By Dan Lee, AIA, IIDA, NCARB, NCIDQ, Project Executive

Complex large-scale healthcare building projects have notably benefited from the design-build project delivery method. This process, in which design and construction services are contracted by one company, has been perfected over several decades but embraced in some areas of the country more than others. Southern California has many design-build success stories, and it remains a preferred construction delivery method for some of the largest healthcare systems in California.

Smaller healthcare projects such as interior remodels and tenant improvement projects have been traditionally managed through the design-bid-build approach, where the owner contracts with different entities for the design and build phases. The question we should raise is, why can’t design-build work even better for the smaller, less complicated projects?

Key benefits of design-build include early assessments and budget building criteria, seamless collaboration between the architect and the contractor, a single source of responsibility, and integration of experts required to design and build with minimum changes. This combination generally yields time and money savings for the client. Most small projects have similar needs, and all these design-build benefits can make a smaller project more successful.

Drilling down into the benefits, we can see that most small projects require the help of the designer, architect, consultants, and contractors early on, especially when assessing existing conditions in an older facility. This team can arrive at project feasibilities quickly and relate them to probable costs. In both an architect-led and a contractor- led design-build project, each team of experts wants to understand the design challenges and opportunities so that design is constructible and can meet the financial goals set by the client.

The design-build process encourages a greater degree of collaboration among all professionals and affords time savings where phasing of work can overlap. Without the need to bid the project to multiple contractors, both the architect and the client save valuable time. Once the project team starts, critical timelines and relative budgets are closely monitored. This can be extremely beneficial for fast-moving, smaller projects where key components and equipment are often design drivers.

Most projects experience some degree of evolution during construction requiring changes and revisions. With the design-build approach, these changes may be made more easily without the need for the traditional delays required between architect and contractor. This team is working directly with the client, cutting out one step of the process.

Design-build is a model where transparency and accountability are essential for the team and the client who has entrusted the team with the project. The experts must work together easily, and the client needs to be engaged and supportive for a fast-paced project. Everyone needs to think like an architect and a builder to be a successful team.

A Design-Build Success Story

One successful design-build project we completed was a 27,300-square-foot medical office building to meet the needs of a healthcare network’s growing to a suburban community’s need.

The project budget was challenging from the start with limited funds available compared with the client’s specific needs. The design and preconstruction teams worked closely to ensure the most efficient and constructible design to deliver an attractive building in a timely manner. The design-build process included multiple iterations of value engineering and pricing evaluations that ultimately resulted in a stunning addition to the campus within their budget.

Notable historical architects have embraced the concept of “master builder,” and with the design-build model, this can be achieved. Most healthcare projects are technically challenging, and in California the OSHPD process can be daunting but collectively the design-build team can manage the code and agency review requirement with greater detail and execution. Even the smaller projects can shine as an example of pride and accomplishments, leaving everyone with shared risk, faster project delivery, and a financial win-win for everyone involved with the project.