In the fast-paced, highly competitive world of healthcare, "Speed to Market" is critical. The success of a project is more frequently being measured by the ever-decreasing time between project initiation (design) and project completion (construction). Of course this acceleration in a project's life cycle shouldn't overshadow the fact that these healthcare projects still need to be patient centered, cost efficient (LEAN), and provide flexibility long-term. However, the time allocated to successfully fulfill these goals is an increasingly valuable commodity.

Delivering these projects from both a design and construction standpoint requires a dedicated team effort from the owner, design team and construction partners. The current framework for creating this mutually accountable team is called Integrated Project Delivery (IPD). Unfortunately, there are very few examples of "pure" IPD projects across the U.S., for various reasons, including general industry inexperience with "non-adversarial" team relationships where success depends heavily upon the individuals comprising the team. And while our industry may be slow to change, change is necessary and ultimately, it is inevitable. For this reason, there is an intermediate step that is proving to be useful in (re)training how we will deliver projects in the future.

A New Paradigm
IPD "Lite" (IPD-L) is the transitional step beyond the traditional CM at Risk (CMAR) delivery method and is leading us on the path toward a true IPD delivery model of the future. Lacking a "formal" definition, IPD-L takes on a variety of forms each tailored to fit specific project requirements and create new and improved team relationships. The IPD-L team typically consists of the owner, architect, contractor and "design-assist" sub-contractors from the major trades (MEP/FP/Drywall at a minimum). This team uses slightly modified industry standard agreements to further define the project goals, expectations and roles of each principal player, all the while dedicating their best efforts in supporting the integrated team relationship focused on the success of the project.

IPD-L In Action
In early 2012, FirstHealth of the Carolinas (FHC, Pinehurst, NC), began implementing their strategic plan for building a new hospital in an adjacent underserved county that didn't have a hospital of its own. The main challenge from the hospital Board was to program, design, build and fully equip a turn-key ready hospital in just 16 months. When choosing their design and construction partners, FHC considered factors such as past performance, experience with this project type, and the perceived compatibility of the principal team members' personalities. The importance of this "compatibility" should not be underestimated as it was repeatedly tested during the more stressful challenges of the project.

At the beginning stages of the project, the selected IPD-L team worked swiftly to develop Programming/Preliminary scope drawings as well as a detailed project budget and schedule. Then, in order to facilitate an early release of foundations and steel packages, it was essential for the team to quickly identify a functional and efficient site plan that further defined the building footprint. The architectural and medical equipment planning teams worked concurrently with the MEP teams and individual department user groups to determine the operational details that were required to inform a good design solution. Finally, the design-assist process was able to unfold with the engineering teams, CM and subcontractors collaborating to design/model all of the main infrastructure and final terminations (such as the sanitary connections, HVAC runs, medical gas risers, etc.) that would standardize components and facilitate pre-fabrication.

The Necessity of BIM
Building Information Modeling (BIM) was an essential tool for focusing all team members' efforts from the very beginning of this project. Early on, the team established which version of BIM to use, what components the design team would model versus what the DA subs would model, and how the CM would facilitate model coordination, systems clash detection/resolution, and building components pre-fabrication activities. The team met weekly to compile the current model from each discipline, review items that affected scope/budget/schedule (positively or negatively), and make any necessary course corrections. As the weeks progressed, the BIM model allowed the team to "virtually" build the facility and work out potential conflicts ahead of the actual construction. Conversely, any as-built or field conditions that were created during simultaneous construction activities were incorporated back into the building model for the design teams to work around.

Decisions, Decisions, Decisions
As with any project that moves at an accelerated pace, decisions need to be made very quickly. This is where the owner was instrumental in laying the ground rules for the various user groups. Essentially, the fear of making a "wrong" decision was replaced by the goal of making the "best" decision based on the information available at the time. The urgency and focused vision of the leadership team also helped to unite all user groups toward the common goal of creating a truly exceptional experience for patients and their families. With everyone focused on the common goal, traditional turf battles between departments were non-existent.

The New Normal
In December of 2013, less than 16-months from the start of the project, the new Hoke Community Hospital opened with tremendous support from the local community and to this day continues to exceed even the most ambitious patient volume projections envisioned. The project was also delivered under budget even after including the value-added changes in the scope requested by the hospital.

Reviewing the numerous success stories of IPD projects, one could reasonably draw the conclusion that only large projects are well suited for this process. However, as our industry changes and grows toward a new reality of delivering more value for less cost on a speed to market schedule, we must look beyond the traditional silos of the past and blaze a new road to a brighter future. IPD-Light is the means to the goal, the transition phase between where we are and where we need to go. It serves as the training ground for developing new ways of working, overcoming an historical framework of adversity, forging strong interdisciplinary project teams and providing value for all.