To meet the demands of an aging population and health care reform, many new hospitals and other health care facilities are being built. These projects are typically large, costly and complex and, therefore, merit careful attention to cost control and efficiency. The health care industry is using new teamwork approaches to design and construct new facilities that significantly reduce project costs, shorten schedules, minimize claims and disputes and improve overall project quality.

Introduction

Traditionally, when a hospital or other health care organization decided to build a new facility, it would hire an architect to prepare plans, solicit bids, select a contractor and build the project. This delivery method, known as “Design-Bid-Build,” often proved to be costly, slow and fraught with numerous change orders and claims.  These issues stemmed primarily from the design and construction team working in “silos” and lacking the benefit of their respective areas of expertise.

Today, hospitals and other health care facilities are successfully using new collaborative approaches to design and construction that are saving significant time and money, reducing change orders and claims and improving the overall project. These new teamwork approaches are the Integrated Project Delivery (“IPD”) and the Design-Assist delivery methods.

Why are these new delivery methods particularly beneficial for health care facilities? Hospitals and other health care facilities are usually large projects that often cost hundreds of millions of dollars and require building systems, equipment and technology that are far more complex than other types of buildings. These projects benefit greatly from involving contractors in the design process and otherwise achieving collaboration among all members of the project team.  Indeed, some new hospitals report savings of 15% to 20% on the cost of new projects, which is huge, considering the large sums of money involved.

Integrated Project Delivery

With IPD, the owner, the architect or engineer and the contractor all function as a cooperative and collaborative team to design and construct the project with shared risks and rewards in the ultimate cost, schedule and quality of the overall project.  In simple terms, IPD is like a joint venture approach to design and construction.

IPD represents a radical departure from traditional delivery methods that isolate responsibilities, liabilities, communication, risks and rewards with contracts that often lack incentives to cooperate and work toward the common goal of a successful project overall for everyone. Parties to an IPD team have incentives to do what is best for the project, rather than what is best for themselves.

IPD typically utilizes Building Information Modeling, commonly referred to as “BIM.” BIM is the use of a digital database to integrate the work of all of the design and construction project team members and generate two- and three-dimensional models, plans and reports. Cost and scheduling can be added to create fourth and fifth dimensions. It is a tool that facilitates design collaboration and is intended to avoid conflicts and errors in plans.

IPD is an evolving delivery method based on broad concepts that can be customized on a project-by-project basis. There is no such thing as one way to do a project by IPD, and there is no need for a rigid definition of it, but it generally includes the following basic elements:

1. One Integrated Agreement: The core team members, typically the owner, the architect/engineer and the contractor, all enter into a single contract. This is a much different contractual arrangement from Design-Bid-Build in which the owner enters into separate contracts with the architect/engineer and the general contractor.
2. Shared Risk and Reward: The core IPD team members manage and share risks and rewards in the outcome of the project, usually its cost and time of completion, but other performance standards can be established, such as energy efficiency. Part of the compensation of the architect/engineer and the general contractor are usually contingent on certain goals being met, and bonuses are paid for exceeding these goals.
3. Collaboration: With IPD, plans, schedules and other information is not only shared, but developed jointly by the team. All parties, including the contractor, are involved from the inception of the project. Some IPD projects literally use a so-called “big room” on site at which all parties are stationed to facilitate collaboration.
4. Joint Decision-Making: IPD normally utilizes a committee approach to decision-making, but the owner may reserve veto power.
5. Dispute and Liability Avoidance: A hallmark of IPD is minimizing the risk of disputes, liability and litigation in order to foster collaboration and a teamwork environment. An internal dispute resolution process is often followed as an initial step prior to mediation, arbitration or litigation. The parties also typically agree upon various ways to reasonably limit liability.

Design-Assist

Innovation in construction delivery methodology for health care is clearly trending toward collaborative, teamwork approaches. Design-Assist is one such approach that requires taking only a small step away from traditional delivery methods, such as Design-Bid-Build, and avoids the leap required by IPD.

Design-Assist is a project delivery method in which the construction team is engaged by the owner to collaborate with the architect or engineer during the design phase. The construction team focuses on value engineering, constructability, cost estimating, scheduling, procurement, BIM, maintenance and building life cycle. Participation by the individual trade subcontractors in the design is intended to allow their specific construction expertise to add value to the plans and reduce the cost and the schedule for the project. Also, Design-Assist allows design issues to be discussed and resolved simply during the design phase, instead of in the field during construction, when the stakes are much higher.

Design-Assist is a unique delivery method because its focus is solely on the design phase of construction (but it promises a positive effect on the entire project). It is used in conjunction with, or incorporated into, other delivery methods. Hospital and other large health care projects are prime candidates for Design-Assist due to their size and complexity. The mechanical, electrical and plumbing (“MEP”) work constitutes roughly 40% of their overall cost.  Involving the MEP trades in the design can have a significant, positive effect on the cost, schedule and quality of the project.

Some owners find IPD to be a very appealing delivery method, but are not willing to take the leap to adopt all of its elements. Design-Assist is a step in the direction of IPD. It has some of the attributes of IPD (teamwork, collaborative design process, etc.) and avoids the more controversial elements of IPD (limited liability, joint decision-making, etc.). Design-Assist may be the perfect alternative.

IPD and Design-Assist are relatively new and evolving project delivery methods. They are part of what seems to be a growing trend toward heightened collaboration between the design team and the construction team, and appear to be well-suited for hospitals and other health care facilities.