The proper and accurate selection of a PDS or project delivery system is recognized as one of the initial determinants of the success of a project as it impacts the subsequent relations among different stakeholders of projects. Over the last years, various systems of project delivery have seemingly emerged for streamlining the execution of procurement of public and minimizing the adversary relationships between stakeholders or projects. The prevalent systems of project delivery can be classified generally into two vast groups: TDS or traditional delivery systems which include management of construction project and DBD or design-bid-build and LODS or lead-oriented delivery systems which include design-build, project alliancing, integrated project delivery, and system of lean project delivery. Among these methods of delivery, DBD has been used mostly since the beginning of 1940s for most of the part of 20^th century.

The model of construction project management also started to be used largely since 1960s like a solution to the high level of inefficiencies of construction industry. The concepts and ideas of partnering among contractors and owners, a primitive form of the projects aligning with the lean orientation, became quite common in the industry of petrochemical construction in 1980s. Moving in on 1990s, the model of design-build was proposed which showed that it had the capability of reducing the cost, speeding up the schedule and improving the caliber of building projects. Around the very same period, the idea of IPD or integrated project delivery was introduced as a solution to the fragmentation issue of the construction industry and at the turn of new century, the delivery system of lean project emerged as a sustainable solution for the delivery of a project from a perspective of life-cycle.

In spite of the prevalence of new methods of project delivery aligned with the lean orientation, which can provide a sustainable alternative to the traditional systems of delivery and are recognized as safe, easier in terms of management, and provide better quality as well. Despite the existence of these new lean-oriented project delivery methods, the number of procurements of public utilizing them still is comparatively small. It can be said that an explanation of this process is unfamiliarity of agencies of public with the prevalence of such alternatives and their effects on the performance of project. In addition, agencies of public can be authorized generally for executing the public procurements. Nonetheless, these agencies seem to be normally confronted with an issue in choosing among the available systems of authorized project delivery, particularly in the projects that need specialized and advanced knowledge or involve the design for innovative technologies like projects of healthcare. For such type of projects, there is actually a lack of authentic underpinning theories along with conceptual methodologies that can guide the public agencies in choosing a proper and eligible system of project delivery. Consequently, the majority of the procurements of public in the context of projects of healthcare are delivered using a traditional approach of delivery, which can frustrate the owner with the results. It is particularly true if the characteristics of project don’t match the requirements of delivery system and generally lead to the waste of funds of public on litigation, disputes, and redesign.

Objectives and Scope of Delivery System

Objectives of Delivery System

The aim of this study is to provide the information and guiding principles necessary to assist the healthcare projects’ owners choose the right method of delivery for projects of healthcare. It also proposes a lean method of project delivery that has its own weaknesses and strengths. Following are the objectives of this study:

The first objective is to understand the specifications lean-oriented and traditional delivery systems utilized in the projects of healthcare.

The second one is to propose a lean-oriented method for the implementation of a healthcare project.

The third objective is to determine the important factors that impact the decision of owner to choose a PDS or project delivery system.

The fourth objective is to determine the effects of selection of a delivery system on the outcomes of a project.

Outcomes and Benefits of Delivery System

Choosing a method: The main benefit of conducting this study is that it will provide the necessary information along with important principles that will help the owners of projects of healthcare in selecting accurate method of delivery of healthcare projects.

Creating a foundation: This study is based on secondary data collected from previous studies and it will also help researchers in conducting further studies. Moreover, it will provide insights into both the traditional and lean-oriented methods of project delivery.

Propose a method: This study will also propose a lean-oriented method of project delivery in terms of healthcare.

Assumptions and Constraints of Delivery System

With respect to the projects of healthcare, there is actually a lack of research that creates conceptual techniques and strategies for choosing a system of project delivery, leading to significant issues during the phases of project construction and design. First of all, there is a constraint that the relation eligible delivery system and projects characteristics is not precisely determined in field of healthcare projects. For selecting an eligible system of project delivery for such kinds of projects, important factors influencing the decision of owner have to clearly be identified before being understood. Projects of healthcare involve the design of multifaceted, unique, and complex facilities. Normally, they are developed by the non-profit organizations and therefore, a key role is played by budget in the delivery of project. Owners of healthcare projects face a major concern about handling the complexity of construction and design, in the limitations of budget, hazard management, and service life.

Because of the rarity of quantitative data on the delivery methods of healthcare projects, the effects of delivery systems are not understood well or considered commonly in the selection of a project delivery system.

Literature Review of Delivery System

LODSs or lean-oriented delivery systems are actually based on the perspective of life cycle of integrating construction and design for maximizing value to owners and reducing the waste. These systems of delivery embed the concepts and philosophies of encouraging the organizations of cross-functional team, adoption of processes of lean design, and minimizing the negative interactions among stakeholders of projects. The early engagement of stakeholders in the phase of design is quite a distinctive feature of these systems of delivery. The concepts of producing a greater value with minimal waster are significant underpinnings of the lean development. Furthermore, value is determine in terms of just what the consumer is ordering i.e., completely in terms of products to be delivered. As a result, it is natural to concentrate on the elimination of waste where waste is not important providing value to the consumer. The lean deal is all about providing a custom product fit for the purpose delivered quickly with almost no waste (Ballard, Kim, Jang, & Liu, 2007)

The most utilized and recognized lean-oriented PDS or project delivery systems for the healthcare projects are IPD system or integrate project delivery and LPDS or lean project delivery system. The format one is an approach of project delivery that focuses on integrating people, practices, business structures, and systems into a process that seems to harness the talent of every stakeholder of project for increasing value, maximizing efficiency, and reducing waste through every phase of the construction, fabrication, and design (AIA, 2017). It seemingly promotes the theory of collaboration among the stakeholders of project including suppliers, fabricators, subcontractors, contractor, designer, and owners.

Meanwhile, LPDS or Lean Project Delivery System is a delivery system based on the project in which the team collaborates to assist owners in deciding what they really want and how they can realize their choices through a process of aligning constraints, means, and ends (Ballard, The Lean Project Delivery System: An Update, 2008)From the perspective of LPDS, a project is actually regarded as the process of value-generation that needs downstream stakeholders in designing and planning the steps of projects through teams which are cross-functional. A roadmap for the lean implementation on projects of capital was created by Ballard et al. (2007) and seems to involve significant principles like structuring the organization of project for engaging the downstream players in in the processes which are upstream, aligning the scope of project, schedule and budget, encouraging a thoughtful experimentation, and celebrating the breakdowns as opportunities for building safety, quality, and learning from projects. In spite of the precise value of LPDS and IPD, they still are not used widely in projects of healthcare.

Other systems of project delivery can be recognized as semi-LODs including the DB or design-bid, project alliancing, and construction management at risk delivery systems. These systems of delivery offer some specific aspects of the LODSs like integrating construction processes and design, enabling collaboration among stakeholders, decreasing the constructability issues, and delivering value to owners by decreasing the potential waste of time. However, they actually lack some aspects of LODSs. For instance, CMR and DB normally put the construction management and contractor firms in the leading role on projects and are normally not transparent to the owner as an LODS. Collaboration among the stakeholders of projects is also limited in the projects of DB in comparison with LODSs. Although there might be some collaboration in the projects of DB, the designer is actually at times limited by the financial priorities and preferences of the contractor which might not be aligned with the preferences and objectives of the owner.

Program Delivery Systems of Delivery System

In the construction of facilities of healthcare, project delivery is recognized as a complex and broad process that involves thorough planning, construction, procurement, design, and planning of a facility that required advanced design and implementation of new technologies which are evolving at rapid dates. In a controlled environment, a facility of healthcare normally integrates chemical, radiation, electromagnetic, and nuclear systems (Lavy & Fernández-Solis, 2010). It can be said that public agencies serving as the owners of public procurements, focus items like commission, contractor selection, construction duration, and project cost. With the limited knowledge of public agencies in terms of the evolving requirements of technology and complexity of design, the selected design of project delivery can be an impediment to completion in time, under the budget at best value, which serves to leave many owners frustrated with results (Reed, 2008).

While creating strategies for projects of healthcare, several systems of project delivery are available to the public agencies including CPM, DB, DBB, and LPDS. The strategy of selection can be complicated even more if the agency doesn’t have the capability of identifying sound and clear process for choosing the method of procurement and format of contract. Generally, there is a broad variety of common methods of procurement including qualifications, best value, sole source, and low bid among many others, though normal formats of contract might include assured maximum price, target price, and unit price among others. Additionally, the strategy of selection of a PDS is complicated further by several contractual relationships and different contracts among stakeholders, including contractor-subcontractor deals and owner-professional CM project among others.

Given the already mentioned project uniqueness and challenges, the owner must decide before selecting an eligible system of project delivery before the stage of procurement; a challenging decision that is overlooked by several agencies, which can create some serious downstream issues. Overall, systems of project delivery for healthcare projects can be categorized into lean-oriented systems and traditional delivery systems. There are actually clear differences between the two in terms of attitudes towards waste, risk, control, quality, planning, structure, theories, and ethos. Still, some methods of project delivery could have a little overlap with one of the characteristics or categories.

Typical Delivery Systems

In the projects of healthcare, a TDS or traditional delivery system is characterized mainly by the disintegration of construction, procurement, and design phases. A professional engineer or architect is hired by the owner for developing the project’s design in four typical phases which include final design, developed design, schematic design, and conceptual design. Following the final design’s development, the designer is typically requested by the owner to create bid documents for seeking bids from contractors in the phase of construction that seems to culminate with choosing a subcontractor for developing the facility of healthcare. This concept of separating construction, procurement, and design is recognized as an important issue in construction projects (Ballard & Koskela, On the agenda of design management research, 1998).

It can be said that most significant form of traditional delivery systems for facilities of healthcare is the DBB or design-bid-build system which is known to many public agencies and owners, particularly those who seem to reject the new methods of delivery. These methods also involve the CPM or Construction Project Management along with its variants which are determined as offshoots of the DBB in which an expert organization of construction management is hired for managing the phase of construction, particularly in projects where several prime contractors are employed.

A unique feature of the traditional delivery systems is that owners are held accountable for designs, and contractors are responsible for the execution of all operations including quality, cost, and time of project. Such arrangements can seemingly develop substantial issues if the owner is unfamiliar with the requirements of design for the facility of healthcare, not able to create a budget of project, expects a rapid delivery of this facility.

Traditional healthcare delivery systems can present significant issues to contractors as well like controlling the costs of project while providing value to owners; managing the bad impacts of poor coordination and design deficiencies; and the general issue of completing a complicated project for avoiding the liquidated damages. In such complex projects,, contractors are normally sensitive to losses from the deficiency of design, if careful attention is not seemingly paid to the management of variation requests and change orders for compensating losses.

Data, Methodology, and Process of Delivery System

Factors Influencing selection & performance of project Delivery System

For choosing an eligible delivery system of healthcare projects, public agencies and private owners have consider various factors that impact the process of selection. Not paying attention to these factors can seemingly lead to substantial issues, litigation, and disputes among the stakeholders of projects, especially when difficulties are faced by owners in the identification of these factors (El-Sayegh, 2008). Therefore, it is significant to have a precise understanding of important elements that impact the selection of a project delivery system and their effects on the execution of healthcare project. Blismas et al. (2004) actually determined ten main elements that impact the selection of a PDS for environments of multi-project: intervention of third-party, lead times, project prototyping, property supply, legislative processes, economic environment, corporate drivers of owners, owner indecisiveness, site geographical disparity, and project uniqueness. Problems like variations in poor definition of project, site uniqueness, scope, and uncertainty supporting the portfolios of organizations were recognized as major issues that hinder the adoption of lean construction’s principles to the delivery of project (Blismas, Sher, Thorpe, & Baldwin, 2004).

Mahdi and Alreshaid (2005) explain that there are thirty-four factors that impact the selection of an eligible system of delivery for a project. these elements can be classified into 7 main groups which include complexity and size, project scope, risks of project budget, needs of cost saving, tightness of deadlines, need for a reduction in time, precision of cost estimation, and characteristics related to projects (Mahdi & Alreshaid, 2005).

El-Sayegh (2008) actually determined twenty one important factors to have a significant effect on the success of project delivery including the definition of scope, requirements of cost reduction, and control of the owner among many others. There are many other factors that have been identified by researchers have been grouped into different categories such project size, uniqueness, and risk management etc. (El-Sayegh, Evaluating the effectiveness of project delivery methods, 2008)

El-Sayegh (2008) also exclaims that influencing factors that impact the selection of a project delivery are the capacity and experience of owners, significance of the duration of shortening project, and significant cost reduction of a project. Other elements were also recognized as integral such as uncertainty, market conditions, construction integration, flexibility requirements, and complexity. In spite of the contributions of aforementioned researches, there were not carried out in healthcare projects’ specific context and were bound to a tiny subset of recognized systems of project delivery. It is quite clear form literature that theoretical criteria and underpinning for the selection of PDS within the projects of healthcare is required. To this very end, the first phase of this combined methods study which is sequential explanatory involved a design of secondary research for obtaining the data about the important factors that impact the selection of en efficient system of project deliver

Selected methodology & process for arriving at an optimum deliver system

In order to conduct this study, the methodology relied heavily on secondary sources. Different journals related to project delivery systems were obtained both from the virtual sources and physical sources such as libraries. Only credible journals were chosen for conducting the study because only they were capable of providing the necessary data. Furthermore, past studies on the same topic or close-related to it were studied for coming up with the ideas and information that is used to facilitate this study.

Data Sources, ease of gathering data, timing and reliability of Delivery System

This approach was quite bound both in terms of time and availability of studies conducted by the previous researchers. Moreover, it was also bound due to the limited time because there was not enough time to go through numerous sources available both on the internet and libraries. What made this process even more complex was that various journals were locked in terms of cost. There was another additional factor that limited this methodology and it was the unavailability of proper studies conducted on the topic.

Optimal Delivery System

IPD is actually an approach of project delivery that seems to integrate practices, business structures, systems, and people into a process that seems to collaboratively harness the insights and talents of every participant. Seemingly, this approach was developed for optimizing the results of project, increasing the value of owner, reducing the waste, and maximizing the efficiency through every phase of construction, fabrication, and design. Several groups in 1990s started concentration on the project collaboration because of declining productivity in the industry of construction. On heels of that concentration, the model of IPD began gaining momentum in early 2000s.

IPD at its central point consists of an agreement at a tri-party. This is actually a contractual arrangement among project management and owners that aligns the interests of business with respect to all the parties. This model is more than just a vehicle that is contractual but a collaborative way to the delivery where there is a mutual trust among members of a team and inefficiencies are evaded. Several models of delivery can develop handoffs and silos from many stakeholders, who are capable of being more focused on individual objectives instead of goals of project. Instead, IPD seems to create a better partnership while fostering an environment that focuses on shared objectives.

SWOT Analysis of Delivery System

Strengths of Delivery System

Although owners might require a collaborative team that focuses on goals at a project level over the individual ones, a full model of IPD is not suitable for every project. This system is seemingly best aligned to projects which are complex and last more than twelve months while carrying very large budgets. While owners may desire a collaborative team focused on project-level goals over individual ones, a full IPD model is not right for every project. This system is best aligned to complex projects that last over 12 months and carry multi-million dollar budgets. It can be said that IPD is effectively implemented in the field of manufacturing, higher education, and especially healthcare sectors.

Trends at present include companies looking for ways for aligning the improvement of process and team health with projects of capital improvement. IPD seems to enable companies to utilize collaborative methods of delivery for driving value through improvement measures which are driven by the teamwork with reward and risk sharing for an effective delivery.

IPD is capable of eliminating waste in project design, establishing the right point of contact for each task, improve the productivity of job, and create cost savings etc.

Weaknesses of Delivery System

This method of delivery needs teams to give and take for improving the project. This type of flow and ebb can result in challenges being presented to the teams that will bear the pain of workload for assisting in the overall success of project. Furthermore, in the absence or weak teamwork, the efficiency of this method decreases a lot.

Opportunities of Delivery System

Projects of IPD seem to share a very common theme around collaboration, focused on the mentality of team backed by a certain agreement. With a strong trust among members of team, the effectiveness of project can increase. The structure of IPD can also create an environment that focuses on open communication while establishing a chain of commands.

Threats of Delivery System

Even though there are several benefits to the usage of IPD model, there are various threats as well. For instance, this method of delivery seems to require each and every team to sacrifice something for improving the project. This can result in issues being presented to the project. A member of the team will have to suffer and take the burn of being overloaded with work for achieve the overall success of project.

Furthermore, it is very significant for each and every member of the team to understand the outcomes of their performance in the betterment of the project, even when they might be needed to pass the normal tasks to other parties on the team. When thriving for innovative ideas, teams which are high functioning require powerful partners. This will the members of team to be knowledgeable, flexible, and available. Seemingly, this process will show weaknesses and strengths of members of teams while pushing stronger members to work harder than before. IPD is not always recognized as a model of lean delivery with respect to personal time. Making sure that information and documentation is readily available through open environment can need further time and work from the key parties.

IPD seems to work quite fine with three types of projects: large projects, complex projects, and repetitive projects. A repetitive project actually resembles a line of assembly in the way it gains better results through the maintenance of a consistent team with various incentives for increasing the outcomes. A complex project harbors a focused effort of team, in spite of the size, focused in proper results, innovation, and planning. The final type of project that has been utilizing the IPD effectively is this type of projects. Large projects gain benefits from strong processes and alliances of teams because teams work in collaboration over a large duration of time.

Review of Case project objectives, business case and requirements of Delivery System

The aim of this study is offer necessary information and integral principles that can assist the healthcare projects’ owners in selecting the appropriate method of delivery for healthcare projects. For this study, secondary research has been relied upon for obtaining data to carry this study out. The objectives of this study have been to determine the characteristics of lean-oriented and traditional systems of project delivery in the healthcare projects, to identify the most important elements that impact the decision of owner to choose a system of project delivery, and to understand the effects of selection of a project delivery method on the outcomes of the project. Primarily, this study is based on the data collected from secondary research by searching credible sources and obtaining the information necessary to complete this project.

Traditional systems of project delivery are recognized to present challenges to the stakeholders of projects like controlling the cost of project, quality, and even time. Normally, traditional systems of project delivery are not efficient in facing the key challenges of complex projects in terms of healthcare. Additionally, in these projects, project owners are normally challenged with controlling the details of design, avoiding a change in claims and orders, and decreasing constructability issues. It has been reported by various case studies that there are cost disputes and overruns when requirements of the owner are not understood well and fulfilled. In the studied case, relations among contractors, consultant, and owner generally become adversarial and variation orders are often faced by the owner that come with addition cost and time impacts.

The effects of traditional systems of delivery on productivity, quality, cost, and time have been reported in various studies focused on projects of building. It has been reported by a study that the delivery speed of a traditional DBB is thirty percent slower than DB (Konchar & Sanvido, 1998). It has also been indicated by the study that the cost of projects of DBB is almost thirteen percent more than the one that belongs to DB.

Evaluation, Revision and Finalization of Delivery System

Adjustments of the optimal delivery system

The project delivery system of IPD will be evaluated on a yearly basis and in each evaluation, the goals of the project will be measured against the outcomes of the project. It will help in analyzing whether the project is performing accordingly or not. It will be the responsibility of the owner of the project to make sure that these tests are conducted along with the maintenance runs. In addition, there must be some meetings between the stakeholders and the owner where the performance of project will be revealed. It will also provide an opportunity for corrective actions.

Implementation of deliver system

First of all, the schedule of the project has to be easily manageable and flexible for an effective implementation of the IPD system. In other words, small delays can be ignored and the deliverability of this project must be divided into phases. However, there has to be a short margin among all the phases because a gradual implementation is better than a hasty one. Furthermore, being a public level project, the cost of the project has to be as minimum as possible. IPD system ensures that the costs of project are not unbearable. Lastly, it is important that all scenarios are expected by the owner of the project so that in case of any issue, it can either be mitigate or properly eliminated. Successful implementation of this project needs efficient management from the handlers of the project because there is a need of consistent monitoring until the project has smoothened out and delivering outcomes as expected.

During this step, construction, tendering, and detailed design of the infrastructure will be considered. In accordance with the complexity and situation, the project may be implemented through a contract of formal construction or an approach of voluntary community. Contracts which are written formally are needed when installation work is undertaken by external contractors. This work has to be awarded through a process that is competitive tended for ensuring the value for money. Meanwhile, other strategies of procurement could build and design scheme. With the use of formal contracts, there is actually a risk of leaving the social framework out along with the requirements of users. That is why, it is significant to incorporate the community during the step of implementation for creating the new infrastructure’s ownership.

In projects which are managed a community, community members are involved in the installation and construction of new infrastructure through schemes of food for work, in-kind contribution, voluntary agreements of labor, and programs of self-help where communities are delivered resources and training for completing their work without any assistance. Generally, it is more cost-effective to utilize labor from in the community but there has to be an assurance of caliber and understanding of the work’s scope. It is quite useful to have written agreements between the secondary and primary responsibilities while agreeing the work’s scope. This will actually help in avoiding disagreement or confusion later on. It is better to use this approach rather than facing issues when the project is in its last stages.

It is quite significant to take into account that in peri-urban or urban areas, numerous individuals seem to earn a living and wouldn’t be prepared to contribute any type of labor to the supply of water or sanitation scheme but would opt for contributing cash. As the project is in its initial stages, it will be beneficial if such a situation is assessed.

Whatever procedure or method is chosen, the installation activity of this project has to be carried out under the monitoring of engineers and experts. Actually, the supervision level needed will naturally rely on the construction work’s complexity. However, if any engineering specification is included in the design then qualified workers have to be available on a complete or full-time basis for overseeing works’ construction. The caliber of work will be suffering if the supervision is ineligible because corners might be cut, inferior materials might be utilized, and safety also might be compromised. Designers’ involvement is also required during the stage of construction, specifically for answering questions and making changes in the early stage of constructions for answering questions and making changes in design when adaptions and improvements are needed. Furthermore, a practical plan of implementation should be prepared by the team of implementation for defining the real time schedule of service delivery like when the purchase of every material is carried out, excavation has been completed, building structures are seemingly constructed, and commission is predicted.

Other aspects that must be considered during the phase of construction are division of labor, supervision of the processes, procedures of payment, presence of funds, and sourcing. It is also significant to ensure that there are meetings with the labor and the contractors. Skills and local practices have to be exploited in the construction and design of infrastructure in some nations, the quality of work is quite poor but masonry skills are quite good. Likewise, construction methods and local materials must be employed wherever possible. Actually, this might not be possible all the times. For instance, in rock, if rotatory drilling is needed but the community must be consulted as they might have their own thoughts and ideas. In some of the cases, the utilization of local materials is not acceptable to the partners if it has a low quality. Probably, it wouldn’t be cost-effective to buy local cement pipes of asbestos if there importer ones have a longer life period.

Conclusion on Delivery System

Overall, it can be said that IPD is actually an approach of project delivery that integrates practices, business structures, systems, and people into a process that seems to collaboratively harness the insights and talents of all the participants. Generally, this approach was created for optimizing the results of project, increase the value of owner, decrease the waste, and optimize the efficiency through every phase of construction, fabrication, and design. Various groups in the 1990s started to focus on the collaboration of project because of the decreasing productivity in the industry of construction and healthcare. Following that focus, the model of IPD started to get in the flow in the early 2000s. This study seems to contribute to knowledge by providing the accurate information for enabling the owners of project for choosing an eligible project delivery system. First of all, the main characteristics of lean-oriented and traditional project delivery systems are contrasted for the projects of healthcare. Secondly, key factors influencing the decision of a healthcare project have been pinpointed by this study for selecting a project delivery system. Thirdly, the effects of a selection of PDS on the outcomes of healthcare project are highlighted. For carrying this project out, the proposed methodology relied on the secondary research by obtaining information by studying journal articles through the internet. Although this methodology has been chosen but it is quite limited due to several factors including the bound resources of time and costs. The research was further limited by the unavailability of sufficient information on the lean project delivery system in the field of healthcare. This adopted methodology actually is an attempt for filling the gap in the prevalent information or knowledge of the existing strategies for choosing the delivery system of healthcare project while facilitating the development of different underpinning theories for evaluating and measuring the effect of guiding principles on the project delivery’s effectiveness. In addition, the proposed methodology can be explored further in studies of comparative analysis to contrast the effects of selection decisions of project delivery system. The outcomes of this study should prove to be quite effective in guiding owners of healthcare projects to the right system of project delivery.

Bibliography of Delivery System

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Ballard, G. (2008). The Lean Project Delivery System: An Update. Lean Construction Journal .

Ballard, G., & Koskela, L. (1998). On the agenda of design management research. Proceedings of the 6th annual conference of the International Group for Lean Construction.

Ballard, G., Kim, Y. W., Jang, J. W., & Liu, M. (2007). Road Map for Lean Implementation at the Project Level. The Construction Industry Institute .

Blismas, N. G., Sher, W. D., Thorpe, A., & Baldwin, A. N. (2004). Factors influencing project delivery within construction clients’ multi-project environments. Engineering, Construction and Architectural Management, 11(2), 113-125.

El-Sayegh, S. M. (2008). Evaluating the effectiveness of project delivery methods. Journal of Construction Management and Economics, 23(5), 457-465.

Konchar, M., & Sanvido, V. (1998). Comparison of US project delivery systems. Journal of construction engineering and management, 124(6), 435-444.

Lavy, S., & Fernández-Solis, J. (2010). Complex healthcare facility management and lean construction. 3-6.

Mahdi, I. M., & Alreshaid, K. (2005). Decision support system for selecting the proper project delivery method using analytical hierarchy process (AHP). International journal of project management, 23(7), 564-572.

Reed, D. (2008). Speech presented to the Cascadia LCI ‘’Introduction to Lean Design’’Workshop.". Retrieved from Leanconstruction: <https://www.leanconstruction.org/media/docs/Lean_Construction_Opportunities_Ideas_Practices-Deans_Speech_in_Seattle_r1.pdf> (Jan. 7, 2018)