theory, it has been of great interest to those from the project management field. This incongruence—comprising the focus of this study—calls for new insights on theorization in context. The paper provides a preliminary theoretical framework combining contingency theory, the historical approach and social theory to understand organizational design, both as a thing and as a process. It provides empirical evidence from three case studies in healthcare. Findings confirm the specificity of each design while at the same time adopting a similar temporal pattern. We take this opportunity to highlight the seminal work of Rodney Turner on project-based organization and design.