The Van Ness and Geary contract has more signatories than the 11 on the $320-million Eden Medical Center in Castro Valley, Sutter's first full-blown IPD project, completed in 2012.

Contract structure aside, "the key element is getting all the design consultants and trade partners who control most of the risk to be 100% at risk in the shared profit pool," says Digby Christian, Sutter's senior program manager. "The profit pool must be shared so that they succeed or fail collectively for the collective performance. No individual rewards for individual performance."

The Van Ness and Geary Campus will have 274 patient beds in a 12-story building. The 730,000-sq-ft hospital also houses women's, children's, cardiology, oncology, emergency care and transplant departments. An adjacent 253,000-sq-ft, nine-story medical office building will accommodate outpatient services. The two structures will connect via a pedestrian tunnel. The development represents the health network's largest single undertaking ever.

To encourage integration, Sutter collocated the more than 200 people from among the primary ILPD participants in an office building adjacent to the Van Ness and Geary site.

"We need to work as a virtual company with a singular intent to deliver a hospital," Christian says. "We are in a sense one company with one goal and one mission, and behaviors need to align with that. Because we work in an industry where most companies still do most of their projects in traditional contract environments, it takes a while to get people to truly understand that this is very different."

It took almost a year for all the parties to understand the process and coalesce into a well-functioning group, says Panos Lampsas, Sutter's regional program manager. "I hear a lot of people say they are doing IPD, but they don't fully understand what it takes to work as an integrated team, how to structure it and how to leave behind the old behaviors of contractor versus subcontractor versus owner."

Numerous strategies keep everyone focused on the end goal—a completed and licensed facility. Designers create detailed 3D models and 100% buildable documents. The project is the first hospital approved for real-time electronic plan review with OSHPD.

For ILPD to work, the owner must be intimately involved. Sutter rigorously plans the project, operating with a single unified budget, schedule and set of goals.

Sutter "tends to be on the lookout for what are the right tools to help communication and collaboration," says Joyce Polhamus, vice president and health care studio leader with project architect SmithGroupJJR. While Sutter runs a meeting-heavy environment, the "goal is to do it collaboratively and together to drive the behavior of the team," she adds.