If there is anything we should learn from this economic collapse, it is that risk costs money! Health care organizations must begin to understand that the default AE/CM process is fraught with risk for which the hospital pays. The risk premium price today is higher than it may have ever been in modern times. Design-build with a lump-sum negotiated price, is the only system that can effectively mitigate this risk.

There is a common misperception among those in the AEC industry, both on the consulting side and in the Owner’s arena, that design-build is not a suitable project delivery method for large projects. There is a “line in the sand” that is often drawn by the industry, which is based on a lack of understanding. This perception is a paradigm whose supporting rationale has long since become obsolete. While the design-build results speak for themselves, individuals who maintain their resistance are typically people who overvalue their individual right to sit in judgment, charging the burden of proof with those who would challenge the status quo, regardless of how many times the status quo may fail. In the meantime all of the potential advantages and efficiencies which would be made available to their healthcare organizations lie untapped. Those who maintain the line in the sand often do so in their own interest, and perhaps rightly so, since their contributions often rely on the faults of the status quo AE/CM delivery method. Now, more than ever in our lifetimes, it is critical that all organizations find ways to increase efficiency, eliminate waste, and increase value. In order to do this, there will be some casualty and discomfort. It is the nature of the process, but there is little choice but to delay, prolong and exacerbate the inevitable. Alan Burcope, AIA, MBA, LEED-AP