Collaboration Isn’t Comfort: How Real Alignment Speeds Up Healthcare Projects
The Real Work Happens in the Room
If everyone in a room agrees, you’re not asking the right questions.
That’s something I’ve learned the hard way. Throughout my career, I’ve often been the one to call out issues no one else wanted to name. Early on, I did it too bluntly. Great mentors taught me how to be more tactful, but I’ve never stopped being direct.
Every performance review I’ve ever had includes some version of, “People appreciate your willingness to speak up — maybe just be a little less direct.”
I have consistently been able to get results for my clients because I refuse to tell people what they want to hear, whether its budget, schedule, or design changes. I work with visionary founders who have a clear picture in their mind of what they want their healthcare clinic to look and feel like, and they also wanted it yesterday and at the lowest cost possible.
Projects stall when people stay quiet in the meeting, then have side conversations afterward. If you aren’t willing to have open dialogue up front, even when its uncomfortable, those conversations will inevitably happen later when making changes cost you time and money.
Progress requires tension, respectful, honest, forward-moving tension. Real collaboration can be uncomfortable, but that discomfort is what breeds alignment, and ultimately, project success.
Early Alignment: Get Everyone in the Room — Early
The fastest projects I’ve ever been part of all share one trait: the Owner, Architect, Project Manager, and Contractor were aligned early — before drawings, budgets, or permits.
That alignment is what saves time and money later.
In the traditional bid-build approach, teams get assembled in sequence: the architect draws, the contractor prices, the owner panics, and everyone blames each other. When that happens, you spend the first half of the project designing and the second half undoing decisions to make the budget work.
True collaboration means starting from one table, one goal, and one set of constraints.
When the owner understands cost, the contractor understands design, and the architect understands the business, you have alignment before a single line is drawn.
That’s not just for big hospital projects, it’s for every outpatient, PACE, and primary care site I touch.
The earlier we get the full team aligned, the smoother every step after becomes.
City Engagement — Don’t Surprise the Inspectors
A major theme at the Healthcare Design Conference and Expo this year was city engagement. Most of the examples came from massive $200M+ hospital projects. Those naturally get attention. When you’re building a tower, the fire marshal knows your name.
But for smaller projects, outpatient clinics, PACE centers, behavioral health sites, that visibility doesn’t come built in. You have to create it.
Engaging city officials early is one of the most effective (and underutilized) ways to accelerate a project.
Too many teams treat inspectors like hurdles instead of partners.
They design, submit, and wait. Then the redlines come back and the project stalls for months. Inspectors don’t like surprises.
If you bring them in early, walk them through what you’re trying to do, and show how your project benefits the community, they’ll often help you succeed.
That’s my process on every project. I meet with the key city building officials throughout the project. Sometimes it’s a quick call, other times a site walk. Those early conversations build trust. And when you need help later, trust gets you time.
Inspectors want safe, compliant, community-serving buildings to open successfully. When they understand your intent, especially in healthcare, they’ll often help you get there faster.
A lot of my recent work has been in PACE, where you have a frail, older adult population, that in an emergency, is going to be the most challenging group of people to get out of the building safely. You can’t blame the plan checkers and inspectors for having an extremely high bar for code alignment.
Show city officials that your goal is the same as theirs: safe, compliant buildings that serve the community. Inspectors are seeing all kinds of buildings, and healthcare design is just different. You need to help them to understand the design intent and how certain design choices contribute to safety, instead of taking away from it.
A ten-minute meeting can save weeks on the backend and show the city you’re building something that matters.
Post-Construction Alignment — Overlap to Accelerate
The biggest delays don’t always happen during construction. Too many owners treat the contractor’s completion date as the finish line. It’s not. It’s the handoff. That’s when the chaos begins.
I’ve seen it: IT installs still pending. Furniture stuck in a warehouse. Supplies stacked in the hallway. Staff onboarding while contractors touch up paint. Everyone’s waiting on someone else.
That “perfect” linear schedule where construction wraps, IT sets up, and operations calmly moves in? I’ve never seen it.
The fastest projects are the ones that intentionally embrace overlap.
Get IT into the building before final inspections. Stage furniture and equipment deliveries in waves. Train staff in parallel with setup so they can learn the space while it’s still being built.
It’s messy. It’s loud. But it works.
Controlled chaos beats idle time, and if done right, can accelerate your first day of business weeks or months.
The key is ownership. Everyone — from GC to IT to facilities — needs to know their role in that overlap. Without that clarity, you get finger-pointing and confusion. With it, you get speed and synergy.
The best-run projects treat post-construction like a live simulation — testing systems, training teams, and fixing issues before opening day. You find what doesn’t work while you can still fix it. Staff get familiar with the building before go-live. Momentum carries through instead of stalling out.
The messy middle is where projects either stall or finish strong. The ones that win plan for it.
Final Reflection: Collaboration Isn’t Comfort — It’s Momentum
If there’s one thread through all of this — from early alignment to city engagement to the post-construction sprint — it’s that real collaboration isn’t comfortable. It’s accountable.
Healthcare development is full of meetings where everyone nods politely, agrees to follow up, and nothing changes.
Progress happens when people are willing to disagree, challenge assumptions, and say what others won’t.
I’ve been that person — sometimes too direct, but always focused on moving things forward. My best mentors taught me how to pair candor with respect. The goal isn’t to be right. It’s to make the work better.
When alignment happens early, cities engage faster, teams execute smarter, and “handoff” becomes a sprint instead of a stall.
That’s how you build healthcare facilities that open on time, on budget, and with teams ready to deliver care from day one.
Collaboration isn’t about keeping the peace. It’s about keeping momentum.