Whitaker says design-build initially arose because of demands by owners for a more efficient process and a single source of responsibility for project delivery. "That is why we are seeing design-bid-build continuing to wither away as sophisticated owners increasingly understand and adopt more efficient delivery models."

Alternative project delivery is making a comeback in markets that finally are beginning to recover after a long time in the doldrums. For example, commercial office, multi-unit residential and higher education work, prime markets for CMR, have taken off over the past couple years.

However, there are new markets that are beginning to open up as owners see the benefits to a more streamlined and team-oriented approach to project delivery. "We have finally begun to see design-build take off in the healthcare sector," says Whitaker. He says that healthcare clients in the past had been more focused on the project outcome, rather than on costs and schedules in construction. "However, in the current uncertain healthcare climate, owners are becoming more focused on the value proposition, and are taking a closer look at delivery systems," he says.

An example of alternative project delivery in health care is Lend Lease. The firm is serving as project developer, design-builder and long-term property manager for the new Dept. of Veterans Affairs Healthcare Center in Kernersville, N.C., says Jeff Arfsten, managing director of project management and construction. The 375,000-sq-ft, four-story healthcare center with more than 1,900 parking spaces will include dental, diagnostic, laboratory, pathology, radiology and other ancillary services. Arfsten says this is the first major project from the firm's new "integrated offering" practice outside of its work on military housing for the U.S. Dept. of Defense.

Integrated project delivery (IPD) is rising, slowly. "We are involved in some cutting-edge IPD projects," says Michael Kuntz, senior vice president of Turner Construction. He notes Turner and DPR Construction joint-ventured under an IPD on a 140-bed hospital in Temecula, Calif., for Universal Health Services.

But some are skeptical about broader use of IPD. "We are seeing most of the activity in IPD projects from the big healthcare providers, like Sutter Health," says Whitaker. He says that, while there are elements of design-build in IPD, the delivery process loses some of the benefits of design-build. "IPD springs from the desire to make everyone equally accountable, but there is no single source of responsibility, unlike with design-build," Whitaker says. He also says IPD usually does not account for a lot of the measurables in cost and scheduling expected in a design-build project.

Public-private partnerships (P3s) are giving a boost to alternative project delivery. "Design-build is inherently a part of any P3 project," says Lisa Washington, CEO of DBIA. She says that, by using design-build, P3 teams do not need to "reinvent the wheel" on project delivery: The P3 financing partner only needs to assemble a team experienced in design-build, she says.

Whitaker agrees that design-build is embedded in any P3 project. However, he warns that members of any P3 team must be sophisticated not just in their role in the project, but also in overall project economics. "Concessionaires are not architects, engineers or contractors. They are businesspeople [who] require project decisions to be made in a businesslike way."

Meeting Infrastructure Needs

The market for design-build and other alternative project delivery methods has continued to expand into infrastructure. Ten years ago, people began to take notice that state departments of Transportation (DOTs) were opening up to the idea of design-build. Now, design-build is commonplace in transportation.