Every so often a “new” concept emerges that is so obvious, you wonder why it isn't an “old” concept, or business as usual. For example, with absolutely no historical knowledge to back me up, I'm willing to bet that the amount of time between discovery of the wheel and the concept of placing a vehicle on multiple wheels was not brief. I can just hear that ancient innovator saying, “What was great-grandpa thinking, just using this thing for a toy or a milling device. Duh!”

That's how I feel as I review the growing number of articles submitted to HEALTHCARE DESIGN discussing the need for “teamwork” and “partnership” in executing large, complex building projects. How anyone can approach such a multifarious operation as this in a military-style, command-and-control, top-down process is a mystery to me. How can anyone hope to coordinate such an effort and minimize waste and inefficiency unless everyone gets into the act from day one?

I do remember my own experience with military-style endeavors, and how “top-down” is sometimes more theory than reality. Obedience is required, of course, but in the execution of plans reality often demands innovation and creativity at all levels.

Nevertheless, the command-and-control image of the big building project remains—perhaps not to the extent of Howard Roark-like autocracy, but very much in the “here are the plans, do as you're told” mode of operations. The “design/bid/build” model often seems to demand this kind of apparent authority.

“Design/build,” of course, is changing that, and has been for a while. The firm that both designs and builds its structures is, by definition, integrating the operation and working a common game plan from day one. The model does have its critics—for example, putting too much decision making in one basket, and possibly not offering expert-level performance in both functions—but the seamless coordination promised by the model is highly attractive.

But integrated performance is going beyond that, these days. One cutting edge influence on this has been the emergence of building information modeling (BIM). By sheer ease of visualization and rapid modeling of major design decisions, it is easy—probably mandatory—to bring in all interested parties from the start to see the effects of their plans and desires on the program as a whole, immediately, in real time, without delay or cost. As you will see with this month's new Design Technology department (p. 12), BIM is a technology that cries out for teamwork.

Also emerging is a conscious effort to create all-encompassing working partnerships that collaborate and consensus-decide on virtually all details of a building project throughout. Consultant Jim Eisenhart introduces the partnership concept and its general approach and benefits on p. 22. To see the concept developed in all its detailed working glory on an actual hospital project, I hope you will see our forthcoming Contractor's View supplement next month, with an article on this authored by the McCarthy Building Company.

One look at the benefits that occurred at this project in terms of safety, cost-efficiency, good community relations, and creation of continuing esprit de corps among builders and planners, and you may have your own “Duh” moment. Except this is one paradigm change that probably won't take a whole lot longer to become business as usual. HD


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