Standardising practices improves clinical diabetic foot management: the Queensland Diabetic Foot Innovation Project, 2006-09

Objective. The aim of this paper is to report the clinical practice changes resulting from strategies to standardise diabetic foot clinical management in three diverse ambulatory service sites in Queensland, Australia. Methods. Multifaceted strategies were implemented in 2008, including: multidisciplinary teams, clinical pathways, clinical training, clinical indicators, and telehealth support. Prior to the intervention, none of the aforementioned strategies were used, except one site had a basic multidisciplinary team. A retrospective audit of consecutive patient records from July 2006 to June 2007 determined baseline clinical activity (n = 101).Aclinical pathway teleform was implemented as a clinical activity analyser in 2008 (n = 327) and followed up in 2009 (n = 406). Pre- and post-implementation data were analysed using Chi-square tests with a significance level set at P < 0.05. Results. There was an improvement in surveillance of the high risk population of 34% in 2008 and 19% in 2009, and treating according to risk of 15% in 2009 (P < 0.05). The documentation of all best-practice clinical activities performed improved 13–66% (P < 0.03). Conclusion. These findings support the use of multifaceted strategies to standardise practice and improve diabetic foot complications management in diverse ambulatory services.

Standardising practices improves ambulatory diabetic foot management and reduces amputations : the Queensland Diabetic Foot Innovation Project, 2006 – 2009

Background Diabetic foot complications are recognised as the most common reason for diabetic related hospitalisation and lower extremity amputations. Multi-faceted strategies to reduce diabetic foot hospitalisation and amputation rates have been successful. However, most diabetic foot ulcers are managed in ambulatory settings where data availability is poor and studies limited. The project aimed to develop and evaluate strategies to improve the management of diabetic foot complications in three diverse ambulatory settings and measure the subsequent impact on ospitalisation and amputation. Methods Multifaceted strategies were implemented in 2008, including: multi-disciplinary teams, clinical pathways and training, clinical indicators, telehealth support and surveys. A retrospective audit of consecutive patient records from July 2006 – June 2007 determined baseline clinical indicators (n = 101). A clinical pathway teleform was implemented as a clinical record and clinical indicator analyser in all sites in 2008 (n = 327) and followed up in 2009 (n = 406). Results Prior to the intervention, clinical pathways were not used and multi-disciplinary teams were limited. There was an absolute improvement in treating according to risk of 15% in 2009 and surveillance of the high risk population of 34% and 19% in 2008 and 2009 respectively (p < 0.001). Improvements of 13 – 66% (p < 0.001) were recorded in 2008 for individual clinical activities to a performance > 92% in perfusion, ulcer depth, infection assessment and management, offloading and education. Hospitalisation impacts recorded reductions of up to 64% in amputation rates / 100,000 population (p < 0.001) and 24% average length of stay (p < 0.001) Conclusion These findings support the use of multi-faceted strategies in diverse ambulatory services to standardise practice, improve diabetic foot complications management and positively impact on hospitalisation outcomes. As of October 2010, these strategies had been rolled out to over 25 ambulatory sites, representing 66% of Queensland Health districts, managing 1,820 patients and 13,380 occasions of service, including 543 healed ulcer patients. It is expected that this number will rise dramatically as an incentive payment for the use of the teleform is expanded.

Living the indie life : mapping creative teams in a 48 hour game jam and playing with data

In contemporary game development circles the ‘game making jam’ has become an important rite of passage and baptism event, an exploration space and a central indie lifestyle affirmation and community event. Game jams have recently become a focus for design researchers interested in the creative process. In this paper we tell the story of an established local game jam and our various documentation and data collection methods. We present the beginnings of the current project, which seeks to map the creative teams and their process in the space of the challenge, and which aims to enable participants to be more than the objects of the data collection. A perceived issue is that typical documentation approaches are ‘about’ the event as opposed to ‘made by’ the participants and are thus both at odds with the spirit of the jam as a phenomenon and do not really access the rich playful potential of participant experience. In the data collection and visualisation projects described here, we focus on using collected data to re-include the participants in telling stories about their experiences of the event as a place-based experience. Our goal is to find a means to encourage production of ‘anecdata’ - data based on individual story telling that is subjective, malleable, and resists collection via formal mechanisms - and to enable mimesis, or active narrating, on the part of the participants. We present a concept design for data as game based on the logic of early medieval maps and we reflect on how we could enable participation in the data collection itself.

Analysing governance categories used on project alliances in the construction industry

In Australia, collaborative contracts, and in particular, project alliances, have been increasingly used to govern infrastructure projects. These contracts use formal and informal governance mechanisms to manage the delivery of infrastructure projects. Formal mechanisms such as financial risk sharing are specified in the contract, while informal mechanisms such as integrated teams are not. Given that the literature contains a multiplicity of often untestable definitions, this paper reports on a review of the literature to operationalize the concepts of formal and informal governance. This work is the first phase of a study that will examine the optimal balance of formal and informal governance structures. Desk-top review of leading journals in the areas of construction management and business management, as well as recent government documents and industry guidelines, was undertaken to to conceptualise and operationalize formal and informal governance mechanisms. The study primarily draws on transaction-cost economics (e.g. Williamson 1979; Williamson 1991), relational contract theory (Feinman 2000; Macneil 2000) and social psychology theory (e.g. Gulati 1995). Content analysis of the literature was undertaken to identify key governance mechanisms. Content analysis is a commonly used methodology in the social sciences area. It provides rich data through the systematic and objective review of literature (Krippendorff 2004). NVivo 9, a qualitative data analysis software package, was used to assist in this process. A previous study by the authors identified that formal governance mechanisms can be classified into seven measurable categories: (1) negotiated cost, (2) competitive cost, (3) commercial framework, (4) risk and reward sharing, (5) qualitative performance, (6) collaborative multi-party agreement, and (7) early contractor involvement. Similarly, informal governance mechanisms can be classified into four measureable categories: (1) leadership structure, (2) integrated team, (3) team workshops, and (4) joint management system. This paper explores and further defines the key operational characteristics of each mechanism category, highlighting its impact on value for money in alliance project delivery. The paper’s contribution is that it provides the basis for future research to compare the impact of a range of individual mechanisms within each category, as a means of improving the performance of construction projects.

A dedicated retrieval and transfer service : the QUARTS project

Background The transfer and/or retrieval of a critically patient is inherently dangerous not only for the patient but for staff as well. The quality and experience of unplanned transfers can influence patient mortality and morbidity. However, international evidence suggests that dedicated transfer/retrieval teams can improve mortality and morbidity outcomes. Aims The initial aim of this paper is to describe an in-house competency-based training programme, which encompasses the STaR approach to develop members of our existing nursing team to be part of the dedicated transfer/retrieval service. The paper also presents audit data findings which examined the source of referrals, number of patients actually transferred and clinical status of those being transferred. Results Audit data illustrate that the most frequent source of referrals comes from Accident and Emergency and the Surgical Directorate with the most common presenting condition being cardio-respiratory failure or arrest. Audit data reveal that the number of patients actually transferred or retrieved is relatively small (33%) compared with the overall number of requests for assistance. However, 36% of those patients transferred had a level 2 or level 3 acuity status that necessitated the admission to a critical care area. Conclusions A number of studies have concluded that the ill-experienced and ill-equipped transfer team can place patients’ at serious risk of harm. Whether planned or unplanned, dedicated critical care transfer/retrieval teams have been shown to reduce patient mortality and morbidity.

How emergent roles and structures create trust In hastily formed inter-organizational teams

Many activities, from disaster response to project management, require cooperation among people from multiple organizations who initially lack interpersonal relationships and trust. Upon entering inter-organizational settings, pre-existing identities and expectations, along with emergent social roles and structures, may all influence trust between colleagues. To sort out these effects, we collected time-lagged data from three cohorts of military MBA students, representing 2,224 directed dyads, shortly after they entered graduate school. Dyads that shared organizational identity, boundary-spanning roles, and similar network positions (structural equivalence) were likely to have stronger professional ties and greater trust.

Designing awareness support for distributed cooperative design teams

Motivation Awareness is an integral part of remote collaborative work and has been an important theme within the CSCW research. Our project aims at understanding and mediating non-verbal cues between remote participants involved in a design project. Research approach Within the AMIDA project we focus on distributed 'cooperative design' teams. We especially focus on the 'material' signals - signals in which people communicate through material artefacts, locations and their embodied actions. We apply an ethnographic approach to understand the role of physical artefacts in co-located naturalistic design setting. Based on the results we will generate important implications to support remote design work. We plan to develop a mixed-reality interface supported by a shared awareness display. This awareness display will provide information about the activities happening in the design room to remotely located participants. Findings/Design Our preliminary investigation with real-world design teams suggests that both the materiality of designers' work settings and their social practices play an important role in understanding these material signals that are at play. Originality/Value Most research supporting computer mediated communication have focused on either face-to-face or linguistically oriented communication paradigms. Our research focuses on mediating the non-verbal, material cues for supporting collaborative activities without impoverishing what designers do in their day to day working lives. Take away message An ethnographic approach allows us to understand the naturalistic practices of design teams, which can lead to designing effective technologies to support group work. In that respect, the findings of our research will have a generic value beyond the application domain chosen (design teams).

The re-introduction project

The Re-introduction Project began with an art-science research residency in 2012, funded through the Australian 'Synapse' art-science residency program. It was developed in partnership with the Australian Wildlife Conservancy, Australia's largest private conservation agency and their South-East regional scientist Matt Hayward and conducted through a series of seven high intensity field-trips to AWC’s remote properties in VIC, NSW and SA. These trips coincided with key times at which the AWC’s mobile scientific teams were undertaking intensive scientific activities. The program coincided with specific events that senior scientist collaborator Dr Matt Hayward led in 2012 at Mallee Regions (Yookamurra, Scotia and Buckaringa), Lake Eyre Basin (Kalamurina) and Sydney (North Head). The initial outcome of the project was the work Pitfall (An Opportunistic Survey) - a new media installation created in light, media, object, text and sound presented near the AWC headquarters at Mildura in far NW Victoria. Pitfall built upon ideas and cross disciplinary processes developed during this residency/collaboration with Australian Wildlife Conservancy inspired by working with their ecological scientists during pitfall-trap survey events used to survey small mammals and invertebrates. ‘Pitfall’ was designed in response to a playful survey that I asked the AWC scientists to engage with around ideas of avoiding ecological pitfalls into the future. This continually-evolving artwork was built from multiple screens, a tabletop landscape mapped with projections, fibre optics, 3D spatial sound and infrared night imagery.

Literacy and numeracy project: Final report 2009

Literacy and numeracy are critical for young people during and after their schooling. The subjects and courses that students undertake during their school years incorporate a range of academic literacy and numeracy practices which students must be able manage if they are to be successful. Pathways beyond schooling also require specific, and changing, understandings of, and proficiencies with, literacy and numeracy as new communication technologies increasingly impact on further study, work, and everyday life. Teaching and learning numeracy is a new emphasis in the SACE and as yet we have little understanding about the ways in which secondary schools handle this area. Students in Years 10 and 11 are at a crucial point in their educational and life pathways as they begin to refine their future aspirations. For those who have difficulty with academic literacies and numeracies – and often a long history of such problems – this period can be fraught unless teachers are able to provide specific support when it is needed, or students are able to access it from care-givers or community members. The School to Work Literacy and Numeracy Project involved teachers from nine schools across the three sectors and university researchers working together to design curriculum interventions for students with a history of low measurable achievement in literacy and/or numeracy. The project started from the premise that working with ‘rich tasks’, an approach to learning and assessment developed in the Productive Pedagogies work undertaken in Queensland (Hayes et al., 2006), would improve students’ motivation, engagement and learning and that this work could best be done by teachers working in school-based, cross-curriculum teams with a school leadership team member and a university researcher as mentor. A key idea in designing rich tasks is that students will have opportunities to demonstrate their learning in assessments which are aligned with the learning expectations (for example a film festival to publicly launch student-produced films, advertising to sell student-made cubby-houses, a household budget based on students’ likely incomes in future work). In other words the assessments should be designed to allow for authentic communication and displays of what the students have learned through serious engagement with the curriculum. The project was conducted from Term 1-4 2009, with follow-up checks with some project teachers in the early weeks of 2010.

The innovation imperative: The relationships between team climate, innovation, and performance in research and development teams

A team’s climate for innovation has been shown to be important for innovation in management and work teams. This article investigates the relationship of team climate with project team innovation and performance in research and development organizations. It is argued that the relationship between team climate and innovation will be stronger for research teams than development teams as research teams have greater scope for creating novel and innovative ideas. A sample of 193 scientists and technologists in 20 research teams and 18 development teams were measured on their team’s climate for innovation, team performance, and six indicators of innovation. Research and development teams showed similar ratings for team climate and for measures of innovation. However, the relationships between team climate and individual and team innovation were stronger for research teams than development teams. These findings are significant for fostering innovativeness and innovation in knowledge work teams.

An investigation into challenges facing distributed teams: Case of South Australian construction projects

There is increasing momentum within the construction industry to deploy distributed teams on projects, yet the major challenges that companies face for managing teams in distributed arrangements have yet to be explored in the construction context. Driven by such need, this study is intended to present an account of the major challenges encountered throughout the life cycle of offshore outsourcing arrangements within the South Australian construction industry. To this end, the study describes the observations made within the natural contexts of one construction project in terms of the challenges to the success of deploying distributed teams for outsourcing of works. Discussions remain in dialogue with relevant theories and the pertinent literature to explain the interpretations and lessons learned and to underpin the conclusions made. It is contended that this study contributes to the field by providing an illuminating insight into potential challenges facing distributed teams being implemented in outsourcing tasks in construction projects. Discussions also offer practical guidelines for construction project managers and assist them in dealing with potential challenges of offshore outsourcing through the lenses of distributed team working principles.

Insights from stimulating creative behaviours in a project-based organization team

Novel and useful ideas and creative behaviours originate in varied work environments, yet the characteristics of work environments that stimulate and foster such creative behaviours are not well defined. The aim of this study was to identify the influences that contribute to creative behaviours in the work environment of a global project-based professional service organization. This article is based on an investigation of the work environment of one project team undertaking interdisciplinary work in the construction of a processing plant in a remote location. This multi-disciplinary team encouraged creative behaviours through regular team meetings, ensuring the presentation of diverse views and commitments to regular interaction and collaboration in co-located environments. In addition, a technology manager dedicated to identifying potential opportunities for patenting and commercialization further extended the creative behaviours of the team by focusing on the best solution for each situation. The study contributes new knowledge to research regarding work environments that facilitate creative behaviours.