As with any other project type, publicly-funded healthcare projects performed under the traditional design-bid-build contractural approach are often laden with financial and scheduling risks.

The design team generates specifications and a two or even three-dimensional set of Construction Drawings. The healthcare provider's cost estimator is able to generate a detailed cost estimate that meets the provider's budget, so the project hits the streets for bid. The contractors competing for the work not only price what is included in the Documents, but also make a mental note of what may have been unclear, in error or omitted. They ignore some of the specification requirements, deciding that their more-efficient, less-expensive materials are "industry standard" and should therefore be accepable to the owner and design team. Driven to reduce costs, the healthcare provider awards the project to the low-bidding contractor.

Throughout coordination and construction, the contractor who was awarded the work raises RFI's highlighting the Documents' confusing items, errors and omissions. These RFI's become change orders and add to those generated by the provider in an effort to keep up with ever-changing healthcare equipment technology. Submittals (sometimes) bring to light lesser materials and debates between contractor and designer ensue.

The team is rapidly approaching the scheduled completion date. There are backlogs of RFI's, submittals and change orders and the owner is signing all contractor requests to compensate for increased overtime to avoid schedule overrun.

In California, cost and schedule risks are particularly high since the government has mandated replacement or retrofit of all non-seismic-code compliant, 24-hour inpatient facilities by the year 2014. Non-compliance has serious financial consequences to the provider.

UCSF Medical Center has experienced enough of the traditional design-bid-build approach and has implemented a revolutionary design-assist approach for their new Medical Campus at Mission Bay.
The 3-dimensional CAD models generated by the design team during Design Development have been handed to the contractors. The contractors continue to detail and coordinate the major trades while the design team continues to develop the design and review the contractors' layouts. This integrated effort results in a virtual hospital Building Information Model from which Permit Documents, shop drawings and coordination drawings can be extruded, along with information regarding materials and quantities that are used to track cost metrics.

The most interesting feature of this delivery model is that most of the entire effort is being conducted within a single, large trailer on site, named the Integrated Center of Design and Construction (ICDC). Owner, architect, engineer, contractor, subcontractors, construction managers, code consultants, detailers, estimators and other members of the design and construction teams are functioning as one large team, under one large roof using state of the art CAD, BIM and visualization technologies. It is this effort, part inspired by the space industry, that UCSF Medical Center believes is the most effective means of delivering a large hospital project on time and on budget.

Although this delivery method is being tested in other medical projects, several team members have expressed their opinion that this is the best. The team members would like to share their thoughts and opinions of why this is the case and what can be done to improve this delivery method even more.