A regional healthcare provider needed a new primary care clinic open before its lease elsewhere expired, and it had roughly ten months to make that happen. By running the project as a single design-build contract instead of a traditional design-bid-build, the team compressed the schedule by an estimated 12 weeks, absorbed two mid-project scope changes without a change order dispute, and delivered the finished clinic about 4% under the approved construction budget. The mechanism was simple: one contract, one accountable team, and design decisions priced in real time by the people who would actually build them.
Here is how that played out on an outpatient project in the Piedmont Triad, and what other healthcare owners can borrow from it.
The Situation: A Hard Opening Date and a Soft Program
The client had signed a physician group, ordered imaging equipment with a fixed delivery window, and told the community when the doors would open. What they did not have yet was a finished floor plan. The exam room count was still moving, the imaging suite location was undecided, and the site itself needed civil work before a foundation could go in.
Under a traditional path, that ambiguity is expensive. You finish drawings, bid the job, discover the number is over budget, redesign, rebid, and lose two to three months. With a fixed opening date, that path was not available.
What We Tried: Design-Build with Early Trade Input
The team wrote a single contract covering both design and construction, with Hayco as the design-builder. Three moves did most of the work.
Concurrent Design and Site Work
While the architect was still refining the interior program, sitework, underground utilities, and the building pad moved forward against a 60% site package. Vertical construction started about six weeks earlier than a sequential bid process would have allowed.
Trade Partners at the Table During Design
The mechanical and electrical subcontractors reviewed drawings at schematic design, not after award. When the imaging suite moved to a different corner of the building, the electrical contractor flagged a service upgrade in the same meeting, and the cost delta was priced within a week. In a bid environment, that same change would have surfaced as an RFI, then a change order, then a fight.
One Contract, One Number, One Throat to Choke
The owner did not have to arbitrate between an architect blaming a contractor and a contractor blaming an architect. Every question routed to one project manager with authority over both sides. Decisions that would have taken a two-week loop closed in two days.
What Happened: The Specifics
The clinic reached substantial completion 11 days before the equipment installation date, giving the medical team a full window to commission imaging, IT, and casework before staff training. Final construction cost came in roughly 4% under the guaranteed maximum price, and the underrun was returned to the owner per the contract’s shared-savings clause.
Two changes worth naming:
- A relocated nurse station added about $18,000 in casework and data drops. Because it was priced against open-book subcontractor pricing, the owner approved it in one meeting.
- A civil scope reduction, where a retaining wall was replaced by a graded slope after a geotech re-review, saved about $46,000, which offset the nurse station change and then some.
Neither of those would have been easy in a hard-bid environment. Both were routine here.
The Reusable Takeaway for Healthcare Owners
If your project has a fixed opening date driven by equipment, staffing, or a lease, design-bid-build is working against you. The value of design-build in healthcare is not just speed, it is the ability to keep making decisions after the shovel is in the ground without every decision becoming a contractual event.
Three practical things to ask for on your next project:
- A guaranteed maximum price with a shared-savings clause, so the contractor is rewarded for underruns rather than protecting a fixed fee.
- Open-book subcontractor bidding, so scope changes are priced against the same numbers the GC sees.
- Trade partner involvement at schematic design, not after permit.
Hayco has delivered outpatient clinics, medical office buildings, and hospital renovations across North Carolina and the broader Southeast under this model. If you have a hard opening date and a program that is not fully settled, that is exactly the situation design-build was built for. Start with a look at our healthcare project experience or get in touch to walk through your schedule.