In an era when healthcare systems are under increasing pressure to deliver more with less, Target Value Delivery (TVD) offers a more innovative and collaborative way to deliver projects with increased cost certainty that truly reflect client values. Rooted in Lean principles, TVD flips the traditional Design-then-Build model on its head by making cost an input to design—not an afterthought.
At its core, TVD is a management practice that aligns design, construction, and client teams around a shared goal: deliver maximum value within a defined budget. Rather than reacting to cost overruns after the fact, TVD emphasizes continuous estimating, collaborating, and adjusting in real time, so there are no surprises down the line. It’s about aligning the team early, understanding what matters most to the client, and delivering the maximum value within budget.
One of the most powerful aspects of TVD is its ability to reduce waste, both in dollars and effort. At all stages in the design process, clients are fully informed about the status of the estimated current cost and monitor every adjustment. By the design development phase, there is no need for speculation. Barton Malow has confidence in its figures, which enables teams to expedite the process. On numerous healthcare projects, we have initiated construction while still refining the design, as the client has faith in both our process and our financial certainty.
At Barton Malow, we spend a lot of time upfront identifying what the client values, not just in terms of square footage or finishes, but in terms of user experience. That might mean walking a peer hospital to align on expectations or building mockups of patient rooms so nurses can weigh in on layout and functionality. Their firsthand knowledge can surface issues early and support efficient, thoughtful care. These conversations help avoid costly redesign and rework later and ensure the final product enhances the patient experience.
The benefits of utilizing TVD on healthcare projects are tangible. Some of Barton Malow’s most impactful healthcare projects, such as Intermountain Health Lutheran Hospital, Roper St. Francis, and Penn State Health Hampden Medical Center and Lancaster Medical Center, have demonstrated these benefits. For example, Intermountain Health Lutheran Hospital achieved cost outcomes within 1% of its target budget and achieved a 14-week time savings.
In a broader context, TVD is an integral part of Integrated Project Delivery (IPD). In 2024 alone, Barton Malow completed $350 million in IPD construction, and over 200 projects have leveraged IPD principles, such as TVD. These outcomes have contributed to Barton Malow’s ranking as Building Design+Construction’s Top IPD Contractor of 2024. Early project engagement, structured collaboration, and Lean tools led to cost certainty, faster delivery, and higher client satisfaction.
Patient Room at Intermountain Health Lutheran Hospital. Photo by Dan Schwalm © 2024 HDR. 
Big Room Planning on the Roper St. Francis Hospital project. 
Prefab ceilings expedited the installation of state-of-the-art operating rooms at Lancaster Medical Center. 
Intermountain Health Lutheran Hospital. Photo by Dan Schwalm © 2024 HDR. 
Bathroom Pod Installation at Lancaster Medical Center.
Prefabrication also plays a big role in the TVD process. Whether it’s modular utility plants or bathroom pods, prefabrication can offer labor certainty, schedule reliability, and often, better quality. It’s not always the initial lowest cost option, but it’s often smarter and more efficient in the end, especially when labor is tight and speed to market is critical. We develop a prefabrication strategy with the project team during our procurement plan, so we know early on what we’re building off-site and how that impacts design.
What makes our approach to TVD different is how we integrate all these complementary tools—early contractor involvement, design assist, big room planning, mockups, prefabrication—into a cohesive strategy. Even if every tool can’t be utilized, using just one or two can make a meaningful difference.
At the end of the day, TVD isn’t just about hitting a number; it’s about delivering what matters most to our clients efficiently, transparently, and collaboratively. By integrating cost certainty with client-centered design, TVD empowers healthcare organizations to make smarter, faster decisions that align with their mission and budget. It’s a proactive, transparent approach that builds trust and delivers results, both in patient outcomes and project performance.
If you’re interested in learning more about how TVD can support your next healthcare project or want to explore how Barton Malow can help bring your vision to life, contact Kathryn.Jacob@BartonMalow.com to continue the conversation.
About the Author: Kathryn Jacob is a Senior Preconstruction Manager at Barton Malow with over 20 years of experience in the construction industry. With a background spanning both preconstruction and field operations, she has served as both a contractor and an owner. For the past seven years, she has focused exclusively on Barton Malow projects utilizing Target Value Delivery. Her work has concentrated on healthcare, laboratory, and higher education, contributing to more than a dozen projects totaling over $3 billion in value.
