Integrated project delivery (IPD), an emerging form of project organization for North American construction projects, offers a compelling case study to understand how new innovative infrastructure project delivery models can emerge and institutionalize. This article frames the early stages of IPD through the actions of an institutional entrepreneur—Sutter Health—working to construct a new arrangement for the delivery of its large healthcare projects. The resulting account uses Suchman’s (1995) multistage model of institutionalization to understand the early-stage actors, processes, conditions, and actions present for creation of an innovative delivery model within a fragmented, project-based industry context.