Health care organizations planning major capital projects, such as hospital expansions, surgical centers and outpatient facilities, often face familiar frustrations: delays, cost overruns, redesign cycles and coordination breakdowns. Traditional delivery models like design‑bid‑build or construction manager‑at‑risk can unintentionally reinforce silos. Integrated Project Delivery Agreements (“IPDA”) offer a collaborative alternative designed to align incentives, reduce waste and improve project performance.

What Is an IPDA?

An IPDA is a single, multi‑party contract that binds the owner, architect, contractor and key consultants to shared financial outcomes. Unlike traditional models with fragmented risk allocation, an IPDA unites the entire project team around common goals for cost, schedule and quality. Industry research shows that Integrated Project Delivery helps teams avoid the inefficiencies of milestone‑based design by applying Target Value Design (“TVD”) from day one, resulting in fewer redesigns and significantly fewer change orders. TVD flips the traditional process by setting budget targets upfront and evaluating every design choice against them. This approach fosters transparency and early problem‑solving, thereby reducing the adversarial behaviors that often arise when teams work in silos.

Why an IPDA Is Well‑Suited for Health Care Projects:

Health care construction is uniquely complex. Projects must consider patient safety, regulatory approvals, infection control, equipment coordination and ongoing clinical operations. Early involvement of all stakeholders, such as clinical teams, regulatory experts, designers and builders, in an IPDA mitigates compliance risks and avoids late‑stage revisions.

Key Advantages of an IPDA:

  1. Innovation and Efficiency. Integrated Project Delivery encourages the use of tools such as Building Information Modeling (“BIM”) and lean workflows. BIM is a data‑rich digital platform that integrates real‑time information about building systems, materials, costs and scheduling into a single coordinated model. By allowing designers, engineers, contractors and owners to work from the same continuously updated source, BIM reduces rework, enhances coordination and provides clearer visibility into clinical layouts, equipment placement and overall system interaction.
  2. Predictable Budget and Schedule. An IPDA aligns incentives and minimizes disputes, helping keep budgets and timelines on track. Its lean‑driven coordination and ongoing budget checks also reduce the need for large contingencies.
  3. Higher Design Quality. Collaborative input, especially from clinical users, improves functionality and reduces post‑design rework.
  4. Reduced Risk of Claims. The shared risk/reward model and joint decision‑making significantly reduce change orders and disputes.

Challenges and Considerations:

  1. Front‑Loaded Effort. Owners must commit more resources early and align with the team during project validation sessions, making strong coordination essential to avoid overwhelming already-stretched owner departments.
  2. Complexity of Multi‑Party Contracting. An IPDA requires trust and disciplined governance across many participants.
  3. Cultural Shift. Teams accustomed to siloed workflows may resist the transparency and collaboration that an IPDA requires.
  4. Financing and Insurance. Some lenders still prefer traditional contract structures.

When an IPDA May Not Be the Right Fit:

An IPDA is not ideal for every project. It tends to be less effective on smaller projects with highly predictable scopes, where the added structure and collaboration requirements may offer little benefit. Likewise, IPDA may not suit owners who prefer rigid oversight, competitive bidding or more traditional contractual arms‑length relationships. Projects constrained by tight financing or limited time for early‑phase collaboration also struggle under the Integrated Project Delivery model, which requires meaningful upfront planning, resource commitment, and team alignment to function well.

Practical Takeaways for Health Care Owners

To strengthen any IPDA, clients should incorporate clear governance and decision‑making protocols, account for regulatory review timelines, define BIM data ownership, establish collaborative dispute‑resolution mechanisms and set measurable performance metrics early in the process. And because IPDA is not a universal solution, owners who prefer more traditional structures, or whose projects lack the time or financing needed for robust early‑phase collaboration, may benefit from exploring a hybrid model that blends collaborative practices with familiar delivery frameworks.

As health care projects grow increasingly complex, delivery models like Integrated Project Delivery offer a viable pathway to more predictable, collaborative and value‑driven outcomes. An IPDA can be highly effective when it aligns all major participants around shared goals, risks and rewards, particularly in complex health care environments that demand tight regulatory and operational coordination. Beyond measurable improvements in cost and schedule performance, many health systems also find that IPDAs cultivate a more positive project culture. Teams often describe greater trust, more effective communication and an increased willingness to innovate. These cultural gains can translate into smoother construction, better‑informed clinical environments and a stronger foundation for future capital planning. Success, however, depends on an organization’s cultural readiness, early stakeholder engagement and disciplined governance, making it essential to evaluate your team’s capacity for transparency and collaboration before committing.

If you have any questions or would like more information, please contact:

Special thanks to Summer Associate Landon McCall for his assistance in the preparation of this article.

Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.

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