On-site Team Research Articles

MO‐D‐105‐04: A Nation‐Wide Three Level Audit Service ‐ the Australian Experience

In February 2011, the Australian Government launched the Australian Clinical Dosimetry Service (ACDS) a three year trial of an independent dosimetric auditing service for Australia. The ACDS has designed and implemented a three level audit program, each succeeding level with a more complex and challenging geometry. It is similar to other audit programs internationally, but is unique in its coverage, national participation (voluntary and free service), audit design and final review process. The ACDS has utilised existing audit protocols, adapted and expanded components of those as needed. The final protocols have been rigorously tested inhouse. The Level I audit is a remotely conducted point dose verification under reference conditions. It was introduced using TLD detectors and has been transitioned to OSLD, following validation of the OSLD technology and setup. By August 2013, each clinical linac in Australia will have received at least one Level I photon beam audit. The Level II audit investigates treatment planning and delivery using a synthetic CT data set and planar array measurements in different geometries. It tests the components treatment planning and linac dose delivery independent of the CT imaging.The Level III audit is an end‐to‐end test. An anthropomorphic phantom is taken through the complete chain of procedures experienced by a patient in a radiotherapy facility. In their first implementation the ACDS Level II and III audits, which are performed by an onsite team, investigate inhomogeneities, wedges and asymmetric fields. Additionally, the Level Ib has been implemented as an onsite reference geometry audit. It uses the facility's watertank and otherwise independent equipment to verify dose delivery for all beams under reference conditions. This audit has been very popular for new installations. Audit design philosophy, tolerance levels, results, lessons learned and future directions (intensity modulated/rotational therapy, flattening‐filter free beams, SRS) will be reviewed and discussed. The Australian Clinical Dosimetry Service is a joint initiative between the Australian Department of Health and Ageing and the Australian Radiation Protection and Nuclear Safety Agency

Assessing Hospital Preparedness: Comparison of an On-site Survey with a Self-reported, Internet-based, Long-distance Tabletop Drill

Methods of defining hospital disaster preparedness are poorly defined in the literature, leaving wide discrepancies between a hospital's self-reported preparedness and that assessed by an objective reviewer. This study compared self-reported surge capacity data from individual hospitals, obtained from a previously reported long-distance tabletop drill (LDTT) prior to the 2010 FIFA World Cup tournament in Cape Town, South Africa, with surge capacity data assessed by an on-site survey inspection team. In this prospective, observational study, contact persons used in the prior LDTT assessing hospital disaster preparedness in the lead-up to the 2010 FIFA World Cup made surge capacity assessments (licensed bed capacity plus surge capacity beds) for the respiratory intensive care unit (RICU), neonatal intensive care unit (NICU), medical intensive care unit (MICU), and general medical/surgical beds in each hospital. Following the 2010 World Cup, this data was then re-evaluated by an on-site survey team consisting of two of the authors. The contact persons for the individual hospitals from the LDTT underreported their individual hospital's surge capacity in 86% (95% CI, 46%-99%) of RICU beds; 100% (95% CI, 63%-100%) of MICU beds; 75% (95% CI, 40%-94%) of NICU beds; and 71% (95% CI, 35%-92%) of medical/surgical beds compared with the on-site inspection team. The contact persons for the LDTT overwhelmingly underreported surge capacity beds compared with the surge capacity determined by the on-site inspection team.

Global Software Development: Commitment, Trust and Cultural Sensitivity in Strategic Partnerships

Abstract Much research has studied off-shore outsourcing from a Western client perspective. This article tries to shed light on what an Indian vendor perceives as important to manage large and complex strategic partnerships in IT outsourcing, and in particular how mutually profitable, long-term relationships with European clients are created and maintained, both at company and project levels. We investigate this issue through qualitative interviews with various vendor representatives in offshore and on-site teams in a top tier multinational company of Indian origin. In the analysis of interview accounts of close collaboration processes in two large and complex projects, where off-shoring of software development is moved to a strategic level, we found that the vendor was able to establish a strategic partnership through long-term engagement with the field of banking and insurance as well as through conscious relationship management with the clients. Three major themes describe important aspects of the strategic partnerships: 1) senior management commitment and employee identification with the projects, 2) mutual trust and transparency, and 3) cross-cultural understanding and sensitivity. The article draws attention to the important collaborative work done by people who are able to span boundaries in the complex organizational set-up of global IT development projects.

Abstract TP288: Introduction of a 24/7 Acute Care Nurse Practitioner-Based Stroke Code Team Improved Compliance with Time Targets

Introduction: An on-site stroke team improves access to IV tPA and speeds assessment of acute stroke patients. The impact of an acute care nurse practitioner (ACNP)-based team to provide 24/7 on-site stroke coverage was studied at a Primary Stroke Center that previously lacked on-site coverage around-the-clock. Hypothesis: We hypothesized that the introduction of 24/7 on-site coverage by an ACNP-based acute stroke team would improve compliance with time targets for rapid assessment of stroke patients. Methods: A single Primary Stroke Center in Honolulu, HI prospectively collected data on acute stroke code activations for the Get With the Guidelines - Stroke clinical database over a 33-month period. We retrospectively analyzed data for consecutive periods of 19 months before and 14 months after introduction of a 24/7 on-site acute stroke code team that included an ACNP as first responder. Data included patient characteristics, target times, and tPA utilization. Results: During the 19-month period prior to ACNP coverage, 200 acute stroke code activations occurred. The mean age of patients was 67.6 years, 51.5% were male, and the mean initial NIH stroke scale score was 15.3 +/- 5.1. Acute ischemic stroke was diagnosed in 47% of acute stroke code activations and 36.2% of those were treated with IV tPA. During the 14-month period after ACNP coverage began, the number of stroke code activations increased to 276. The mean age of patients was 67.5 years, 44.6% were male, and the mean initial NIH stroke scale score was 12.4 +/- 7.2. Acute ischemic stroke was diagnosed in 53.3% of acute stroke code activations and 33.3% of those were treated with IV tPA. After the intervention, door-to-CT-completion time improved from 45.2 +/- 30.1 to 37.8 +/- 20/8 minutes (p=0.192), door-to-lab-result time improved from 42.2 +/- 11.4 to 34.0 +/- 12.4 minutes (p=0.003), and door-to-needle time improved from 60.8 +/- 30.2 to 55.1 +/- 24.3 minutes (p=0.367). After the intervention, compliance with the 60-minute target door-to-needle time improved from 62.1% to 72.3% (p=0.247). Conclusions: Introduction of 24/7 on-site ACNP coverage as first responder for acute stroke code activations resulted in modest improvement of compliance with target times for assessment of acute stroke patients.

Well-Performance Monitoring (WPM): Creating Added Value From Raw Data and Application to the Girassol Deepwater-Field Case

Summary Capitalizing on early successes in advanced well control and realtime monitoring, Total Exploration and Production has engaged in a major "digital-field" initiative. Combining both proven and leading-edge technologies, the field-monitoring template is providing a powerful tool for well and facilities performance monitoring and optimization. This paper presents the concept of the WPM module, and the early results of its pilot application whose implementation began in 2009 at the Girassol field located offshore Angola. The WPM module constitutes an integrated real-time monitoring solution for subsea installations, from reservoir inflow to receiving facilities. Proposing advanced features (e.g., a common asset model, a business orchestrator, and a Web-based interface), the tool provides remote access to timely and quality field data, improves communication and collaboration between offshore and onshore, and provides support by specialists from exploration- and-production headquarters. Functional capabilities include data validation, virtual metering, wells and networks modeling, smart alarming, and production optimization. Specific workflows have also been defined to sustain continuous updating of the models to match observed field behavior. This paper illustrates the benefits of the WPM solution in terms of improved production and enhanced well diagnosis. It also reviews the organizational challenges associated with such a project and discusses the key factors ensuring successful implementation and good support from on-site teams. WPM brings forth a new approach for the intelligent surveillance of complex subsea-production systems. Well performance and production and reservoir teams have gained benefit from such a tool. Pertinent information is delivered to the right people in real time, enabling instant diagnosis and minimization of production shortfalls. In addition, the online simulator supports the continuous optimization of the field throughput by real-time integration of changing well behavior or production constraints.

Critical success factors for offshoring of enterprise resource planning (ERP) implementations

Critical success factors for offshoring of enterprise resource planning (ERP) implementations Background: In recent years, offshoring enterprise resource planning (ERP) implementation has been an emerging trend in the field of offshoring information technology (IT). However, both ERP implementations and IT offshoring are fraught with risks, and when both ERP implementation and IT offshoring happen together, the risks become even more pronounced. Therefore, it is important to understand and identify the issues of ERP implementation in an offshoring situation. Objectives: The purpose of this paper is to highlight the key factors that enable successful offshoring ERP implementation from the client and the vendor perspective. Methods/Approach: The paper uses literature as a basis for identifying a critical success factor, data collected through semi-structured interviews with ERP managers at various levels of the subject organizations, and eventually their analysis. Results: The findings of the paper reveal that various factors are critical while implementing offshoring ERP. They include: offshoring partnership, project management, project team composition, people issues, communications and compliance of the onsite team composition. It is also noticed that ten factors are grouped into three categories: the client side, the vendor side, and both. Conclusions: Organizations are currently undertaking or considering the offshoring ERP implementation particularly from India. This paper will enable them to understand the possible challenges and areas of offshoring the ERP implementation program. The value and originality of the paper comes from the fact that up to now, ERP implementation in offshoring has not been comprehensively explored. This research provides a complete understanding of the critical success factors from the client, the vendor or both the client and the vendor perspective. It also enables researchers to analyse ili rethink ili review offshoring in different service areas.

Confined Space Emergency Response: Assessing Employer and Fire Department Practices

An emergency response plan for industrial permit-required confined space entry is essential for employee safety and is legally required. Maintaining a trained confined space rescue team, however, is costly and technically challenging. Some employers turn to public fire departments to meet their emergency response requirements. The confined space emergency response practices of employers and fire departments have not been previously assessed. We present (1) federal data on the U.S. occurrence between 1992 and 2005 of confined space fatal incidents involving toxic and/or oxygen-deficient atmospheres; (2) survey data from 21 large companies on permit-required confined space emergency response practices; (3) data on fire department arrival times; and (4) estimates by 10 senior fire officers of fire department rescue times for confined space incidents. Between 1992 and 2005, 431 confined space incidents that met the case definition claimed 530 lives, or about 0.63% of the 84,446 all-cause U.S. occupational fatal injuries that occurred during this period. Eighty-seven (20%) incidents resulted in multiple fatalities. Twelve (57%) of 21 surveyed companies reported that they relied on the fire department for permit-required confined space emergency response. Median fire department arrival times were about 5 min for engines and 7 min for technical rescue units. Fire department confined space rescue time estimates ranged from 48 to 123 min and increased to 70 and 173 min when hazardous materials were present. The study illustrates that (1) confined space incidents represent a small but continuing source of fatal occupational injuries in the United States; (2) a sizeable portion of employers may be relying on public fire departments for permit-required confined space emergency response; and (3) in the event of a life-threatening emergency, fire departments usually are not able to effect a confined space rescue in a timely manner. We propose that the appropriate role for the fire department is to support a properly trained and equipped on-site rescue team and to provide advanced life support intervention following extrication and during ambulance transportation.

Characteristics and triage of a maritime disaster: an accidental passenger ship collision in Korea

The aim of this study was to analyze the characteristics of and responses to a maritime disaster, by reviewing the events surrounding the accidental collision of a high-speed passenger ship in South Korea. Of the 215 boarded passengers on a high-speed passenger ship sailing from Fukuoka to Busan, we retrospectively examined information of 114 victims of the ship's collision with a whale on 12 April 2007. We referenced reports from the on-site disaster medical assistance team members; recorded notifications to the Busan 1339 Emergency Medical Information Centre, from the scene of the accident and data from the ship's insurer. The 114 victims were transported to 20 different hospitals. Many patients were transported to nearby local hospitals from the scene of the accident; other patients were transported to more distant hospitals. Eighty-five patients were transported to hospitals through mobile emergency support units, whereas the other patients were transported directly by fire officers from the 119 Fire Officer Centre. One patient died in the transport. In conclusion, our national emergency medical service and disaster response system each suffer from many problems - especially a lack of cooperation among related departments and insufficient communication therein. The onboard planning and practice of a disaster plan is required, and a reliable information system between the scene of a maritime disaster and our emergency medical service system should be developed.

Mount Elbert Gas Hydrate Stratigraphic Test Well, Alaska North Slope: Coring operations, core sedimentology, and lithostratigraphy

In February 2007, BP Exploration (Alaska), the U.S. Department of Energy, and the U.S. Geological Survey completed the BPXA-DOE-USGS Mount Elbert Gas Hydrate Stratigraphic Test Well (Mount Elbert well) in the Milne Point Unit on the Alaska North Slope. The program achieved its primary goals of validating the pre-drill estimates of gas hydrate occurrence and thickness based on 3-D seismic interpretations and wireline log correlations and collecting a comprehensive suite of logging, coring, and pressure testing data. The upper section of the Mount Elbert well was drilled through the base of ice-bearing permafrost to a casing point of 594 m (1950 ft), approximately 15 m (50 ft) above the top of the targeted reservoir interval. The lower portion of the well was continuously cored from 606 m (1987 ft) to 760 m (2494 ft) and drilled to a total depth of 914 m. Ice-bearing permafrost extends to a depth of roughly 536 m and the base of gas hydrate stability is interpreted to extend to a depth of 870 m. Coring through the targeted gas hydrate bearing reservoirs was completed using a wireline-retrievable system. The coring program achieved 85% recovery of 7.6 cm (3 in) diameter core through 154 m (504 ft) of the hole. An onsite team processed the cores, collecting and preserving approximately 250 sub-samples for analyses of pore water geochemistry, microbiology, gas chemistry, petrophysical analysis, and thermal and physical properties. Eleven samples were immediately transferred to either methane-charged pressure vessels or liquid nitrogen for future study of the preserved gas hydrate. Additional offsite sampling, analyses, and detailed description of the cores were also conducted. Based on this work, one lithostratigraphic unit with eight subunits was identified across the cored interval. Subunits II and Va comprise the majority of the reservoir facies and are dominantly very fine to fine, moderately sorted, quartz, feldspar, and lithic fragment-bearing to -rich sands. Lithostratigraphic and palynologic data indicate that this section is most likely early Eocene to late Paleocene in age. The examined units contain evidence for both marine and non-marine lithofacies, and indications that the depositional environment for the reservoir facies may have been shallower marine than originally interpreted based on pre-drill wireline log interpretations. There is also evidence of reduced salinity marine conditions during deposition that may be related to the paleo-climate and depositional conditions during the early Eocene.

The impact of a clinical team assisting the Coroner’s investigation of healthcare-related deaths: Reflections on six-years of service

Aim This study describes the short-term impacts of an on-site team of practising clinicians (Clinical Liaison Service, CLS), in enhancing the Coroner’s investigation for the prevention of healthcare-related deaths. Methods An internal observational program evaluation was conducted where objective and externally verifiable achievements of CLS over a six-year period were provided in relation to definable program components. Results From 2003–2008, the same conceptual model for CLS was in place. CLS developed and implemented for the death investigation process: (i) a working model for a comprehensive and standardised clinical review; (ii) a knowledge management strategy to enhance the healthcare sector access to information and coronial (iii) activities to improve communication channels between the Coroner’s Office and the healthcare sector. The short-term impact included improved appropriateness of cases that proceed to investigation; improvements in the nature and depth of the investigation, and self-reported changes to clinicians practice. CLS reflected that the clinically enhanced investigation improved the credibility of the Coroner’s death investigation, reduced apprehension in the healthcare sector about the purpose of the investigation and engendered co-operation between involved parties. Discussion This study suggests that a team of practising clinicians assisting the Coroner’s investigation of healthcare-related deaths contributes towards improving patient safety.

Production Optimization by Real-Time Modeling and Alarming: The Sendji Field Case

Summary Digital technologies can improve oil production and reduce operating costs. In this prospect, TOTAL launched a corporate program called "Field Monitoring" to capitalize affiliate previous experiences. For gas-lifted wells, it resulted in the development of the "Well Performance Monitoring" (WPM) tool implemented in December 2006 at the Sendji field located offshore Congo. This paper presents the main workflows, functionalities, and added value of WPM. Besides multi-real-time data trends, the application offers color-coded multialarm visualization versus time. These alarms are ranked in terms of "priority" and aggregated at each well, platform, field, and asset level, which allows well engineers to easily track down underperforming wells. Alarms priority can be linked either to well integrity issues or production losses. These real-time estimated losses are computed using network and well-modeling softwares; they highlight deviation from optimum operating set points. WPM makes easier regular optimization of gas-lift optimization by feeding models inputs with user-validated real-time data. A major challenge of right-time production optimization is to sustain updated models. Two workflows address this issue: 1) automatic modeling of production well tests and 2) real-time modeling of the actual behavior of the production system. When a significant difference occurs between modeling and reality, a specific alarm is triggered. This paper shows various examples of enhanced well performance diagnosis and the corresponding production gains. Also, good support from onsite teams was achieved thanks to key technical solutions, such as user-friendly interface, possible individual tuning of each alarm, and handling of unstable or unmatched wells. Finally, WPM enables computation of KPIs that allow the evaluation of potential well interventions. This tool will be deployed at a corporate level and extended to ESP-lifted wells, gas injectors or producers, and to subsea wells in deep offshore environment. The general alarming, interface features, and data architecture will be applied to surface equipment monitoring and optimization.

Initiation of Assertive Community Treatment Among Veterans With Serious Mental Illness: Client and Program Factors

Ensuring equitable access to mental health services is a national priority. The authors examined assertive community treatment (ACT) services initiation in the Veterans Affairs (VA) health system among program-eligible patients. The VA's National Psychosis Registry included 6,540 patients who met program eligibility criteria (mental illness diagnosis and prior hospitalization) in fiscal year (FY) 2003 (FY 2003) and had not received VA ACT services in FY 2001-FY 2003. Receipt of VA ACT services during FY 2004 was assessed with generalized estimating equations. Independent variables included age, gender, race and ethnicity, marital status, service-connected disability benefits, substance use disorder, psychiatric inpatient days in FY 2003, distance to the nearest facility with a VA ACT team, presence of an on-site team at the facility where the last VA psychiatric hospitalization occurred, and number of open slots with the nearest ACT team. A total of 452 of the eligible patients (7%) received VA ACT services in FY 2004. In multivariate analyses, older age was associated with reduced odds of receiving ACT services (odds ratio [OR]=.92 per five years); being female (OR=1.86) and having schizophrenia (OR=1.64) were positively associated with ACT services initiation. Individuals living farther from ACT sites were less likely to receive ACT services (OR=.95 per ten miles). The marginal effects of distance were most substantial in the first 30 miles and beyond 100 miles. Most patients who were eligible for yet not already receiving VA ACT services went without these services in FY 2004. Geographic distance limited services initiation. Focused efforts are needed to enhance ACT services initiation and delivery, particularly for individuals in remote locations.

Thinking about questions caused by cell morphological examination in the on-site inspection of ISO15189 accreditation

As an on-site inspection team leader, I have joined the inspection on the clinical laboratories in six hospitals designed especially 2008 Olympic game organized by China National Laboratory Accreditation Committee (ISO15189 Accreditation). Two years' preparation promotes the standization, skill, management and academic level of these laboratories and boost the development 2-3 years forward. But there still were some deficiencies in the cell morphological examination including: ( 1 ) Low ratio of blood smear check when machine was used for hematological analysis; (2) Lack of criteria for blood smear check ; (3) Low capability of identification of cell; (4) Lack of personnel for microscopic examination. The reasons causing above deficiencies were concluded as follows: (1) The lab director did not pay sufficient attention to the morphological examination;(2)The technicians were unable to perform microscopic examination properly due to the heavy workload and lack of personnel; (3) The technicians were unable to use machine correctly as screening tool. So I put forward some measures for improvement of morphological examination. These measures included: (1) strengthening the propaganda on the importance of morphology examination and training the new stuffs; (2) Renovating the concept and improving the skill of lab technicians. Key words: Accreditation; Morphology; ISO15189

Hospital-Based Event Medical Support for the Baltimore Marathon, 2002−2005

Objectives. We present a four-year, cross-sectional epidemiologic description of injuries andillnesses among Baltimore Marathon participants andthe evaluation, treatment, anddisposition of those conditions by an on-site event medical team led by physicians andstaff from an urban, academic emergency department. Methods.We analyzed data from injuries encountered during the marathon. Subjects presenting to a medical aid station along the course route or at the finish line were defined as “injured or ill” andwere prospectively divided into two groups: 1) a brief-encounter group and2) an extended-encounter group. Data collected included gender, presenting complaint(s), assessment, treatment(s), anddisposition. Results.Three percent (N = 1,144) of approximately 33,700 total participants over four years presented to medical aid stations during the Baltimore Marathon between 2002 and2005. Most participants (66%) did not require a full clinical evaluation. Common complaints encountered were dehydration (32%), musculoskeletal injuries (25%), andcutaneous wounds (20%). Transport to the hospital was required for 4% of all injured participants, and61% returned to the race. Conclusions.Most injuries/illnesses encountered at the Baltimore Marathon in 2002–2005 were minor, although some were serious enough to require transport to a hospital. The year with the highest average race-day temperature had the highest observed injury rates andthe highest number of hospital transports. These results help to improve understanding of the types, severity, anddistribution of injuries commonly sustained by marathon participants andmay guide decisions regarding the appropriate distribution of emergency medical resources at such events.

Lightning, sudden cardiac death, simulation and an automated external defibrillator: The perfect storm

This is a report of an 11-year-old boy who had sudden cardiac death after a lightning strike while playing lacrosse at summer camp. The camp staff had performed weekly drills to prepare for various medical emergencies and quickly activated their "Emergency Activation System". The child received immediate cardiopulmonary resuscitation (CPR) and was defibrillated with an automated defibrillator (AED) within 3 min of becoming pulseless and was ultimately resuscitated after being defibrillated three times. A community ambulance with a defibrillator on board did not arrive until several minutes after the on-site team had achieved return of spontaneous circulation. In this report, we describe the clinical course of this patient; briefly review lightning injuries, other causes of sudden cardiac death in children and use of AEDs. Finally, we review how simulation has been used in this case and others as a mechanism to ensure preparedness for medical emergencies. This child is alive and well today because of these well-trained camp counselors. Their system of using simulation to maintain emergency readiness serves as an example for lay and professional medical providers alike.

A Pilot Survey of Inmate Preferences for On-Site, Visiting Consultant, and Telemedicine Psychiatric Services

To assess inmate preferences for in-prison mental health services, outside psychiatric consultants, and telemedicine psychiatric consultation for 16 mental health services. Structured interviews were conducted of the service modality preferences of 28 inmates who received psychiatric telemedicine consultations in New York State Department of Corrections facilities. For five of the 16 mental health services assessed, a significantly larger proportion of inmates preferred delivery of mental services by their on-site mental health team to an outside psychiatric consultant, whether visiting or using telemedicine. For another eight services, inmate preferences were approximately equal. For three services (treatment progress, evaluation of childhood sexual abuse, and sexual concerns), inmates reported a trend toward preference for outside consultation (visiting and telemedicine combined). For no service did inmates prefer telemedicine to a visiting consultant. Although inmates prefer the use of on-site mental health professionals for many mental health services, some inmates prefer visiting or telemedicine consultants for the evaluation of safety and sexual issues. Because telemedicine is efficient and readily available, its role in these areas requires further evaluation.

Agile Outsourcing Projects

Agile methods are lightweight, iterative software development frameworks used predominantly on small- and mid-sized software development projects. This article introduces a project structure and management practices creating Agile conditions for large software projects outsourced either offshore or onshore. Agility is achieved by slicing a large project into a number of small-sized projects working in Agile settings. Development is divided into R&D activities, located onsite, and production activities, located offsite. The proposed approach makes Agile applicable to the stressed conditions of outsourcing without compromising the quality or pace of the software development effort. Creating an Agile environment in an outsourcing project relies on maintaining a balance between the functions and sizes of onsite and offsite teams, on redefining the developers’ roles, and on reorganizing the information flow between the different development activities to compensate for the lack of customer onsite, team co-location, and tacit project knowledge.

Potential for international business consultancies in wastewater treatment in China

PurposeThe purpose of this paper is to assess the business potential for international consultancies in wastewater treatment in China using a New Zealand consultancy as an example. China's water shortage, and the requirement for innovative solutions, provides the potential for New Zealand, and other international, engineering consultancies to do business in wastewater treatment in China.Design/methodology/approachA detailed case study was undertaken on a New Zealand company with experience of business in China. The company's key strategic factors were identified – its own strengths and weaknesses, as well as the external opportunities and threats that the company faces in China.FindingsBased on the analysis of the case study company, a series of recommendations have been suggested for both the company's further sustainable development, and for other New Zealand and international consultancies that plan to gain access into the Chinese market. The results and discussion suggest that there are some main requirements for companies to successfully compete in the Chinese market such as developing close relationships with clients, local construction companies and design institutes; providing an effective onsite project team; having effective design capability; introducing project management skills and the use of a “one stop shop” approach to business.Practical implicationsThe paper makes recommendations on how other companies might be able to compete in the Chinese market in the wastewater industry. Specifically, comments are made on developing long‐term relationships, making use of Chinese experience and developing a bi‐lingual capability.Originality/valueThere are potential opportunities for New Zealand and international companies to compete in China in the wastewater treatment field. The lessons learned from this research show what possible threats they will face but also highlight the opportunities.

Developing a participatory multidisciplinary team approach to enhance the quality of school start

The article discusses how participatory action research was applied during a three-year project at 27 schools in Norway in order to enhance the quality of school start. A multidisciplinary on-site team approach was developed, supported by workshops and dialogue seminars. External professionals from the supportive municipal health care system and special education/school psychology services assisted children and teachers in the first grade, focusing on early health promotion and support to children at risk of developing problems. The project was reported to improve multidisciplinary teamwork and relationships, to increase focus on developmental and health care issues, to develop professional knowledge and practical skills, to increase support to local educational staff, and to provide a better school-start for all and particularly vulnerable children. Local creativity and ownership within supportive administrative structures were reported as promoting factors, while available time and external professional resources were the main constraints. The building of learning partnerships based on face-to-face interaction appeared to be a particular strength of the approach.

Patterns of interaction in construction team meetings

Sir John Egan's 1998 report on the construction industry (Construction Task Force 1998) noted its confrontational and adversarial nature. Both the original report and its subsequent endorsement in Accelerating Change (Strategic Forum 2002) called for improved working relationships—so-called ‘integration’—within and between both design and construction aspects. In this paper, we report on our observations of on-site team meetings for a major UK project during its construction phase. We attended a series of team meetings and recorded the patterns of verbal interaction that took place within them. In reporting our findings, we have deliberately used a graphical method for presenting the results, in the expectation that this will make them more readily accessible to designers. Our diagrams of these interaction patterns have already proved to be intuitively and quickly understood, and have generated interest and discussion among both those we observed and others who have seen them. We noted that different patterns of communication occurred in different types of meetings. Specifically, in the problem-solving meeting, there was a richness of interaction that was largely missing from progress meetings and technical meetings. Team members expressed greater satisfaction with this problem-solving meeting where these enriched exchanges took place. By making comparisons between the different patterns, we are also able to explore functional roles and their interactions. From this and other published evidence, we conclude that good teamworking practices depend on a complex interplay of relations and dependencies embedded within the team.