IDB Not a Trip to the Doctor

Posted on June 21, 2010

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One of the many analogies in favor of integrated design-build (IDB) over traditional project delivery systems is the current healthcare billing catastrophe. 

Those who have participated in non-routine medical treatment know what I mean when the bills start coming:  bills from the hospital, the physician’s group (who subcontracts through the hospital), any specialists (billed separately, natch), the lab, the pharmacy…you get the picture.  You quickly realize that what we call a health care system is not a system at all, but a collection of independent contractors looking out for themselves. 

Not only is this apparent in billing, but it can read through in care also.  Diagnosis in silos can be defensive and uncoordinated, uncollaborative and reactive, taking a path of least resistance.  It may be easy to order a bunch of tests and punt to the next specialist, but it is surely not cost-effective. In an effort to ‘do no harm’, the servicers ‘provides no help’. Piecemeal healthcare can be like the Wizard of Oz:  intimidating from the outside, but hardly impressive from the inside.  Does this sound like a familiar experience with past design and construction project teams?

Teams who practice ‘defense first’ project management, who operate by worrying about their risk exposure above all else, do not serve the client best.  The client is number one, always.  Expertise and confidence pair to deflect risk by providing excellent service and value-decision power to the owner.  The more comprehensively and completely a job is done, and the more a client impressed, the less likely the owner is to find fault with the work. 

Common design-build (DB) and design-bid-build (DBB) setups are Rube Goldberg devices— arrangements that feature a bunch of individual moving parts (working for different pots of money) but tentatively and temporarily, glued together contractually. Their rickety structures look novel, but the outcomes are in doubt as you watch them work.

IDB, the kind of design-build not contractually-based but based in an ownership model, is quite the opposite. It is everything make-shift teams and healthcare billing is not:  organized, comprehensive and takes care of project concerns by providing control through decision-making owners seek.

What healthcare provider “teams” do not realize is that poor service reflects poorly on service, in this case the care provided.  Billing may not be directly in control of the doctors, but it is substandard and leaves a bad taste in the mouth of the person who pays—the patient—or in the case of building projects, the client. It is no wonder people liken bad experiences “like a trip to the doctor”.

When an owner chooses integrated design-build, they will receive a maximum choice, maximum flexibility, maximum control experience that delivers a turnkey project solution—and an experience that is unlike “pulling teeth”.

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Posted in: Design-Build