Health Matters: The value of design assist partners

Mark Bultman, Associate AIA


The practice of engaging sub-contractors early in project development as Design Assist Partners is becoming a common method to improve the project delivery and achieve greater financial value for healthcare facility Owners. By providing the team with timely input on pre-fabrication, sustainability, BIM, schedule and budget, Design Assist Partners place the right information in the hands of the right people at the right time to improve the reliability of decision-making, eliminate loopbacks, and improve schedule and budget predictability.


Let's look at key components of the Design Assist process in which the team collaborates to maximize project value:

Pre-Fabrication: The team identifies opportunities within the project to pre-fabricate components. Pre-fabrication off-site maximizes quality, minimizes on-site material handling, and expedites installation time. By soliciting the input of the Design Assists early, the team can maximize the opportunities and ensure that the details of design will facilitate pre-fabrication. Through this collaboration, the team increases value derived from both design and construction.

Sustainability: Achieving a high-performance building is the result of the team collaborating to develop sustainable strategies that minimize both first cost and long-term operating cost. The Design Assists provide support evaluating innovative solutions for cost, reliability, maintenance and natural resource consumption so the team can determine which systems, materials and construction methods deliver the highest value.

BIM/Project Documentation: During the Design Phase, the ongoing input of the Design Assist Partners around constructability and efficient routing of systems ensure that the final design model is well coordinated and suitable for being developed into shop drawings and fabrication drawings. The BIM Execution Plan defines who draws what so that duplication of effort is minimized and the highest value from the design and delivery process is derived.

Schedule: The collaboration with the Design Assists on pre-fabrication, sustainability and BIM informs the development of the project schedule. The team uses Pull Schedules to determine project milestones and information hand-offs that streamline the efficiency of the design and construction process.

Budget: Throughout the design process, the Design Assist Partners collaborate with the team to provide real-time input on how options impact the budget through on-going discussions around pre-fabrication, sustainability, BIM, and schedule. This collaborative teamwork effectively eliminates the traditional value engineering process at the end of each phase and provides the team and Owner with the confidence that design decisions will be delivered.


Key topics to consider when developing a Design Assist process are pre-construction costs, maintaining competition, scope of services, and organizing preferred Design Assists. Below are details on each step:


Construction Management: The time required for the Construction Manager to manage the Design Assists during pre-construction will be funded through reallocation of the general conditions. The Design Assist model results in fewer change orders than the design/bid/build model, and the resources traditionally reserved for that can be shifted to pre-construction.

Design Assist Partners: The pre-construction costs for the Design Assist Partners are included within their respective component team targets. The value returned to the project through their involvement in pre-fabrication strategies, sustainability, BIM, schedule and budget efforts results in the Owner realizing the highest value for the project.


The selection of key sub-contractors involves a competitive interview process that includes each sub-contractor proposing a fee and providing a project estimate for their scope of work.

Selection of Design Assists: A detailed RFP is issued to invited candidates and each is asked to prepare a response. On the basis of the response, a short list of candidates is selected for interviews. A scorecard is utilized during interviews to facilitate an objective review of each candidate around criteria such as fee, experience, team leadership, estimating ability, familiarity with Design Assist project delivery, ability to innovate, and proposed schedule. The awarded partner then proceeds on a cost-of-the-work-plus-fee basis. Should a partner not fulfill expectations, their contract stipulates that they can be compensated for services performed and released. This provides accountability within the Design Assist arrangement.

Bidding: The Design Assists provide labor for their scope at a known cost determined in the competitive interview process. A competitive bid process is used for selection of any additional sub-contractors that are required and likewise for any purchase of materials, supplies, and services. As a result, apart from the labor associated with the Design Assist sub-contractors, everything else is competitively bid.


During the Design Phase, the Design Assist Partners support the design team by providing regular input on schedule, cost, constructability, and pre-fabrication. This input is provided through the following mechanisms:

Component Teams: Regularly scheduled component team meetings serve as the primary outlet through which formal communication between the design team and sub-contractors occur. They provide ongoing input as content experts on schedule, budget and constructability to ensure that all factors are considered as decisions are made. This eliminates loopbacks.

Integration Events: As the design progresses, integration meetings facilitate collaboration and communication between the component teams. These are topic-specific meetings held to facilitate decision-making and information hand-off between teams. The sub-contractors provide input on constructability, cost, pre-fabrication, and schedule. Their input is valued by the design team as it allows them to make design decisions with the confidence that they will meet all of the criteria for a successful project.

Pull Schedule Sessions: At key points within each design phase, the team conducts Pull Schedule sessions to set project milestones and determine how decisions and information flow between milestones. This is the case for both the Design Phase and the Construction Phase, and the Design Assists equally participate and provide input.

BIM Meetings: As the Building Information Model (BIM) is developed, the Design Assist Partners participate in review and development sessions. They provide input on detail development, routing, sizing, etc., in conjunction with the coordination around documentation development.

Informal Meetings: Periodically, work sessions occur within the offices of the various disciplines to focus on detailed design development, information sharing and collaboration to ensure that all partners remain informed about progress and are able to provide the right input at the right time.


The Design Assist Partners generally fall into three tiers, and the specific Design Assists vary by the complexity and demands of each project.

Tier 1: Mechanical, Electrical, Plumbing and Structural - These are among the earliest Design Assist Partners engaged, generally entering during the mid- to late-Schematic Design.

Tier 2: Exterior Wall, Roofing and Specialty Foundation Systems - These Design Assist Partners generally enter during the early- to mid-Design Development stage.

Tier 3: Elevator, Casework and Ceiling - Design Assist Partners enter during the early-to-mid Design Development phase.


Design Assist Partners help achieve an efficient, high-performance project delivery. With the support of Design Assists, the team can maximize innovation and project value while lowering risk-ultimately benefitting the Owner and building users.

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