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Integrated project delivery (IPD) on a healthcare project works best when the owner, designers, constructors, users and regulators make decisions as one delivery system rather than as disconnected handoffs. The most defensible seven-key playbook comes from a 2010 California healthcare case and consists of setting a baseline, involving affected parties early, keeping a reliable schedule, communicating design intent, using target costing, learning from collaboration breakdowns and making owner trade-offs explicit.
Those practices are useful implementation prompts, not a universally validated checklist. A 2023 peer-reviewed study of 66 experienced practitioners in Ireland found limited familiarity and use of IPD and identified contractual, cultural, policy and knowledge barriers. Treat the seven keys as a way to structure project conversations, then adapt the governance, commercial terms and regulatory process to the jurisdiction and project.
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The sequence below translates the practices summarized by Bonnie Walker, AIA, in Building Design + Construction’s 2010 account into actions a project team can assign and document.
| No. | Key | What the team must do | Useful output |
|---|---|---|---|
| 1 | Define the project and baseline | Integrate feasibility work with a detailed scope, schedule and budget. | Approved project definition and baseline |
| 2 | Change the working relationships | Bring people who can affect the outcome into the process early and establish how they will collaborate. | Stakeholder map and working agreement |
| 3 | Set a schedule the team will keep | Put the necessary meetings and decision points on the calendar, then honor the agreed rhythm. | Integrated schedule with meeting and decision cadence |
| 4 | Communicate intent clearly | Make room requirements, design direction and acceptance conditions explicit. | Current room data sheets and decision records |
| 5 | Use target costing | Estimate the cost effect of design choices while changes are still practical. | Target-cost options and cost-decision log |
| 6 | Use breakdowns to solve underlying problems | Treat misunderstandings and missed commitments as signals of a deeper process issue. | Root-cause issue record and agreed corrective action |
| 7 | Make owner trade-offs explicit | Distinguish essential requirements from preferences and state the consequence of each choice. | Owner decision with scope or budget consequence |
1. How do you establish a project definition and baseline?
Start by combining feasibility work with a detailed budget so that scope, schedule and money describe the same project. The baseline is not merely an early estimate; it is the reference the integrated team uses to test later decisions.
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Build one shared definition
- Describe the clinical or operational outcomes the facility must support.
- Record the spaces, capacity, major systems, site assumptions and regulatory dependencies that make those outcomes possible.
- Pair the scope narrative with a cost plan and a milestone schedule. If an assumption is uncertain, label it rather than hiding it in a contingency.
- Identify who can approve a change and what information that person needs.
When feasibility, budget and schedule are produced separately, the team can appear aligned while each discipline is solving a different problem. An integrated baseline makes the conflict visible early: a requested room, system or milestone must fit all three dimensions or trigger an explicit decision.
Keep the baseline alive without making it meaningless
Healthcare projects evolve as clinicians, facilities staff and authorities clarify requirements. Keep the original baseline, record the reason for each approved change and show its effect on cost and dates. A baseline that changes without a decision record cannot support target costing or owner trade-offs; one that can never change will encourage workarounds.
2. How should the team change working relationships?
Invite every party that can materially affect the outcome early enough to influence the solution, then agree how those parties will work together. IPD depends on behavior and information flow as much as on a delivery diagram.
Map influence before design hardens
The early group may include the owner and clinical users, architects and engineers, constructors and key trades, facilities and infection-control representatives, commissioning participants, cost expertise and the responsible review authorities. The 2010 California group included healthcare organizations, a state planning agency, design firms, a contractor and UC Berkeley researchers; its composition illustrates why a hospital cannot be designed effectively by a single discipline.
For each participant, document decisions they control, information they supply, constraints they impose and the point at which their input becomes expensive to incorporate. This is more useful than inviting people to meetings without a defined role.
Agree the rules of collaboration
- Use a common issue and decision register rather than private lists.
- Define how disagreements are raised, who facilitates resolution and when an unresolved item is escalated.
- Make assumptions visible and ask participants to challenge them without assigning blame.
- Confirm that representatives have authority to speak for their organizations or can obtain a prompt decision.
These practices address a practical problem: early collaboration fails when attendance is broad but authority, information and accountability remain fragmented.
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3. How do you set a schedule the team will actually keep?
Create a schedule that includes the team’s decision and coordination work, not only design submissions and construction activities. Then protect the meeting rhythm and close the loop on commitments.
Schedule the work of integration
Show design development, user reviews, estimating updates, authority interactions, procurement decisions and construction readiness alongside the physical milestones. Put recurring coordination meetings, focused issue sessions and owner decision gates on the same calendar. The correct frequency depends on project phase and risk; the key is that the team agrees to it and treats attendance and preparation as project work.
Use commitments, not attendance, as the measure
End each meeting with an owner, due date and definition of done for every action. At the next session, mark each commitment complete, late or blocked and record the reason. If a milestone slips, expose the dependency that caused it and re-plan with the affected parties instead of silently moving downstream dates.
A reliable rhythm also gives the team a place to use the other six keys: target-cost updates can be reviewed on schedule, room data sheets can be approved in batches and owner trade-offs can be decided before they become field changes.
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4. How can a healthcare team communicate design intent clearly?
Translate broad goals into information that a designer, builder, user and reviewer can interpret the same way. The source article specifically identifies room data sheets during design development as a tool for articulating each space’s needs.
Make each room requirement testable
A useful room data sheet can identify the room’s function, users, activities, equipment, adjacency needs, environmental conditions, technology, utilities, maintainability and applicable approvals. The exact fields should reflect the project; the principle is to move critical intent out of informal conversations and into a controlled record.
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- Assign an accountable clinical or operational owner for the content.
- Give the sheet a revision, date and approval status.
- Link unusual requirements to the decision or source that created them.
- Flag unresolved items rather than filling gaps with an unconfirmed assumption.
When a layout or specification changes, update the related requirement and notify the disciplines affected. Clear intent reduces the chance that a late interpretation will be mistaken for a design change or a construction error.
5. How does target costing guide healthcare design choices?
Target costing brings cost information into design while the team can still change the design. It is a decision method, not a promise of savings or a substitute for a complete estimate.
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Run cost decisions as design decisions
- Set a target consistent with the approved baseline and identify what the target includes.
- At planned design milestones, update the estimate using the current scope and stated assumptions.
- When an option changes cost, show the operational benefit, risk, schedule effect and downstream implications beside the price.
- Ask the owner to select an option, revise scope or authorize a budget change; record the decision.
Early estimates are uncertain. The discipline is to expose that uncertainty and its drivers, not to present a single number with false precision. A target-cost log should show allowances, exclusions, unresolved requirements and the date of the estimate so later users understand what was known when the decision was made.
The available data provides no measured IPD savings percentage or success rate. Target costing should therefore be presented as a way to make trade-offs earlier, not as evidence that a particular project will cost less.
6. How should the team use collaboration breakdowns to find root causes?
A misunderstanding, missed handoff or contradictory requirement is useful only if the team investigates why it occurred. The recommended response is to solve the underlying process or information problem, not merely correct the immediate document.
Turn an incident into a learning cycle
- Describe the observable breakdown without assigning motive: for example, two teams used different versions of a room requirement.
- Identify where the information originated, who interpreted it and where control was lost.
- Ask which missing rule, role, approval or communication channel allowed the condition to persist.
- Agree a corrective action, an owner and a date, then check whether the fix works on the next related decision.
This approach creates psychological safety only when leaders distinguish a process failure from deliberate negligence. Repeated breakdowns may indicate unclear authority, inadequate information management, unrealistic deadlines or a participant who lacks the capacity to make required decisions. Those are management issues the integrated team must address directly.
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7. How do owners make trade-offs explicit in IPD?
Ask whether each request is essential or preferred, then state the consequence. If it is essential, ask what can be removed or changed; if it is preferred, ask whether the owner accepts a higher budget or another effect.
| Owner answer | Next question | Decision record |
|---|---|---|
| Essential | What scope, quality, sequence or existing assumption can be removed or altered to make room? | Requirement retained; offsetting change identified |
| Preferred | Is the additional cost, time or complexity acceptable? | Preference approved with consequence, or deferred |
| Unclear | What operational outcome would be lost if the request were omitted? | Evidence and accountable decision-maker identified |
This conversation prevents “must-have” language from expanding the project invisibly. It also respects the owner’s priorities: a preference may be worth funding, but the team should not discover that only after procurement or construction has started.
How do you put the seven keys into a healthcare IPD work plan?
Use the keys as a sequence of decision controls, while revisiting them throughout design and construction.
- Charter the outcome and baseline. Approve the project definition, initial scope, schedule, budget assumptions and decision authority.
- Assemble the integrated group. Map affected parties, confirm representatives and agree collaboration and escalation rules.
- Publish the decision rhythm. Put coordination meetings, user reviews, estimating updates and owner gates on the integrated schedule.
- Develop requirements in a controlled format. Create and approve room data sheets and other intent records; keep revisions traceable.
- Cycle design and target cost. At each agreed milestone, compare options with current cost and schedule information before the design hardens.
- Resolve breakdowns visibly. Log misunderstandings and missed commitments, investigate root causes and verify corrective actions.
- Hold explicit owner gates. For every significant request, classify it as essential or preferred and record the scope or budget consequence.
- Carry the records forward. Preserve the baseline, requirements, estimates, decisions and issue history so construction and later operations inherit the reasoning, not just the final drawings.
This work plan is a practical synthesis of the case-derived keys. It is not a prescribed contract form, software stack or regulatory procedure.
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The 2010 article described work by healthcare stakeholders who met at UC Berkeley in 2006 to improve hospital design and permitting and address project costs. Glenn Ballard led the group and studied integrated delivery on Sutter Roseville Acute Rehabilitation Institute. The account also described a $496 million, 11-story, 300-bed, 765,000-square-foot Palomar Medical Center project and said it was scheduled to open in 2011. Those figures and the scheduled date are historical statements from the article; the date should not be treated as a verified final outcome.
The article reported that phased plan review had been introduced at California’s Office of Statewide Health Planning and Development (OSHPD), allowing submissions and reviews in phases as design progressed. It identified the structural design of Palomar Medical Center as an early use and suggested that earlier review could catch errors and omissions and reduce review time on complex projects. That is a 2010 account, not confirmation of the current California review procedure. The responsible agency should be consulted before a team relies on phased review.
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Nothing in the source establishes that IPD is always faster, cheaper or safer than another delivery method, nor does it identify a universally best contract form. The seven keys are best used to improve decisions and collaboration within the delivery arrangement a project can legally and commercially support.
What barriers should a project team plan for?
A 2023 peer-reviewed study of 66 experienced practitioners in Ireland reported low familiarity with and limited use of IPD in its sample. Traditional and design-and-build delivery were more common. The reported barriers included client reluctance to change, limited IPD knowledge, litigation concerns, lack of trust, policy constraints and limited BIM knowledge.
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One free scan finds every outdated or missing driver and matches the right update for your exact hardware.Free scan · exact hardware matchThe geography and sample matter: these findings describe the surveyed Irish construction sector, not a global adoption rate. They are nevertheless a useful warning for any healthcare owner. Collaboration principles do not remove procurement rules, risk-allocation concerns, institutional habits or the need for participants who understand the information and modeling processes the project adopts.
Before committing to an IPD approach, confirm the jurisdiction’s procurement and review requirements, obtain legal advice on the proposed commercial structure, define information responsibilities and assess whether the owner and supply chain can provide decision-capable participants. No particular BIM platform or project-management product is required by the evidence reviewed; evaluate tools as categories against the project’s information, security and interoperability needs.
How we picked these seven keys
The list follows the seven elements summarized in the 2010 healthcare case, preserving their order and practical intent. Each key is included because it changes a decision the project team can make: establish a shared baseline, involve the people affected, protect coordination time, make requirements explicit, expose cost consequences, learn from breakdowns and force owner priorities into the open. The article treats them as case-derived implementation guidance and pairs them with the 2023 Ireland evidence so readers can distinguish a useful practice framework from proof of universal adoption or performance.
Implementation checklist for the next project meeting
- Is there one approved definition of scope, schedule and budget assumptions?
- Have all parties who can affect clinical, technical, regulatory or construction outcomes been invited early enough to influence design?
- Are meetings, decision gates and estimating updates on an integrated calendar?
- Do room data sheets or equivalent records state requirements, ownership and revision status?
- Can the team show the cost and schedule effect of a design option before approving it?
- Are breakdowns logged and investigated for root causes rather than patched privately?
- For each owner request, is the essential-versus-preferred choice and its offsetting consequence recorded?
- Have current procurement, contract and regulatory requirements been verified for the project’s location?
Frequently Asked Questions
Is IPD the same as design-build for a hospital?
No. They are different delivery concepts, although a project may use collaborative practices within several commercial arrangements. The reviewed sources do not provide a head-to-head performance comparison or identify a universally best contract form, so the owner should evaluate procurement law, risk allocation and participant readiness for the specific project.
Do healthcare IPD projects have to use BIM?
The evidence does not require a particular BIM platform or software product. The 2023 Irish study identifies limited BIM knowledge as one adoption barrier, which means the team should define information, modeling and interoperability requirements and confirm that participants can meet them.
Can a California hospital still use phased plan review?
The 2010 case account describes phased review at the then-named OSHPD and cites Palomar’s structural design as an early use. Because procedures and agency requirements can change, confirm the current process directly with the responsible California authority before placing it in the project schedule.
What measurable savings should an owner expect from these seven keys?
None is established by the supplied evidence. The sources provide no general IPD savings percentage, success rate or validated outcome metric; they support using the keys to expose requirements, cost effects and decisions earlier.
