Along with drawings and schedules, Jim Mladucky, vice president of design and construction at Indiana University Health, credits a well-told 304-page book with helping shape one of the largest construction efforts in American health care history: the $2.31 billion IU Health hospital in downtown Indianapolis. The book is “Team of Teams” by retired General Stanley McChrystal, a former commander of US and coalition forces in Iraq. McChrystal’s thesis that Mladucky is applying to building the 864-bed hospital is simple but radical: In complex, fast-paced environments, rigid hierarchies fail; Success depends on empowered, interconnected teams that share information freely and make decisions quickly. Mladucky doesn’t finish reading the book; he is putting his message into practice.
A drone shot at sunrise shows cranes in place above the new hospital.
Photo courtesy of Gilbane
“I read ‘Team of Teams’ when it first came out and kept coming back to it,” says Mladucky. “As we looked at the scale of this project, the market conditions resulting from COVID, the labor constraints and the risks of price escalation, it became clear that a traditional approach was not going to get us where we needed to be.”
So Mladucky gave copies of the book to the management team responsible for building IU Health’s new hospital. He then restructured the delivery model around his principles.
That decision set the tone for a project located on 44 acres at 16th Street and Senate Avenue. Workers are constructing three 16-story bed towers as part of the planned $4.3 billion health campus, which will eventually consolidate IU Health Methodist and University Hospitals into a single facility. At 2.6 million square feet, with 50 operating rooms and 110 emergency department spaces, the hospital is expected to serve Indiana for generations.
The hospital is being built in a busy location near major streets and civic landmarks.
Photo courtesy of Gilbane
Alignment of incentives
Under the “Team of Teams” structure, IU Health staff members are directly integrated into the day-to-day leadership of the project rather than operating remotely. Instead of a conventional guaranteed maximum price model, IU Health took a cost-plus approach, taking on more risk in exchange for greater transparency and speed. The owner had more than $100 million in contingency funds to manage labor shortages, material escalations, supply chain disruptions and to fund incentives for 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 be introduced into projects of this size. Everyone has skin in the game.”
“Projects like this require decisions to be made quickly, sometimes daily.”
—Aaron Perry, vice president and project manager, Gilbane
For the construction partners, this alignment mattered. Aaron Perry, Gilbane’s vice president and project manager, says the integrated structure bypassed traditional hierarchies and allowed decisions to be made at the pace required by a job of this scale.
“Projects like this require decisions to be made quickly, sometimes daily, sometimes hourly,” says Perry. “The integrated team structure allowed us to do this. It improved schedule performance, cost control and accountability across the board.”
The incentive model reinforced an ownership mentality among construction partners who could earn up to double their share by meeting or exceeding schedule, budget and safety goals. Miss those benchmarks and the incentive is gone. The result, team members say, was a shared focus on outcomes, fostering transparency, accountability and collaboration.
Although the management model was unconventional, the physical challenges were typical of a site on the edge of a busy downtown district filled with hospitals, high streets, and civic landmarks. Capital Avenue, a main route to the Indiana Statehouse, runs through the eastern end of the site. And an active emergency service had to remain open throughout construction. The city’s major events, from the Indy Mini Marathon to the Indianapolis 500, dictated what could be built and when.
The project required 70,000 cubic meters of concrete in the foundation alone.
Photo courtesy of Gilbane
Ryan Decker, corporate quality assurance manager for FA Wilhelm Construction, oversaw the project’s concrete quality assurance and supported sustainability efforts for the self-made concrete work.
“This is a big place, but it’s also a very restricted place,” says Decker. “We’re coordinating street closures, bus loops, crane changes and just-in-time deliveries in a dense urban environment. This level of orchestration requires discipline and cooperation.”
At its peak, up to 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 surrounded the structure during the heaviest phases of construction, feeding materials into the building with little margin for error. Massive concrete pours, some exceeding 6,000 cubic meters, often began early in the morning and lasted up to 16 hours to minimize disruption to surrounding neighborhoods.
A larger 1,700-acre health campus with medical offices and greenways is planned in the area around the hospital.
Photo courtesy of Gilbane
Concrete on an unprecedented scale
Few elements better illustrate the complexity of the project than its concrete work. The hospital’s structure is entirely made of concrete, designed to withstand a magnitude 6.9 seismic event associated with the New Madrid seismic zone. This resulted in dense reinforcement, high-strength mixes and thorough inspections.
“The scale alone is extraordinary,” says Decker. “You’re talking about almost 70,000 cubic meters of concrete in the base alone, and all designed with long-term sustainability and adaptability in mind.”
“If health care changes, and it will, this building has to change with it.”
—Jim Mladucky, Vice President of Design and Construction, Indiana University Health
One of the most technically demanding tasks involved radiology/oncology treatment rooms that required radiation shielding, which was traditionally achieved with walls up to 8 feet thick. Space limitations made this impossible. Instead, the team designed 30-inch-thick walls made of heavy-duty concrete with a dry unit weight of 350 pounds per cubic foot.
“To get there, we used certified heavyweight aggregates, steel shot, special shapes and constant testing,” says Decker. “Each prepared truck could only carry three yards due to weight. Each load was tested before placement to ensure density. It was unlike anything most of us had done before.”
The team also pushed the limits of sustainability. By using high levels of slag cement replacement, sometimes up to 60%, and newer type IL cement, the project achieved a more than 20% reduction in the carbon footprint of its concrete. Advanced maturity monitoring systems allowed crews to track strength in situ and continue building vertically, even when mixes were curing more slowly.
“It required trust in the data and trust in others,” says Decker. “But it worked.”
The medical campus is expected to serve Indiana’s health care needs for generations to come.
Photo courtesy of Gilbane
Prefabrication and preparation for the future
Prefabrication played a key role in managing both schedule and quality. The bath pods were fabricated off-site and coordinated using a detailed virtual design and construction model to align with structural and MEP systems prior to installation. The main lifting assemblies, ducts, pipes and modular OR components were also prefabricated.
“Prefab was a tool, not a gimmick,” says Perry. “It helped with predictability, reduced congestion in critical areas and improved consistency.”
This approach proved particularly valuable in the surgical and interventional platform, which houses 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.
Large-scale models further shaped the design. More than 250 IU Health physicians participated in the evaluation of patient rooms, operating rooms, imaging rooms and emergency department designs. 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,” says Mladucky. “If health care changes, and it will, this building has to change with it.”
Beyond the walls of the hospital itself, the campus aims to be a catalyst for a larger health district that spans 1,700 acres of Indianapolis. Plans include doctor’s offices, parking lots, new greenways, widened trails and the planting of more than 1,000 trees in an area that has long lacked green space.
“It’s not just about replacing buildings,” says Mladucky, 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 who build it, the hospital has both professional weight and personal meaning.
“It’s exhilarating and exhausting at the same time,” says Mladucky, “for me, it’s a cornerstone of a career spanning more than 30 years.”
Perry echoes that sentiment, noting the collaborative culture that fosters a team-of-teams approach. “It allowed the best ideas to surface, regardless of where they came from,” he says. “That’s rare in projects of this size.”
Decker sat down more simply. “I live here. My family will use this hospital,” he says. “Knowing that I had a small part in building something that will serve this community for decades is something to be proud of.”
