While the construction industry has long been known for conflicts and adversarial behavior, there are different delivery methods and approaches that have been developed to overcome these shortfalls. This paper aims to compare Design-Build (DB) and partnering through the lens of the lean construction approach. We examine to what extent partnering and DB are aligned with the lean construction’s five big ideas and whether Design Build can be improved by adopting elements from partnering. This study was carried out by conducting a literature study in combination with five case studies. The case studies were carried out via document review in addition, nine semi-structured in-depth interviews. The interviews were conducted with key personnel from target projects to understand the practitioner’s point of view and the way that partnering and design-build are practiced in the industry. In this paper, the authors conclude that partnering aligns to LC and its five big ideas to a high degree and that partnering includes embedded tools and mechanisms designed to meet what literature and interviews consider to be the main challenges with construction projects. It is also concluded that the use of DB can be improved by adopting suitable elements from the partnering approach.