- Integrated project delivery (IPD) and progressive design-build (PDB) help healthcare teams deliver complex facilities faster, with greater cost certainty.
- IPD aligns owner, designer, contractor, and trade partner behavior through a shared risk-reward structure tied to overall project outcomes, not individual milestones. PDB achieves many of the same benefits as IPD through early collaboration and transparent cost development, without requiring a fully integrated contractual framework.
- At Advocate Illinois Masonic Medical Center, an IPD approach delivered 40 percent prefabrication, 70 percent off-site quality testing, and a schedule accelerated by 10 to 14 weeks.
For decades, healthcare projects have largely relied on traditional delivery methods such as design-bid-build. These models have served the industry well and remain appropriate for many project types. However, they were developed for a world of considerably less complexity than the one healthcare organizations navigate today, as pressure mounts to deliver increasingly complex facilities faster, with greater cost certainty, and minimal disruption to ongoing operations.
In traditional delivery, designers, contractors, and trade partners are engaged sequentially, each contributing expertise at defined stages. For straightforward projects, this structure is workable. But as projects grow in scale, technical sophistication, and operational sensitivity, the gaps between those stages can create missed opportunities for earlier input to inform more constructable, cost-effective, or schedule-efficient solutions.
Over the past 20 years, the healthcare industry has adopted many of the same principles that transformed automotive and aerospace manufacturing.
Early trade partner involvement, prefabrication, digital coordination through building information modeling (BIM), and Lean planning methodologies have improved quality, reduced waste, enhanced safety, and increased schedule reliability.
These gains, however, depend on a delivery structure designed to integrate participants early and coordinate decision-making throughout the project lifecycle.
How collaborative delivery changes the equation
Collaborative approaches like integrated project delivery (IPD) and progressive design-build (PDB) support these advancements by creating early alignment, increasing transparency, and improving project performance.
IPD binds owners, designers, and builders under a single multiparty agreement, pooling contingency and tying compensation to collective outcomes rather than individual milestones.
PDB takes a different contractual path (using a two-party agreement between the owner and a design-build entity) but achieves many of the same benefits through collaborative pre-construction planning that defines scope, design, and price before construction commitments are finalized.
In practice, healthcare organizations are working across a spectrum of these models; some adopt a hybrid approach that layers Lean delivery principles and integrated team practices into a standard design-build contract, capturing many of IPD’s collaborative benefits within a more conventional framework.
Both IPD and PDB allow project stakeholders to identify risks, evaluate alternatives, and make informed decisions when they can have the greatest impact on cost, schedule, and performance. Budgets, target costs, and project risks are developed collaboratively, giving all participants visibility into the factors influencing project success.
Perhaps most importantly, IPD aligns team behavior through shared financial incentives. Owners, designers, contractors, and trade partners participate in a shared risk-reward structure tied to overall project outcomes. PDB instead coordinates parties through early collaboration, transparent cost development, and a jointly defined path to construction.
Choosing between IPD and PDB often comes down to the owner’s risk appetite, organizational readiness, and project scale and complexity. IPD’s shared financial structure is most effective when all major parties are experienced with collaborative delivery and prepared to operate under shared accountability. PDB offers a lower-friction entry point. For organizations new to collaborative delivery, or for projects where a fully integrated multiparty agreement is not feasible, PDB and its hybrid variations can serve as an effective middle path.
Proof in practice: collaborative delivery in action
The Advocate Illinois Masonic Medical Center (AIMMC) Center for Advanced Care and West Bed Tower expansion in Chicago illustrates what IPD can deliver under pressure. The 346,545-square-foot project faced significant constraints from the outset: a dense urban site, limited construction staging area, and the need to maintain uninterrupted operations throughout construction.
Advocate Health (Oak Brook, Ill.), SmithGroup (Chicago), and Turner Construction (Chicago) aligned early around shared goals, establishing the integrated structure that would prove critical when the COVID-19 pandemic accelerated demand for the new tower.
The expansion required a complex vertical addition above the existing hospital, involving structural modifications, infrastructure upgrades, and code-compliance work within occupied clinical spaces. Through a shared risk-reward structure, the team tracked costs in real time and proactively secured materials during a period of unprecedented supply chain volatility.
The results were measurable: 40 percent prefabrication, 70 percent of quality testing performed off-site, and a schedule accelerated by 10 to 14 weeks.
UC Davis Health’s California Tower in Sacramento, Calif., offers a different but equally instructive example. The health system pursued a hybrid PDB model, bringing together SmithGroup (San Francisco), McCarthy Building Companies (Sacramento), and Cambridge CM (San Francisco) under a structure designed to capture the collaborative benefits of IPD without requiring full multiparty integration.
When the schematic design phase coincided with the early stages of the pandemic, the hybrid PDB team worked across design, construction, and owner stakeholders to develop an acuity-adaptable approach. The strategy would allow more than 250 standard medical/surgical rooms to convert to fully functional ICU-level care—with full air isolation capability—in the event of a future pandemic or mass casualty surge.
That kind of rapid, iterative problem-solving is precisely where the hybrid PDB structure proved its value. The team modeled the optimal day-one ratio of medical/surgical to ICU beds and confirmed costs against the program budget and business case in real time. This allowed them to validate a complex solution without the sequential approval cycles required by traditional delivery—and without the schedule delays those cycles typically produce.
How can healthcare owners rethink project delivery?
Successfully implementing an IPD, PDB, or hybrid approach requires more than adopting a new contract structure. It requires owners to rethink how projects are planned, managed, and measured. Here are four strategies to consider:
- Select for culture, not just credentials. Owners should evaluate potential partners not only on technical expertise, experience, and qualifications but on their willingness to communicate openly and solve problems collectively. The most effective teams are built on a commitment to project success that consistently outweighs individual organizational interests.
- Prepare for collaborative delivery. Collaborative delivery requires owners to adopt a different leadership mindset—establishing broader, value-based objectives that support patient care, staff experience, operational performance, and long-term flexibility—rather than defining success solely through budget and schedule metrics. A useful starting point is an assessment of past project performance to determine whether incremental improvements are sufficient or whether a more fundamental shift is needed. Owner engagement is also a key differentiator. Organizations such as Kaiser Permanente (Oakland, Calif.) and Sutter Health (Sacramento) have made significant commitments to integrated delivery, beginning with executive participation and sustaining leadership involvement throughout the process. Other healthcare systems such as Corewell Health (Grand Rapids, Mich.) have achieved similar alignment by embedding construction management professionals in a Big Room collaborative environment with cluster teams to represent the owner.
- Engage key partners early. One of the greatest advantages of integrated delivery is the ability to incorporate the expertise of architects, contractors, and trade partners during planning and design—before decisions become costly to change. Early involvement enables smarter choices around cost, constructability, logistics, procurement, and operational continuity, while helping teams proactively identify and mitigate risk. Organizations that assemble project teams late consistently forfeit the alignment and advanced problem-solving that drive better constructability, reduce waste, and accelerate schedules.
- Use the Big Room as a leadership tool. Integrated delivery succeeds when communication becomes a daily practice rather than an occasional event. Whether physical or virtual, Big Room environments colocate project resources where teams can coordinate activities, address constraints, and make decisions collaboratively. Combined with pull-planning techniques, visual management tools, and regular performance reviews, these environments improve accountability and increase workflow reliability.
Clear decision-making procedures and consistent documentation protocols give teams the tools to make durable, well-founded decisions. Owners who actively participate in these processes help establish the culture of continuous improvement that drives successful outcomes.
Collaborative delivery as a competitive advantage
By replacing fragmented decision-making with alignment, transparency, and shared accountability, IPD and PDB approaches can improve predictability while reducing risk, waste, and the uncertainty that has long defined large-scale healthcare construction.
The industry will continue to refine these approaches, but the direction is clear. Collaborative delivery is no longer simply a project strategy; it’s a leadership strategy—one that positions healthcare organizations to respond more effectively to complexity, change, and the growing demands placed on the facilities they build and the communities they serve.
Project outcomes are shaped as much by the delivery model as by the design itself. Owners who understand that—and align their organizations accordingly—will be best positioned to deliver the facilities, experiences, and outcomes healthcare demands tomorrow.
Kent Hetherwick is vice president at SmithGroup (San Francisco) and can be reached at [email protected]. Brian Powers is a project architect at SmithGroup (Chicago) and can be reached at [email protected].
