Most previous studies of target value delivery have focused on steering to targets in design, but value is not delivered to clients until design is converted into constructed assets. Working with Sutter Health’s VNGC and St. Luke’s Hospital projects in San Francisco, the research objective is to document what is done to hit targets for safety, quality, schedule, cost and people, which includes local employment, project team use of alternative transportation and a project team pulse report. ‘What is done’ includes both processes for accomplishing the various objectives, but also the lean culture of learning and improvement on which processes are founded.