Delays and cost overruns are major challenges in construction projects worldwide, especially in rapidly urbanizing cities such as Ho Chi Minh City, Vietnam. Special pressures such as resource constraints and large infrastructure needs contribute to this inefficiency. Research on the factors that impact delays and cost overruns is needed, especially in the local environment. This study identifies and analyzes the main factors that contribute to construction inefficiency in Ho Chi Minh City. A literature review was conducted to identify important factors. A survey was conducted using a 5-point Likert scale with 109 experts, including contractors, owners, and consultants. Data analysis included descriptive statistics, Relative Importance Index (RII) to rank factors, and Exploratory Factor Analysis (EFA) to group-related variables. The five key factors are Finance and Cash Flow, Financial Capacity and Payment Delays, Construction Defects, Legal Factors, and Planning and Scheduling. In addition, the EFA results indicate four components: Contractor and Financial Management, Procurement and Equipment Management, Planning and Decision Making, and External and Stakeholder Management. The priorities for the factors are inconsistent between the owner and the consultant, highlighting the need for closer collaboration. The study emphasizes addressing financial challenges, improving contractor capacity, and promoting stakeholder communication to improve project efficiency and sustainability. The study provides insights that can build an actionable framework to address construction inefficiencies in urbanized areas.