Integrated project delivery (IPD) has continued to gain popularity in the healthcare design and construction industry over the past several years. Ask someone who has gone through this process and hopefully they’ll provide an enthusiastic oration on the wealth of benefits that IPD brings—increased collaboration and accuracy, less rework, full transparency, incentivized performance, etc.

But they’re also sure to deliver an equally long list of “things I wish I would have known” before the journey began. Because most project team members bring their traditional, individual responsibility perspectives to the process, these lists can be quite extensive.

One way to get a better understanding of these issues is to bring together a project team that has just completed an IPD project and have a frank and open discussion—so that’s exactly what our team at Array Architects (Philadelphia) did.

The project

The Inspira Mullica Hill Medical Center is a 204-bed, 450,000 square-foot greenfield replacement hospital in Mullica Hill, N.J., which opened in November 2019. When Inspira (with CBRE acting as its program manager) began the process of selecting a team for this project, they issued a request for integrated team that asked the designers (architects and engineers) and construction teams to join in a relationship that brought the highest level of expertise and collaboration to the project.

Following a four-week, workshop-style interview process, an integrated team was selected, composed of Array Architects (architecture and interior design), Leach Wallace Associates (mechanical, electrical, plumbing, and fire protection engineering), and Skanska (construction management). Although some team members had previous experience working together, the Mullica Hill project represented their first joined IPD project and, for many on the team, their first experience with IPD in any capacity.

As the project was nearing construction completion last fall, the team sat down to not only review the project’s successes, but also dig into the aspects of the IPD structure that the healthcare design industry can learn from. Each team member from Inspira’s Mullica Hill Project was asked to list the top three things that they wished they would have known. Here are summaries of what some of them shared:

Owners’ perspective:

Brandon Bardowsky, vice president of facilities and construction at Inspira Mullica Medical Center, served as Inspira’s representative on the project’s senior management team (SMT), which is the executive-level decision-making group that includes members from all parties that are joined by the poly-party contract.

  1. An accurately defined project base scope is critical. The project design team is working under a contractual obligation to deliver a specific scope for a fixed cost. Therefore, having a higher level of clarity around the project scope will free the team to direct its energies toward delivering the defined scope in the most efficient and cost-effective method possible, instead of spending that energy on scope revisions.
  2. A well-defined and prioritized list of out-of-scope items can both expedite approvals and help with planning work. If the process results in cost savings and/or generates confidence that contingencies can be released, then providing the team with a prioritized wish list of scope that could be added to the project can help the design team evaluate the potential to achieve the savings required. It also helps plan for the eventual integration of that scope with minimal rework. Having this list can also inform and incentivize the design team to achieve this scope within the original budget.
  3. IPD management structure and incentives result in less owner control. IPD is a collaborative endeavor. With shared risks and rewards comes shared control of the project budget, including its contingency. The team collectively determines how to use, or not use, this resource for project success. Surplus budgetary funds and contingencies can be used to cover scope gaps or unexpected problems within the team’s scope, study opportunities that can yield savings, or accelerate work to achieve savings.

Designers’ perspective:

Kent Doss, vice president for the Mid-Atlantic region at Array Architects, served as senior designer for the project; James Britt, associate principal at Array Architects, was senior engagement manager and a member of the project management team (PMT), which is the project-level management group that includes representatives from all parties joined by the poly-party contract; and Nick Nucci, senior vice president at Leach Wallace Associates, was lead engineer on the project and served on the SMT.

  1. The capabilities of the design-assist partners need to be fully understood and verified to prevent overlap and gaps. This relates not only to specific design tasks, but also to the documentation platforms that will be used and shared across the team. Before reaching out to potential design-assist partners, the core team needs to identify what tasks it’s best situated to adopt to deliver quality and control risk, and then look for a partner who can best complement and complete the effort.
  2. A singular accounting entity can greatly simplify the process. There’s no shortage of financial information that the IPD team needs to collect and report to ensure its performance is in line with expectations. This requires a way to track current target values and scope changes, as well as projected and actual invoices. Each partner will likely have a different way of generating and sharing the information, and it can be time-consuming and confusing for team leadership to absorb. Collecting key data into one platform is critical to communicating the project’s financial health in a meaningful way. Consider designating one partner’s accounting department to collect, input, reconcile, and report key information to the team to help ensure accuracy.
  3. All team members must be prepared to represent themselves. IPD partners all have a seat at the table and must be prepared to use it to speak for the project’s and their interests. This is often a new role for some in the design field who are accustomed to assuming the role of a “sub” to an architect. Be prepared to speak up and start a conversation with your partners.

Builder’s perspective:

Rebecca Pizzi, vice president of operations at Skanska USA, served on the PMT.

  1. Transparency is a requirement. Although each team member’s firm may have its own unique and often confidential business practices and standards, decision-making cannot be secretive and self-serving for the entire team to perform in the project’s best interest. Open communication can often generate solutions from unexpected collaborators that serve to improve everyone’s position.
  2. Schedule accuracy is much more important in IPD. In a traditional contract environment, when one entity doesn’t live up to its schedule commitments the impact is usually limited to individual compensation. In fact, fellow team members can sometimes even benefit from this lack of performance through additional services and change orders. In IPD, however, if one team member doesn’t perform, it affects the entire team’s profitability. So, it’s critical for both design and construction partners to accurately forecast the time it will take them to complete each task and to commit the required resources.
  3. Project estimating must keep pace with design progress (and vice versa). For the project to move forward with confidence and minimize risk to the team (which includes the owner), rapid and accurate estimating is required. A change of mindset that shifts continuous estimating from a sole responsibility of the construction manager onto the entire team can prove greatly beneficial to coordinated project progress and decision making. This means that the construction manager must be willing to engage the owner and design team in the estimating process in a more meaningful manner than the traditional end-of-phase fact checking capacity. The estimator must understand intent, not just what is documented.

Shifting to team-based thinking

Beyond these critical considerations, one universally accepted wish among team members was greater upfront education about the process to expedite the required shift to team-based thinking. The IPD process requires a mindset that’s different from the protectionist views that traditional project team relationships can foster—and that shift can be difficult to achieve. Team trust-building rhetoric is simple to engage in, but often elusive in practice.

Each project team can expect to go through some growing pains (commonly referred to as the “forming, storming, norming, and performing sequence”). One thing that the Inspira team did to help everyone understand and embrace their responsibilities to each other and the project was to engage an independent facilitator, who isn’t linked to the project or any team members in any other capacity. The facilitator for the Inspira project led contract negotiations with an eye toward objective fairness, helped establish clear communications protocols among team members, assisted in conceptualizing project dashboards that clearly conveyed project status, and helped the team build trust in each other that was critical to success of the project.

The Inspira Mullica Hill Medical Center was completed ahead of schedule and delivers an environment that far exceeds what the team thought was possible within the time and budgetary constraints of the project. The quality of the patient environment, the dynamic public spaces, the material palette, the efficiency of the plans, the performance of the systems, and the quality of the construction are a testament to what the IPD methodology can achieve.

Kent Doss, LEED AP BD+C, Lean Six Sigma Black Belt, is principal and regional vice president, Mid-Atlantic region, at Array Architects (Conshohocken, Pa.). He can be reached at