Integrated Project Delivery (IPD) is the highest-collaboration delivery model in healthcare construction: a single multi-party relational contract that binds the owner, the architect, and the construction manager/general contractor (and often the key trade contractors and major engineering firms) into one agreement governed jointly, with shared financial risk and reward. IPD aligns every signatory's commercial interest with the success of the project as a whole rather than the success of any one firm, which is what distinguishes it from the transactional models (Design-Bid-Build, CM at Risk, Design-Build) where each party optimizes its own scope and protects its own margin.

IPD is a relational, multi-party agreement — not a delivery sequence

In the transactional models, the owner holds separate bilateral contracts — one with the designer, one (or many) with the builder — and risk is allocated by pushing it down the chain through change orders, claims, and contingency. IPD replaces that web of bilateral agreements with one multi-party contract that the core team signs together.

The defining features of the relational agreement are:

• Three (or more) signatories on one contract. At minimum the owner, the lead designer (architect), and the lead constructor (CM/GC) are parties to the same agreement. On larger acute-care programs the contract commonly extends to the structural, MEP, and medical-equipment designers and the major trade partners (mechanical, electrical, plumbing, fire protection, low-voltage) so the people who actually carry the cost and schedule risk are inside the risk/reward structure.
• Aligned, not adversarial, incentives. Compensation is structured so that the team members make (or lose) money together based on project outcomes — not on the volume of work or change orders each individually generates. Direct costs are typically reimbursed; profit is pooled and put at risk against jointly agreed targets.
• Mutual waiver of liability among the team. IPD agreements include a no-suit / liability-waiver provision (with carve-outs for willful misconduct, insured losses, and warranty obligations) so that team members collaborate openly without fear that surfacing a problem creates a claim against them. This is one of the most consequential cultural shifts the model introduces.
• Early involvement of everyone who matters. Constructors and key trades are brought in during design — not after a completed set of documents is bid — so means-and-methods, cost, and constructability knowledge flow into the design while it is still cheap to change.
• Collaborative decision-making and transparency. Open-book costs, shared models, and consensus-based governance replace the information asymmetry that drives disputes in transactional delivery.

The standard industry contract families that codify these features are the AIA C191 multi-party agreement and the ConsensusDocs 300 family. (The lighter-weight AIA C195 single-purpose-entity approach and various owner-authored relational agreements exist as well.) The detailed mechanics of the risk pool, profit-at-risk, and target cost live in the sibling Article on contract and risk structure; this Article stays at the model and governance level.

The collaborative governance structure organizes the team into tiers

IPD does not run on a traditional owner-led command chain. It runs on a shared management structure in which decisions are pushed to the lowest competent level and escalated by consensus. Most IPD programs organize governance into three tiers (names vary by contract family, but the structure is consistent):

Two structural principles hold this together:

• Consensus governance with unanimous escalation. The SMT (and frequently the PMT) acts only when the core parties agree. Because no party can be outvoted, every party has both a veto and an obligation to find a workable answer — which forces issues to be solved on the merits rather than by contractual leverage.
• Decisions pushed to the lowest competent level. The cluster groups are empowered to make most design and coordination calls. Only what they cannot resolve rises to the PMT, and only what the PMT cannot resolve rises to the SMT. This keeps decision velocity high and keeps senior leaders focused on genuine conflicts.

In practice the governance structure is operationalized through co-location (the "big room" / co-located team) and Lean working methods (the Last Planner System, pull planning, A3 problem-solving, Choosing By Advantages for set-based decisions). Co-location and target-value design are covered in their own sibling Articles; the point here is that IPD's contract structure requires an active governance body to function — the agreement alone does not deliver collaboration, the team operating model does.

The model proceeds through validation-gated phases

IPD reorganizes the project timeline around a small number of collaborative phases, with a critical validation gate early that the transactional models do not have. While naming varies, a representative IPD phase sequence is:

1. Conceptualization — the core team is assembled and aligned; the owner's business case, program, and conditions of satisfaction are established. (This is where team selection and onboarding happen — covered in the procurement sibling Article.)