Contractor involvement also helps reduce the risk of owner or design team expectations that might not match realities. "The most fertile environment is when contractors have a full understanding of the intent of the design and designers know the ability of the trades to carry it out," adds Romano N.A. Nickerson, a principal in the San Francisco office of Boulder Associates, which uses TVD for health care projects in California.

Though TVD is a relatively recent addition to the family of project-delivery approaches, it has already garnered an impressive track record across a variety of projects. As chief engineer for implementing the California Prison Health Care Receivership's multibillion-dollar update and expansion of its health care facilities, architect Stan Chiu, now a senior vice president at HOK, Los Angeles, organized and managed the seven cross-functional groups tasked with addressing aspects of the program. Over the course of a few weeks, the teams focused on specific issues, with regular integration events to share results. "It was almost like a telethon, as you saw each group making progress toward its targets," says Chiu. "They went from higher-order concepts to specific designs, from things with big impacts to smaller issues."

By the time the group finished, what had been a $7.2-billion design program was confidently priced at $5.7 billion. "We didn't cut back on beds, but we did improve the quality of patient care, cut staffing needs and make operations more efficient," Chiu says.

Other medical facilities have benefited from TVD, including the $320-million, 230,000-sq-ft Sutter Medical Center in Castro Valley, Calif., for which DPR is serving as general contractor. "Projects such as these have the conflicting goals of sustainability and LEED certification, building system capacity and operational support for 24/7 acute clinical care," Reed says. "The only way we could reconcile them was setting the goal up front and working through issues."

Making TVD Work

Though many lean construction advocates feel TVD has a place in every project, Mark Konchar, Balfour Beatty's vice president of national integration, counters that its success depends on the right environment. "You need an owner that's open-minded and willing to commit to lean construction early so that the best tools for the project—including TVD—can be identified," Konchar says.

Nickerson adds that unless team members think beyond their core areas of expertise and constantly consider the project as a whole, "it's a recipe for disaster. Individuals need to offer lessons learned from other projects they've been involved with but also accept critiques and other perspectives."

Contractors should also fully understand the owner's business and what trends and issues influence it. "You add value because you understand what value means to the owner," Sanvido says.

Above all, participants in a TVD project must continually reject any assumption that improvement is not possible. "You can't do business as usual," Sanvido adds, "because you'll only get a conventional solution at a conventional price."