The concept of construction management (CM) is simple: Construction requires many activities and trades to be managed and coordinated simultaneously. “Agency Construction Management” is a recent term describing services that focus on owner representation rather than the physical performance of construction tasks. In short, an Agency CM’s role is to assist clients with understanding project construction requirements and related costs, assembling a team of contractors and subcontractors to provide the construction services directly for the owner rather than through tiers of contractors, and managing schedules and budgets. Agency CM is a common vehicle for construction in other parts of the country and has been utilized locally with great success at the Dartmouth Hitchcock Medical Center.