insights

imageRethinking Project Delivery:Integrated Teams Help Manage Risk, Maximize Investments
This story begins with a move across the street. Ultimately, though, it’s a story about more than a change of address. Shands Cancer Hospital is the story about a shift in attitude and approach that yielded remarkable results.

Shands HealthCare had a hospital on the University of Florida campus in Gainesville. Operating at capacity, Shands at UF ran the risk of being unable to meet the growing demand for cancer care. Hospital management had remodeled and carved space from the existing hospital to add beds a half dozen at a time. The need, however, was growing faster than Shands could respond. The American Cancer Society estimates that Florida will see 100,000 new cancer cases annually, and Shands HealthCare will provide cancer treatment to 1 in 7 Floridians.

Facing this reality, Shands decided to “jump the street” and create a new South Campus on the other side of SW Archer Road.

The move made sense strategically. By bringing most adult cancer care under one roof, doctors could better meet the growing need for cancer care and collaborate more fully on individual patients and their treatment plans. Yet developing a new South Campus would prove to be no small task. It required extraordinary vision and a unique approach to the traditional design and construction process.

Shands partnered with Flad Architects and general contractor SkanskaUSA. Together the three organizations worked as a noncontractual integrated team to create a long-term expansion plan and then design and build the first phase of that plan. Operating on principles of shared risk, budgeting transparency, mutual respect, and collaborative problem-solving and conflict resolution, the integrated team delivered a $364 million, 500,000-square-foot building in 48 months—shaving a year off the traditional timetable for a project of this size and scope.

Laura Stillman, Flad principal and national leader of its health care group, says the nontraditional process—which she expects to become a new model for the construction industry—worked because the owner, architect, and builder were all equally committed to the approach, timeline, and product.

“There was nothing adversarial about this process or these relationships. This was truly an integrated team,” Stillman says. “Everyone was publicly accountable, project leaders had the authority to make decisions and take action, and an atmosphere of cooperation and collaboration was maintained by constant vigilance.”

The shared goals, incentives, and rewards of an integrated team give each team member a stake in each other’s success. Without the need to protect individual interests, deflect blame, or expose others’ inefficiencies or errors, team members were freed and motivated to direct all energy and resources into efforts that moved the project toward completion.

“Shands has always had a belief in team,” says Brad Pollitt, vice president of facilities for Shands HealthCare. “I felt confident that if we hired the right people, this would work.”

The right people had to share Pollitt’s commitment to innovation. After all, an integrated team required a fundamental shift in attitude and approach toward project delivery. Each team member would have to shed expectations and assumptions and approach the project with no preconceived notions about the other team members or their roles.

Stillman says Flad embraced the opportunity. “Our overriding differentiator is strategic approach,” she says. “Medical planning and design are expected to be excellent. Beyond that our firm customizes each service to the strategic need of the client. This client wanted an integrated team, which requires not only a different attitude, but also a different staffing model. Flad was committed to both.”

At the outset, the integrated team had to establish shared goals, objectives, standards, and expectations. They had to adopt uniform approaches and communication strategies so that all staff could work together, across organizations, and unencumbered by traditional hierarchies. They then had to maintain these approaches and strategies for the duration of the process.

If the team failed, the process itself would fail. If the process failed, the benefits and efficiencies of integration would be undermined or lost altogether. With Shands, that never happened because of rigorous methodology used to ensure that the shift in organizational structure lost none of the rigor necessary to achieve all design, budgeting, and timing goals of the building program.

“Standards were higher, not lower,” says Stillman, “and we developed tools and systems to ensure that those standards were met and maintained throughout the project.”

Indeed, vigilant project tracking and ongoing measurement kept the team focused on progress and goals. Flad utilized several specific project delivery tools to evaluate individual and collective performance and to identify issues that required additional attention.

A custom Scorecard allowed the team to routinely and consistently revisit and measure progress toward project goals. The tool assessed hard metrics (including deadlines, budgets, RFIs, and other quantifiable factors) along with soft metrics (including organizational readiness, plan quality, and clarity of goals). All project goals were broken down into discrete objectives that were periodically ranked as “high performance,” “mid-range performance,” or “low performance.” Scorecards allowed the team to not only measure performance on specific items, but also to capture data to track changes in performance to ensure continued excellence or improvement when and where necessary.

Other tools included a Total Project Budget, Cost Event Log Tracking, Future Cost Events (which projected cost analysis at key milestones) and Special Studies (used to verify early cost estimates throughout the project). As a result, at every juncture all team members knew exactly where they stood in terms of budget, performance, deliverables, and quality. The tools also made clear all expectations moving forward, and this reinforced accountability across the entire team.

Ultimately, the integrated team is more than a different approach — it is an excellent strategy to meet and exceed client expectations and program goals. Here the accelerated timeline allowed Shands to save construction costs and accelerate market-share penetration and growth with a design that reflects its organizational commitment to patient-centered care.

“This was an expansion project, but it became much more than that,” says Brad Pollitt, vice president of facilities for Shands HealthCare. “It has changed Archer Road. It has set up a new campus. Everyone who sees it is amazed. It is overwhelmingly impressive.”

Shands partnered with Flad Architects and general contractor SkanskaUSA. Together the three organizations worked as a noncontractual integrated team to create a long-term expansion plan and then design and build the first phase of that plan.At the outset, the integrated team had to establish shared goals, objectives, standards and expectations.Related LinksGallery Images of Shands Cancer Hospital


Flad Architects, Skanska USA, University of Florida, Gainesville, Archer Road, Laura Stillman, nontraditional process, architect, builder, shared goals, incentives, Brad Pollitt, strategic approach, expectations, medical planning, tools, project tracking, scorecard, project budget, flad_health_change