Delivery methods vary from project to project. For complex schedule- and capital-intensive facilities such as large hospitals, construction management at-risk with design-assist is typically the option of choice.

"Because we want the process to go quickly and accurately the first time, we rely on major subcontractors for input on construction documents," Sanders says. For smaller and less complex projects, including parking structures and office buildings, "we've been using sealed bids," he says.

Design-build also figures into the mix, allowing Houston Methodist to expedite modifications to existing freestanding emergency departments according to a prototype design. To date, it has executed the strategy at four locations, the most recent being the 9,600-sq-ft Cypress Emergency Care Center, a facility that will include 10 treatment rooms, general radiology capabilities, CT imaging, ultrasound and full onsite laboratory services when it opens later this year.

"[Houston Methodist] supports methods that enhance efforts to complete projects because they fully understand that traditional processes can be wasteful," says Tom Vaughn, CEO with Houston-based contractor Vaughn Construction. Vaughn estimates that his firm has worked on projects for Houston Methodist totaling 4 million sq ft and $750 million.

Fundamental to the owner's approach is standardization of specifications of its community hospital—usually atrium-connected towers rising from a three-story platform programmed with major diagnostic and support services in addition to the mechanical systems. Procedure spaces, such as those in Houston Methodist Hospital tower, are large enough to accommodate the advanced equipment required to support image-guided heart and brain procedures, minimally invasive treatments for conditions previously requiring more extensive surgery.

"Ninety-nine percent of our schematic designs share similar features," Sanders says. "Patient areas are designed for both comfort and caregiver efficiency while the public spaces tend to adopt features associated with hospitality."

"They are very astute at the programming side of business and vested in the results," says Sonny LaRue, vice president with the Dallas office of Hunt Construction Group and a project executive with the North Campus Expansion. "They're aware of the special needs of the building's users."

While a hospital's energy requirements can make LEED certification an iffy proposition, Houston Methodist nevertheless references corresponding guidelines as it undertakes planning for its facilities. A greater priority, says Sanders, is durability, given Houston's vulnerability to hurricanes and other major storms. As such, robust concrete structures are generally the rule.

Commitment and Trust

Perhaps the factor that best distinguishes Houston Methodist is its decisiveness throughout a project's life cycle, an attribute that David W. Syphard, vice president with Houston-based Jacobs Project Management Co., says is critical, especially among owners undertaking major capital programs.