When evaluating delivery methods for complex hospital construction projects, integrated project delivery (IPD) may not immediately seem like the easiest solution. The collaborative approach integrates the owner, construction team, and design team under a single contract. For high-stakes projects such as the development of a new hospital, relinquishing control of one’s individual contract with an owner and committing to a shared risk-reward model can be challenging.

To succeed, projects using IPD require an up-front investment of time and resources to establish trust and create a structure for shared decision-making. However, with the right team and the right project, IPD can optimize project results, reduce waste, and maximize efficiency, which is why the approach has been gaining traction in the healthcare industry.

One example is the 465,000-square-foot Inspira Medical Center Mullica Hill, in Mullica Hill, N.J., which celebrated its grand opening in November. The new state-of-the-art, five-story inpatient hospital is Gloucester County’s first hospital to open in 45 years and will help meet growing demand in the region.

The project was a natural candidate for the collaborative IPD approach because many technical elements of a new hospital, such as operating rooms, sterile labs, and pharmacies, require close alignment from all partners and subcontractors. Additionally, the project was fast paced, requiring early and intensive planning in the design and planning phase to ensure the facility could be delivered in a 28-month time frame required by the owner.

In a shared risk-reward model, teams must work together to develop an incentive plan that’s mutually agreeable and beneficial for all parties. For the Inspira Medical Center, IPD team members Inspira Health, Array Architects, Leach Wallace Associates (consulting engineers), and Skanska (inclusive of adjoined trade partners) signed a multiparty contract—a commitment that requires a significant level of trust that all members will hold up their end of the bargain.

The contract sets the stage for a truly collaborative process and is designed to bring teams together as a single stakeholder group. Under this model, everyone shares the same overall project goal and silos are eliminated because the owner isn’t communicating with the construction manager or architect through a third party. In order to succeed, all team members must be comfortable with open lines of communication and a team environment.

Problem solving

One of the biggest challenges on a large-scale project is timely decision-making. This is particularly true with large institutional projects, where there are multiple layers of stakeholders and leadership to navigate, making it a challenge to align all parties and receive timely approvals. The complexity only increases as more decision-makers and team members are onboarded as the project progresses. This is where IPD really shines, because project teams are arranged in a multidisciplinary team structure—senior management team, project management team, and project implementation team—that must work nimbly to resolve questions and issues quickly without negatively impacting the schedule and budget.

Timely decision-making is the key to success for IPD and helps ensure the project is being managed as efficiently and effectively as possible, ultimately saving time and money. At Inspira, there was ongoing education, onboarding, and facilitation to ensure everyone involved understood what it meant to be on an IPD project, as well as the behaviors and attitudes required to make it a success.

Even with a high-functioning team, maintaining transparency throughout the process can be a major challenge in large capital projects. A breakdown in communication can lead to costly schedule overruns if errors are made or if the schedule isn’t clearly understood. At Inspira, the IPD team collectively developed a schedule based on milestones to make the flow from design to construction as streamlined as possible. This is a shift from traditional models, where design and construction schedules are often developed independently.

For example, a common construction delay can occur when a subcontractor realizes the engineering or design drawings they’re working from will need to be redrawn in order to work successfully in the field. In this case, IPD helped eliminate the need for redesign, guided early coordination with trade subcontractors, and led to extensive use of prefabrication to eliminate delays.

Design-assist, a procurement method where subcontractors are retained prior to the completion of the design to assist in the development of design and construction documents, was also employed to ensure the project stayed on track. The Inspira IPD team identified several areas where design assist would be beneficial, notably the mechanical, electrical, and fire protection trades to support collaboration between the contractors and the design team to coordinate the complicated healthcare building systems.

The collective schedule allowed design and construction to work hand-in-hand, enabling the team to address inefficiencies early on and design only what is needed to accommodate the work in place schedule. The design and construction teams worked together rather than in silos to create packaged deliverables based on the construction schedule. With this layered approach, Skanska was able to move forward on building the exterior structure while the design team finalized interior design elements, such as color and finishes. In the end, the hospital celebrated its grand opening ahead of schedule .

Fostering IPD adoption

As with any new approach, adoption can be slow and users can be reluctant to make the change from familiar systems and methods. Because IPD focuses on a collective group sharing a mutual goal from the beginning, a collaborative team culture must be established early on in the project timeline. Staffing for the project needs to focus on people who are comfortable and capable in a transparent and team-centric environment.

In this context, having existing positive relationships with owners, designers, and subcontractors works well in IPD because trust and working style have already been established. For instance, Skanska’s subcontractor selection at Inspira has been based on working relationships, individual expertise, and comfort with a team environment.

As the construction industry evolves, owners, designers, and construction managers will continue to be on the lookout for creative ways to deliver projects to be more predictable with schedule and budget. With the right team, a collaborative culture, and team members who respect each other’s professional expertise, IPD can deliver positive outcomes with tangible benefits for all parties.

Rebecca Pizzi is vice president of operations at Skanska USA (Philadelphia). She can be reached at rebecca.pizzi@skanska.com.