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The series' premise originated with Paul Attanasio, while David Shore, who is credited as creator, was primarily responsible for the conception of the title character.

The series' executive producers included Shore, Attanasio, Attanasio's business partner Katie Jacobs, and film director Bryan Singer. Meanwhile, Chase and Cameron continue to appear in different roles at the hospital.

Jacobs later expressed her gratitude for the network's insistence that the character be reimagined—putting him on his feet added a crucial physical dimension.Friend and Lerner, who are business partners, had been offered positions when the series launched, but turned the opportunity down.After observing the show's success, they accepted when Jacobs offered them jobs again the following year.The producers originally planned to recruit two new full-time actors, with Foreman, who returns in season four's fifth episode, bringing the team back up to three members; ultimately, the decision was made to add three new regular cast members.(Along with Epps, actors Morrison and Spencer remained in the cast, as their characters moved on to new assignments.) During production, the show's writers dismissed a single candidate per episode; as a result, said Jacobs, neither the producers nor the cast knew who was going to be hired until the last minute.Attanasio was inspired to develop a medical procedural drama by The New York Times Magazine column, "Diagnosis", written by physician Lisa Sanders, who is an attending physician at Yale-New Haven Hospital (YNHH), and Princeton-Plainsboro Teaching Hospital (PPTH, not to be confused with the University Medical Center of Princeton at Plainsboro) is modeled after this teaching institution."We knew the network was looking for procedurals, and Paul [Attanasio] came up with this medical idea that was like a cop procedural. But I quickly began to realize that we needed that character element.

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