Preconstruction process in a lean project delivery system was studied in one large healthcare project working for a general contractor. Researchers joined a new lean delivery project for approximately six weeks and participated in preconstruction process including design coordination, management coordination, and target costing while concurrently interviewing other project participants and employees, recording activity in meetings , and otherwise observing the process. The preconstruction process in lean project delivery system , called integrated project design, showed many benefits such as brining expertise of downstream players (i.e., mechanical and electrical contractors) into the design phase. However, lack of leadership and lack of design-integrator blocked the successful application of a new concept of design process.