In this paper we present a healthcare case study that leveraged Integrated Project Delivery (IPD), Building Information Modeling (BIM) and lean construction (Lean). With this project, we aim to investigate organizational alignment and focus on how team building facilitated innovation in the design and construction processes and had significant positive impact on the operational efficiencies of the building. Through structured interviews, we found that a unique proposal process, which was focused on building team chemistry and understanding, lead to the team's development of a culture of open communication and teamwork that set the ground work for designers and builders to work closely together, blending teams and blurring boundaries throughout the execution of design and construction. In this paper, we explore how The IPD allowed the overlaps to occur in a productive way. In doing so, we build on previous finding that the antecedents of effective integration were the development of the team's orientation and culture as well as the processes of working together. The tools, IPD, lean and BIM, supported the integrated teamwork, but did not create the integrated team; however, the contract, lean and BIM tools did reinforce the project team's integration and facilitated better results in terms of design and construction products. In this paper, we focus on how the drive for efficiencies in construction and operations influenced design processes and outcomes, and how team alignment overcame technological and logistical challenges throughout their project process.