Due to the complexities and long lengths of time that are involved with the development of most healthcare building projects, many of our project teams are realizing the advantages of engaging key subcontractor trades in design-assist arrangements. The benefit of this collaborative approach to formally involving certain trades in the preconstruction process overall, is better, and allows for earlier decision making by the project team. Specific positive results can include improved cost estimating accuracy, better systems evaluation and selection, more detailed design information earlier, more extensive and meaningful constructability reviews, and savvier procurement planning with prepurchasing options.

However, these benefits have not come with out a significant amount of applied experience and planning from our healthcare builders. Some of the lessons we have learned in our experience with design-assist services include:

• Select the right trades depending on the needs of the project scope and team capabilities. Typical design-assist trades on healthcare projects include HVAC/plumbing, electrical/low voltage, fire protection, exterior wall (curtainwall, masonry, etc.), structure, interior framing/drywall, and perhaps pneumatic tubes.
• Use the appropriate selection process and agreement format for the situation. For example, an emphasis on conceptual estimating and design experience with a professional services agreement may be more important when engaging a design-assist partner at the early programming/conceptual design phase of a project. Whatever the priorities and agreement approach, a thorough RFP process should be used that engages the entire project team.
• Define and set clear expectations of the design-assist subcontractor for scope, staffing, and participation as a project team member from the beginning. Manage the design-assist subcontractor as you would a member of your own healthcare preconstruction team.

While the additional expense for design-assist services in the preconstruction phase is sometimes hard for a healthcare client to accept, we have demonstrated paybacks in terms of project costs and schedule savings in the range of 2 to 10 times the amount of the investment. What experiences have others had with design-assist?