So Mladucky gave copies of the book to the leadership team responsible for building IU Health’s new hospital. Then he restructured the delivery model around its principles.

That decision set the tone for a project situated on 44 acres at 16th Street and Senate Avenue. Workers are building three 16-story bed towers as part of the $4.3-billion planned health campus, which will eventually consolidate IU Health Methodist and University hospitals into a single facility. At 2.6 million sq ft, with 50 operating rooms and 110 emergency department spaces, the hospital is expected to serve Indiana for generations.

The hospital is being built on a busy site near major streets and civic landmarks.
Photo courtesy of Gilbane

Aligning Incentives

Under the “Team of Teams” structure, IU Health staff members are embedded directly into the day-to-day leadership of the project rather than operating at arm’s length. Instead of a conventional guaranteed maximum price model, IU Health adopted a cost-plus approach, taking on more risk in exchange for greater transparency and speed. More than $100 million in contingency funds was held by the owner to manage labor shortages, material escalation, supply-chain disruptions and to fund incentives for the on-time completion of tasks.

“At first, I think people thought I was crazy,” Mladucky says. “But the idea was to align incentives, reduce fear and eliminate the antagonism that can creep into projects of this size. Everybody has skin in the game.”

For the construction partners, that alignment mattered. Aaron Perry, vice president and project director with Gilbane, says the integrated structure bypassed traditional hierarchies and allowed decisions to happen at the pace demanded by a job of this scale.

“Projects like this require decisions to be made quickly—sometimes daily, sometimes hourly,” Perry says. “The integrated team structure allowed us to do that. It improved schedule performance, cost control and accountability across the board.”

The incentive model reinforced an ownership mindset among construction partners who could earn up to double their fee by hitting or exceeding schedule, budget and safety targets. Miss those benchmarks, and the incentive disappeared. The result, team members say, was a shared focus on outcomes, encouraging transparency, accountability and collaboration.

While the management model was unconventional, the physical challenges were typical for a site on the edge of a busy downtown district bustling with hospitals, major streets and civic landmarks. Capital Avenue, a primary route to the Indiana Statehouse, runs along the eastern edge of the site. And an active emergency department had to remain open throughout construction. Major city events, from the Indy Mini Marathon to the Indianapolis 500, dictated what could be built—and when.

The project required 70,000 cu yd of concrete in the foundation alone.
Photo courtesy of Gilbane

Ryan Decker, corporate quality assurance manager with F.A. Wilhelm Construction, oversaw quality assurance for concrete on the project and supported sustainability efforts for self-performed concrete work.

“This is a big site, but it’s also a very constrained site,” Decker says. “We’re coordinating street closures, bus loops, crane swings and just-in-time deliveries in a dense urban environment. That level of orchestration takes discipline and cooperation.”

At peak, as many as 2,000 workers have been on site across the campus, with approximately 1,500 to 1,600 focused on the hospital itself. Four tower cranes ringed the structure during the heaviest phases of construction, feeding materials into the building with little room for error. Massive concrete pours—some exceeding 6,000 cu yd—often began in the early morning hours and ran for up to 16 hours to minimize disruption to surrounding neighborhoods.

A larger, 1,700-acre health care campus with medical offices and greenways is planned for the area around the hospital.
Photo courtesy of Gilbane

Concrete at an Unprecedented Scale

Few elements better illustrate the project’s complexity than its concrete work. The hospital’s structure is entirely concrete, designed to meet a 6.9-magnitude seismic event associated with the New Madrid seismic zone. That resulted in dense reinforcement, high-strength mixes and meticulous inspections.

“The scale alone is extraordinary,” Decker says. “You’re talking about nearly 70,000 cu yd of concrete just in the foundation, and all of it designed with sustainability and long-term adaptability in mind.”

One of the most technically demanding tasks involved radiology/oncology treatment rooms that required radiation shielding, traditionally achieved with walls up to 8 ft thick. Space constraints made that impossible. Instead, the team engineered 30-in.-thick walls made of heavyweight concrete with a dry unit weight of 350 lb per cu ft.

“To get there, we used certified heavyweight aggregate, steel shot, special forms and constant testing,” Decker says. “Each ready-mix truck could only carry three yards because of the weight. Every load was tested before placement to ensure density. It was unlike anything most of us had done before.”

The team also pushed sustainability boundaries. By using high levels of slag cement replacement—sometimes as much as 60%—and newer Type IL cement, the project achieved more than a 20% reduction in the carbon footprint of its concrete. Advanced maturity monitoring systems allowed crews to track in-situ strength and continue building vertically even as mixes cured more slowly.

“It required trust in the data and in each other,” Decker says. “But it worked.”

The medical campus is expected to serve Indiana’s health needs for generations to come.
Photo courtesy of Gilbane

Prefabrication and Future-proofing

Prefabrication played a key role in managing both schedule and quality. Bathroom pods were manufactured off site and coordinated through detailed virtual design and construction modeling to align with structural and MEP systems before installation. Major riser assemblies, ductwork, piping and modular operating room components were also prefabricated.

“Prefab was a tool, not a gimmick,” Perry says. “It helped with predictability, reduced congestion in critical areas and improved consistency.”

That approach proved especially valuable in the surgical and interventional platform, home to 74 surgical and procedure rooms. By using modular ceiling and wall systems, the team transformed what was once the longest interior critical path into one of the shortest.

Full-scale mock-ups further shaped the design. More than 250 IU Health clinicians participated in evaluating patient rooms, operating rooms, imaging suites and emergency department layouts. The result is a universal patient room design that can flex between acute care, progressive care and ICU use—an idea reinforced by lessons from the COVID-19 pandemic.

“Adaptability is a guiding principle for us,” Mladucky says. “If health care changes—and it will—this building has to change with it.”

Beyond the walls of the hospital itself, the campus is intended as a catalyst for a broader health district stretching across 1,700 acres of Indianapolis. Plans include medical offices, parking, new greenways, extended trails and the planting of more than 1,000 trees in an area that has long lacked green space.

“This isn’t just about replacing buildings,” Mladucky says, noting that Indiana ranks 37th in overall health care among the 50 states.

A team of between 1,500 and 1,600 workers are building the hospital.
Photo courtesy of Gilbane

The Bigger Picture

For those building it, the hospital carries both professional weight and personal meaning.

“It’s exhilarating and exhausting at the same time,” Mladucky says, “For me, it’s a capstone to a 30-plus-year career.”

Perry echoes that sentiment, pointing to the collaborative culture fostered by the team-of-teams approach. “It allowed the best ideas to surface, regardless of where they came from,” he says. “That’s rare on projects of this size.”

Decker put sit more simply. “I live here. My family will use this hospital,” he says. “Knowing I had a small part in building something that will serve this community for decades—that’s something to be proud of.”