On the Advocate Health Care Front: How Project Success moved from “IPDish” to IFOA

Advocate Health Care, one of the largest health systems in Illinois treats more pediatric, heart and cancer patients than any other hospital, operates more than 400 sites of care, 12 acute-care hospitals, a children’s hospital with two campuses, and the state’s largest integrated children’s network – all serving 3.4 million patients. Given its extensive real estate and capital investments, Advocate is constantly seeking the most efficient and innovative project delivery methods possible.

To make its recently opened Advocate Christ Medical Center’s East Tower a reality, the Advocate team leveraged an Integrated Lean Project Delivery (ILPD) approach. Via this delivery system, Advocate was able to reduce change orders, RFIs and construction capital throughout the course of the project while also limiting spend and reducing operating expense through efficient design, less utilities usage and less overall built square footage. Key value add metrics for the project included $6,074,223 in the value of cost reduction opportunities and $2,773,715 in the value of scope enhancements/project risks accepted by the integrated team.

The project has proved remarkably successful for Advocate Health Care and there are numerous lessons other healthcare systems can learn from its execution. Below is a project overview and key lessons learned.

Engage Trade Partners Early

One of the keys to achieving a successful ILPD was the early engagement of trade partners from day one of the design process. These trade contractors assisted in designing and pricing of the various building systems allowing us to provide Advocate Health Care with options that optimized system design value and included long-term value analysis with accurate trade pricing to achieve higher value for the project. It also helped us identify clash detection issues and expedite the design process by working through architectural details in real time.

This effort proved especially helpful in dealing with the new LEED for Healthcare process which demanded greater rigor by both our design team and Advocate Health Care to understand how design decisions impact human health and wellness. Ultimately, the new building uses 28% less water than a typical hospital in Illinois, achieves $259,000 in energy savings annually over code baseline, and facilities 54% daylight autonomy.

Consider Using An Integrated Form of Agreement (IFOA)
The delivery of Advocate Health Care’s new patient tower used an Integrated Form of Agreement (IFOA). Here are some key components of it:

  • A partnership between the entire integrated team is formalized in a single project specific work agreement including the client, all architecture, engineering and construction entities and trades people.
  • The IFOA contract is both procedural and behavioral-based
  • The business terms of the project are established collaboratively between the team members to determine the target value and shared savings approach.
  • Teams are rewarded for collaborative behavior and performance that increases the project value delivered to Advocate Health Care.
  • The financial success of the project and eat participatory company is directly tied to the overall performance of the collective team.

Explore New Methods of Design

Within the realm of IFOA delivery, there are a number of design strategies that can be implemented to achieve success. Given the partnership established by the unifying nature of IFOA delivery, there is more room for experimentation and design exploration. Team should be encouraged to leverage these strategies:

Target Value Design – A Collaborative design process involving designers, builders, suppliers, estimators and owners co-located in one place to collaboratively produce a design that provides the best value for the Owner. In this model, the budget is the target to design towards rather than an outcome of the design process. By leveraging this model with Advocate Health Care, the team was able to reduce costs by $4.35 million.

Pull Planning Design & Construction – Pull planning is the design process through which teams work from a target completion date backward. The scheduling process often exposes the need for smaller batches, just in time delivery, improved leveling of resources and reduced lead times. Our team worked with Advocate to execute this process and it delivered key results and performance outcomes throughout the design and construction process.

Modular Design – Advocate Christ Medical Center also leveraged modular design during the creation of their new patient tower. The use of prefabricated materials helped Advocate eliminate 10 weeks of construction time during the delivery process and has also helped them create higher quality and safer work environments.

One of the key things to recognize about experimentation with any of these design strategies is that you will experience failure at certain points. These strategies welcome new ideas and you may not get them right in the first try. The key is to get back up and keep trying until you get them right, as their value and benefits will become inherent over time.

These strategies and numerous others that have informed the Advocate Health Care project and have made it a dynamic success for the health system. It is a strong example of how integrated project delivery approaches can drive immense value for healthcare organizations, systems and projects.

Featured Post


10 Easy Ways to Run a Lean Meeting

I try to apply “lean thinking” into all aspects of life, not just to work and certainly not just to construction projects (if you ever meet me in person, ask me to tell you how I manage my family’s weekly grocery list). When trying to inspire lean thinking in others, I encourage them to pick something that bugs them – it doesn’t matter what it is – and work their way backwards from there. The goal is to make life easier by reducing waste and/or add value; finding ways to simplify the process by speeding up or eliminating steps and handoffs wherever possible.

Lean TransformationRead more


The Human Factor in the Implementation of the Last Planner® System

The aim of this post is to describe, from experience in Argentina, the impact the Last Planner System (LPS) had on a group of responsible people involved in a project. Implementing the LPS raises different types of technical and human factor challenges. Regarding technical matters, LPS improves productivity, fulfills the terms of agreements between last planners, and reduces variability. Above all and most importantly, production is planned focusing on flow and value. In this post, we will approach the human factor challenges highlighting how correctly implementing the five elements of LPS - i.e. should; can; will; did; and learn - transforms a group of people in a work team.

Lean TransformationRead more


Owner Criteria for Lean Provider Selection

A popularly quoted and important concept is that "Lean Transformation is a journey, not a destination". At the 2016 International Congress on Lean Construction, people at all stages of the journey were on display: beginners, in-progress implementers, advanced practitioners, etc. How can an Owner distinguish between the levels of Lean and Integrated Project Delivery (IPD) experience when selecting AEC team members for a project? As an "ILPD" Coach, here are 5 questions that I recommend my clients to ask when selecting their Lean service providers.

Lean TransformationRead more

Copyright © 2015- Lean Construction Blog