Healthcare Design - November 2015 - 108

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role in the design phase than it traditionally does
under a design-bid-build contract, which can
be a drawback if it isn't yet fully engaged or
focused on the project
* The team relies on the CM for estimating, and
occasionally the pricing may not reflect design
evolution or intent.
Design-build
The design-build model creates a single entity;
there is just one contract. The client provides the
goals and program for the project and works with
a design-build team (contractor and architect)
that's fully responsible for delivery of the project.
It's more often utilized for simpler building types,
such as MOBs or parking garages, rather than
hospital projects. In more complex project types,
such as a significant healthcare expansion or
renovation, design professionals can better serve
the client if they're contracted directly to them
rather than working for the builder.
Pros:
* There's a single contract for both design and
construction
* Schedules can be expedited
* Decisions happen more quickly
* Costs are established early and client risk is
controlled
* The design team is generally contracted
through the general contractor, which simplifies the client interface by having just one party
to work through.
Cons:
* There's a loss of checks and balances in the
architect/general contractor relationship
* The owner's involvement is limited
* The process may not bring the best designer
and best builder together.
Integrated project delivery
The integrated project delivery (IPD) model creates a new contractual business structure that
includes the owner, the architect, and the CM,
which are brought together in a limited partnership. The American Institute of Architects currently defines IPD as "a project delivery method that
integrates people, systems, business structures,
and practices into a process that collaboratively
harnesses the talents and insights of all participants to reduce waste and optimize efficiency
through all phases of design, fabrication, and
construction."
Pros:
* The tripartite team is contractually bound
together under a true IPD contract
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* Multilateral collaboration is encouraged
* It's a high-efficiency delivery model
* Owner risk is limited by a team approach to risk
and reward incentives
* Teams are better able to deliver projects within
budget and schedule.
Cons:
* It requires a sophisticated owner that's willing to
be highly involved in the project delivery
* Contractual issues will often have to be addressed
* Additional risk is created for the design and construction entities, in exchange for incentives that
may or may not be achieved.

Design-assist is a relatively new delivery
model that requires early involvement of
subcontractors.
Design-assist
Design-assist is a relatively new delivery method
that isn't a true contractual arrangement like the
other examples and requires early involvement of
subcontractors. This delivery approach can be used
with almost any of the contracts described above
and is always used with another method. Design-assist is especially valuable when there's need to save
design and construction time or secure time-sensitive materials, or if there's an unusual requirement
of some kind. Specialty contractors (MEP, glazing,
structural steel, elevators, waterproofing) join the
team early to assist in the design.
It's possible to create a more efficient process by
having the subcontractor that will be building the
project assist the design team in developing layouts,
details, and even systems to maintain a certain price
and/or schedule. To be most effective, the designassist team members should be brought onto the
team at the end of schematic design or the first portion of the design development phase.
Pros:
* Approval time is reduced, since the subcontractor
has been engaged in the design process
* There's potential for fewer changes in the field
* Overall scheduling (by securing manufacturing production slots to ensure timely delivery) is
improved
* Prefabrication of building components-which
supports the schedule, project quality, and jobsite
safety-works well with this method.
Cons:
* Competition is reduced because the team commits to a certain subcontractor with an agreed-
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Healthcare Design - November 2015

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