The U.S. Army Medical Command has been testing a leadership based structure to increase the performance of delivering construction and facility services in its system of $600M of construction and 26 major hospital facilities in the U.S. The organizational requirement was to minimize the management and oversight of contractors and simultaneously increase project performance. The research proposes that a leadership based structure can supplement the perception, preplanning, and risk minimization capability of a contractor's project manager, thus increasing the project performance (on time, within budget, and meeting expectations) and decreasing client management requirement. The projects were delivered in a best value and low price environment. The major impact of this research was that proactive management by contractors was more effective than traditional management such as direction, control, and inspection by client's professional representatives. The results based on data collection and date analyses validated that a leadership based structure can increase the performance of an organization and reduce its management requirement.