As the adage goes, can you only get just two? For decades, Design-Bid-Build has been the standard approach to healthcare construction. But today’s healthcare environment looks very different from what it did even a decade ago.

Health systems are balancing tighter capital budgets, swelling regulatory requirements, rapidly evolving technology, and more pressure to deliver projects faster without compromising care. As a result, many organizations have begun asking the question: Is the traditional Design-Bid-Build model still the best fit?

The answer isn’t simply yes or no. Instead, healthcare leaders should understand the strengths and limitations of each delivery method and choose the one that best aligns with the complexity, timeline, and goals of their project.

Why the Traditional Model Is Being Challenged

The Design-Bid-Build process follows a straightforward sequence. A need is identified — perhaps a physician office expansion or imaging equipment replacement. The healthcare organization develops a budget, hires an architect to complete the design, and then sends finished drawings out for competitive bids. The challenge is that contractors often aren’t involved until the design is complete. By that point, construction costs may have shifted due to labor availability, material pricing, or unforeseen building conditions — I call that the “oh no” moment. Nobody wants to go back to the planning committee or the board for more money.

When that happens, organizations are often forced into difficult decisions:

For hospitals, those delays carry real financial consequences. Every day that a new operating room, imaging suite, or emergency department remains under construction is another day it cannot generate revenue or serve patients. The economics of operating room time help put that impact into perspective: A 2026 study published in Optimed reported net contribution margins ranging from roughly $8,000 to over $10,000 per hour of actual operative time for lucrative elective procedures (like orthopedics or soft tissue operations), once variable costs are subtracted. They underscore the significant financial value attached to clinical capacity and the importance of getting critical spaces operational as quickly as possible.

New Methods Meet the Demands of Modern Healthcare Delivery

Healthcare construction has become significantly more complex. Projects now involve more stakeholders than ever before, and healthcare organizations are under pressure to maximize every capital dollar while minimizing disruptions to patient care.

That’s why many organizations are moving toward delivery methods that bring architects, contractors, and owners together at the beginning of the project rather than at the end of the design phase.

Design-Bid-Build

Design-Bid-Build remains an effective option for smaller, less complex projects with clearly defined scopes. Examples include:

When scope is well understood and changes are unlikely, Design-Bid-Build provides a familiar process with competitive bidding after design is complete.

Design-Build

In a Design-Build approach, the owner contracts with a single Design-Builder, who manages both the architectural and construction teams. Rather than bidding on completed drawings, organizations are selecting the team responsible for delivering the project. Because contractors are involved during design, pricing becomes more reliable throughout the process. Construction expertise informs design decisions in real time, helping reduce redesigns, shorten schedules, and better account for unforeseen conditions.

This approach is especially effective for projects involving significant imaging equipment, major renovations, and projects where speed is critical. When done with an open-book process, the hospital can still see a competitive process, critical, especially to networks with community-based scrutiny.

Construction Management

Construction Management introduces construction expertise early while maintaining transparency throughout the process. Construction managers provide real-time cost estimating, coordinate subcontractor bidding, and help owners understand pricing as decisions are being made. An open-book approach gives healthcare organizations greater visibility into project costs while allowing them to remain actively involved in contractor selection. When done with an open-book process, the hospital still has visibility into a competitive process. Early site investigations and ongoing budget validation can significantly reduce surprises once construction begins.

Integrated Project Delivery

Integrated Project Delivery takes collaboration even further. Instead of each party operating under separate objectives, owners, designers, and builders work as an integrated team with shared goals, shared risks, and shared rewards.

Integrated Project Delivery has gained significant traction on large, highly complex healthcare projects, particularly on the West Coast, where organizations have used the model to improve collaboration and reduce costly conflicts during construction. A budget is determined early during the process. Valued subcontractors are also brought into the design process early to help with timelines and infrastructure coordination. In a true Integrated Project Delivery contract, savings below the original budget are shared by the team members upon project completion.

A Practical Decision Framework

When evaluating a healthcare construction project, a few key questions can help select a delivery method:

Project complexity is a good place to start when considering a delivery method. On one end of the spectrum, a straightforward lobby refresh may be well suited to Design-Bid-Build. On the other, complex projects like operating rooms and emergency departments require greater coordination, stakeholder involvement and specialized equipment. For these high-acuity environments, collaborative delivery models can better balance schedule, cost and quality.

The Bottom Line

Design-Bid-Build is far from obsolete. It continues to serve many healthcare projects well, particularly those with straightforward scopes and limited complexity. However, today’s healthcare environment demands greater speed, cost certainty and earlier collaboration than traditional procurement methods were originally designed to provide.

As projects become more technically complex and operationally critical, healthcare organizations are increasingly finding value in bringing designers, contractors and owners together from day one.