Design-build has become an increasingly popular delivery method in the construction industry, integrating design and construction under a single contract. By unifying project teams from the outset, it streamlines communication, improves coordination, and enables faster, more informed decision-making throughout the design and construction process. With builders engaged early, projects gain real-time cost insight and constructability input, helping teams stay aligned with budget and schedule goals. Clients benefit from greater efficiency, reduced administrative burden, and a single point of accountability. As projects grow more complex and timelines are compressed, design-build continues to gain traction by offering owners greater certainty and another project delivery option that may better serve them for a specific project.
For Middlesex Health, design-build is more than simply a delivery method – it redefined their approach to how they do projects. Over the course of multiple projects, they have aligned with SLAM through an architect-led design-build model that relies on a single, unified team that includes not only the design and construction but also the Hospital.
This collaborative approach allows Middlesex to maintain continuity across projects and make decisions with confidence at any point in the process, knowing both design intent and construction execution are aligned from day one and will be maintained throughout the entire project.
Unlike traditional design-build structures that are contractor-led, SLAM’s model places design at the center of the process, and integrates construction under one roof. For Middlesex Health, this integrated design has led to the success of multiple projects. It ensures that clinical goals, patient experience, and long-term operational needs drive decision-making, while still benefiting from the speed, cost insight, and efficiency of a fully unified team.
This partnership is exemplified in the new Medical Office Building in Cromwell, Connecticut. The 22,000-square-foot, two-story facility expands access to primary care and physical rehabilitation, bringing multiple specialties together in a modern, patient-centered environment. From the outset, Middlesex Health and SLAM worked as one team, aligning project goals, budget, and schedule in real time.
Because design and construction were consolidated, the team was able to proactively address challenges, streamline coordination, and maintain momentum throughout the project. Decisions that might traditionally take weeks were resolved quickly, without the friction of separate contracts or competing priorities. The flexibility of this approach also allows the team to adapt as needs evolve, whether driven by healthcare trends, operational changes, or unforeseen conditions, without losing alignment or schedule. The result was a more efficient process with reduced risk and a facility delivered with both speed and precision and on time and under budget.
With SLAM leading both design and construction, accountability is clear and collaboration is inherent. For Middlesex Health, that has translated into fewer surprises, stronger outcomes, and a trusted partnership they can rely on across projects.
The project is especially meaningful for David Giuffrida, Vice President of Operations. “I love building these things – it’s what I was born to do,” he says. “But what really excites me is turning these projects over to the clinical teams who will use them to care for patients.”
For Middlesex Health, the value of architect-led design-build is clear: a streamlined process, a trusted partner, and consistently strong results. By aligning design vision and construction execution under one roof, SLAM provides a level of continuity and certainty that fully supports project goals and the Hospital’s expectations.
Matthew Ciaglo 
Steve Doherty 