Podcasts about ipd

In this international edition of the EMS One-Stop podcast, host Rob Lawrence welcomes Lewis Andrews, the chief operating officer of the United Kingdom's College of Paramedics, for an insightful discussion on two major topics shaping global paramedicine. First up is International Paramedic Day, taking place on July 8, 2025. Now in its third year, the day honors the contribution of paramedics across the world and draws its inspiration from the birthday of Dominique-Jean Larrey, the father of battlefield ambulance care. Lewis explains how the day has grown from 50 initial partners to over 150 global organizations, with this year's theme being “Unity and community.” The day aims to raise awareness of the profession, share innovations and bring together the global paramedic community. MORE | How community paramedicine is thriving in the UK: Dr. Linda Dykes and Rom Duckworth discuss trans-Atlantic lessons in emergency management In the second half of the show, Lewis delves into the structure and significance of the College of Paramedics, which represents nearly half of the UK's registered paramedics. He describes how the UK paramedic profession is regulated and protected by law, with a rigorous educational pathway that now includes the potential for prescribing paramedics and direct-to-primary-care tracks. Rob and Lewis explore how paramedics in the UK are increasingly working beyond emergency ambulances — in GP surgeries, urgent care centers and academic roles. Their conversation offers a rich comparison point for U.S. EMS leaders seeking to elevate paramedicine through autonomy, education and broader clinical roles. Memorable quotes “This is not a commercial platform — this is about us celebrating us.” — Lewis Andrews, on the ethos of International Paramedic Day “Let's not reinvent the wheel, but let's look at what the wheel is for the environment that it's required to roll in.” — Lewis Andrews, on global EMS collaboration “The title ‘paramedic' is protected by law in the UK — you can't simply do a first aid course and call yourself one.” — Rob Lawrence “Autonomy — in a word — that's what makes a prescribing paramedic.” — Lewis Andrews, on expanding paramedic roles “We're also promoting the profession to those who don't yet know they want to be in the profession.” — Lewis Andrews, on recruitment and professional identity “We have a career framework … that actually shows that you can develop from that day one newly qualified right through to a consultant paramedic, chief paramedic, director, professor.” — Lewis Andrews Episode timeline 00:55 – Introduction to International Paramedic Day (IPD) and its origins 02:17 – Why July 8 was chosen: Dominique-Jean Larrey's birthday 03:02 – Growth of IPD from 50 to over 150 partners 05:06 – 2025 theme: “Unity and community” and sub-objectives 06:45 – How to participate: share stories, use hashtags (#UnityAndCommunity and #IPD2025), connect globally 08:58 – The global nature of IPD and U.S. partners' involvement 11:25 – Promoting awareness and the importance of celebrating paramedics 12:50 – Part 2 — The role of the College of Paramedics 14:09 – Overview of College functions: CPD, representation, research, advocacy 18:15 – Registration with HCPC, protected title and the regulator's role 21:12 – Paramedic education in the UK: degree pathways, demand and cost 23:46 – Discussion on streaming directly into primary care roles 27:09 – Career framework: from graduate paramedic to chief paramedic/professor 30:16 – Prescribing paramedics: autonomy and improved patient experience 33:08 – Recap and call to action: visit www.internationalparamedicsday.com 34:17 – Like, subscribe and engage ADDITIONAL RESOURCES International Paramedics Day Resources UK College of Paramedics The standards of proficiency for paramedics RATE & REVIEW Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Wall Street closed mixed on Friday but posted strong gains across the key indices for the month of May as investors shrugged off Trump's tariff turmoil and global trade uncertainty to send equities higher for the month. The S&P500 closed flat on Friday but gained 6.2% for the month, the Dow Jones rose 0.13% on Friday and 3.9% for the month, and the tech-heavy Nasdaq ended the day down 0.32% but posted a 9.6% surge for the month of May.On Friday a trade deal between the U.S. and UK was reached, boosting investor optimism that more deals of this kind can be done.Across the European region on Friday, markets closed mostly higher on the UK trade deal and as investors welcomed the potential blocking of his tariffs on certain regions.The STOXX600 rose 0.1%, Germany's DAX added 0.3%, the French CAC fell 0.36%, and, in the UK, the FTSE100 ended the day up 0.64%.Across the Asia region on Friday markets closed mostly lower as the appeals court in the U.S. allowed majority of Trump's tariffs to be re-instated. Japan's Nikkei fell 1.22%, China's CSI index lost 0.48%, South Korea's Kospi index declined 0.84%, and Hong Kong's Hang Seng ended the day down 1.2%.Locally on Friday, the ASX200 posted a 0.3% gain despite Trump's tariff-related volatility weighing on the key index early in the session. Investors again moved into defensive and safe-haven stocks like the banks and staples, while shifting out of riskier stocks like tech on Friday as uncertainty arose again on the tariffs front. The local market posted a second straight monthly gain for the month of May despite heightened volatility and macro uncertainty.On Friday morning it was announced that a federal appeals court temporarily upheld many of President Trump's tariffs on China and other countries, pausing a lower court ruling that had challenged them. This move allows the tariffs to remain in place while the court reviews the case and considers the administration's request for more time. The appeal success came not even 12-hours after a federal court announced a blockage of the tariffs amid overuse of Presidential power. This week will be an interesting time for tariffs as the appeals process unfolds, but we are no closer to clarity on exactly what tariffs are allowed to remain and the implications on our locally listed companies.Retail sales fell by 0.1%, missing the forecasted 0.3% increase, with warmer weather contributing to reduced clothing purchases. Clothing and department store spend were the key contributors to the weaker-than-expected reading for April, while cafes and food related spend was still on the rise. Surprisingly, niche retailers like Accent Group and Universal Stores still rallied on Friday despite the retail spend figure being released.In data out this week, Q1 2025 GDP figures are also expected to show a slowdown in growth to 0.2%, down from 0.6% in Q4 2024, primarily due to weaker household consumption. Markets are now factoring in a 73% chance of a rate cut out of the RBA when it next meets in July, up from the 59% chance expected prior to the retail sales data being released. What to watch today:On the commodities front this morning, oil is trading 0.25% lower at US$60.79/barrel, gold is 0.9% lower at US$3288.58/ounce and iron ore is down 0.15% at U.S.$99.12/tonne.The Aussie dollar has weakened against the greenback to buy 64.37 U.S. cents, 92.57 Japanese yen, 47.76 British pence and 1 New Zealand dollar and 8 cents.Ahead of Monday's trading session here in Australia the SPI futures are anticipating the ASX will open the first trading session of June up 0.09%.Trading ideas:Bell Potter has decreased the 12-month price target on IPD Group (ASX:IPG) from $4.60 to $4.10 and maintain a buy rating on the leading Australian distributor of electrical equipment and industrial digital technologies, following the company provid

(00:00) Golf Discussion With Joe Bosco This chapter takes a fascinating look at the mental and emotional aspects of golf with special guest Joe Bosco, a respected expert in human performance. We discuss how the mind can both enhance and inhibit physical performance on the golf course, emphasizing the importance of mental control and emotional management. Joe shares insights into how golfers can improve by integrating mental strategies with physical skills, transforming them into more complete players. We explore scenarios that test a golfer's mental resilience, like facing a challenging par three over water, and highlight the common tendency for golfers to get stuck in their heads, focusing too much on mechanics rather than trusting their skills. Through this engaging conversation, we aim to help golfers overcome mental obstacles and enhance their performance by aligning their mind and body. (06:57) Navigating Parental Pressure in Junior Golf This chapter addresses the pressing issue of parental pressure in youth sports, particularly in junior golf. We explore the detrimental effects of parents who hover over their children, pushing them to perform for reasons tied to parental pride rather than the child's love for the game. Discussing personal experiences and observations, we highlight the shift from a time when young athletes played more independently to the current landscape where children often face burnout from external pressures. The conversation touches on the mental and emotional hurdles young athletes encounter, exacerbated by parental involvement and social media influences, and stresses the importance of allowing children to develop their skills and passion independently. (15:43) Mental Game in Junior Golf This chapter explores the misconceptions around perfectionism in golf, particularly for young players and their parents. I share an anecdote about an eighth-grade golfer and his parents, who have a skewed perspective due to watching highlight reels on TV, thinking professional golfers like Tiger Woods never make mistakes. By showing them PGA Tour bloopers, I challenge this perception, highlighting the reality that even top golfers miss shots. We discuss how parents, especially those unfamiliar with golf, may place unrealistic expectations on their children, drawing parallels with other sports like baseball, where failure is more accepted. I also touch on strategies for improving golf performance, referencing Joe's book "Real Golf." A key method is the self-scramble, where players hit multiple shots and choose the best one, fostering self-coaching and adaptability, essential skills in golf due to its nature of constant adjustments. (27:39) Visualization Training for Golf Performance This chapter explores the transformative power of an app designed to enhance golfers' performance by focusing on mental conditioning and visualization techniques. We discuss the importance of helping both parents and young golfers navigate the pressures of the sport, while also highlighting the app's benefits for adult players like John. The conversation touches on the app's integration of hypnotherapy elements, which aim to retrain players' responses to pressure situations, ultimately leading to improved performance. Jeff's insights on reducing pressure and fostering positivity through strategies like not keeping score but counting good shots are emphasized. A success story is shared about a young golfer who, through the app's training modules and recordings, significantly improved his ability to visualize and recall details from his games, impressing even his mother with his progress. (32:25) Mastering Mental Performance in Golf This chapter focuses on the power of visualization in enhancing golf performance and overall human potential. We explore the concept of "pre-living," which goes beyond traditional visualization by incorporating all senses and emotions to vividly imagine and rehearse future actions. Jeff Smith, a top 100 golf instructor, and Joe Bosco, a mental performance expert, discuss how this technique can help golfers of all levels by fostering a positive mindset and focusing on constructive thoughts. We also introduce Joe Bosco's newly launched app, Real Mental Golf, available in the Apple Store, which offers tools and content to support mental training for golf and life. Through engaging community features and resources, users can strengthen their focus and concentration, overcoming negative spirals to enhance performance on and off the golf course. (37:48) Mindset Mastery in Golf Coaching This chapter focuses on the significance of mental coaching in golf and how leveraging positive thoughts can enhance performance. We explore the idea of "give credit and steal shamelessly," emphasizing the value of being a transmitter of good ideas to foster personal growth and enjoyment in the game. Highlighting contributions from renowned mental coaches like Dr. Bob Rotella and Brett McCabe, the discussion underscores the importance of mindset in both individual and competitive play. By focusing on positive outcomes, such as counting good shots, golfers can shift their mindset to improve performance and enjoy the game more. A personal anecdote about helping a young player overcome the pressures of competitive golf illustrates how the right mental approach can transform one's experience. (43:05) Fascination in Golf Mindset Training This chapter focuses on cultivating a positive mindset on the golf course by encouraging players to embrace every shot, whether good or bad, with the phrase "Isn't that fascinating?" We explore how holding one's finish and maintaining balance while acknowledging the result can help take the pressure off, turning the game into an enjoyable learning experience. I share insights from working with corporate groups, where introducing this perspective leads to laughter and relaxation, even among CEOs. By reminding ourselves that golf is a game meant for fun and learning, we can enhance our performance without being bogged down by unrealistic expectations. This approach allows us to learn more effectively by focusing on enjoyment rather than self-criticism. Access the App for iPone of iPd here: (00:00) Golf Discussion With Joe Bosco This chapter takes a fascinating look at the mental and emotional aspects of golf with special guest Joe Bosco, a respected expert in human performance. We discuss how the mind can both enhance and inhibit physical performance on the golf course, emphasizing the importance of mental control and emotional management. Joe shares insights into how golfers can improve by integrating mental strategies with physical skills, transforming them into more complete players. We explore scenarios that test a golfer's mental resilience, like facing a challenging par three over water, and highlight the common tendency for golfers to get stuck in their heads, focusing too much on mechanics rather than trusting their skills. Through this engaging conversation, we aim to help golfers overcome mental obstacles and enhance their performance by aligning their mind and body. (06:57) Navigating Parental Pressure in Junior Golf This chapter addresses the pressing issue of parental pressure in youth sports, particularly in junior golf. We explore the detrimental effects of parents who hover over their children, pushing them to perform for reasons tied to parental pride rather than the child's love for the game. Discussing personal experiences and observations, we highlight the shift from a time when young athletes played more independently to the current landscape where children often face burnout from external pressures. The conversation touches on the mental and emotional hurdles young athletes encounter, exacerbated by parental involvement and social media influences, and stresses the importance of allowing children to develop their skills and passion independently. (15:43) Mental Game in Junior Golf This chapter explores the misconceptions around perfectionism in golf, particularly for young players and their parents. I share an anecdote about an eighth-grade golfer and his parents, who have a skewed perspective due to watching highlight reels on TV, thinking professional golfers like Tiger Woods never make mistakes. By showing them PGA Tour bloopers, I challenge this perception, highlighting the reality that even top golfers miss shots. We discuss how parents, especially those unfamiliar with golf, may place unrealistic expectations on their children, drawing parallels with other sports like baseball, where failure is more accepted. I also touch on strategies for improving golf performance, referencing Joe's book "Real Golf." A key method is the self-scramble, where players hit multiple shots and choose the best one, fostering self-coaching and adaptability, essential skills in golf due to its nature of constant adjustments. (27:39) Visualization Training for Golf Performance This chapter explores the transformative power of an app designed to enhance golfers' performance by focusing on mental conditioning and visualization techniques. We discuss the importance of helping both parents and young golfers navigate the pressures of the sport, while also highlighting the app's benefits for adult players like John. The conversation touches on the app's integration of hypnotherapy elements, which aim to retrain players' responses to pressure situations, ultimately leading to improved performance. Jeff's insights on reducing pressure and fostering positivity through strategies like not keeping score but counting good shots are emphasized. A success story is shared about a young golfer who, through the app's training modules and recordings, significantly improved his ability to visualize and recall details from his games, impressing even his mother with his progress. (32:25) Mastering Mental Performance in Golf This chapter focuses on the power of visualization in enhancing golf performance and overall human potential. We explore the concept of "pre-living," which goes beyond traditional visualization by incorporating all senses and emotions to vividly imagine and rehearse future actions. Jeff Smith, a top 100 golf instructor, and Joe Bosco, a mental performance expert, discuss how this technique can help golfers of all levels by fostering a positive mindset and focusing on constructive thoughts. We also introduce Joe Bosco's newly launched app, Real Mental Golf, available in the Apple Store, which offers tools and content to support mental training for golf and life. Through engaging community features and resources, users can strengthen their focus and concentration, overcoming negative spirals to enhance performance on and off the golf course. (37:48) Mindset Mastery in Golf Coaching This chapter focuses on the significance of mental coaching in golf and how leveraging positive thoughts can enhance performance. We explore the idea of "give credit and steal shamelessly," emphasizing the value of being a transmitter of good ideas to foster personal growth and enjoyment in the game. Highlighting contributions from renowned mental coaches like Dr. Bob Rotella and Brett McCabe, the discussion underscores the importance of mindset in both individual and competitive play. By focusing on positive outcomes, such as counting good shots, golfers can shift their mindset to improve performance and enjoy the game more. A personal anecdote about helping a young player overcome the pressures of competitive golf illustrates how the right mental approach can transform one's experience. (43:05) Fascination in Golf Mindset Training This chapter focuses on cultivating a positive mindset on the golf course by encouraging players to embrace every shot, whether good or bad, with the phrase "Isn't that fascinating?" We explore how holding one's finish and maintaining balance while acknowledging the result can help take the pressure off, turning the game into an enjoyable learning experience. I share insights from working with corporate groups, where introducing this perspective leads to laughter and relaxation, even among CEOs. By reminding ourselves that golf is a game meant for fun and learning, we can enhance our performance without being bogged down by unrealistic expectations. This approach allows us to learn more effectively by focusing on enjoyment rather than self-criticism.

What if planning with your builder from day one could save you hundreds of thousands?   In this episode, I sit down with Nick Roth, founder of Habikon, to break down what truly makes a real estate project succeed. From building high-end custom homes to multifamily developments, Nick shares how he turned his love for structure into a company that thrives on trust, collaboration, and detailed planning.   We talk about why most projects go over budget, how to fix it with integrated project delivery (IPD), and the surprising tech stack powering his construction process. Nick explains how aligning expectations upfront, building in phases, and using cost simulation tools are helping clients build smarter—not just bigger.   Tune in to hear why planning is the most underrated skill in real estate—and how choosing the right builder could be your biggest investment decision.   —   Tired of spreadsheets and admin headaches in your rental business?   If you're a real estate investor looking to simplify operations and grow your portfolio, Kompas is your new best friend. This all-in-one property management and accounting software helps you automate the tedious stuff—like receivables, renewals, and leasing—so you can focus on creating value.   Boost your cash flow, improve your NOI, cut down back-office work, and scale with confidence.  

Darlene Cadman joins Justin Neagle to discuss Integrated Project Delivery (IPD) in the AEC industry. They explore IPD contracts, focusing on collaboration, risk, and reward sharing, and emphasize target value design and team selection in lean construction. Darlene shares insights on lean practices, including respect for people and understanding flow, as well as pull planning, visual planning, and collaboration. The episode highlights the importance of leadership, accountability, and structured planning in both work and personal life. It concludes with Darlene's contact information and productivity hacks.

Take 10 with Tim – May 2, 2025 – 7:00/6:00 amMicrosoft Teams:PodcastFriday, May 2, 20257:00 AM - 8:30 AMhttps://teams.live.com/meet/9344301938391?p=FbWCGwzXFMz4LKSw4a1.Closers have once again been the bane of many fantasy managers' existence. I know I'm struggling. I have excellent teams in a couple of leagues, but my closers suck or are hurt. Last Sunday, I spent a fortune on Will Vest in Detroit as it looked like he had the job. Now, maybe he doesn't.a.What's your advice for me and others who are struggling?b.Should managers go for the hot potential closer like Vest or instead spend less on setup guys?2.Potential young breakout pitchers. Who are you buying? We will talk about each and then I'll have you order them in how you like them for the rest of the season and then their careers?a.Brandon Pfaadt (AZ, age=26, rank=18) – 6 GS, 5 wins, 2.78 ERA, 1.12 WHIP, 29Ks/4BB in 35.2 IPb.Jesus Luzardo (PHI, 27, 15) – 6 GS, 3 wins, 1.73 ERA, 1.07 WHIP, 41K/10BB in 36.1 IPc.McKenzie Gore (Was, 26, 26) – 7 GS, 2 wins, 3.51 ERA, 1.10 WHIP, 59K/9BB in 41 IPd.Max Meyer (Mia, 26, 37) – 6 GS, 2 wins, 3.18 ERA, 1.20 WHIP, 47K/11BB in 34 IPe.Casey Mize (Det, 28, 42) – 5 GS, 4 wins, 2.12 ERA, 1.05 WHIP, 23K/7BB in 29.2 IP3.Potential young breakout pitchers. Who are you buying? We will talk about each and then I'll have you order them in how you like them for the rest of the season and then their careers?a.Pete Crow Armstrong (CHC, 23, 10) - 6 HR, 12 SB, 23 runs, 21 RBI, .315 BAb.Tyler Soderstrom (ATH, 23, 50) – 9 HR, 1 SB, 20 runs, 24 RBI, .349 BAc.Spencer Torkelson (Det, 25, 65) – 8 HR, 1 SB, 20 runs, 24 RBI, .359 BAd.Wilyer Abreu (Bos, 25, 78) – 6 HR, 4 SB, 18 runs, 21 RBI, .295 BAe.Ben Rice (NYY, 26, 113) – 8 HR, 2 SB, 22 runs, 13 RBI, .266 BA4.In doing the research for the potential breakouts, two players caught my eye. What do you think about these two:a.JP Sears (ATH, 29, 33) – 6 GS, 4 wins, 2.94 ERA, 1.07 WHIP, 30K/6BB in 33.2 IPb.Griffin Canning (NYM, 28, 40) – 6 GS, 4 wins, 2.61 ERA, 1.38 WHIP, 31K/14BB in 31 IP5.Lance McCullers Jr (Remember him?) will make his 2025 debut on Sunday against the White Sox. I'm assuming you have to start him, but is there anything there with this kid or is it impossible to tell?a.Ranger Suarez also makes his debut on Sunday against the Diamondbacks. Are you starting him?b.ROS – McCullers or Suarez?6.Over/Under gamea.Aaron Judge: AL MVP – more yes or nob.Oneil Cruz: 1st round pick in 2026 – more yes or noc.Corbin Carroll: 25-25 seasond.Kyle Manzardo: 30 HRse.MacKenzie Gore: 200 strikeouts – 11 were over 200 in 20247.What hitter are you targeting for this week's FAAB?8.What pitcher are you targeting for this week's FAAB?

“This isn't like a conference you go to and just listen to people give presentations, this is interactive. You're actually solving real world problems and working together to come up with those solutions. {You} have everyone at the table, really why you want to join is so you can be at the table and direct the future of our industry.” In this conversation, Devon Tilly and co-host Nathan Wood chat with Todd Sutton from Zachary Corporation! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd – 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! With over 35 years of construction industry service with Zachry Corporation, Todd has supported various business units and industry markets in finding user-inspired, process-based solutions through the implementation of technologies or construction methods to assist in project execution. He is an enthusiastic advocate for workforce initiatives, participating in Zachry's Career Exploration Program internship for high school students. At Zachry Corporation, he works on R&D to improve processes, as well as on the technologies that enable these improvements. He is currently involved in several industry data exchange standards, primarily focused on openBIM IFC efforts and FHWA, AASHTO, and State DOT-led digital delivery efforts. Co-host Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Additional Resources mentioned in this episode: What is Digital Delivery? National BIM Standards BuildingSMART BIM for Infrastructure Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, and LinkedIn! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

"Take that step back and look at how the fabric that we exist in with our industries can change...I think there is so much room to embrace the opportunities, a challenge generally means there is money to be made as soon as you figure out how to do it." This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd – 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Use the promo code “AOCMFER” that will take $250 off registration. In this conversation, Devon Tilly and co-host Nathan Wood chat withNick Caravella in preparation for the  AEC Summit in Austin, Texas in April 2025! With over a decade of experience in the industry, Nick Caravella has a unique outlook by starting his career as an architect. His passion for using new technology on projects led him to a career in construction technology, where he worked in a series of product and community focused initiatives which further highlighted how companies could be enabling growth through optimizing their technology approach. Through this journey, Nick joined Avicado Construction Technology Services, where he currently works as the Director of Growth and Industry Strategy, as well as the Host/Producer of the company's construction technology podcast, Wired to Build. His background in architecture and expertise with technology provides a unique background that understands the needs of the AEC-O industry and how to apply the solutions being created to the problems we're trying to solve today. Nick holds a Bachelor of Architecture degree from the New Jersey Institute of Technology and is a registered Architect. Co-host Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Additional listening to Bill Allen Episode! Listen to Nick on the ConTech Roadshow as a guest! Listen to Nick on the Building Bite as a guest! Listen to Nick on last year's WTB Epsiode on AECiS with Nathan! Avicado Research on how Owner's are Using Technology: Optimizing Construction Technology for Owners Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, and LinkedIn! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

Esta semana ha terminado la semana del Cerebro. ¿Por qué es tan importante la investigación? Responde en la firma invitada José Ramón Pineda, investigador IPD de la Facultad de Medicina y Enfermería de la Universidad del País Vasco.

"In the spirit of getting the right people to Austin… Nathan...if 70 people are registered, then we will be a go for Coffee & Chaos at the Museum of Illusions in Austin" "That event was mind bending, and opened my eyes to how our position impacts our perspective." Help Nathan register 70 people so the mind bending trip to the Museum of Illusions will be a go! Register here! Use the promo code “AOCMFER” that will take $250 off registration. In this conversation, Devon Tilly and co-host Nathan Wood chat with Chad Pearson and Charlie Dunn in preparation for the  AEC Summit in Austin, Texas in April 2025! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd – 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Charlie tells a good story. From lightning fast development on the Las Vegas strip, to oil fueled expansion in Edmonton, Alberta, to once in a generation energy plant upgrades throughout the Southeast, to global mission critical and life science construction for enterprise owners, he thrives in the challenging delivery gap between “as is” conditions and the “to be” designed state. His career highlights include the on-site project management of over 2.5 million square feet of new distribution space across North America with zero recordable injuries, and WANO (World Association of Nuclear Operators) recognition for the use of 4D technology in project delivery. He knows that projects succeed because of people—what they believe, strategy—as it supports creativity and innovation, and tools—to deliver value, drive out waste, and improve safety. Charlie's current working definition of a project storyteller is this: imagine that which is not, and take others there with you. He believes that construction may be the highest form of storytelling, for it transports humanity in a permanent way. Chad is a partner at Plexxis Software, where he helps deliver software to the ‘trades' while coaching teammates on performance under pressure. Outside of Plexxis, Chad is a Mixed Martial Arts and Wrestling coach. Prior to ConTech, Chad worked in Law Enforcement in Emergency Response, CIB (Criminal Investigation Bureau) and as an Outlaw Motorcycle Gang Liaison Officer. His formal training includes a Bachelor of Arts from University of Guelph, Crisis Resolution & tactical communication, CBRN (Chemical, Biological, Radiological & Nuclear Response), Police Defensive Tactics and Use of Force. Co-host Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, and LinkedIn! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

Dr. Neeraj Agarwal and Dr. Peter Hoskin discuss key abstracts in GU cancers from the 2025 ASCO Genitourinary Cancers Symposium, including novel therapies in prostate, bladder, and kidney cancer and the impact of combination therapies on patient outcomes. TRANSCSRIPT Dr. Neeraj Agarwal: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, the director of the Genitourinary Oncology Program and professor of medicine at the Huntsman Cancer Institute at the University of Utah, and editor-in-chief of ASCO Daily News. Today, we'll be discussing practice-informing abstracts and other key advances in GU oncology featured at the 2025 ASCO Genitourinary Cancers Symposium. Joining me for this discussion is Dr. Peter Hoskin, the chair of this year's ASCO GU Symposium. Dr. Hoskin is a professor in clinical oncology in the University of Manchester and honorary consultant in clinical oncology at the Christie Hospital, Manchester, and University College Hospital London, in the United Kingdom. Our full disclosures are available in the transcript of this episode. Peter, thank you for joining us today. Dr. Peter Hoskin: Thank you so much, Neeraj. I am very pleased to be here. Dr. Neeraj Agarwal: The GU meeting highlighted remarkable advancements across the spectrum of GU malignancies. What stood out to you as the most exciting developments at the ASCO GU Symposium?  Dr. Peter Hoskin: The theme of this year's meeting was "Driving Innovation, Improving Patient Care," and this reflected ASCO GU's incredible milestone in GU cancer research over the years. We were thrilled to welcome almost 6,000 attendees on this occasion from over 70 countries, and most of them were attending in person and not online, although this was a hybrid meeting. Furthermore, we had more than 1,000 abstract submissions. You can imagine then that it fostered fantastic networking opportunities and facilitated valuable knowledge and idea exchanges among experts, trainees, and mentees. So, to start I'd like to come back to you for a second because the first day started with a focus on prostate cancer and some of the key clinical trials. And congratulations to you, Neeraj, on sharing the data from the TALAPRO-2 trial, which we were eagerly awaiting. I'd love to get your thoughts on the data that you presented. Could you tell us more about that trial, Abstract LBA18?  Dr. Neeraj Agarwal: Yes, Peter, I agree with you. It was such an exciting conference overall and thank you for your leadership of this conference. So, let's talk about the TALAPRO-2 trial. First of all, I would like to remind our audience that the combination of talazoparib plus enzalutamide was approved by the U.S. FDA in June 2023 in patients with metastatic castration-resistant prostate cancer harboring HRR gene alterations, after this combination improved the primary endpoint of radiographic progression-free survival compared to enzalutamide alone in the randomized, double-blind, placebo-controlled, multi-cohort phase 3 TALAPRO-2 trial. In the abstract I presented at ASCO GU 2025, we reported the final overall survival data, which was a key alpha-protected secondary endpoint in cohort 1, which enrolled an all-comer population of patients with mCRPC. So, at a median follow-up of around 53 months, in the intention-to-treat population, the combination of talazoparib plus enzalutamide significantly reduced the risk of death by 20% compared to enzalutamide alone, with a median OS of 45.8 months in the experimental arm versus 37 months in the control arm, which was an active control arm of enzalutamide. This improvement was consistent in patients with HRR alterations with a hazard ratio of 0.54 and in those with non-deficient or unknown HRR status, with a hazard ratio of 0.87. In a post hoc analysis, the hazard ratio for OS was 0.78 favoring the combination in those patients who did not have any HRR gene alteration in their tumors by both tissue and ctDNA testing. Consistent with the primary analysis, the updated rPFS data also favored the experimental arm with a median rPFS of 33.1 compared to 19.5 months in the control arm, and a hazard ratio of 0.667. No new safety signals were identified with extended follow-up. Thus, TALAPRO-2 is the first PARP inhibitor plus ARPI study to show a statistically significant and a clinically meaningful improvement in OS compared to standard-of-care enzalutamide as first-line treatment in patients with mCRPC unselected for HRR gene alterations. Dr. Peter Hoskin: Thank you, Neeraj. That's a great summary of the data presented and very important data indeed. There was another abstract also featured in the same session, Abstract 20, titled “Which patients with metastatic hormone-sensitive prostate cancer benefit more from androgen receptor pathway inhibitors? STOPCAP meta-analyses of individual participant data.” Neeraj, could you tell us more about this abstract? Dr. Neeraj Agarwal: Absolutely, I would be delighted to. So, in this meta-analysis, Dr. David Fischer and colleagues pooled individual participant data from different randomized phase 3 trials in the mHSPC setting to assess the potential ARPI effect modifiers and determine who benefits more from an ARPI plus ADT doublet. The primary outcome was OS for main effects and PFS for subgroup analyses. Prostate cancer specific survival was a sensitivity outcome. The investigators pooled data from 11 ARPI trials and more than 11,000 patients. Overall, there was a clear benefit of adding an ARPI on both OS and PFS, with hazard ratios of 0.66 and 0.51, respectively, representing a 13% and 21% absolute improvement at 5 years, respectively, with no clear difference by the class of agent. When stratifying the patients by age group, the effects of adding an ARPI on OS and PFS were slightly smaller in patients older than 75, than in those younger than 65, or aged between 65 and 75 years. Notably, in the trials assessing the use of abiraterone, we saw very little OS effects in the group of patients older than 75, however there was some benefit maintained in prostate-cancer specific survival, suggesting that other causes of death may be having an impact. The effects of the other ARPIs, or ‘lutamides' as I would call them, were similar across all three age subgroups on both OS and PFS. Therefore, the majority of patients with mHSPC benefit from the addition of ARPIs, and the benefits/risks of abiraterone and other ‘amides' must be considered in older patients.  Dr. Peter Hoskin: Thanks, Neeraj. Another great summary relevant to our day-to-day practice. Of course, there's ongoing collection of individual patient data from other key trials, which will allow robust comparison of ARPI doublet with triplet therapy (including docetaxel), guiding more personalized treatment.   Dr. Neeraj Agarwal: I agree with you, Peter, we need more data to help guide personalized treatment for patients with mHSPC and potentially guide de-escalation versus escalation strategies. Now, moving on to a different setting in prostate cancer, would you like to mention Abstract 17 titled, “Overall survival and quality of life with Lu-PSMA-617 plus enzalutamide versus enzalutamide alone in poor-risk, metastatic, castration-resistant prostate cancer in ENZA-p (ANZUP 1901),” presented by Dr. Louise Emmett? Dr. Peter Hoskin: Of course I will. So, ENZA-p was a multicenter, open-label, randomized, phase 2 trial conducted in Australia. It randomized 163 patients into adaptive doses (2 or 4 cycles) of Lu-PSMA-617 plus enzalutamide versus enzalutamide alone as first-line treatment in PSMA-PET-CT-positive, poor-risk, mCRPC. The interim analysis of ENZA-p with median follow-up 20 months showed improved PSA-progression-free survival with the addition of Lu-PSMA-617 to enzalutamide. Here, the investigators reported the secondary outcomes, overall survival, and health-related quality of life (HRQOL). After a median follow up of 34 months, overall survival was longer in the combination arm compared to the enzalutamide arm, with a median OS of 34 months compared to 26 months; with an HR of 0.55. Moreover, the combination improved both deterioration-free survival and health-related quality of life indicators for pain, fatigue, physical function, and overall health and quality of life compared to the control arm. Consistent with the primary analysis, the rPFS also favored the experimental arm with a median rPFS of 17 months compared to 14 months with a HR of 0.61. So, the addition of LuPSMA improved overall survival, and HRQOL in patients with high-risk mCRPC. Dr. Neeraj Agarwal: Thank you, Peter. Great summary, and promising results with Lu-177 and ARPI combination in first line treatment for mCRPC among patients who had two or more high risk features associated with early enzalutamide failure. Before we move on to bladder cancer, would you like to tell us about Abstract 15 titled, “World-wide oligometastatic prostate cancer (omPC) meta-analysis leveraging individual patient data (IPD) from randomized trials (WOLVERINE): An analysis from the X-MET collaboration,” presented by Dr. Chad Tang?  Dr. Peter Hoskin: Sure. So, with metastatic-directed therapy (MDT), we have a number of phase 2 studies making up the database, and the X-MET collaboration aimed to consolidate all randomized data on oligometastatic solid tumors. This abstract presented pooled individual patient data from all the published trials involving patients with oligometastatic prostate cancer who received MDT alongside standard of care (SOC) against SOC alone. The analysis included data from five trials, encompassing 472 patients with oligometastatic prostate cancer, and followed for a median of 41 months. Patients were randomly assigned in a 1:1 ratio to receive either MDT plus SOC or SOC alone. The addition of MDT significantly improved PFS. The median PFS was 32 months with MDT compared to 14.9 months with SOC alone, with an HR of 0.45. Subgroup analyses further confirmed the consistent benefits of MDT across different patient groups. Regardless of factors like castration status, receipt of prior primary treatment, stage, or number of metastases, MDT consistently improved PFS. In patients with mHSPC, MDT significantly delayed the time to castration resistance by nine months, extending it to a median of 72 months compared to 63 months in the SOC group with an HR of 0.58. In terms of OS, the addition of MDT improved the 48-month survival rate by 12%, with OS rates of 87% in the MDT+SOC group compared to 75% in the SOC alone group. Dr. Neeraj Agarwal: Thank you, Peter. These data demonstrate that adding MDT to systemic therapy significantly improves PFS, rPFS, and castration resistance-free survival, reinforcing its potential role in the treatment of oligometastatic prostate cancer. So, let's switch gears to bladder cancer and start with Abstract 658 reporting the OS analysis of the CheckMate-274 trial. Would you like to tell us about this abstract?  Dr. Peter Hoskin: Yes, sure, Neeraj. This was presented by Dr. Matt Milowsky, and it was additional efficacy outcomes, including overall survival, from the CheckMate-274 trial which evaluated adjuvant nivolumab versus placebo in patients with high-risk muscle-invasive bladder cancer after radical surgery. The phase 3 trial previously demonstrated a significant improvement in disease-free survival with nivolumab. With a median follow-up of 36.1 months, disease-free survival was longer with nivolumab compared to placebo across all patients with muscle-invasive bladder cancer, reducing the risk of disease recurrence or death by 37%. Among patients who had received prior neoadjuvant cisplatin-based chemotherapy, nivolumab reduced this risk by 42%, whilst in those who had not received chemotherapy, the risk was reduced by 31%. Overall survival also favored nivolumab over placebo, reducing the risk of death by 30% in all patients with muscle-invasive bladder cancer and by 52% in those with tumors expressing PD-L1 at 1% or higher. Among patients who had received prior neoadjuvant chemotherapy, nivolumab reduced the risk of death by 26%, whilst in those who had not received chemotherapy, the risk was reduced by 33%. Alongside this, the safety profile remained consistent with previous findings. Dr. Neeraj Agarwal: Thank you, Peter, for such a nice overview of this abstract. These results reinforce adjuvant nivolumab as a standard of care for high-risk muscle-invasive bladder cancer, offering the potential for a curative outcome for our patients. Dr. Peter Hoskin: I agree with you Neeraj. Perhaps you would like to mention Abstract 659 titled, “Additional efficacy and safety outcomes and an exploratory analysis of the impact of pathological complete response (pCR) on long-term outcomes from NIAGARA.” Dr. Neeraj Agarwal: Of course. Dr. Galsky presented additional outcomes from the phase 3 NIAGARA study, which evaluated perioperative durvalumab combined with neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer. The study previously demonstrated a significant improvement in event-free survival and overall survival with durvalumab compared to chemotherapy alone, with a manageable safety profile and no negative impact on the ability to undergo radical cystectomy. Among the 1,063 randomized patients, those who received durvalumab had a 33% reduction in the risk of developing distant metastases or death and a 31% reduction in the risk of dying from bladder cancer compared to those who received chemotherapy alone. More patients who received durvalumab achieved a pathological complete response at the time of surgery with 37% compared to 28% in the chemotherapy-alone group. Patients who achieved a pathological complete response had better event-free survival and overall survival compared to those who did not. In both groups, durvalumab provided additional survival benefits, reducing the risk of disease progression or death by 42% and the risk of death by 28% in patients with a pathological complete response, while in those patients without a pathological complete response, the risk of disease progression or death was reduced by 23% and the risk of death by 16% when durvalumab was added to the chemotherapy. Immune-mediated adverse events occurred in 21% of patients in the durvalumab group compared to 3% in the chemotherapy-alone group, with grade 3 or higher events occurring in 3% compared to 0.2%. The most common immune-related adverse events included hypothyroidism in 10% of patients treated with durvalumab compared to 1% in the chemotherapy-alone group, and hyperthyroidism in 3% versus 0.8%. At the time of the data cutoff, these adverse events had resolved in 41% of affected patients in the durvalumab group and 44% in the chemotherapy-alone group. Dr. Peter Hoskin: Thank you, Neeraj, for the great summary. These findings further support the role of perioperative durvalumab as a potential standard of care for patients with muscle-invasive bladder cancer. Dr. Neeraj Agarwal: I concur with your thoughts, Peter. Before wrapping up the bladder cancer section, would you like to mention Abstract 664 reporting updated results from the EV-302 trial, which evaluated enfortumab vedotin in combination with pembrolizumab compared to chemotherapy as first-line treatment for patients with previously untreated locally advanced or metastatic urothelial carcinoma? Dr. Peter Hoskin: Yes, of course. Dr. Tom Powles presented updated findings from the EV-302 study, and in this abstract presented 12 months of additional follow-up for EV-302 (>2 y of median follow-up) and an exploratory analysis of patients with confirmed complete response (cCR). The study had a median follow-up of 29.1 months and previously demonstrated significant improvements in progression-free survival and overall survival with enfortumab vedotin and pembrolizumab. This is now the standard of care in global treatment guidelines. Among the 886 randomized patients, enfortumab vedotin and pembrolizumab reduced the risk of disease progression or death by 52% and the risk of death by 49% compared to chemotherapy. The survival benefit was consistent regardless of cisplatin eligibility or the presence of liver metastases. The confirmed objective response rate was higher with enfortumab vedotin and pembrolizumab at 67.5% compared to 44.2% with chemotherapy. The median duration of response was 23.3 months with enfortumab vedotin and pembrolizumab compared to 7.0 months with chemotherapy. A complete response was achieved in 30.4% of patients in the enfortumab vedotin and pembrolizumab group compared to 14.5% in the chemotherapy group, with the median duration of complete response not yet reached in the enfortumab vedotin and pembrolizumab group compared to 15.2 months in the chemotherapy group. Severe treatment-related adverse events occurred in 57.3% of patients treated with enfortumab vedotin and pembrolizumab compared to 69.5% in the chemotherapy group, while in patients who achieved a complete response, severe adverse events occurred in 61.7% of those treated with enfortumab vedotin and pembrolizumab compared to 71.9% with chemotherapy. Treatment-related deaths were reported in 1.1% of patients treated with enfortumab vedotin and pembrolizumab compared to 0.9% with chemotherapy, with no treatment-related deaths occurring in those who achieved a complete response. These findings clearly confirm the durable efficacy of enfortumab vedotin and pembrolizumab, reinforcing its role as the standard of care for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma, and no new safety concerns have been identified. Dr. Neeraj Agarwal: Thank you for this great summary. Moving on to kidney cancer, let's talk about Abstract 439 titled, “Nivolumab plus cabozantinib (N+C) vs sunitinib (S) for previously untreated advanced renal cell carcinoma (aRCC): Final follow-up results from the CheckMate-9ER trial.” Dr. Peter Hoskin: Sure. Dr. Motzer presented the final results from the phase 3 CheckMate-9ER trial, which compared the combination of cabozantinib and nivolumab against sunitinib in previously untreated advanced renal cell carcinoma. The data after more than five years follow-up show that the combination therapy provided sustained superior efficacy compared to sunitinib. In terms of overall survival, we see an 11-month improvement in median OS, 46.5 months for the cabo-nivo versus 35.5 months for sunitinib and a 42% reduction in the risk of disease progression or death, with median progression-free survival nearly doubling – that's 16.4 months in the combination group and 8.3 months with sunitinib. Importantly, the safety profile was consistent with the known safety profiles of the individual medicines, with no new safety concerns identified. Dr. Neeraj Agarwal: Great summary, Peter. These data further support the efficacy of cabo-nivo combination therapy in advanced renal cell carcinoma, which is showing a 11-month difference in overall survival. Dr. Peter Hoskin: Neeraj, before wrapping up this podcast, would you like to tell us about Abstract 618? This is titled “Prospective COTRIMS (Cologne trial of retroperitoneal lymphadenectomy in metastatic seminoma) trial: Final results.” Dr. Neeraj Agarwal: Sure, Peter. I would be delighted to. Dr Heidenrich from the University of Cologne in Germany presented the COTRIMS data evaluating retroperitoneal LN dissection in patients with clinical stage 2A/B seminomas. Seminomas are classified as 2A or B when the disease spreads to the retroperitoneal lymph nodes of up to 2 cm (CS IIA) or of more than 2 cm to up to 5 cm (CS 2B) in maximum diameter, respectively. They account for 10-15% of seminomas and they are usually treated with radiation and chemotherapy. However, radiation and chemo can be associated with long-term toxicities such as cardiovascular toxicities, diabetes, solid cancers, leukemia, particularly for younger patients. From this standpoint, Dr Heidenrich and colleagues evaluated unilateral, modified template, nerve-sparing retroperitoneal lymph node dissection as a less toxic alternative compared to chemo and radiation. They included 34 patients with negative AFP, beta-HCG, and clinical stage 2A/B seminomas. At a median follow-up of 43.2 months, the trial demonstrated great outcomes: a 99.3% treatment-free survival rate and 100% overall survival, with only four relapses. Antegrade ejaculation was preserved in 88% of patients, and severe complications such as grade 3 and 4 were observed in 12% of patients. Pathological analysis revealed metastatic seminoma in 85% of cases, with miR371 being true positive in 23 out of 24 cases and true negative in 100% of cases. It appears to be a valid biomarker for predicting the presence of lymph node metastases. These findings highlight retroperitoneal lymph node dissection is feasible; it has low morbidity, and excellent oncologic outcomes, avoiding overtreatment in 80% of patients and sparing unnecessary chemotherapy or radiotherapy in 10-15% of cases. Dr. Peter Hoskin: Great summary and important data on retroperitoneal lymphadenectomy in metastatic seminoma. These findings will help shape clinical practice. Any final remarks before we conclude today's podcast? Dr. Neeraj Agarwal: Before wrapping up this podcast, I would like to say that we have reviewed several abstracts addressing prostate, bladder, kidney cancers, and seminoma, which are impacting our medical practices now and in the near future. Peter, thank you for sharing your insights with us today. These updates are undoubtedly exciting for the entire GU oncology community, and we greatly appreciate your valuable contribution to the discussion and your leadership of the conference. Many thanks. Dr. Peter Hoskin: Thank you, Neeraj. Thank you for the opportunity to share this information more widely. I'm aware that whilst we have nearly 6,000 delegates, there are many other tens of thousands of colleagues around the world who need to have access to this information. And it was a great privilege to chair this ASCO GU25. So, thank you once again, Neeraj, for this opportunity to share more of this information that we discussed over those few days. Dr. Neeraj Agarwal: Thank you, Peter. And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  Find out more about today's speakers:   Dr. Neeraj Agarwal    @neerajaiims    Dr. Peter Hoskin Follow ASCO on social media:      @ASCO on Twitter      ASCO on Bluesky  ASCO on Facebook      ASCO on LinkedIn      Disclosures: Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas Dr. Peter Hoskin: Research Funding (Institution): Varian Medical Systems, Astellas Pharma, Bayer, Roche, Pfizer, Elekta, Bristol Myers  

In a new pharmaphorum podcast, web editor Nicole Raleigh speaks with two PharmaLex experts about navigating complex R&D processes to unleash the next wave of biopharma breakthroughs. PharmaLex's Dr Christian Schneider, VP & Chief Medical Officer, Clinical Development Services, together with Dr Christelle Boileau, Director of Regulatory Development Strategy and IPD solution lead at PharmaLex, which is part of Cencora, explore the many challenges faced across the clinical trial landscape when it comes to new therapies, including ATMP development. From preclinical to market access and regulatory considerations, Dr Boileau warns that development is not a linear process, and for both an early-as-possible strategy is paramount. Comparing classical paradigms with the new, traditional endpoints need to be reassessed – for example, when defining dosage – says Dr Schneider. You can listen to episode 165a of the pharmaphorum podcast in the player below, download the episode to your computer, or find it - and subscribe to the rest of the series - in iTunes, Spotify, Amazon Music, Podbean, and pretty much wherever you get your other podcasts!

As a new year kicks off, it is natural to look ahead with a bit, or a lot, of uncertainty.  What risks lie ahead and how can they be managed?  We invite Michael Dubreuil, managing partner of PTAG, to join us on to the show.  He works on projects that can span decades!In this episode, Michael dives into collaborative contracting, which basically is IPD (integrated project delivery) on steroids.  This powerful method of contracting provides balance, stability, and trust in the project team, providing confidence in risk sharing and management.  Have you ever wondered how oil and gas projects, or nuclear projects get built? Let's learn how MEGA collaboration on MEGA projects defines certainty in any situation.  

ஆஸ்திரேலியாவில் Invasive pneumococcal disease (IPD) என்ற உயிருக்கு ஆபத்தான பாக்டீரியா நோய்த்தொற்றின் பரவல் விகிதங்கள் 2004 ஆம் ஆண்டுடன் ஒப்பிடும்போது மிக உயர்ந்த மட்டத்தில் உள்ளதாக எச்சரிக்கப்பட்டுள்ளது. இது குறித்த செய்தியை எடுத்துவருகிறார் றேனுகா துரைசிங்கம்.

"Double your time, save four times the frustration." In this conversation, Devon Tilly and co-host Nathan Wood chat with Chad Pearson in preparation for the  AEC Summit in Austin, Texas in April 2025! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd - 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, LinkedIn, and Youtube! Submit a Team Topic for the AEC Summit 2025!  Currently, Chad is a partner at Plexxis Software, where he helps deliver software to the ‘trades' while coaching teammates on performance under pressure. Outside of Plexxis, Chad is a Mixed Martial Arts and Wrestling coach. Prior to ConTech, Chad worked in Law Enforcement in Emergency Response, CIB (Criminal Investigation Bureau) and as an Outlaw Motorcycle Gang Liaison Officer. His formal training includes a Bachelor of Arts from University of Guelph, Crisis Resolution & tactical communication, CBRN (Chemical, Biological, Radiological & Nuclear Response), Police Defensive Tactics and Use of Force. Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Video: ‘Positive Proximity' and the not so obvious consequences of physically fragmented teams Video: Tips for Construction Tech Selection and Adoption Video: Using Police tactics to negotiate technology agreements Tips for Team Cohesion prior to tech adoption! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

Neste episódio, mergulhamos na discussão sobre identidade digital e infraestrutura pública digital. Ambos os temas estão interligados, e a infraestrutura pública digital é tema prioritário do G20 em 2024. Em teoria, se bem implementados significam uma melhoria no acesso a serviços públicos e privados pela população. Por outro lado, há o medo de impactos negativos, como exclusão de pessoas no sistemas, compartilhamento excessivo de dados, apagamento de subjetividades, entre outros. Para falar sobre isso, participam deste episódio Eduardo Lacerda, coordenador-geral de Identificação Civil da Secretaria de Governo Digital, Pedro Martins, coordenador acadêmico da Data Privacy Brasil, Janaína Costa, especialista em identidade digital e consultora independente, e Yasodara Córdova, especialista em identidade digital e privacidade da Unico e parte do board de investimentos do Co-Develop Fund. Este episódio é parte da pesquisa "Arquiteturas Cidadãs em Identidade Digital", financiada pela Ripple. Dentro deste projeto, há diversos outros materiais produzidos. Acesse aqui uma série de cards explicativos sobre os conceitos mais importantes dessa discussão. E leia a primeira publicação com os resultados do trabalho até agora: “A infraestrutura da identidade: os influxos de uma identidade digital como aplicação da IPD”. *** Inscreva-se na Data Privacy Global Conference. É só usar o código DADOCRACIA para ganhar um desconto especial.

“One thing that I always say is you have to build a plan, build a strategic plan with actionable and attainable goals - and look for those opportunities to collaborate...it's a game changer." In this conversation, Devon Tilly and co-host Nathan Wood chat with Denise Devine from Veloris Consulting about her background and the upcoming AEC Summit in Austin, Texas in April 2025! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd - 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, LinkedIn, and Youtube! Submit a Team Topic for the AEC Summit 2025!  Denise has over 20 years of expertise in growth strategy and operational efficiencies and serves the industry as a consultant, researcher, author and speaker as Founder of Veloris Consulting. Her most recent work was the 2024 edition of the Construction Technology Report for NECA, MCAA and SMACNA after supporting the research and keynote presentation at the 2024 MEP Innovation Conference (pending publication). She is currently co-authoring a curriculum and textbook on AI for the Construction Industry with The New School of Architecture. To further support the industry, Denise also holds a position as Senior Manager with Continuum Advisory Group and she serves as the Construction Progress Coalition's Communication Director, Chair of Women Construction Coalition's, Julia Morgan Society, and is the Treasurer of CMAA San Diego's DEIB committee. Denise's commitment to continued education underscores her passion for optimizing the industry and supporting contractors nationwide. Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Subscribe to us and leave us a review on Apple Podcasts or Spotify!

INVX Morning Call 31/10/2024: Investment Theme :Data Centre ( DELTA INSET) and SET50/100 new list ( calculation till end Nov24 /announcement in mid Dec24 / effective Early Jan25)SET 50 COM7 and SET 100. PR9Research : SCC 3 Q24 Earnings weaker than mkt exp and 9 m Earnings accounted 69% of FY24 with 4 Q24 weakest quarter from LSP interest expense and impairment . Neutral tp Bt 260BCH 3Q24 Earnings preview core profit Bt 474 mn buy mkt concerned on lower Kuwaiti patients and no conclusion on IPD and SC services revenue. Valuation -1 SD Outperform tp Bt 21INVX Invitation : โค้งสุดท้ายเลือกตั้งสหรัฐ ใครจะมา? ไทยจะได้จะเสียอย่างไร? (Group meeting; MS Team) Date : Thursday 31, Oct 2024 Time : 16.00 – 17.00 Speaker :            Dr. Piyasak (Austin) Join the meeting nowhttps://teams.microsoft.com/l/meetup-join/19%3ameeting_NTExZjFhMTgtN2E1Mi00Y2Y4LWI0YWItYWI0ZjJiOGI5MzJh%40thread.v2/0?context=%7b%22Tid%22%3a%2245202dee-4088-4e8c-8ebd-c01f56740e8f%22%2c%22Oid%22%3a%227067516c-a5a8-4c1d-96cf-f266d1dcba1f%22%7d

Our guest this week is a Young Pro Ripper from Newport. When he isn't chasing swells or travelin he holds down a salesman position at one of the best shops in the world Surfside Sports! He is one of very few to pack some thick tubes out at Cylinders when it is pumping, resulting in a couple of concussions and a GoPro Wedge Entry Clip of the Year. Make sure to check his sick edit charging some Keggers at Nias in the IPD movie “Passport”. He is a humble cool kid, with tons of talent, and has some Grande Cojones. We welcome to the show Ty “TY-BORG“ Burgess.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

UP.FIT, a division of exterior and interior upgrader Unplugged Performance, announced that it deployed a Tesla Cybertruck upfitted for law enforcement in California. The project was completed in collaboration with the Irvine Police Department and Tesla and will be used as part of the department's Drug Abuse Resistance Education (DARE) program. The Cybertruck joins the DARE program's list of unique vehicles, which includes other pick-ups and a PT Cruiser with IPD decals.Download and listen to the audio version below and click here to subscribe to the Today in Manufacturing podcast.

Wie stellst du dir die Zukunft der Service-Hotlines vor ☎️

Presented in partnership with Fertility and Sterility onsite at the 2024 ANZSREI meeting in Sydney, Australia.  The ANZSREI 2024 debate discussed whether patients with unexplained infertility should go straight to IVF. Experts on both sides weighed the effectiveness, cost, and psychological impact of IVF versus alternatives like IUI. The pro side emphasized IVF's high success rates and diagnostic value, while the con side argued for less invasive, cost-effective options. The debate highlighted the need for individualized care, with no clear consensus reached among the audience. View Fertility and Sterility at https://www.fertstert.org/ TRANSCRIPT: Welcome to Fertility and Sterility On Air, the podcast where you can stay current on the latest global research in the field of reproductive medicine. This podcast brings you an overview of this month's journal, in-depth discussion with authors, and other special features. F&S On Air is brought to you by Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine, and is hosted by Dr. Kurt Barnhart, Editor-in-Chief, Dr. Eve Feinberg, Editorial Editor, Dr. Micah Hill, Media Editor, and Dr. Pietro Bordoletto, Interactive Associate-in-Chief. I'd just like to say welcome to our third and final day of the ANZSREI conference. We've got our now traditional F&S podcast where we've got an expert panel, we've got our international speaker, Pietro, and we've got a wonderful debate ahead of us. This is all being recorded. You're welcome, and please think of questions to ask the panel at the end, because it's quite an interactive session, and we're going to get some of the best advice on some of the really controversial areas, like unexplained infertility. Hi, everyone. Welcome to the second annual Fertility and Sterility Journal Club Global, coming to you live from the Australia and New Zealand Society for Reproductive Endocrinology and Infertility meeting. I think I speak on behalf of everyone at F&S that we are so delighted to be here. Over the last two years, we've really made a concerted effort to take the podcast on the road, and this, I think, is a nice continuation of that. For the folks who are tuning in from home and listening to this podcast after the fact, the Australia and New Zealand Society for Reproductive Endocrinology is a group of over 100 certified reproductive endocrinologists across Australia and New Zealand, and this is their annual meeting live in Sydney, Australia. Today's debate is a topic that I think has vexed a lot of individuals, a lot of patients, a lot of professional groups. There's a fair amount of disagreement, and today we're going to try to unpack a little bit of unexplained infertility, and the question really is, should we be going straight to IVF? As always, we try to anchor to literature, and there are two wonderful documents in fertility and sterility that we'll be using as our guide for discussion today. The first one is a wonderful series that was published just a few months ago in the May issue, 2024, that is a views and reviews section, which means there's a series of three to five articles that kind of dig into this topic in depth. And the second article is our professional society guideline, the ASRM Committee Opinion, entitled Evidence-Based Treatments for Couples with Unexplained Infertility, a guideline. The format for today's discussion is debate style. We have a group of six experts, and I've asked them to randomly assign themselves to a pro and a con side. So I'll make the caveat here that the things that they may be saying, positions they may be trying to influence us on, are not necessarily things that they believe in their academic or clinical life, but for the purposes of a rich debate, they're going to have to be pretty deliberate in convincing us otherwise. I want to introduce my panel for today. We have on my immediate right, Dr. Raewyn Tierney. She's my co-moderator for tonight, and she's a practicing board-certified fertility specialist at IVF Australia. And on my immediate left, we have the con side. Going from left to right, Dr. Michelle Quick, practicing board-certified fertility specialist at IVF Australia. Dr. Robert LaHood, board-certified reproductive endocrinologist and clinical director of IVF Australia here in Sydney. And Dr. Clara Bothroyd, medical director at Care Fertility and the current president of the Asia Pacific Initiative in Reproduction. Welcome. On the pro side, going from right to left, I have Dr. Aurelia Liu. She is a practicing board-certified fertility specialist, medical director of Women's Health Melbourne, and clinical director at Life Fertility in Melbourne. Dr. Marcin Stankiewicz, a practicing board-certified fertility specialist and medical director at Family Fertility Centre in Adelaide. And finally, but certainly not least, the one who came with a tie this morning, Dr. Roger Hart, who is a professor of reproductive medicine at the University of Western Australia and the national medical director of City Fertility. Welcome, pro side. Thank you.  I feel naked without it. APPLAUSE I've asked both sides to prepare opening arguments. Think of this like a legal case. We want to hear from the defence, we want to hear from the plaintiffs, and I'm going to start with our pro side. I'd like to give them a few minutes to each kind of introduce their salient points for why we should be starting with IVF for patients with unexplained infertility. Thanks, Pietro. To provide a diagnosis of unexplained infertility, it's really a reflection of the degree investigation we've undertaken. I believe we all understand that unexplained infertility is diagnosed in the presence of adequate intercourse, normal semen parameters, an absence ovulatory disorder, patent fallopian tubes, and a normal detailed pelvic ultrasound examination. Now, the opposing team will try to convince you that I have not investigated the couple adequately. Personally, I'm affronted by that suggestion. But what possible causes of infertility have I not investigated? We cannot assess easily sperm fertilising capability, we cannot assess oocyte quality, oocyte fertilisation potential, embryonic development, euploidy rate, and implantation potential. Surely these causes of unexplained fertility will only become evident during an IVF cycle. As IVF is often diagnostic, it's also a therapeutic intervention. Now, I hear you cry, what about endometriosis? And I agree, what about endometriosis? Remember, we're discussing unexplained infertility here. Yes, there is very good evidence that laparoscopic treatment for symptomatic patients with endometriosis improves pelvic pain, but there is scant evidence that a diagnostic laparoscopy and treating any minor disease in the absence of pain symptoms will improve the chance of natural conception, or to that matter, improve the ultimate success of IVF. Indeed, in the absence of endometriomas, there is no negative impact on the serum AMH level in women with endometriosis who have not undergone surgery. Furthermore, there is no influence on the number of oocytes collected in an IVF cycle, the rate of embryonic aneuploidy, and the live birth rate after embryo transfer. So why put the woman through a painful, possibly expensive operation with its attendant risks as you're actually delaying her going straight to IVF? What do esteemed societies say about a diagnostic laparoscopy in the setting of unexplained infertility? The ESHRE guidelines state routine diagnostic laparoscopy is not recommended for the diagnosis of unexplained infertility. Indeed, our own ANZSREI consensus statement says that for a woman with a minimal and mild endometriosis, that the number of women needed to treat for one additional ongoing pregnancy is between 3 and 100 women with endometriosis. Is that reasonable to put an asymptomatic woman through a laparoscopy for that limited potential benefit? Now, regarding the guidelines for unexplained infertility, I agree the ASRM guidelines do not support IVF as a first-line therapy for unexplained infertility for women under 37 years of age. What they should say, and they don't, is that it is assumed that she is trying for her last child. There's no doubt if this is her last child, if it isn't her last child, sorry, she will be returning, seeking treatment, now over 37 years of age, where the guidelines do state there is good evidence that going straight to IVF may be associated with higher pregnancy rates, a shorter time to pregnancy, as opposed to other strategies. They then state it's important to note that many of these included studies were conducted in an area of low IVF success rates than those currently observed, which may alter this approach, suggesting they do not even endorse their own recommendations. The UK NICE guidelines, what do they say for unexplained infertility? Go straight to IVF. So while you're listening to my esteemed colleagues on my left speaking against the motion, I'd like to be thinking about other important factors that my colleagues on my right will discuss in more detail. Consider the superior efficacy of IVF versus IUI, the excellent safety profile of IVF and its cost-effectiveness. Further, other factors favouring a direct approach to IVF in the setting of unexplained infertility are what is the woman's desired family? We should not be focusing on her first child, we should be focusing on giving her the family that she desires and how we can minimise her inconvenience during treatment, as this has social, career and financial consequences for those impediments for her while we attempt to help her achieve her desired family. Thank you. APPLAUSE I think the young crowd would say that that was shots fired. LAUGHTER Con side? We're going to save the rebuttal for the time you've allocated to that, but first I want to put the case about unexplained infertility. Unexplained infertility in 2024 is very different to what it was 10 and 20 years ago when many of the randomised controlled trials that investigated unexplained infertility were performed. The armamentarium of investigative procedures and options that we have has changed, as indeed has our understanding of the mechanisms of infertility. So much so that that old definition of normal semen analysis, normal pelvis and ovulatory, which I think was in Roy Homburg's day, is now no longer fit for purpose as a definition of unexplained infertility. And I commend to you ICMART's very long definition of unexplained infertility, which really relies on a whole lot of things, which I'm going to now take you through what we need to do. It is said, or was said, that 30% of infertility was unexplained. I think it's way, way less than that if we actually look at our patients, both of them, carefully with history and examination and directed tests, and you will probably reduce that to about 3%. Let me take you through female age first. Now, in the old trials, some of the women recruited were as old as 42. That is not unexplained infertility. We know about oocyte aneuploidy and female ageing. 41, it's not unexplained. 40, it's not unexplained. 39, it's not unexplained. And I would put it to you that the cut-off where you start to see oocyte aneuploidy significantly constraining fertility is probably 35. So unexplained infertility has to, by definition, be a woman who is less than 35. I put that to you. Now, let's look at the male. Now, what do we know about the male, the effect of male age on fertility? We know that if the woman is over 35, and this is beautiful work that's really done many years ago in Europe, that if the woman is over 35 and the male is five years older than her, her chance of natural conception is reduced by a further 30%. So I put it to you that, therefore, the male age is relevant. And if she's 35 and has a partner who's 35 years older than her or more, it's not unexplained infertility. It's related to couple age. Now, we're going to... So that's age. Now, my colleagues are going to take you through a number of treatment interventions other than IVF, which we can do with good effect if we actually make the diagnosis and don't put them into the category of unexplained infertility. You will remember from the old trials that mild or moderate or mild or minimal endometriosis was often included, as was mild male factor or seminal fluid abnormalities. These were really multifactorial infertility, and I think that's the take-home message, that much of what we call unexplained is multifactorial. You have two minor components that act to reduce natural fecundability. So I now just want to take you through some of the diagnoses that contribute to infertility that we may not, in our routine laparoscopy and workup, we may not pick up and have previously been called unexplained infertility. For instance, we know that adenomyosis is probably one of the mechanisms by which endometriosis contributes to infertility. Chronic endometritis is now emerging as an operative factor in infertility, and that will not be diagnosed easily. Mild or minimal endometriosis, my colleagues will cover. The mid-cycle scan will lead you to the thin endometrium, which may be due to unexpected adhesive disease, but also a thin endometrium, which we know has a very adverse prognostic factor, may be due to long-term progestin contraception. We are starting to see this emerge. Secondary infertility after a caesarean section may be due to an isthma seal, and we won't recognise that unless we do mid-cycle scans. That's the female. Let's look at the male. We know now that seminal fluid analysis is not a good predictor of male fertility, and there is now evidence from Ranjith Ramasamy's work that we are missing clinical varicoceles because we failed to examine the male partner. My colleagues will talk more about that. We may miss DNA fragmentation, which again may contribute via the basic seminal fluid analysis. Now, most of these diagnoses can be made or sorted out or excluded within one or two months of your detailed assessment of both partners by history and examination. So it's not straight to IVF, ladies and gentlemen. It's just a little digression, a little lay-by, where you actually assess the patient thoroughly. She did not need a tie for that rebuttal. LAUGHTER Prasad. Thank you. Well, following from what Professor Hart has said, I'm going to show that IVF should be a go-to option because of its effectiveness, cost-effectiveness and safety. Now, let me first talk about the effectiveness, and as this is an interaction session, I would like to ask the audience, please, by show of hands, to show me how many of you would accept a medical treatment or buy a new incubator if it had a 94% chance of failure? Well, let the moderator please note that no hands have been raised. Thank you very much. Yet, the chance of live birth in Australian population following IUI is 6%, where, after IVF, the live birth is 40%. Almost seven times more. Now, why would we subject our patients to something we ourselves would not choose? Similarly, findings were reported from international studies that the hazard ratio of 1.25 favouring immediate IVF, and I will talk later about why it is important from a safety perspective. Cost-effectiveness. And I quote ESHRE guidelines. The costs, treatment options have not been subject to robust evaluations. Now, again, I would like to ask the audience, this time it's an easy question, how many of you would accept as standard an ongoing pregnancy rate of at least 38% for an average IVF cycle? Yeah, hands up. All right, I've got three-quarters of the room. OK. Well, I could really rest my case now, as we have good evidence that if a clinic has got an ongoing pregnancy rate of 38% or higher with IVF with single embryo transfer, then it is more effective, more cost-effective, and should be a treatment of choice. And that evidence comes from the authors that are sitting in this room. Again, what would the patients do? If the patients are paying for the treatment, would they do IUI? Most of them would actually go straight to IVF. And we also have very nice guidelines which advise against IUI based on cost-effectiveness. Another factor to mention briefly is the multiple births, which cost five to 20 times more than singleton. The neonatal cost of a twin birth costs about five times more than singletons, and pregnancy with delivery of triplets or more costs nearly 20 times. Now, the costs that I'm going to quote are in American dollars and from some time ago, from Fertility and Sterility. However, the total adjusted all healthcare costs for a single-dom delivery is about US$21,000, US$105,000 for twins, and US$400,000 for triplets and more. Then the very, very important is the psychological cost of the high risk of failure with IUI. Now, it is well established that infertility has a psychological impact on our patients. Studies have shown that prolonged time to conception extends stress, anxiety, and depression, and sexual functioning is significantly negatively impacted. Literature shows that 56% of women and 32% of men undergoing fertility treatment report significant symptoms of depression, and 76% of women and 61% of men report significant symptoms of anxiety. Shockingly, it is reported that 9.4% of women reported having suicidal thoughts or attempts. The longer the treatment takes, the more our patients display symptoms of distress, depression, and anxiety. Safety. Again, ESHRE guideline says the safety of treatment options have not been subjected to robust evaluation. But let me talk you through it. In our Australian expert hands, IVF is safe, with the risk of complications of ectopic being about 1 in 1,500 and other risks 1 in 3,000. However, let's think for a moment on impact of multiple births. A multiple pregnancy has significant psychological, physical, social, and financial consequences, which I can go further into details if required. I just want to mention that the stillbirth rate increases from under 1% for singleton pregnancies to 4.5% for twins and 8.3% for higher-order multiples, and that multiple pregnancies have potential long-term adverse health outcomes for the offspring, such as the increased risk of health issues through their life, increased learning difficulties, language delay, and attention and behavior problems. The lifelong disability is over 25% for babies weighing less than 1 kilogram at delivery. And please note that the quoted multiple pregnancy rates with IUI can reach up to 33%, although in expert hands it's usually around 15%, which is significantly higher than single embryo transfer. In conclusion, from the mother and child safety perspective, for the reason of medical efficacy and cost effectiveness, we have reasons to believe you should go straight to IVF. We're going to be doing these debates more often from Australia. This is a great panel. One side, please. Unexplained infertility. My colleagues were comparing IUI ovulation induction with IVF, but there are other ways of achieving pregnancies with unexplained fertility. I'm going to take the patient's perspective a little bit here. It's all about shared decision-making, so the patient needs to be involved in the decision-making. And it's quite clear from all the data that many patients with unexplained infertility will fall pregnant naturally by themselves even if you do nothing. So sometimes there's definitely a place in doing nothing, and the patient needs to be aware of that. So it's all about informed consent. How do we inform the patient? So we've got to make a proper diagnosis, as my colleague Dr. Boothright has already mentioned, and just to jump into IVF because it's cost-effective is not doing our patients a justice. The prognosis is really, really important, and even after 20 years of doing this, it's all about the duration of infertility, the age of the patient, and discussing that prognosis with the patient. We all know that patients who have been trying for longer and who are older do have a worse prognosis, and maybe they do need to look at treatment quicker, but there are many patients that we see that have a good prognosis, and just explaining that to them is all they need to achieve a pregnancy naturally. And then we're going to talk about other options. It's wrong not to offer those to patients, and my colleague Dr. Quick will talk about that in a moment. Look, we've all had patients that have been scarred by IVF who've spent a lot of money on IVF, did not fall pregnant, and I think the fact that they weren't informed properly, that the diagnosis wasn't made properly, is very frustrating to them. So to just jump into IVF again is not doing the patients a justice. And look, there are negatives to IVF. There's not just the cost to the patient, the cost to society. As taxpayers, we all pay for IVF. It's funded here, or sponsored to some degree, and it's also the family and everyone else that's involved in paying for this. So this is not a treatment that is without cost. There are some harms. We know that ovarian hyperstimulation syndrome still exists, even though it's much less than it used to be. There's a risk of infection and bleeding from the procedures. And we can look at the baby. The data still suggests that babies born from IVF are smaller and they're born earlier, and monozygotic twinning is more common with IVF, so these are high-risk pregnancies, and all this may have an impact on the long-term health of the babies somewhere down the track at the moment. That is important to still look out for. But I come back to the emotional toll. Our colleagues were saying that finishing infertility quicker helps to kind of reduce the emotional toll, but the procedure itself does have its own toll if it doesn't work, and so we've got to prepare patients, have them informed. But at the end of the day, it's all about patient choice. How can a patient make a choice if we don't make a proper diagnosis, give them a prognosis and offer them some other choices that exist? And running the anchor leg of the race for the pro side. IVF in couples with unexplained infertility is the best tool we have in our reproductive medicine toolkit for multiple reasons. Professor Hart has clarified the definition of unexplained infertility. As a reflection of the degree of investigation we've undertaken. He's explained that IVF is often importantly diagnostic as well as therapeutic, both demonstrating and overcoming barriers to natural conception. Dr Stankiewicz has convinced us that IVF is efficient, safe and cost-effective. My goal is to show you that IVF is the correct therapy to meet the immediate and big picture family planning goals for our patients with unexplained infertility. More than 80% of couples with defined unexplained infertility who attempt IVF treatment will have a baby. In Australia, ANZSREI data shows us that the average age of the female patients who present with primary unexplained infertility is over 35 years. And in fact the average is 38 years. We're all aware that the average age of first maternity in Australia has progressively become later over the past two decades. Currently it stands in the mothers and babies report at 32 years. If the average age of first maternity is 32 years, this means that at least 50% of women attempting their first pregnancy are over 32 years. Research I conducted in Melbourne University with my student Eugenie Pryor asking university students of their family planning intentions and aspirations demonstrated that most people, male and female, want to be parents and most want to have more than one child. However, in Australia, our most recent survey shows that births are at an all-time low, below replacement rate and falling, with an ever greater proportion of our population being unable to have the number of children they aspire to and an ever growing proportion seeking assisted reproductive care. Fertility declines with age. Factors include egg quality concerns, sperm quality concerns and the accumulation of pathologies over time. Adenomyosis, fibroids, endometriosis are concerns that no person is born with. They exist on a spectrum and progress over time and may be contributing factors for unexplained infertility. Our patients, when we meet them, are the best IVF candidates that they will ever be. They are the youngest they will ever be and they have the best ovarian reserve they will ever have. They will generate more euploid embryos now than they will in years to come. The sooner we get our patients pregnant, the sooner they will give birth. It takes nine months to have a baby, 12 months potentially to breastfeed and wean and of course most patients will need time to care for a young infant and recover prior to attempting another pregnancy. IVF and embryo banking may represent not only their best chance of conception with reduced time to pregnancy but also an opportunity for embryo banking to improve their cumulative live birth rate potential over time. By the time our 38-year-old patient returns to try to conceive for a second child, she will undoubtedly be aged over 40. Her chance of live birth per cycle initiated at IVF at this stage has reduced phenomenally. The ANZSREI dataset from our most recent report quotes that statistic to be 5%. Her chance of conception with an embryo frozen at 38 years, conversely, is one in three to one in four. There is no room for doubt that IVF gives couples with unexplained infertility not only the most effective treatment we have to help them have a baby, but their best opportunity to have a family. Last but certainly not least, Dr. Quick, to round out the con sides arguments before we open up for rebuttal. And I'll make a small plea that if you have questions that you'd like to pose directly to the panel, prepare them and we'll make sure we get to them from the audience shortly. Thank you. So, whilst we have heard that we may be bad doctors because we're delaying our patients' time to pregnancy, I would perhaps put it to you that unexplained infertility is a diagnosis which is made based on exclusion. So perhaps you are the bad doctors because you haven't looked hard enough for the cause of the unexplained infertility. So, in terms of the tests that we all would do, I think, we would all ensure that the woman has an ovarian reserve. We would all ensure that she has no structural anomaly inside the uterus. We would all ensure that her tubes are patent. We would all ensure that she has regular cycles. We would ensure that he has a normal semen analysis. I think these are tests that we would all do when trying to evaluate a couple for fertility who are struggling to conceive. And therefore, the chance of them getting pregnant naturally, it's never going to be zero. And one option therefore, instead of running straight to IVF, would be to say, OK, continue timed intercourse because the chance of you conceiving naturally is not actually zero and this would be the most natural way to conceive, the cheapest way to conceive, the least interventional way to conceive. And whether that be with cycle tracking to ensure appropriate timed intercourse, whether that be with cycle tracking to ensure adequate luteal phase support. When you clear the fallopian tubes, we know that there are studies showing an improvement in natural conception. Lipidol or oil-based tubal flushing techniques may also help couples to conceive naturally. And then you don't have this multiple pregnancy rate that IVF has. You don't have the cost that you incur with IVF, not just for the couple but to Australian society because IVF is subsidised in this country. You don't have the risks that the woman goes through to undergo IVF treatment. You don't have the risks that the baby takes on being conceived via IVF. And so conceiving naturally, because it's not going to be zero, is definitely an option for these couples. In terms of further tests or further investigations that you could do, some people would argue, yes, we haven't looked hard enough for the reason for infertility, therefore we know that ultrasound is notoriously bad at picking up superficial endometriosis. We know that ultrasound cannot pick up subtle changes in the endometrium, as Dr Boothroyd referred to chronic endometritis, for example. So these patients perhaps should undergo a hysteroscopy to see if there is an endometrial issue. Perhaps these patients should undergo a laparoscopy to see if there is superficial endometriosis. And there are meta-analyses showing that resecting or treating superficial endometriosis may actually help these couples conceive naturally down the track and then therefore they avoid having more interventional treatment in order to conceive. There is also intrauterine insemination with or without ovarian stimulation, which may improve their chances of conceiving naturally. And that again would be less invasive, less intervention and cheaper for the patient. And we know that therefore there are a lot of other treatment options available to help these couples to conceive. And if it's less invasive, it's more natural, it's cheaper, that ends up being better for the patient. Psychologically as well, which the other side have brought up, even with Dr Stankiewicz's 38% ongoing pregnancy rate, that also means that 62% of his patients are not going to be pregnant. The psychological impact of that cannot be underestimated because for a lot of patients, IVF is your last resort. And when you don't get pregnant with IVF, that creates an issue too for them. Embryo banking, which was also brought up, what happens when you create surplus embryos and what's the psychological impact of having to deal with embryos that you are then not going to use in the future? So therefore for those reasons we feel that IVF is not your first line treatment for couples who are diagnosed with unexplained infertility. There are many other ways to help these couples to conceive. We just have a multitude of things to unpack. And I want to start off by opening up an opportunity for rebuttal. I saw both sides of the panel here taking diligent notes. I think all of us have a full page worth of things that kind of stood out to us. Since the pro side had an opportunity to begin, I'm actually going to start with the con side and allow the con side to answer specific points made by the pro side and provide just a little bit more detail and clarity for why they think IVF is not the way forward. My learned first speaker, wearing his tie of course, indicated that it was all about laparoscopy and IUI, and it's way more than that. I just want to highlight to you the paper by Dressler in 2017 in the New England Journal of Medicine, a randomised controlled trial of what would be unexplained infertility according to the definition I put out, the less than 35 ovulatory normal semen analysis. And the intervention was an HSG with either oil-based contrast or water-based contrast. And over the six months, there was clear separation, and this is an effective treatment for unexplained infertility or mild or minimal endometriosis, however it might work. And there's probably separation out to three years. So as a single intervention, as an alternative to IVF, the use of oil-based contrast is an option. So it's not just about laparoscopy and IUI. I guess the other thing the second speaker did allude to, fairly abysmal success rates with IUI being 6%. That is a problem, and I would like to allude to a very good pragmatic trial conducted by Cindy Farquhar and Emily Lu and their co-workers in New Zealand that really swung the meta-analysis for the use of clomiphene and IUI to clinical efficacy. And they reported a 33% chance of live birth in their IUI and clomiphene arm. I'm going across to Auckland to see what the magic is in that city. What are they doing? The third speaker did allude to the problem of declining fertility, a global problem, and Australia is not alone. We have solved the problem to date, which we've had for 40 years, with immigration. But Georgina Chambers' work shows beautifully that IVF is not the answer to the falling fertility rates. It is a way more complex social problem and is probably outside the scope of today's discussion. So those are my three rebuttals to our wonderful team. Thank you very much. So... You can't bury them. We'll give them an opportunity. Thank you for the opportunity. So I'd like to address some of the points that my learned debaters on the opposition raised. The first speaker really suggested quite a few things that we probably omitted, like endometritis, failing to examine the male. I think things like that... I think, at a good history, that is essential what we do as part of our investigation. We're looking for a history of cesarean section, complications subsequent to that. We're doing a detailed scan, and that will exclude the fact that she's got a poor endometrium development, she's got a cesarean scar niche. A good history of a male will allude to the fact that he has some metabolic disorder, degree of hypogonadism. So we're not delaying anything by these appropriate investigations. Adenomyosis will be raised. I talked about a detailed gynaecological examination. So I honestly think that a very... As my opening line was, a detailed gynaecological scan, obviously with a very good history taken, is essential. We're not delaying her opportunity to go straight to IVF if we've addressed all these factors. The second speaker talked about shared decision-making, and we'd all completely agree with that. But we have to be honest and open about the success, which my second speaker talked about, the success of the treatment we're offering. And one thing we should sort of dwell on is it's all... It's a fundamental description of the success of treatment is probably all about prognostic models, and that who not model, that's the original model about the success of conception, is really... Everything flows on from that, which basically talks about a good prognosis patient. 30% chance of live birth after a year. That's what they talk about, a good prognosis patient. Perhaps the rest of the world is different to your average Australian patient, but if we talked about that being a good prognosis, you've got a one in three chance of being pregnant by a year. I think most of our patients would throttle us. So that is what all the models are sort of based on, that being a good prognosis patient. So I completely agree with the second speaker that we do have a shared decision. We have to be honest with our patients about the success. We have to be honest about giving them the prognosis of any treatment that we offer. But really, as my third speaker was talking about, it's about giving the patient the opportunity to have a family, minimal career disruption, minimal life disruption. We have to be honest and talk about the whole picture. They're focused on the first child because really they can't think beyond that. We're talking about giving them the family that they need. The third speaker spoke very eloquently about the risks associated with the treatment we offer. I believe we offer a very safe service with our IVF, particularly in Australia, with our 2% twin pregnancy rate. We talk about the higher risk of these pregnancies, but they perhaps don't relate to the treatment we're offering. Perhaps, unfortunately, is the patient, if she's got polycystic ovary syndrome, if she's more likely to have diabetes, premature delivery, preeclampsia. So I think often the risks associated with IVF and potentially the risks associated to the child born from IVF perhaps don't relate to the treatment of IVF per se. It may well be the woman and perhaps her partner, their underlying medical condition, which lead those risks. So I strongly would encourage you to believe that you take a very good history from your patient, you do a thorough investigation, as I've alluded to, looking for any signs of ovulatory disorder, any gynaecological disorder by a detailed scan, checking tubal patency and a detailed history and the similarities from the man, and then you'll find you're probably going straight to IVF. APPLAUSE I'd like to talk a bit about the embryo banking and having been in this field for a long time, as a word of caution, we're setting a lot of expectations. I remember going to an ASRM meeting probably 10 years ago where they had this headline, all your embryos in the freezer, your whole family in the freezer, basically expecting that if you get four or five embryos frozen that you'll end up with a family at the end. We all know that for the patient, they're not a percentage, it's either zero or 100%. And if all the embryos don't work, they don't have a family at the end, you know, it didn't work for them and their expectations haven't been met. And the way we talk about the percentages and that we can solve the patient's problems, that we can make families, it doesn't always happen. So the expectations our position is setting here, we're not always able to meet and so we're going to end up with very unhappy patients. So this is just a warning to everyone that we need to tell people that this doesn't always work and sometimes they'll end up with no success at all. And from that point of view, I think the way it's presented is way too simplistic and we've got to go back to looking at the other options and not promising things we can't always deliver. So just taking into account all our esteemed interlocutors have said, we don't necessarily disagree with the amount of investigations that they described because nowhere in our argument we said that as soon as the patient registers with the receptionist, they will direct it to an IVF lab. I think to imply so, we'd be very rich indeed. Maybe there are some clinics that are so efficient. I don't know how it works overseas, but certainly not in Australia. The other point that was made about the cost of IVF and our, again, esteemed interlocutors are very well aware from the studies done here in Australia that actually every baby that we have to conceive through IVF and create and lives is actually more than 10 to 100 times return on investment because we are creating future taxpayers. We are creating people that will repay the IVF treatment costs over and over and over again. So I'll put to you, Rob, that if you are saying that we can't do IVF because it costs money, you are robbing future treasurers of a huge amount of dollars. I hope the American audience is listening. In America, we call embryos unborn children in freezers in certain parts and here they're unborn taxpayers. Con side, final opportunity for rebuttal before some audience questions and one more word from the pro side. Well, actually, Dr Stankiewicz was very happy to hear that you're not going to send your patients straight to the IVF lab because we've managed to convince you that that's not the right thing to do. I clearly have forgotten how to debate because I did all my rebuttals at the end of my presentation but essentially I'll recap because when we're talking about IVF, as we're saying, the chance of pregnancy is not going to be 100% and so there is a psychological impact to IVF not working. There is a psychological impact to banking embryos and creating surplus embryos that eventually may not be used and they were my main rebuttal points in terms of why IVF was not the first-line treatment. Thank you. So we've heard from the opposition some very valid points of how our patients can be psychologically impacted when fertility treatment is unsuccessful. I will again remind you that IVF is the most successful fertility treatment we have in our treatment armoury. We are most likely to help our patients have a baby with IVF. The cumulative pregnancy rates for IVF have started back in the late 70s and early 80s in single-digit percentages. We now, with a best prognosis candidate, have at least a one-in-two chance of that patient having a baby per embryo transfer and in our patients with unexplained infertility, the vast majority of our patients will have success. We also heard from the negative team about the significant chance of pregnancy in patients with expectant management. You're right, there's not a 0% chance of natural conception in patients who have unexplained infertility, but there is a not very good chance. We know from data that we've had for a really long time, going back as far as the Hutterite data, to today's non-contradictory models, which tell us that a couple's chance of conception per month in best prognosis candidates is one in five. If they've been trying for six months, it's one in ten. If they've been trying for 12 months, it's only 5%, and if they've been trying for 24 months, it's less than 1%. So it may not be zero, but it isn't very good. In terms of our team reminding us of the extended ICMART definition of unexplained infertility, we don't argue. When we say someone has unexplained infertility, we make the assumption that they have been comprehensively diagnosed by a robust reproductive endocrinologist, as everyone in this room is. And I would say one closing rebuttal. IUI success rates have been the same for the last 50 years, whereas IVF success rates continue to improve. Why would you offer your patient a treatment from 50 years ago when you can offer them one from today? Thank you. APPLAUSE I'm going to take a personal privilege and ask the first question, in hoping that the microphone makes its way to the second question in the audience. My colleagues on the pro side have said IVF, IVF, IVF. Can you be a little bit more specific about what kind of IVF? Do you mean IVF with ICSI? Do you mean IVF, ICSI, and PGT? Be a little bit more deliberate for us and tell us exactly how the patient with unexplained infertility should receive IVF. As I said in my statement, I think it's a diagnostic evaluation. I think there is an argument to consider ICSI, but I think ICSI does have some negative consequences for children born. I think perhaps going straight to ICSI is too much. I think going straight to PGTA perhaps is too much, unless there is something in their history which should indicate that. But we're talking about unexplained infertility. So I believe a standard IVF cycle, looking at the opportunity to assess embryonic development, is the way to go. I do not think you should be going straight to ICSI. I think the principle of first do no harm is probably a safe approach. I don't know whether my colleagues have some other comments, but I think that would be the first approach rather than going all guns blazing. I can understand, though, in different settings in the world, there may have... We're very fortunate in Australia, we're very well supported from the government support for IVF, but I think the imperatives in different countries may be different. But I think that approach would be the right one first. We'll start with a question from the audience. And if you could introduce yourself and have the question allowed for our members in the audience who are not here. It's Louise Hull here from Adelaide. The question I would like to put to both the pro and con team is that Geeta Mishra from the University of Queensland showed that if you had diagnosed endometriosis before IVF, you were more likely to have a pregnancy and much less likely to have high-order IVF cycles. Given that we now have really good non-invasive diagnostics, we're actually... A lot of the time we can pick up superficial or stage 2 endometriosis if you get the right scan. We're going to do IVF better if we know about it. Can you comment on that impacting even the diagnosis of unexplained infertility? Thanks. I'd love to take that. Can I go first, Roger? LAUGHTER Please do. Look, I'd love to take that question. It's a really good question. And, of course, this is not unexplained infertility, so this is outside the scope here. And I think, really, what we're seeing now, in contrast to where we were at the time of the Markku study, which was all... And the Tulandy study on endometrioma excision, we now see that that is actually damaging to fertility, particularly where there is ovarian endometriosis, and that we compromise their ovarian reserve by doing this surgery before we preserve their fertility, be it oocyte cryopreservation or embryo cryopreservation. So I think it's a bit outside the scope of this talk, but I think the swing of the data now is that we should be doing fertility preservation before we do surgery for deeply infiltrated ovarian endometriosis. And that would fit with Gita's findings. A brief response. Thanks very much, Louise. Yeah, we're talking about unexplained infertility here, and my opening line was we need a history, but a detailed gynaecological ultrasound. I think it's important it's a really good ultrasound to exclude that, because the evidence around very minor endometriosis is not there. I agree with significant endometriosis, but that's not the subject of this discussion. But I do believe with very minimal endometriosis there is really no evidence for that. Janelle MacDonald from Sydney. I'm going to play devil's advocate here. So everyone is probably aware of the recent government inquiry about obstetric violence. I'm a little concerned that if we are perceived to be encouraging women to IVF first, are we guilty as a profession of performing fertility violence? That's just digressing a little bit, just thinking about how the consumers may perceive this. I think our patients want to have a baby, and that's why they come to see us, and that's what we help them to do through IVF. I'm not sure the microphone's working. And just introduce yourself. I'm from Sydney, Australia. Can I disagree with you, Roger, about that question about minimal and mild endometriosis? I'm 68, so I'm old enough to have read a whole lot of papers in the past that are probably seen as relics. But Mark Khoo published an unusual study, because it was actually an RCT. Well, sorry, not an RCT. It was a study whereby... Well, it was an RCT, and it was randomised really well. It was done in Canada, and there were about 350 subjects, and they were identified to have stage 1 or stage 2 endometriosis at laparoscopy. And the interesting thing is it was seen as an intervention which didn't greatly increase the chance of conception, but it doubled the monthly chance of conception. So there was clearly a difference between those patients who didn't have endometriosis and those that had stage 1 and stage 2 endometriosis. So the intervention did actually result in an improvement. One of the quotes was, well, I heard since then, well, it didn't make much difference. But when you realise that infertility is multifactorial, there were probably other factors involved as well. So any increase like that in stage 1 and stage 2 endometriosis sufferers was clearly beneficial for them. So I wouldn't disagree with you completely, but I do think you've got to take it on board that there is some evidence that surgical intervention can help. And certainly in those patients whereby the financial costs of IVF are still quite, even in Australia, astronomical. Many patients can get this through the public sector or the private sector treatment of their endometriosis laparoscopically very cheaply or at no cost. Thanks, Dr Persson. So you're right that there was also a counter-randomised controlled trial by the Grupo Italiano which was a counter to that. And actually did not show any benefit. But I believe the Marcu study demonstrated an excess of conception and with treatment of minima and endometriosis of about 4% per month for a few months. So absolutely, that shared decision-making. Personally, I wouldn't like a laparoscopy to give me an extra 4% chance of a natural conception for four months, which I think the data was. So basically, the basis to my statement that I said without going into great detail was a review article published by Samy Glarner recently in Reproductive Biology and Endocrinology. And their conclusions were what I basically said, that from looking at all the data, there is no real evidence of intervention for minor endometriosis. We're not talking about pain or significant diagnosed endometriosis on the outcomes of IVF, ovarian reserve, egg quality, embryo development, and euploidy rate. So that was the basis of my... I hate to disagree... I hate to agree with my opponents in a debate, but I'm going to... But there is actually a new network analysis by Rui Wang and some serious heavyweights in evidence-based medicine that pulls together the surgical studies. And the thing that made the most difference to this of mild and minimal endometriosis from a fertility point of view, not pain, is the use of oil-based uterine contrast. And I commend that paper to you, which fits with exactly what Roger is saying. Hi, my name's Lucy Prentice.  I work in Auckland. And I just wanted to point out the New Zealand perspective a little bit. Where we come from a country with very limited public funding for IVF. I'm currently running an RCT with Cindy Farquad directly looking at IVF versus IUI for unexplained infertility. And I'd just like to point out that both the ASRM and ESHRE guidelines, which are the most recent ones, both suggest that IUI should be a first-line treatment with oral ovarian stimulation. We have no evidence that IVF is superior based on an IPD meta-analysis published very recently and also a Cochrane review. And although we would love to be able to complete the family that our patients want from IVF and embryo banking, that option is really not available to a lot of people in New Zealand because of prohibitive costs. We know that IUI with ovarian stimulation is a very effective treatment for people with poor prognosis and unexplained infertility. And I also would just like to add that there's not a cost-effectiveness analysis that shows an improvement in cost-effectiveness for IVF. There's also never been a study looking at treatment tolerability between the two, so I don't think that you can say that IVF is a treatment that people prefer over IUI. So I may turn around and shoot myself in the foot based on our results that will be coming out next year, but I think at the moment I don't think you can say that IVF is better than IUI with ovarian stimulation for unexplained. We have time for two more questions from the audience, and we have two hands in the back. Now we can. It's the light green. OK. Hossam Zini from Melbourne. Thank you very much for the debate. It's very interesting. The problem is that all of the studies that have been done about comparing IUI to IVF, they are not head-to-head studies. The designs are different. They are having, like, algorithmic approach. For example, they compare three or four or five cycles of IUI to one cycle of IVF. But about 10 years ago, our group at the Royal Women's Hospital, we have done a study, a randomized control study, to compare IUI to IVF head-to-head, and we randomized the patients at the time of the trigger who only developed, so we did a low stimulation to get two to three follicles only, and that's why it was so hard to recruit lots of patients. So the criticism that was given to the study that it's a small sample size, but we end up with having IVF as a cost-effective treatment. Our IVF group had a live birth rate about 38%, and on the IUI, 12%. And with our cost calculations, we find out that the IVF is much more cost-effective than the IUI. But I believe that we all now believe in individualized kind of treatment, so patients probably who are younger than 34 years old probably wouldn't go straight to IVF. Maybe I'll do a laparoscopy and a histroscopy first, okay, and we may give them a chance to achieve a natural conception in the next three months or so. Patients who are older than 35, 37 years old probably will benefit straight from IVF. But again, in day-to-day life cases, we will not force the patient to go straight to IVF. I will talk to her and I'll tell her, these are your options, expectant treatment. This is the percentage that you would expect. IUI, this is what you expect. IUI with ovulation induction, this is what you expect. IVF, this is what you expect. And then she will discuss that with her partner and come back to me and tell me what she wants to do. Thanks. I saw a hand show up right next to you, so I'll add one more question given our time limitation. Thanks so much, Kate Stone-Mellon. I'd like to ask our panel to take themselves out of their role playing and put themselves in another role where they were the head of a very, very well-funded public service, and I'd like to ask the two sides what they really think about what they would do with a patient at the age of 35 with 12 months of unexplained infertility. Well, can I say that? Because that's my role in a different hat. LAUGHTER So, yeah, I run the state facility service in Western Australia. We looked at the data, because obviously that's what we're doing, IUI, IVF, and unfortunately we stopped doing IUI treatment. The success rate was so low. So we do go straight to IVF with unexplained infertility. Disappointing, as I'm sure you hear that, Kate, that we do. We looked at the data. Yeah, I think that I would still offer the patients the options, because some people don't want to do IVF. Even though it's completely free, they may not still want to do the injections and the procedure and take on the risks of the actual egg collection procedure. I don't know, religious issues with creating embryos. Yeah, I would still give patients the option. We have time for one more question in the back. We'll take the other ones offline afterwards. We'll get you a microphone just to make sure our listeners afterwards can listen. Following on from the New Zealand experience, which I've experienced... Hello? Yeah. From the New Zealand experience, and having worked here extensively and in New Zealand, you're not comparing apples with apples, Claire. That unexplained couple in New Zealand will wait five years to get funding and currently perhaps another two years to get any treatment. That's then an apples group compared to the pilot group who may, in fact, walk past the hospital and get treatment. The other thing about this, I think, that we need to forget, or don't forget, is the ethics of things here, two of which is that the whole understanding of unexplained infertility needs research and thinking. And if it wasn't for that understanding of what is the natural history of normal and then the understanding of pathology, we wouldn't do a lot of things in medicine. So if we have got a subgroup here that's unexplained, it's not just to the patient, we have a responsibility to future patients and ourselves to be honest and do research and learn about these factors. Now, it doesn't answer the debate, but it is something that's what drives the investigation and management of unexplained delay. And, for example, at the moment, there's quite a discussion about two issues of ethics, one about the involuntary childlessness of people that don't get to see us but don't have those children that they wanted to have because they didn't want to undergo treatment, or it was the involuntary childlessness of a second or subsequent child. And that's quite a big research issue in Europe, I realise, at the moment. And the final thing is about the information giving. The British case Montgomery 2015 has changed consent substantially, for those of you from England, that all information given to patients must include and document the discussion about expectant management versus all the different types of treatment, for and against and risks. And we're not currently doing that in IVF in this area, but if you read about what's happened in England, it's transformed consent in surgery. And I think a lot of our decision-making isn't in that way. So there are a couple of ethical principles to think about. Wonderful questions from the audience. Since we're coming up at the end of our time, we typically end the debate with closing remarks, but we'll forego that for this debate. And I'd actually like to just poll the audience. After hearing both the pro and the con side's arguments, by a show of hands, who in the audience believes that for the patient with unexplained infertility, as defined and detailed here broadly, should we be beginning with IVF? Should we be going straight to IVF? So by a show of hands. And I would say probably 50% of the room raised their hand. And those who think we should not be going straight to IVF? It feels like a little bit more. 40-60, now that I saw the other hands. Well, I'm going to call this a hung jury. I don't know that we have a definitive answer. Please join me in a round of applause for our panelists. In America, we would call that election interference. I wanted to thank our panelists, our live audience, and the listeners of the podcast. On behalf of Fertility and Sterility, thank you for the invitation to be here at your meeting and hosting this debate live from the Australian New Zealand Society for Reproductive Endocrinology meeting in Sydney, Australia. Thank you. This concludes our episode of Fertility and Sterility On Air, brought to you by the Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine. This podcast was developed by Fertility and Sterility and the American Society for Reproductive Medicine as an educational resource and service to its members and other practicing clinicians. While the podcast reflects the views of the authors and the hosts, it is not intended to be the only approved standard of living or to direct an exclusive course of treatment. The opinions expressed are those of the discussants and do not reflect Fertility and Sterility or the American Society for Reproductive Medicine.    

¡Buenos días! 🇻🇪Hoy se cumplen cinco días días sin que el Consejo Nacional Electoral de Venezuela muestre las actas de la votación, pese a la presión de varios países y que han estallado protestas en todo el país. Gabriel Vegas nos cuenta más detalles MIENTRAS...El Congreso que dice condenar la dictadura en Venezuela, ahora quiere APROBAR darle pensión vitalicia al exdictador peruano Alberto Fujimori. ADEMÁS: Alonso Correa nos hace soñar con traer una medalla olímpica al Perú. ¿Recibió apoyo del IPD? Y... Hoy es el último día de Romina Badoino siendo productora de La Encerrona. Ella les cuenta un poco de lo que han sido estos cuatro años detrás del programa. ¿A dónde se va? **** ¿Te gustó este episodio? ¿Buscas las fuentes de los datos mencionados hoy? SUSCRÍBETE en / ocram para acceder a nuestros GRUPOS EXCLUSIVOS de Telegram y WhatsApp. También puedes hacerte MIEMBRO de nuestro canal de YouTube aquí / @marcosifuentes **** Únete a nuestro CANAL de WhatsApp aquí https://whatsapp.com/channel/0029VaAg... **** Para más información legal: http://laencerrona.pe

In this episode, Nick Carman is joined by Derek Williams, Managing Director for Investor Relations at the Valesco Group. Derek shares his journey from his early days in research to his senior roles in investment management with companies like Landsec, Global Student Accommodation, and Rothschild, leading up to his current position at Valesco Group. The conversation covers his career milestones, the challenges he faced, his leadership philosophy, and his continuous quest for learning and growth.Come and join our LinkedIn community: https://www.linkedin.com/groups/9054319/Leave a review on the platform of choice if you've enjoyed this episodeKey Points:Introduction to Derek Williams (00:00:00)Nick introduces Derek Williams and provides an overview of his career.Early Career and Interest in Real Estate (00:00:32)Derek discusses his initial interest in the real estate market during his school days in the 1980s.Learning from Mentors (00:03:16)Derek reflects on the values and professionalism he learned from his early mentors.Transition to Investment Management (00:04:16)Derek explains his move to investment management and his decision to pursue a master's degree at Cass Business School.Joining IPD and Early Management Experience (00:06:42)Derek discusses his role at IPD, managing a team, and the challenges he faced in his early management days.Role at Land Securities (00:09:13)Derek talks about his transition to Land Securities, working with Francis Solway, and the lessons he learned during this period.Expanding Horizons to Global Markets (00:14:00)Derek shares his desire to globalize his experience and his subsequent move to Russell Investments.Experiences at Russell Investments (00:16:00)Derek discusses launching global REIT products, his mentors, and his leadership experiences in the US.Entrepreneurial Ventures (00:21:00)Derek talks about reconnecting with his entrepreneurial spirit and his roles at B Finance and Global Student Accommodation.Current Role at Valesco Group (00:28:27)Derek describes his current role at Valesco Group, the company's unique approach, and his focus on growth and team spirit.Personal Reflections on Success (00:30:11)Derek shares his thoughts on success, the importance of learning, and maintaining personal relationships in his career.Conclusion: Derek Williams shares valuable insights into his career journey, highlighting the importance of continuous learning, mentorship, and taking calculated risks. His experiences offer a blueprint for aspiring real estate professionals looking to accelerate their careers.Sponsor: This podcast is brought to you by MacDonald and Company, the global real estate recruiter. Don't forget to click follow and leave a rating to ensure you never miss an episode. Hosted on Acast. See acast.com/privacy for more information.

Visit nascentmc.com for the full writup of this episode and medical writing assistance.  Visit learnamastyle.com for free downloads directed towards medical writing and editing. • The FDA has approved the 21-valent pneumococcal conjugate vaccine, CAPVAXIVE™ (Merck), for the prevention of invasive disease and pneumonia in adults aged 18 years and older caused by 21 Streptococcus pneumoniae serotypes. Capvaxive includes eight serotypes not covered by other pneumococcal vaccines, addressing approximately 27% of IPD cases in adults aged 50 and older, and 30% in adults aged 65 and older, based on CDC data from 2018-2021. The approval follows an FDA Priority Review and is based on immune responses measured in the Phase 3 STRIDE-3 trial, with continued approval contingent upon verification of clinical benefit in a confirmatory trial.  • The FDA has approved delandistrogene moxeparvovec-rokl (Elevidys) for Duchenne muscular dystrophy (DMD) in ambulatory individuals aged 4 and older with a confirmed mutation in the DMD gene, as well as granting accelerated approval for non-ambulatory individuals. Elevidys, a one-time intravenous gene therapy, delivers a working copy of the DMD gene to address the muscle degeneration caused by mutations in this gene. The approvals are based on findings from a confirmatory trial that, while not meeting its primary endpoint, showed success in several secondary measures, with the Phase 3 ENVISION study underway to serve as a postmarketing requirement. • The FDA has approved adagrasib (Krazati) plus cetuximab for adults with KRAS G12C-mutated locally advanced or metastatic colorectal cancer (CRC) who have received prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy. Adagrasib targets the KRAS G12C mutation, a common driver mutation in several cancers including colorectal cancer, while cetuximab enhances its antitumor activity. The approval was based on findings from the KRYSTAL-1 trial, which demonstrated a confirmed overall response rate (ORR) of 34% and a median duration of response (DOR) of 5.8 months. • The FDA has approved pembrolizumab (Keytruda) in combination with carboplatin and paclitaxel, followed by pembrolizumab monotherapy, to treat primary advanced or recurrent endometrial carcinoma in adults, marking the third endometrial carcinoma indication for Keytruda in the US. Keytruda enhances the body's immune response against tumor cells by blocking the interaction between PD-1 and its ligands, PD-L1 and PD-L2. The approval is based on results from the phase 3 KEYNOTE-868 clinical trial, which demonstrated significant improvements in progression-free survival for patients treated with Keytruda plus chemotherapy compared to those receiving a placebo with chemotherapy.  • The FDA has approved risankizumab-rzaa (Skyrizi) for the treatment of moderately to severely active ulcerative colitis in adults, making it the first specific anti–interleukin 23 monoclonal antibody indicated for both ulcerative colitis and moderate to severe Crohn's disease. Risankizumab-rzaa inhibits interleukin-23 (IL-23), a cytokine involved in inflammatory and immune responses, thereby reducing inflammation. The approval is based on data from two phase 3 clinical trials, INSPIRE and COMMAND, which demonstrated the achievement of clinical remission and endoscopic improvement. • A supplemental Biologics License Application (sBLA) has been submitted for guselkumab (Tremfya) for the treatment of adults with moderately to severely active Crohn's disease. Guselkumab, a fully-human, dual-acting monoclonal antibody that blocks IL-23 and binds to CD64, was previously approved for moderate-to-severe plaque psoriasis and active psoriatic arthritis. Support for the BLA is based on findings from the Phase 3 GALAXI and GRAVITI clinical trials.

In this episode, I interview Tammy Pilton-Pluck, an accomplished nurse with over 20 years of diverse international nursing experience. Tammy shares her journey from an unexpected start in nursing to founding Intrepid Professional Development, where she empowers nurses globally. They delve into career resilience, personal growth, and the importance of clinical supervision and supportive environments in nursing.Key Moments:00:00:02 - IntroductionLiam welcomes Tammy Pilton-Pluck to the podcast, highlighting her extensive nursing background.00:00:54 - Behind the ScenesDiscussing the support Tammy provides to nurses and the importance of behind-the-scenes conversations.00:01:08 - Tammy's Diverse Nursing BackgroundTammy's journey through various nursing specialties, from phlebotomy to palliative care.00:03:16 - Beginning in NursingTammy shares how a personal experience in her church community led her to nursing.00:05:56 - Career Challenges and Palliative CareTammy's move to palliative care and how it shaped her perspective on life and nursing.00:07:26 - 30 Seconds of CourageTammy explains her life motto of “30 seconds of courage” and how it has driven her career decisions.00:13:16 - Importance of Exit StrategiesDiscussing why every healthcare professional should have an exit strategy for continuous growth and avoiding burnout.00:20:22 - Appraisals and Self-ReflectionTammy emphasizes the need for self-appraisals and preparing for professional growth discussions.00:32:34 - Professional Nurse Advocacy (PNA)Introduction to PNA and its role in providing psychological safety and professional support for nurses.00:41:52 - Restorative Clinical SupervisionTammy discusses the importance of non-managerial, confidential supervision for nurses to discuss challenges and successes.00:57:03 - Launching Intrepid Professional DevelopmentTammy's motivation and journey in starting her business to support nurses' professional development.Listen to the full episode to gain insights into Tammy's remarkable nursing journey, the concept of 30 seconds of courage, and the essential strategies for building a resilient and fulfilling nursing career.For more episodes and resources, visit High Performance Nursing Podcast.Connect with Tammy here. Listen to the IPD podcast here!

Riccardo Cosentino takes an ongoing LinkedIn debate with Ian Heptinstall live in this episode of Navigating Major Programmes for a fascinating conversation with one common goal: to elevate major programmes. The pair discuss the use of reference class forecasting, the predominance of strategic misrepresentation, and optimism bias during project estimation—both drawing on their practical and academic experiences to substantiate their points. “One of my concerns, if we think the problem with projects is that our estimates are too light and the answer is to increase the estimates, is that it is a vicious spiral. That just means expected costs will go up and up and up over time. If we separate the three elements of time, and think maybe we missed the target, not because the target was impossible, but our methods of execution were such that it made it very hard to achieve the target. That actually gives us an opening for a virtuous cycle because there are, so called, black swans that show that the same estimates are achievable and can be done reliably. ” –   Ian Heptinstall   Ian Heptinstall combines over 35 years of industry experience with academic expertise, to bring a unique perspective to CapEx & Construction Project Management and Procurement & Supply Chain. As an Associate Professor at the University of Birmingham, Ian focuses on practical methodologies like Theory of Constraints (TOC), critical chain, and collaborative procurement, which he advocates for practically improving performance in various industries. Key Takeaways:The importance of focusing on execution and preparation over quality of estimations  Tipping the Iron Law on its head with collaborative contracting, IPD and alliance contracting  Reference class forecasting in project management: advantages and limitationsImpact of strategic misrepresentation and optimism bias; the political influence on project estimates and management  If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. The conversation doesn't stop here—connect and converse with our LinkedIn community: Follow Ian Heptinstall on LinkedInFollow Navigating Major Programmes on LinkedInFollow Riccardo Cosentino on LinkedInRead Riccardo's latest at wwww.riccardocosentino.com Transcript:Riccardo Cosentino  0:05  You're listening to Navigating Major Programmes, a podcast that aims to elevate the conversations happening in the infrastructure industry and inspire you to have a more efficient approach within it. I'm your host, Riccardo Cosentino. I bring over 20 years of Major Programme Management experience. Most recently, I graduated from Oxford University Saïd Business School, which shook my belief when it comes to navigating major programmes. Now it's time to shake yours. Join me in each episode as I press the industry experts about the complexity of Major Programme Management, emerging digital trends and the critical leadership required to approach these multibillion-dollar projects. Let's see where the conversation takes us.   Riccardo Cosentino  0:53  Hello, everyone, and welcome to a new episode of Navigating Major Programmes. I'm here today with Ian Heptinstall, who is Associate Professor in Programme and Project Management at the University of Birmingham and he's joining me today from Birmingham, I assume. How are you doing, Ian?   Ian Heptinstall  1:09  Hi, Riccardo. Not quite Birmingham, I live in Cheshire. So I'm closer to Manchester or Liverpool than Birmingham.   Riccardo Cosentino  1:15  Okay.   Ian Heptinstall  1:16  But fortunately, most of my students aren't at Birmingham either, they're all over the world. Riccardo Cosentino  1:21  And I mean, maybe just for the audience, you and I connected a few times on LinkedIn exchanging views, exchanging comments on various posts on various topics. And so I think we finally, I think you finally prompted that we could have a more productive conversation on the podcast rather than on comments on LinkedIn, which is always helpful, but probably not the most conducive way of having a conversation. And so why don't you tell us a little bit about yourself?   Ian Heptinstall  1:48  Exactly, thank you, Riccardo. I am Ian Heptinstall. I'm a late career academic, I've been working in academia at the University of Birmingham now for five years, primarily in a teaching role, although I've started to add some research elements to that. And I currently teach on an MSc program that's delivered to part-time students who study by distance learning. So my students are working in project organizations on projects all around the world. And they want to add to that master's level insight. And as we were chatting too before, our focus in the UK is that at master's level, the key component of that is critical thinking, critical analysis, critical thinking, understanding the evidence behind ideas. But before I joined academia, I had 35 years or so in practical experience. I qualified as an engineer. I started working in the chemical industry in the mid-80s, mostly in project-related roles, either managing small projects or manufacturing facilities, and managing larger projects, being a technical expert, often supporting projects. That was back in the days when project owners had a self-delivery capability, so they had their own engineering organizations. Interestingly, in the 90s, the company I worked for was known as ICI, which doesn't really exist anymore. But it was the third largest chemical company in the world, so-called bellwether of the U.K. business environment and the U.K. stock market. But during the 90s, it was one of the many organizations that started to sort of what Professor Stuart Reid calls "hollowing out," that in-house capability of employees was reduced with a view to what we can but that service in as and when we needed it. And actually, in the late 90s and early 2000s, client organizations could buy that in because the contractors and consultancies had ex-employees there who had got that 20 years of experience of how to think like a project owner and what impact that had on managing the project through its own lifecycle. So that gave me the chance to see projects from the owner's perspective and a supplier's perspective. Later in the 90s, I was involved in one of the first collaborative contracted project alliances in the U.K. that wasn't in the oil and gas industry. And now, I don't understand why all project procurement is not done collaboratively using project alliances. But that's not the topic for tonight's discussion.  Riccardo Cosentino  5:08  Yeah, that's another podcast. That's another long podcast. You and I exchanged on this a few times.   Ian Heptinstall  5:14  Yeah, definitely.   Riccardo Cosentino  5:17  So what are we talking about today, then? Ian Heptinstall  5:20  We, as you said, we had some chats on LinkedIn about the ideas of the use of reference class forecasting, the predominance of strategic misrepresentation, optimism bias during project estimation, all wrapped up into what I've started calling the optimistic estimate hypothesis. In the debts, a proposed way that project environments work. The idea being because the data shows that most estimates, sorry, most projects fail to achieve their targets, Flyvbjerg made famous as the Iron Law of projects, was the Iron Law of mega project management, but became projects, that is about over time, over budget, under benefits, over and over again. And I think there's a significantly strong range of data that says a large proportion of projects fail to hit their own targets. So my argument wasn't with that conclusion. What I'm calling the optimistic estimate hypothesis says the reason for that is that the targets themselves were always impossible to achieve. And because they're impossible to achieve, that's why we never hit them. And therefore, the solution to that is to stop impossible targets being associated with projects when they get approved. And then the proposed intervention is using a technique known as reference class forecasting or a variation of reference class forecasting. So not always based on absolute values but relative percentage performance, which is another concern of the implementation of the method. It basically says, let's make sure that the target is at least compatible to targets we've had in the past. And on face value, I've got no issue with that. If, like me, you've come up from fairly mature project management and engineering environments, one of the estimating methods that has always been used is based on past performance. Riccardo Cosentino  7:56  Benchmarking.   Ian Heptinstall  7:57  Yeah. It's not performance benchmarking in the true sense of the term, it's taking your own data and seeing how compatible it is. Parametric estimating is a method, so long as you've got the feedback cycles from actuals that keep your estimating databases up to date. Now maybe tying into the observation about the hollowing out of project-owning organizations, maybe that feedback loop of capturing actuals and feeding it back into estimating data was broken. I don't know, you're probably more closely associated with that than I am. Professional estimators should not be naive of real estimating data in the past. I can't see it just as being biased from professional estimators. Amateur estimators, I can understand how they would be naive and miss things, but not professionals. Riccardo Cosentino  9:02  Look, I'm a big subscriber of your theory. I am 100% in agreement with you. In fact, I think your theory or thesis has got a lot of strength and in fact.   Ian Heptinstall  9:21  Can we clarify which one because I don't think the optimistic estimate hypothesis is valid. I'm just describing what it is. We're here for me to fix some holes in it.   Riccardo Cosentino  9:31  So, I actually think it's, I think it's actually very valid. And the reason I think it's very valid, because in my experience, I have always looked at a project, you know I've 25 years experience in this industry, and I always wondered from a purely technical standpoint, if you had unlimited access to data or if you have a lot of data and you have a lot of experience and you have a lot of experienced individuals, you can approximate an estimate. However, historically, or my experience was that all of the projects I worked on were over budget, all of them. So I could not understand how very capable, very intelligent human beings, with great experience could not estimate a closer to the actual. Because statistically speaking, I mean, if it was random, it will be 50/50. Right? You know, sometimes.   Ian Heptinstall  10:33  Why? There's many phenomena in the world that are not normally distributed. So why would we expect it if it was really random? But I don't think it is random? I think it's (inaudible). Riccardo Cosentino  10:48  I don't think it is random either. But that's what I'm saying. It's like, if it was random, it would be 50/50. Right? So if he was really, if it was impossible to estimate something, or really, really, really difficult to estimate something, then it will be a random outcome, which will be a 50/50. But that's not a problem we have because the majority of the projects are over budget, right? It's not, or at least the mega project. Let me define it a bit, a bit better, it's not really the mega project that I have experience with.   Ian Heptinstall  11:25  Shall I give you a mega project that smashed the reference class?   Riccardo Cosentino  11:31  Yes.   Ian Heptinstall  11:33  Anyone who travels a lot long distances will know Embraer who work along with Bombardier, make the sort of medium-sized passenger jets, with Boeing and Airbus on the much bigger jet. The reference class for designing, developing and bringing to operations a new passenger jet was between 80 and 100 months. And in the new jets that have been produced the century since the turn of the millennium, many have estimated six years, but they've all taken about eight years. Embraer estimated five years and completed the project seven weeks early. So had they planned and achieved to the reference class, they'd have brought the second generation E-jets, the E2 jets to market just before COVID struck. As it is now, the E2 jets have had, for them, record sales performance and one of the most efficient in their class on the market at the moment. So they didn't follow the reference class. And it's extremely complex to about a four to $5 billion project. Riccardo Cosentino  13:08  And I don't, okay, I think, I think, I don't, I think we were saying, I think I was trying to explain why I believe that the, how do you call it, the optimism estimate hypothesis, because it resonates with, why it resonates with me is because I think there is something systemic in the way the estimates are put together. I couldn't put my finger to it before I started reading, got myself educated on the topic. And that sounds a fairly rational explanation that, you know, strategic misrepresentation and optimism bias play a role in that. The reference class forecasting, I think I need to clarify, because I would never make an estimate out of a reference class forecaste. Like, that's not how you estimate things. And I think when you don't have the certainty, when you're talking about things where you making assumptions, you're never going to be 100% correct. So the way, personally, I think you have to do it and this is done in other industry, you triangulate, you know, you start from a bottom up, then you do a top down and then you start layering on qualitative factors and then at the end, you make a decision on what number to pick, but it's a decision based on on multiple parameters. And to me, reference forecasts, you know, I give the example many times about the mergers and acquisition industry, right? In M&A, you start with the discounted cash flow, lets you bottom up estimate of how much your company's worth and then, but whenever you do a DCF you need to make assumptions you know, you got to predict what the revenue growth over the next five years is going to be, blah, blah, blah. And so those assumptions might or might not be right. So you have one data point, then you have another data point, which is your reference class forecast. So in the finance industry, it's going to comps ratio, comps analysis, where you're looking at similar companies. You're looking at how much they're worth on the stock market and you trying to draw similarity. And that's your second data point that will be different from your bottom up. It'd be your top, right? So now you got two data points on trying to identify what a company is worth, and the worth of a company is very subjective as well. So then you got to layer in your qualitative analysis. So to me, yeah, I'm not here to debate the reference class forecast. It is an estimating tool. I'm here to debate that there is optimism bias and the risk strategic measure representation. And so what do we do about that? Ian Heptinstall  15:56  I agree that those things exist. The optimism bias, I'm not sure. I'm still still thinking about that bit. Because if you, in reading the literature, a strong link is made to the work of Kahneman and Tversky and Daniel Kahneman's introduction of the term optimism bias and estimates. And what's interesting is if you look at, Kahneman use as an example that he was involved in developing a new educational course and textbook in Israel, and when you read it through, the bad with retrospect estimates were from the non-experts, the expert in the room knew it would take seven years and had the reference class in their head. But they were not, you know, they were in a support role. So actually, the expert estimate was quite good. It was the amateur estimate that was deemed to be optimistic. But when thinking about that, it seemed to me that when we're talking about time and money, either spent or estimated, they, an estimate will have three components. The first component is what it is feasible to do with it. The perfect position. Then there's another set of factors that relate to things outside your control, outside influences, unknowable risks and things that could emerge that have an impact on how long something will take. But there are two separate components. There's actually a third component particularly relevant when we're talking about projects, and that the whole collection of, of managerial practices of how we go about doing the thing, so that the time that we estimate and the time that it takes, I like to see us having at least those three major components. Now, the "iron law of projects" tells us that the total time estimate was less than it actually took us. I think we get much more insight, if we think okay, well, which of those three components had the biggest role to play? Was it, it being feasible or unfeasible? Was the estimate that bad it was physically impossible to do? Were there things that were unreasonable that professionals to have known about in advance? Were there the black swans, so to speak? And if there were, at least that explains to us where the issue arose? Or was it how we go about managing and implementing our projects? Are they inherently inefficient? Are they the reason that we struggle so much to deliver to our estimates? So, I'm questioning is it the feasibility of the estimate that's wrong? Or is it how we've gone about doing it? Because in the field of construction capital projects, the methods around the world are fairly consistent. You know, where I've done my straw polls over my career, I see great levels of similarity. People often, "How do you know so much because you've never been to our country before?" Colombia, you're not that different. How do you know African oil and gas industry? I've had the same conversations. Because I've said you're not as different as you think you are. But I think that third element is where the differences arise. Now, an analogy that I often use is if we think about the winning a marathon, world class athletes have no problem running a marathon in two and a half hours. Now, if I estimate that I will run my first ever marathon in two and a half hours, that estimate is not unfeasible. It's very unlikely. But it's unlikely because of the managerial aspects. Will I put the time and effort into the training? Will I do the preparation? Will I drink less and eat better food? Will I? So it's how I go about preparing for the marathon. One of my concerns if we think the problem with projects is our estimates are too light, and the answer is to increase the estimates, that's a vicious spiral. That just means expected costs will go up and up and up over time. If we separate the three elements of time and think maybe we missed the target, not because the target was impossible, but our methods of execution was such that it made it very hard to achieve the target, that actually gives us an opening for a virtuous cycle because there are so-called black swans that show that the same estimates are achievable and can be done reliably. We touched upon the area of collaborative contracting, IBD, project alliancing. This project from hundreds of real-life projects that have tipped the iron law on its head, you probably know, well know the Walker Hartley and Mills paper from 2013 from Australia, they had, 4% of projects went over budget, and about 20% went over time. So 90% were on or under budget 75% were on or under time. And all they changed was how the projects was procured. Riccardo Cosentino  22:13  So you're not going to get an argument from me on on that topic because I do believe, I, you know, another hypothesis, I do believe that collaboration is the answer when you're dealing with complex projects. However, just going back challenging a little bit on the is it the estimate was not feasible to begin with, is it actually the execution, if we increase the budgets to begin with, are we just to even cover the poor execution. I'm paraphrasing what you're saying. But, having said that, well, yeah, and this, this is more on the, you know, when you are dealing with lump sum, turnkey contracts rather than Alliance contract, where ultimately, a client comes up with an estimate, right, they have their own estimate, they have a budget, and especially for public sector clients, those budget are, even are fully disclosed and known in ballparks. And now you have a contractor trying to win the work. And, I think we talked about this, before we came online is you know, the contractor knows that in order to win the contract will have to be near or below the client estimate. And so now, the optimism bias, the strategic misrepresentation is perpetuated in the bidding process by the contractors because they need to secure the work. Right? So in in an environment where you have lump sum turnkey fixed price, I do think it matters to start with the right budget, because that dictates the behaviors of the parties in the following steps.   Ian Heptinstall  23:57  But what is the right budget? If you want a budget that is very feasible to be achieved? If people work in a particular way, yes. But then you risk just wasting lots of money because a fixed price lump sum contract is that what it will cost you whether it's needed or not. And yeah, if there weren't these high-risk pressures on the participants to sort of play games, hide things, not be totally open and honest. And one of my concerns with the idea of strategic misrepresentation and the term deception, these people are being deceptive, no, they're playing by the rules of the game that are set in. Now, as Eli Goldratt once said, "Tell me how you measure me, and I'll tell you how I will behave. If you measure me in a dumb way, don't complain about my behavior." And I think that's what we're observing in many of the practices in the construction sector where owners are using processes and then they're complaining when they don't win, or change the rules of the game or the approach they take is to get better at this adversarial aggressive game. So we see projects where the most experienced, the most capable and the most highly-salaried individuals are those trying to control and police the contractual loopholes and administrating and nail everything down, and the lawyers, the commercial managers, the senior (inaudible). Yep. A fortune is being spent on people who are not thinking about   Riccardo Cosentino  26:00  Solving problems. Ian Heptinstall  26:01  How do we get this hospital built quickly? How do we get this hospital built so that it's open and treating people 18 months sooner than we have in the past? Or that we can have 20 more beds, or that we can free up some money to employ so many more healthcare practitioners? It's focusing on the skills on the wrong thing. And actually, I think the industry is going to have a big problem if we get our way and collaborative contracting becomes the norm. What are we going to do with the hundreds of thousands of professionally qualified contract police? That's what a lot of people do. Riccardo Cosentino  26:46  Ian, again, I'm not gonna argue with you, because on that you and I agree, 100, like, to me, I think you said it and I always say it, like, there are resources on projects that add no value or solving problems for the success of the project. And so redirecting the the effort to those results, or redirecting those resources, to more meaningful, yeah, as I said, a lawyer, you know, a claim against the client does not make concrete being poured faster, you know? A schedule analysis in order to substantiate a claim does not make concrete being poured faster. Ian Heptinstall  27:29  And actually, the the issue with that is I think that the skills and the capability to manage the detail flow of work so that concrete is poured faster and worked on sooner, that sort of logistics flow management capability is also petrifying. Now, projects that are getting into techniques and methods like lean construction, are starting to work on that, or project production management are starting to bring in some of those skills and knowledge of how to how to manage the flow of work. But it's suddenly become a niche rather, whereas it should really be core. And the core skill is actually contract administering and locking up (inaudible).   Riccardo Cosentino  28:23  No value add, right? There is no value add to the ultimate goal, which is building infrastructure.   Ian Heptinstall  28:29  Back to the strategic misrepresentation, maybe. Riccardo Cosentino  28:30  No, I actually wanted to probe you on this, because I've had a few people in the past challenging me, and you and I have exchanged messages on this topic. But you know, one of the big criticism, and this is a small parenthesis because this is not what we're talking about today, but like the cost certainty, right? You know, I have people telling me, well, you know, if you don't have a fixed price contract, you don't have cost certainty. Ian Heptinstall  28:58  And they have got evidence that the contracted price is the final price. I have not seen that evidence. And whenever I ask experienced practitioners, they say none of the final price is always more than the tender price. So if you want cost certainty, put so much padding in there that everybody can fill their boots. But if you're in the public sector, that's almost malfeasance. Yeah, just just wasting taxpayers money just so that you can have an easy life. That's not what a professional job should be about, in my view. And I think the important point in there is focusing on reliability. Are you hitting our targets? The only thing that we can do is we take the target as sort of wherever it comes from that's the important thing and we've just got to match it. What about absolute value?  Why are we not focusing on what is the absolute value? Yeah, but by the reliability school of thinking, it's better if your company makes $10 million a year, having targeted $10 million, that's actually better than making $15 million of profit in the year, because your target was 18. The 15 is rubbish, because you were 18% underneath your target, it's much better to have 100% reliability even if the profit is lower. I don't buy that. There is a role for a stretch target. The idea of smart has caused a lot of damage to performance improvement. Now, if you're looking to strive to continuously improve the performance, you don't want to put too much pressure on the individual if they miss what they're trying to achieve. Now you need to be able to manage in different ways. You need to be able to, the accountability is about how somebody goes about doing the job. Not the trivial, easy to measure accountability of numbers on a spreadsheet. I don't need to know how they're doing the job, I just need to look at some numbers. Well, if you want a simple career, become an arm's length investor or go buy a casino in Las Vegas. Because then you don't care about the individual gamblers and who makes or less. You're managing by the average statistics of the organization. On project, we want to be the individual who knows what to do. We need to be striving for what is it we do to deliver a P-10 project? Not let's make our life easy, and plan for P-90. And that's my other concern about if we blame the estimate, we're taking the focus off our leverage improvements or improvement, our leverage opportunities for improvement rather, those are how we go about doing projects. And I actually believe that if we focus first on absolute performance, reliability will get better. Yeah, that I don't whether you play golf, I (inaudible). Riccardo Cosentino  32:45  Unsuccessfully. Yes. Ian Heptinstall  32:47  My son is very good at playing golf. And he's got a very low handicap, certainly much lower than mine. And his focus, the focus of low handicap golfers is getting better at golf. Their focus is absolute performance. And you know what comes with it? They're much more reliable, their variability of play also goes down. But if you focus on just playing to your handicap, yeah, you will do some very different things. And you might, you might play to your handicap, but you won't do very good rounds of golf. And I think on project, we should be focusing on how can we make your project performance significantly better? Yeah, I think if I was still operating in large, mega projects, I'd be frustrated that the Starrett Brothers and Eken could build the Empire State Building and formed it in 10 days in 1929 when we can't do anything like that today, and I don't believe it's because we have safety rules these days. It's nowhere near as simple as that. If the industry had started to perform like other industries have, the Ford was making the Model T around that time, yet cars are just as affordable these days, but you get much, much, much more for your money. Construction projects cost more and take longer.   Riccardo Cosentino  34:31  Yeah, I take your point. I mean, you know, absolutely, I mean, we should be focusing on measuring performance and focusing on the performance because ultimately, that's the stuff that gets things built. It's not, an initial estimate is not what gets things built. But unfortunately, stakeholders and shareholders focus on it.   Ian Heptinstall  34:57  They want to make more money. If you've only got a business, the idea of risk comes with any entrepreneurship and business. They know all their forecasts or estimates. Yeah, if sales come in on forecasts, somebody's been playing with the numbers. Yeah, nobody can see the future. So where do you think that comes from? Riccardo Cosentino  35:23  Again, I think cooperation and public, especially public company, by any corporation, has to deliver, has to provide indication of future performance.   Ian Heptinstall  35:37  Yeah. Let me give you an example. Because my other set of black swans that disprove the optimistic estimate hypothesis, so I've mentioned all the data on collaboratively contracted budgets, so all done. All projects are not overspending. It is possible to deliver and achieve the estimates. There's no evidence on those projects that the estimates have been done in any different way. And if they have, then that approach has helped avoid optimism bias and strategic misrepresentation. Which surely must also be a good thing. But one of my other set, and this is the Embraer example that I used earlier on, that's an example that have used the critical chain of both scheduling and execution management, which is, needs a collaborative team. But exploits that collaboration to identify issues much earlier on and overcome them. So it focuses on that doing the work. Even though from one perspective, it's just a way of scheduling and reporting. If it's done well, it helps to introduce a much higher frequency, a higher cadence of reporting and decision making at a much lower level. That is what achieves more efficient performance. So on critical chain, critical chain, scheduling and execution projects, hit their project-level commitments, very, very regularly. I know many organizations and I have talked to people in many organizations who have sort of moved from 20% projects on time in full to 95-100% in all sorts of project domains, simply from changing how they're scheduing and managing execution. They've also increased productivity as well. But if we're just looking, the reliability has gone up at the project level. What hasn't changed is the ability to predict how long individual tasks take. So that's the sort of strange dilemma, the individual tasks are nowhere near as predictable and reliable. But the overall project is, and I think if you're striving for reliable project level, cost and time is quite feasible, I think. I think it's quite feasible to live it. But if you pass the same mindset down at the detail levels of projects and try and get each individual task and activity to give an estimate, turn it into a commitment will hold you to accountable for it, that actually drives the behaviors that makes the project level achievement much worse. Riccardo Cosentino  38:56  Yeah and why is that? Ian Heptinstall  38:59  I think its inherent in the behavior of complex systems. Because the future is unknowable. And we all know that estimate is a fancy professional name for guests. So the important thing when you're working is to work efficiently and flag up issues that can have a consequence to the rest of the project as soon as you notice them without giving the boy who cried wolf signals that sort of says I've got a problem when it's not a real problem. And methods like critical chain, try and sort of do that damping. So individual tasks that are just taking a bit longer than normal the project to accommodate because we know that some projects, some tasks will have problems and some will go smoothly. But in advance we don't know which. So methods like critical chain and the costing equivalent for collaborative contracting, let's not worry about it. Because if we don't make those estimates into commitments, they will average each other out. That's one of the ironies of organizations that use Monte Carlo simulation to try and sort of aggregate up the numbers and produce and use the central limit theorem to get overall probability distributions at the project level. Because the the basic method of sorry, the basic algorithm for Monte Carlo assumes that the pluses balance the minuses. That's built into the maths. The trouble is, behaviorally, the managerial behaviors inhibit that, because the task estimates are commitment, what tends to happen is tasks get completed, on the due date or later. It's the managerial behaviors that inhibit a project or task saying ours finished three weeks early, the next task can start earlier. But that plus and minus is built into the maths of Monte Carlo. So when critics say well, Monte Carlo analysis is inaccurate, because the numbers never look like the analysis, and you know, a P-80, we never, we don't have 80% of the cases coming in, under or on that number. So the method must be wrong. Or actually, maybe it's giving us some insight into our managerial practices, or inhibiting the sort of pluses and the minuses. So I think that's what critical chain builds in. It allows and encourages the Task Managers to, so long as they're working in a focused way and they're reporting regularly, if it takes longer, it takes longer, because we know, there'll be other tasks in the project that go shorter than expected. And because we've removed the managerial obstacles to reporting admitting an early finish, nobody's going to come back and said, You must have added your estimate. We will reduce all of your other future estimates. We'll say, great, well done. Look who's with you. So in effect, you're embracing the inherent uncertainty, so that the central limit theorem will apply. And so that the project actually gets a tighter normal distribution. So the reason we don't get that in reality, in more common conventions, is that the management practices inhibit the pluses and the minuses averaging out. That's one hypothesis. That's the underpinning thinking.   Riccardo Cosentino  43:05  So if we link that back to the initial, at the beginning, you were talking about the three element of the hypothesis, right? Is a project over budget because of the inherent lack of feasibility of the initial estimate, poor, at the other spectrum, is the poor management, sorry the management practices we're not running these jobs properly and that's why we're late and over budget. And what was the middle one? The middle one was   Ian Heptinstall  43:34  Those are the true black swans and unknowable risks that come along with that, you know, they, that the the ground conditions on your chosen route, really were bad. Yeah, whether you do lots of geotechnical surveys before or after that is still at risk. Riccardo Cosentino  43:57  So your, one of your hypothesis, if I'm not mistaken, is that if we focus on the unfeasibility of the estimate, if we assume that is the unfeasibility of the estimate that is creating the delays we were hiding, that allows us to hide the true reasons why the project is going bad. Ian Heptinstall  44:20  Yeah, and it   Riccardo Cosentino  44:21  It could be the black swans or it could be poor performance.   Ian Heptinstall  44:24  Yeah, it hides it and it stops us focusing on getting our performance well. So yeah, back to my marathon running analogy. I had someone looked at some data from the London Marathon. So the P-90 duration for winning the marathon is six hours 15 minutes. And if I planned for the P-90, six hours 15, and managed to achieve it, great but no big thing counts a great winner. And to be honest, I will be dissatisfied myself. Because I know if you've, if you've put some time and effort in, it's quite feasible for average humans to hit the P-25 or the P-10 number. So it's not it's not the estimate, it's how we go about doing it. That's, that's my main concern. We've lost, we're blaming the estimate, and we're losing focus on execution. And there's so much actual strategic opportunity for executing differently. I, once we get the estimate, right, we turn the handle, turn the handle, churn out the railway easy.   Riccardo Cosentino  45:47  Okay, so now, the comments on LinkedIn are not very conducive to understand each other's points. So I think that's the conclusion I draw. And I agree with you, I 100% agree with you. My only note is that I also tried, the reason I'm a big defender of optimism bias, which is human representation is for very similar reason to yours, but I'm coming from a different perspective. You know, I am so fed up of seeing, especially in large, mega projects, sponsored by the public sector, they end up becoming political, in Canada will be a hockey puck, a political party, right? They just get tossed around. And, you know, there's a new government and an old government and you know, there's a blame game that happens. And the blame games is always around project over budget and late, right? And there is never a recognition of, you know, there's, the management of the project was very poor and that's why he's over budget. Well, you don't actually know that, Mr. Politician, or Miss Politician, you don't know that. You just, you're using that situation to your political to create political advantage. And so to me, I find that it's also disingenuous, right? It's both sides of the coin, it's two sides of the same coin, right? Where, you know, estimate could be used not to focus on the performance, but that performance being good or bad? Because a lot of time, my experience is that project leaders get blamed for project being late. And the analysis is never done why was the project late? And there's never an analysis around was it ran properly and you had a bad estimate? Or did you have a good estimate and and they were ran badly? I think I agree with you that the conversation should be about the project performance, always should be about the project performance. And I would, I, sometimes, you need a proper estimate to have a proper conversation. Ian Heptinstall  48:01  Oh, yes, you, you definitely need to have a decent estimate that in the same way, that the iron law of projects doesn't prove that the management was bad, it doesn't prove that the estimate was bad, either.   Riccardo Cosentino  48:16  Absolutely. Ian Heptinstall  48:17  You need to scratch below the surface. That's my concern about the optimistic estimate hypothesis is it's being used in many environments as the explanation for the iron law. And therefore we focus on the estimate. And there's promotion of reference class forecasting, which good estimates are always based on the reference class anyway. And if they're not, there's something sort of structurally strategic wrong with the organization that's delivering the projects. And that will touch upon your comment there regarding that. Where's the analysis being done? Where's the evidence being gathered from an individual project and fed back so that future projects at least don't suffer from those particular issues and problems? How's that being built in? When I started, we had such a system, this so-called double loop feedback, so that project managers on a project, the guidance was reasonably well up to date, whether it was estimates, methodologies, checklists, they were kept up to date. If you don't have that, it's very difficult for organizations to manage and continuously improve their performance. But, having said that, I see these so many execution, efficiency opportunities that I'm not sure why that's where we don't start. Yeah, there's some opportunities in that I've mentioned and discussed that there's also the idea, which also has a very strong evidence base, that projects that move into execution, before sufficient preparation has been done, the extensive data from IPA, Independent Project Analysis and the CII, Construction Industry Institute, in the U.S. Yeah, that sort of 30-year-old data, a strong correlation between the degree of preparation before execution is commenced. But how many projects today, the politicians want to talk, they talk about shovels up, get shovels on the ground. I want some shovel-ready projects. Okay. But that does mean we've spent seven to 10% of the capital value to get them to shovel-ready state. No, you can't do that. I know one of the Canadian public sector bodies has that, oh that's done on out of operating expenses. And we don't want you to spend more than 2% of the capital value, getting it to a final business case. Well, that's bonkers. Because as soon as the business case is approved, somebody's going to rush into execution. And that's going to be wasteful.   Riccardo Cosentino  51:35  Absolutely. Absolutely. Ian Heptinstall  51:37  So I think, once we've sorted those things out, then we can start using the once we've crossed the execution and the preparation things off the list, then we can start looking at the quality of the estimates, I think.   Riccardo Cosentino  51:54  I mean, as project practitioners, I mean, researchers in the U.K., I mean, there is, unfortunately, sometimes we discuss and discuss these topics with a certain amount of preassumptions in, there are some things that I assumed are understood, right? And so my starting point is always I assume that we have capable contractors and capable supply chain. So that's typically the starting point for my analysis, which is not always true, but that I want to, I always try to start from there. So if you start from there, then obviously I've already solved that problem. And then now I want to focus on the strategic misrepresentation and optimism bias in the estimate process, right? Because my starting assumption is that we have a capable supply chain. Ian Heptinstall  52:55  Let me give you just one example from my own experience, when I worked at a contractor. We had a probably one of our largest clients, we had a strategic relationship with actually the project owner that we did all the building services work on their projects, and they had dozens of projects every year. When we estimated, and interestingly, we put an estimate for the building services together when the conceptual design was put together. And this, although our pricing was through an agreed mechanism, this particular client had a fixed-price approach, I want to go to a main contractor, but your work will be sort of given to them on a platter, they will be told to use you etc. But we want single point of contact. That meant that when we estimated the amount of man-hours we put in on a job, it ranged from x to 2x. Simply dependent upon who we were working alongside. And that was not just competence. It wasn't even at the level of the company. Yet the people who came and the way they managed the worksite could double the demand on our resources. And that that's a significant impact. And strangely, it was the same number that I had when I was buying spray dryers in the chemical industry 20 years earlier. And one of the global manufacturers told me yeah, depending who the client is, some clients take two times the demand on our engineering hours than others with the questions they asked. They're all competent. So there's enormous differences with how you put competent people together. You can't just assume a team forms like putting a hockey team together.   Riccardo Cosentino  55:01  I said, I made that assumption and never said it was the correct assumption. But, you know, I need to simplify certain things in order to have certain conversation. But yeah, you're right. I mean, it's not the right assumption. Ian Heptinstall  55:15  And it's a common one. And the, particularly, if you tie it with this assumption that a competitive market force will drive innovation within your supply base. It may do but it won't necessarily, particularly since main contractors are basically, variable cost organizations. They're not high-fixed cost. They're not major upfront investment that they react and increase temporarily, their variable costs only after they've won a contract. I'm not sure that that sort of market will drive innovation, you, you just need to be similar or slightly better than your fellow competitors. You don't need to be world-class, you just need to beat the other guy or gal in the room. Riccardo Cosentino  56:12  That's the bear story, right? We have that. Ian Heptinstall  56:15  That's it. That's exactly the bear story. And I think there's many from back in my procurement days, there's many examples where owners facilitating supply-side innovation, drove significant improvements. But if they just sat there and waited for responses to tenders, nothing would have changed. They the whole topic of so-called reverse marketing, where it's the customer who encourages suppliers to enter new supply markets, or to work in different ways. It's a known technique that I wish I saw more of it amongst major project owners in the construction space. Riccardo Cosentino  57:07  Look, I mean, I might not have time to unpack this, but like, and it goes back to your alliance contract, right? I mean, that the reason and it's a very crude description, and you're probably gonna cringe the way I say it. But you know, when you have alliance contracting, especially the public sector clients have to be at the table, right? Now, the cost overruns are no longer somebody else's problem. They're our collective problem. And so you need to come to the table. So the, you know, for the contractor, it basically removes the unproductive resource, legal and commercial resources. And so now you have all of the resources, just focusing on problems. On the public sector, you actually create skin in the game, where now you don't longer have a command and control posture, because you have transmitted fixed price risk to somebody else, you're at the table, you need to contribute to problem solving, and you need to help, like you said, innovation. But that only happens if you have the legal and the right legal commercial framework that is associated with alliance, in my mind. I don't think you can achieve that through any other, because any other commercial contractual method, because the behaviors that those frameworks create, are not conducive to collaboration and innovation. Because exactly what you said, I mean, a contractor, a contractor will do what a contractor will do. Like it's a variable cost organization, they're not going to invest in R&D because the next project might not need the R&D you just developed for this project. And an owner wants to, as you said, there was an all-knowing how to most of the owners worldwide. And now the owner organization doesn't actually have the resources and the capability to be at the table, to be the informed or capable owner that is needed to run these projects. Ian Heptinstall  59:10  They got to have some of it. Because I think that input depends on what the project is about. I'd like to start thinking about the inherent project and forget who employs the people that you need in your project team. So doing a project is a team sport. And you need people around that table with the sort of operating experience for what the asset will be used for. And you need that mix of expertise. And very often the owner organization is the obvious place to provide that kind of expertise. Now, I'm less convinced that the owner has to be the one with the team facilitation syncronization skill. I think that depends on the individual you've got. And that can come from any, ideally, any one of the participants. And if you're short there, you might have to bring in an additional individual or party to manage that synchronization. But that could that could come from any of them, not necessarily the owner. But which is, you know, thinking lifecycle cost, an understanding of needs, regulatory environment, the political environment, those sorts of changes will probably come from the owner. So their representatives, there's a lot of value they can add, rather than being arm's length, and hoping that the, your contractors will sort that out by themselves is, as one of my friends would say that you're taking hopium. Riccardo Cosentino  1:01:01  The command and control posture right, I think you call it arm's length, I call it command and control posture. Anyway, I'm conscious of time. (Inaudible) Yeah, I mean, this has been a fascinating conversation that I want to thank you for, for joining me, thank you for suggesting that we do this. And honestly, I'd love to maybe, on another episode, to pick up the collaborative contracting versus lump sum debate, right? Because it's a very live debate right now in where I am in Canada, even in the U.S. a little bit. But Canada, or we are certainly now starting to enter the collaborative space and you can see, yeah, I love to have a conversation with you about that on another episode.   Ian Heptinstall  1:01:57  That sounds like a plan, Riccardo we'll work on it. Riccardo Cosentino  1:02:01  Great. Okay. Ian, on that note, again, thank you for joining me, and I look forward to further exchanges, both on another episode or on LinkedIn. Ian Heptinstall  1:02:14  Thanks, for the opportunity. And yes, this gets around the 125 or 1250 character limit of LinkedIn. Riccardo Cosentino  1:02:23  Absolutely. Ian Heptinstall  1:02:24  Thanks for the opportunity. I've enjoyed it. Thank you. Riccardo Cosentino  1:02:26  Thank you. Bye now.   Riccardo Cosentino  1:02:29  That's it for this episode of Navigating Major Programmes. I hope you found today's conversation as informative or provoking as I did. If you enjoyed this conversation, please consider subscribing and leaving a review. I would also like to personally invite you to continue the conversation by joining me on my personal LinkedIn at Riccardo Cosentino. Listening to the next episode, we will continue to explore the latest trends and challenges in major programme management. Our next in-depth conversation promises to continue to dive into topics such as leadership risk management and the impact of emerging technology in infrastructure. It's a conversation you're not going to want to miss. Thanks for listening to Navigating Major Programmes and I look forward to keeping the conversation going. Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.DISCLAIMER: The opinions, beliefs, and viewpoints expressed by the hosts and guests on this podcast do not necessarily represent or reflect the official policy, opinions, beliefs, and viewpoints of Disenyo.co LLC and its employees.

This week, Dan and Laurie Dean are joined by Independence Police Chief Adam Dustman and Deputy Chief Michelle Sumstad as they discuss the loss of Officer Cody Allen, the Honor Flag, and the support the men and women of the IPD get from the community as they protect Independence. --- Send in a voice message: https://podcasters.spotify.com/pod/show/we-have-issues5/message

Watch on Youtube.Vince Chapman started his tenure at the University of Texas as a philosophy major.  He didn't do well in his first accounting course, so like a never fail Longhorn would do, he decided to master that degree.  In the interim, he has become one of the best known auditors of IPD and other construction delivery contracts.  Join us as we explore the three major transparency questions in IPD:  overhead, hourly rates and profit.

David Villa is the Founder and CEO of iPD Agency, a marketing and media firm that works with over 600 companies in several industries across the United States and Canada. David has over 20 years of national sales and executive management experience. Since the establishment of iPD Agency in 1995, David has been responsible for pioneering, growing, and scaling iPD into one of the nation's leading database management, business development, and digital marketing companies in the automotive industry and beyond. In addition to his sales and leadership experience, David is also a dedicated follower of Christ. He credits his success to those who he's been privileged enough to call his teammates, and to his savior Jesus Christ. https://davidvilla.me/ We discuss: TRANSITION & WHAT MOST PEOPLE STRUGGLE WITH DURING TRANSITION? HOW DO WE KNOW IT'S A DOOR GOD IS OPENING? ADVERSITY OR OPPOSITION DOESN'T NECESSARILY MEAN IT'S THE WRONG PATH | DISCUSS We discuss: FEAR & UNCERTAINTY & HOW WE BALANCE BEING INFORMED WHILE ALERT OF FEAR MONGERS? We discuss: MINDSET & OBEDIENCE DOES OUR LEVEL OF OBEDIENCE REFLECT OUR LEVEL OF EXPECTATION?FINE LINE BETWEEN OVER-INFLATED EXP AND COMPLACENTLY UNDERACHIEVING? PURCHASE OUR BOOK ON SPIRITUAL WARFARE: https://last-in-line-leadership.square.site/product/operation-333-the-little-black-book-on-strategic-spiritual-warfare/14?cs=true&cst=custom

In this episode of Navigating Major Programmes, Riccardo Cosentino sits down to reflect on the conversations during the first season of Navigating Major Programmes and what he's learned about the industry because of them. Plus, Riccardo shares why he started a podcast in the first place and his final thoughts before taking a brief break ahead of an exciting season two. “The opportunity to sit down and interact with individuals who have spent six months researching a specific major programme topic and engaging into a debate about their findings and their conclusions has been very, very inspiring for me. To a point where all my initial concerns and fears of starting a podcast have now completely vanished and I'm really looking forward to building upon the first season of Navigating Major Programmes and bringing even more in-depth topics in season two.” —Riccardo Cosentino  Key Takeaways: The importance of being an ally for women in major programmes (listen to episodes 1, 2, 3, 4 and 5)Collaborative contracting as an alternative in complex programmes (listen to episodes 6, 10, 11 and 15)Leadership in major programmes (listen to episodes 7, 12 and 14)Setting the right expectation of technology in major programmes (listen to episodes 8 and 13)  If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. The conversation doesn't stop here—connect and converse with our LinkedIn community: Navigating Major Programmes PodcastRiccardo CosentinoTranscript:Riccardo Cosentino  00:00If you're listening to navigate the major programs, the podcast that aims to elevate the conversations happening in the infrastructure industry and inspire you to have a more efficient approach within it. I'm your host Riccardo Cosentino I bring over 20 years of major programme management experience. Most recently, I graduated from Oxford universities Said business school, which shook my belief when it comes to navigating major problems. Now it's time to shake yours. Join me in each episode as a press the industry experts about the complexity of major problem management, emerging digital trends and the critical leadership required to approach these multibillion dollar projects. Let's see where the conversation takes us.  Hello, and welcome to a new episode on navigating major programs. This episode will be the final episode in Season One. And in this episode, I will try to recap the topics that we covered in the first 15 podcasts. I will try to also recap the guests that join the podcast and the themes that we covered in the 15 episodes. But before I go into that, I think it's important that I also tried to recap and remind ourselves why I started the podcast in the first place.  I started this podcast for two reasons. The first one was a personal reason which was wanted to overcome my fear of public speaking, I wanted to practice the skills of interacting with guests and to record myself and listen to myself and overcome this cringe that we all have in listening ourselves speaking. And it was very important to me, it was very important for my journey to always become a better leader, I really wanted to put myself out of my comfort zone.  But the second reason which is to be more addressed stick is I wanted to create a platform for individuals that don't normally have access to these type of platforms such as podcasts and blogs. The idea really started from when I was finishing my dissertation at Oxford. And I realized that I just spent six months researching a topic using very rigorous academic research methods. And most likely the now the dissertation will probably end up on my bookshelf. And I also realized that in my class, there were another 60 People who had created similar research of similar standards. And also then I realized that because I was part of cohort 12, at Oxford for the master major program management, there were approximately 700 People who had written dissertation who had research, major program topics, and most of them probably never talked about the research. So those were the two main reasons why I started the podcast. But as you probably realize the first five episodes of the podcast was actually a mini series called Building Bridges. And the reason I started with a mini series is because I was very scared of getting the podcast off the ground, I had a huge amount of impostor syndrome. And so together with with my personal brand coach, we decided to actually create a mini series so that it wouldn't be too daunting. It wouldn't be a full podcast, and it was going to be a bit more manageable with a limited number of episodes in a very limited topic, which was the experience of women in working a male dominated industry. However, as I was launching the miniseries, and by the way, the miniseries took me two years to launch because I recorded the first podcast in 2020. And I ended up launching it in 2023. So I should have been more than two years, it took me more than two years to launch the podcast. But when I ended up doing it, when I started recording the second and third episode, I got really galvanized and decided to bite the bullet and to actually launch the full podcast. And that's how we ended up having navigated major programs together with building bridges, women in infrastructure.  I also picked the woman infrastructure topic because I'm a big ally to women. And I think our industry needs more women. And so I felt this was a topic very close to me, and probably a very easy place to start since I was quite confident about the topic. So in building bridges, we started with Mariska Pinto and she came in talk to us about being the only woman in the room and the challenges have been in a male dominated environment at the beginning of our career. We then had Corrail Bourrelier Fabiani, who has now become a regular guest as well as co host of the podcast where she discussed the importance of allyship. Then I decided to have an old colleague of mine, Hannelie Stockenstrom, who is being a big role model for me and also represented somebody in an advanced stage of our career, and somebody that is really passionate about infrastructure. Then in episode four, we had Divya Shah joining us and talking about how labels put limits on what women can achieve and how labels are detrimental to the advancement of women. And then finally, in Episode Five, we had my ex colleague Shormila Chatterjee, that came to talk to us about gender bias and their experience with gender bias, being an engineer, managing engineers, and getting pushback from these engineers because she was a female. Overall, the biggest lesson learned for the miniseries is that ally ship is very, very important. All women described how in a male dominated environment, some sort of allyship is necessary, because there just aren't enough women at the top. So if women want to try to make at the top in a male dominated industry, they need the support of men.  Once I concluded building bridges, women in infrastructure I launched right into navigating major programs. As I mentioned before, the podcast was meant to give a platform to some of my classmates who had done extensive research on major program topics and didn't really have a platform to present their findings. So I started with several guests. And we followed three major themes. We talked about collaborative contracts, we talked about leadership in general leadership in major programs. And then we talked about technology and technology in major programs. There was also one episode where I invited back Corail to talk about her dissertation, which was linked to building bridges. But we were able to do a deep dive into a very interesting topic, which was, Do women need to play golf in order to lead major programs, and Corail was able to articulate the importance of women networks and how fundamental women networks are for the success of women and major projects in general.  In the collaborative contracts stream, we talk to Carol Tansley, about the use of IPD in nuclear mega projects. We also talk to Rachel Patel, about the use of integrated project delivery or IPD in the healthcare sector in Ontario for mega hospitals. And we looked at the strand for challenges of integrated project delivery in the Ontario context.  Then we also talk to Vicenta Cunha about the use of collaborative contracting in the procurement of oil rigs and in general ships and the use of schedule incentive for the completion of mega project on time. And then finally, in the collaborative contract stream, I had a bit of a role reversal, where I invited my classmate and podcast guest, Jim, to actually be the host and interview me so that I could present my research about the use of collaborative contracting in PPPs. Overall, the collaborative contract streams told us that although these forms of contract are not widely used, they're not new. And they can provide a very good alternative to standard contracting models used for large complex programs. And in fact, they may actually be a better contracting model for complex programs.  We also had a leadership stream, which had three episodes. And in these free episodes, we had Jim Barnard coming in to talk to us about his dissertation, which was centered around practical major program leadership. Then I had my very first solo podcast where I talked about the cost of bad leadership in major programs. And then finally, we had Dr. Diana Nada, who came in talk to us about our PhD dissertation on the psychology of major programs.  The biggest takeaway from this leadership focus episode is that major programs are delivered by people and people are at the center of their success. So we can have a show or a podcast about major programs without talking about the people in the major programs.  And then finally, we had a stream about technology. We had my classmate, Kimberley Heraux, coming in and talking about intelligent technology, major programs. And then I did a collaboration with the digital twin fan club where Henry-Fenby Taylor and Neal Thompson, from the digital twin fan club came in and had a discussion with me about the challenges of adopting technology, major programs, and how can technology help major programs moving forward? I think the most important takeaway from the technology stream is actually a quote from Neil Thompson, where he says they think, "Oh, we're going to be able to predict the future are actually the value of these things isn't about being able to predict the future is about being able to adapt as quickly as possible to change circumstances".  As we come to an end, which is a one on navigating major programs, I want to take the time to reflect on how inspiring the last 15 episodes have been, for me, the opportunity to sit down and interact with individuals who have spent six months researching a specific major program topic, and engaging into a into a debate about their findings. And their conclusion has been very, very inspiring for me to a point where all of my initial concerns and fears of starting a podcast have now completely vanished. And I'm really, really looking forward about building upon the first season of navigating major programs, and bringing even more in depth topic in season two. My plan is to take them off for December and January off, I will be producing the new episode in January. And I'm hoping to be able to launch Season Two sometime in February 2024. In the meanwhile, you can still listen to the podcasts that are available where you get your podcasts. And I will also interact through my navigate imager programs LinkedIn page, which is now available in case you want to find other material related to the podcast.  So for now, thank you very much for joining me over the last several months. I hope you found these podcasts interesting. And I hope that you're going to join me again for season two. Until then, I wish you happy holidays and prosper New Year. We'll see you soon in 2024.  That's it for this episode on navigating major problems. I hope you found today's conversation as informative and thought provoking as I did. If you enjoyed this conversation, please consider subscribing and leaving a review. I would also like to personally invite you to continue the conversation by joining me on my personal LinkedIn at Riccardo Cosentino. Listening to the next episode, where we will continue to explore the latest trends and challenges in major program management. Our next in depth conversation promises to continue to dive into topics such as leadership risk management, and the impact of emerging technology in infrastructure. It's a conversation you're not going to want to miss. Thanks for listening to navigate the major programs and I look forward to keeping the conversation going. Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.DISCLAIMER: The opinions, beliefs, and viewpoints expressed by the hosts and guests on this podcast do not necessarily represent or reflect the official policy, opinions, beliefs, and viewpoints of Disenyo.co LLC and its employees.

We went down to Portland to visit some of our Avants friends and partners to the south! This week we finally got to chat with one of the smartest and nicest people we have interviewed to date, Chris Delano, President of IPD. Chris is as true of an enthusiast as it gets, who has always loved Volvos and upgrading them in every way. If you have a Volvo, you need to check out IPD! https://www.ipdusa.com/

In this episode, Riccardo Cosentino sits down with fellow Oxford alumni, Rachael Patel, to discuss integrated project delivery (IPD). With a background as a registered nurse, Rachael brings her unique expertise to her current role in the health sector specializing in strategic planning and execution of health services, research and infrastructure projects in North America. The pair discuss the impediments and challenges of adoption of the IPD model, specifically how it relates to private and public healthcare major infrastructure projects and the procurement process.“You add an integrated project delivery, where the idea is risk sharing and then you use that same methodology to calculate value for money, IPD will never win because IPDs base core base is sharing risk. It's two issues in our procurement, it's the idea of what value for money is and how we calculate money.”– Rachael Patel Key Takeaways: The origin of IPD and how its optimizing project design and construction Why value for money is problematic for IPDFinding a better way to allocate risk, relational over transactional  The policy associated in procurement and how it is hindering the marketplace shift to alternative models Links Mentioned: A critical perspective on Integrated Project Delivery (IPD) applied in a Norwegian public hospital projectBenefits and challenges to applying IPD: experiences from a Norwegian mega-project If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. The conversation doesn't stop here—connect and converse with our LinkedIn community: Navigating Major Programmes PodcastRiccardo CosentinoRachael Patel Transcript:Riccardo Cosentino  00:00If you're listening to Navigating Major Programmes, the podcast that aims to elevate the conversations happening in the infrastructure industry and inspire you to have a more efficient approach within it. I'm your host Riccardo Cosentino. I bring over 20 years of major programme management experience. Most recently, I graduated from Oxford Universities they business group, which shook my belief when it comes to navigating major problems. Now it's time to shake yours. Join me in each episode as a press the industry experts about the complexity of major program management, emerging digital trends and the critical leadership required to approach these multibillion dollar projects. Let's see where the conversation takes us.  Racheal Patel is an Associate Vice President and senior project manager at a global architecture and engineering firm. She's a registered nurse, and also the Master of Science in major program management from the University of Oxford, and a Master of nursing from the University of Toronto. Racheal is a skilled leader in the health sector specializing in strategic planning and execution of health services, research and infrastructure projects in Canada and the United States. Her expertise includes guiding organization for the initial strategic planning phase, through detailed planning and design to the implementation of transformative and innovative capital projects. Hello, everyone.  Welcome to another episode of navigating major programs. I'm here today with Richard Patel. I met Racheal at Oxford University when we were completing together our mastering major program management. And I asked Racheal today to join us on the podcast to discuss her dissertation, which is quite interesting and very relevant to the topics that we've been discussing on navigating major programs. How're you doing, Racheal? Racheal Patel  02:00I'm good Ricardo. And thanks for having me here. I'm excited to have a platform to talk about my dissertation and you providing that platform to talk about major programs. So thank you very much for having me.   Riccardo Cosentino  02:14It's my pleasure. So maybe since I've tucked up your dissertation a little bit, well, what was the topic of your dissertation?  Yeah, so my topic was actually looking at the challenges of adopting integrated project delivery in health infrastructure here specifically in Ontario. And I kind of was interested in this because here in Ontario, as you know, we've been in a transactional type of model for some time, and I wanted to see could we push the boundary and look at other project delivery models that would achieve the the goals of infrastructure for healthcare in a different manner? Interesting. And you talk about transactional contracting, and you talk about IPD, can you maybe explain for some of our listeners the difference or what was in the context of your, your research, what those terms mean? Racheal Patel  03:20So when we when I say transactional, it's more of a contractual obligation. So it's what we see today, like a p3, you know, alternative delivery model where you have a relationship based on some terms and conditions. Relational, it's a similar idea in that more, they're not similar, but it's a similar idea, in that it's a relationship based model where you're working together as a team, there's no one, you know, a buyer and a seller you are, I guess, in a way, a group or collaborative, all working towards the same goal and you have incentives and so forth, in a nutshell, that it's different. We in transactional, as you know, you have contractual requirements, you're obligated to meet certain things, whereas in relational, it's really about the relationships and the collaboration and the people and people organizations that come together to deliver. So it's, it's harder, sorry, relational is more softer compared to transactional in my non legal way of trying to explain. Riccardo Cosentino  04:41So another way of putting that is an is one that of an example that I use in the past is that transactional contracting or is more of a zero sum game where there is a party, a winning party in the losing party. We're in relational contracting. We're all on the same table, we all have one common goal, one common incentive. And all of the incentives are aligned providing a more collaborative environment.   Racheal Patel  05:11Yeah, yeah, that's probably more eloquent and articulate in the way I'm trying to explain it. That yeah, like, with relational, and specifically with IPD, you have everyone coming together with a common goal objective, and you're all measured on that same group of objectives or metrics metrics. And I would say transactional is a very much risk transfer moving risk to one party to hold that and your obligation to meet those risks, that transfer of that risk. But yes, I would say what you what you said is more eloquent than how I'm trying to explain it. Riccardo Cosentino  05:54No, yours is more is more detailed and more accurate by this very broad strokes. But maybe maybe for again, for our listeners, I know, in your research, you know, part of your literature review you you actually had a bit of a dive into IPD, which means integrated project delivery. And I actually cover some of that in my dissertation. So in a previous podcast, where I talked about IPD, Alliance and collaborative contracting, maybe just for those listeners that didn't listen to that podcast. Can you talk a little bit about the origin of IPD?  Yeah, no problem. So IPD, which is integrated project delivery is the definition. It's kind of vetted by the American Institute of Architects, or specifically the California Council that came up with this notion of IPD. Being that it's a project delivery model that integrates people, businesses, and legal structures into a process that drives collaboration, while it optimizes efficiencies in the design and the construction phases of a project. So what that really means is that your you know, you're kind of like a temporary project organization, or a temporary organization all set to one vision, a shared vision, purpose, and a goal. And you're all working together, in, in what we work in organizations to achieve that. And each part like, you know, you have a joint management decision making where you come together. It's not one party oversight on one, you have key party members within your organization that sit together make decisions, for the best project outcome, you agree on the targets and goals. So what what are we trying to like? What is our project mission values, but what are we trying to achieve with this, you bring everyone to the table. So it's early engagement of parties, like in our current models, or in some of the models, we're all used to, you know, you have owner, you know, their designers are the design team, and then they work together, then you bring in somebody else later in the game, whereas in this one, everyone's sitting at the table on day one, working together to achieve the vision. The other thing with integrated project delivery is that you're sharing the risks and rewards. So it's not self interest driven. It's more we work together, and we share the risk of the solutions we put together or the rewards of the solutions like we work together to do that. So it's a pain share gain kind of model, where if we all do it together, and we're successful, we profit in it together. If we made some bad judgments, we all suffer together in a nutshell. And then the other thing that's different than probably an alliance model, is that our life, reduce liability exposure. So there's no blame game, you know, you're waiving claim and liability between each other. I mean, I'm sure there are legal mechanisms that if it's willful, or negligent, like in that way, that it's purposeful, there's repercussions. But basically, what you're trying to do is create an environment that has trust or respect. And in order to do that, you don't have legal mechanisms that will point to someone and say, Well, you did this, now you're a blame because you all are all on the same page or sharing that reward or the risk or making the decisions.  Yeah, that's why I was That's why I was talking about a zero sum game, because I think what you described it, you know, I think the legal recourse creates a situation where there's going to be a winner and a loser in case things go wrong. I mean, at the end of the day, I mean, my my experience is that yeah, a contract. If a project goes well a contrast is on the shelves and nobody looks at it, but is when things start to go wrong, that you take out the contract. Look what the contract says and you pursue your legal remedies. I think what what you did ascribe to the IPD. And to a certain extent, even the Alliance model, or any relational contract allows for that. You know, if the project starts going badly, you don't reach for the contract to start appointing blame, but you actually have to sit at the table and come up with with a solution from the project team, rather than from the contract. Racheal Patel  10:25Yeah, like it's very much in this type of model. It's working together, you know, and in my experience, too, on the other types of contracts, if a project goes well, right, yeah, you're never gonna, you're never going to open it up and blame game. But I think, as the complexities of health infrastructure continues, and I'm talking health infrastructure, like continues to grow, I think we're more heading down the line. And I've seen it going down the line where that contract is open, and that blame game starts. Whereas an IP D, and what I like what I've seen in the industry, and those that have used it, you don't see those levels of escalation, or you don't hear about yourself as an escalation, because everyone that's in this delivery in this project are working together to achieve the same thing. So if, you know if blame is shared, everyone shares I mean, if blame is to be shared, everyone shares that blame. And so that that's the difference in this model, for sure.   Riccardo Cosentino  11:28Okay, so I think I think we've set the scene and we talked about IPD. So hopefully, people listening who are not familiar with a Marvel getting a sense. So like to take you back to your dissertation. And, you know, ask, I'd like to ask you, what were the key findings of your, of your, of your research. Racheal Patel  11:52So my, just to kind of give your listeners a little bit of context. So what I was trying to understand in this in this research is, what are the impediments or the challenges of adoption of this model? And so when I looked at, when I looked at, you know, how, how I would identify them, I interviewed individuals in Ontario, both in the public and the private end of health infrastructure, that are decision makers in the process and have been involved. And, you know, we looked at different categories. So is our market even ready to accept a model? Right? Like, are we are we in Ontario, even willing to say, hey, let's look at different project delivery models? You know, what's the impact of culture and environment? The legal ramifications, financial procurement, because we work through a different procurement body? And is there any impact of our regulatory authorities on how we go through it? And so I think, overarching, like one of the biggest findings, and the resounding is, the individuals that I interviewed, were all were like, We need a different model. So it was a resounding yes. The marketplace is saying we need to look at different ways to deliver these infrastructure projects. Because the complexities, the cost they're increasing. And the current models we have, while they deliver an amount saying that P3 are not good, but they do deliver. But for what we're delivering, it's not the best solution. And from a culture and environment, I think, you know, with integrated project delivery, it's about trust and collaboration. And our environment has a huge impact on trust, how we work together and so forth. So I think, I don't think are the culture we work in or in the environment. Everyone's like, it's going to be difficult to apply this model. And I think from a procurement perspective, one of the biggest, you know, ideas that came out was, you know, our procurement, the way we procure projects, that whole process, not necessarily, the broader procurement of the BPS has to change but we have to look at it in a different way to apply this type of model. I think those were some of the key big findings. Riccardo Cosentino  14:22Okay, so I think in your, your dissertation, you you talk about some of the challenges and some of the findings and I think procurement challenges is the one that I found quite interesting. And you talk about how the how the the process to secure funding for the developing new or new health infrastructure. creates challenges in adopting IPD. And also you look at the the value for money analysis used when procuring new infrastructure now that could be a barrier for the for the deployment of integrated project delivery. And so I'm very curious to draw upon your knowledge of what the MO Ministry of Health process is, and why is it detrimental? Racheal Patel  15:18So, I mean, it comes back to so the Ministry of Health process, if we look at, you know, how hospitals kind of work within our system, the hospitals are within, you know, the Ministry of Health. And it's not that they're regulated by the Ministry of Health, because each hospitals, independent corporations, they have their own board of directors, but they're tied to a lot of the operational funding the capital funding come through the Ministry of Health, so you have to work with them in order to get funding for whether it's a renovation or a new build. And so the capital, the health capital planning process, and I know they've changed it in in the last year, or they've added some different nomenclature of stages. But basically, it's separated into two different stages, in that you have your early planning, that talks about, you know, what is the infrastructure proposal how you're going to address it. And that then is requires approval to proceed further into the actual development of the health infrastructure structure project you want to actually implement. And so there's two different approval process within the government through the Treasury Board that your project has to go through. And then during that those approval processes, set dollar amount, whatever that is, whatever is established for that project, and that includes, you know, transaction fees. And so all the other fees that are held, that number is carried across the process. And that kind of is you're upset value or your total value of the project. But when you look at the process, the duration of this process is so long, and you know, healthcare projects can take 10, to, you know, 13 years to get through this process, where you actually go to a part where you go to RFP and start to bid and build, that there's such an evolution, the way we deliver healthcare, because it's rapidly changing with technology operations, and so forth, and different models of care, that what you first envisioned in your project, maybe you're one and where you ended up, when you're about to go to bed could change, but that number doesn't change. And so it's not agile enough to respond to the market. Riccardo Cosentino  17:36I guess another challenge is that when you know, because of the planning process, you develop a design and a solution. And you develop it to probably award 5% design completion. And so you lock in in certain certain things with your, with your master planning, you block schematic as you go through the approval process. And obviously, you wouldn't be able to have an IPD contractor on board, that early on to start that collaboration is that one of the findings, one of the challenges, Racheal Patel  18:11it is a challenge, but I think if you look at the way the US where IPDS is predominantly used for healthcare, you can have your business case written and your idea written, but then you know, when you get into blocks, or schematics, you engage that contractor into the process, right. And then together with the designer, the owner, the and the contractor in some of their sub trades, you start to build or design and plan for that future facility. So in the US, they do do that. Here in Ontario, we have a very process driven stream that contractors are not engaged and their value is not added until they get the bid documents. And so could the contractor come in earlier in the process? I believe it could. But that means you're procuring certain things earlier in order to have those conversations at the table. And they would have to be integrated into this. I don't see it being a barrier. I think it's a shift in mindset and how we approach it. And if this is the what we have to do with the ministry's process and Treasury board's approval for release of funding, then I think we have to look at, you know, when does a contract or when does the sub trades When did those key individuals get involved? Riccardo Cosentino  19:33Well, yeah, because what we have is a very linear process, you know, you have all these stages and you know, you can only is a Stage Gate approach. Well, I think without with IBD, you want a more fluid, more fluid approach that creates collaboration and interaction as early as possible because that's where that's where the value is created. And that's where optimization has appearance is it's at the early stages of the project. Racheal Patel  20:02Right. And it's also where the innovation happens, right? Like with the optimization, but it's innovation and maybe how we address mechanical I mean, you look at healthcare, mechanical, maybe 45, to, if not 50, but close to 50% of the value of our healthcare project is the engineering systems that run, not a name, excluding the equipment that you know, that it's put into the organization. But when you have such a heavy value of your costs sitting, like and you don't have those players that are going to build it at the table, it's a huge detriment, right. And we ended up having issues going down. And I think that's the benefit of this process of IPD. Everyone comes to the table early in design, so you can work out those solutions and the problems, say, you know, what's the best approach for, you know, air handling? What's the best approach for, you know, feature flexibility of data and so forth? I mean, I'm not an engineering to talk technical, but, you know, I've worked in situations where you have everyone at the table, and you can create something more efficient in its operation, but also in the price. Riccardo Cosentino  21:11Yes. Yeah. You know, enough to be dangerous. That's the mean. So, touched upon value for money. So let's, let's jump on to that. Because I think that's the other that, you know, and I worked for infrastructure, Ontario, and I know the value for money methodology. But, again, I think in your findings, you describe it beautifully. Why is problematic, so I won't steal your thunder. I leave, I leave you to explain why the VFM methodology is problematic. Racheal Patel  21:52Yeah, so So you, I get in trouble and not you. Alright. So I do believe that the value for money calculation that we use in Ontario is problematic, because the way we calculate value for money is that, and, again, I've listened and not at Infrastructure Ontario. So I can't say that with certainty. But my understanding of it is that when so let me take a step back when the idea of I think it's the idea of value for money first is problematic. When we think of value for money, we think of lowest price in Ontario. But when you look at what really value for money, it's the best, it's the best solution based on financial and non financial objectives. That's what value for money is value for money is not finding the cheapest bid. And I think, in Ontario, and I'm not just talking p3, but in Ontario, whether it's through supply chain procurement, so if we always look for this lowest price, because we believe that that is value for money, that itself is problematic for IPD. Because in IPD, its value for money is based on a number of other things, right? Value for money is on the team, it's on. It's not on a fixed price, it's how the team works together, right? Like, that's, you know, when you procure IPD, you're not procuring a fixed price, what you're procuring is the team that comes to the table that will work with you to develop the solution for what you're coming together for, you know, their qualifications, their experience, how they work together, their behaviors, that is what you're evaluating how you choose a team. It's not like, here's my lowest bid. And so I think that's one of the biggest challenges in Ontario is that we had this idea of low bid is the right solution. And then sorry, go   Riccardo Cosentino  21:52yeah, I was gonna I was gonna, you seem reluctant to come to the punch line. So I was gonna I was for you, in case you're too scared. Racheal Patel  24:00Scared, so but I just wanted to say, you know, like, so when you get to value for money calculation, and the way we do it is that it's about transferring the risk, right? So when you look at the value for money calculation, and how, you know, how one thing is, like one procurement model, p3 is better. It's because they're seeing the risk allocation, the transfers of the risk to the private sector is value for money for the public sector, because they're not burdened by that risk. And so that's kind of the premise. And I don't think that's correct, because you're measuring, you know, p3, the risk transference and against a traditional model where there isn't a risk transfer. So that's kind of the issue with the value for money calculation. Now you add an integrated project delivery, where the idea is risk sharing, and then you use that same methodology to calculate value for money IPD will never win because it's IPDs base core base is sharing risk. Because, you know, the definition is if you share a risk, you share solutions, right? Like you're working together to problem solve, as opposed to transferring that problem to somebody else doesn't get to the punch. Thank you. I'm not afraid to say it. But I just wanted to kind of, you know, I think it's two issues in our procurement, it's the idea of what value for money is and how we calculate money.   Riccardo Cosentino  25:26Okay, so I think I think that paints a pretty good picture of what what are the, in my mind, I mean, I'm your research talks about other challenges. And I think there's there's most the softer type challenges, which is, you know, resources, availability of resources, and culture and environment, which you talked at the beginning, but I'm a commercial person. So I always gravitate toward the heard liabilities and the heard numbers. So not that's not the sort of stuff but you know, the soft stuff is important. And yeah, I agree with you, I mean, value for money as to be and it to be to give credit to Infrastructure Ontario for for new projects. Now, on the civil side, they are starting to use more collaborative model, the studying to assess cognitive they do cognitive behavioral assessments for all the people that work on those project, because at the end of the day, there needs to be a culture of fit of everybody's at the table, because otherwise, you're not going to achieve the collaboration that you need. Racheal Patel  26:29100%. And, you know, I, I've spoken to people at Metrolinx, as well about the different ways they're trying to approach project delivery, civil projects are so complex, I would say probably even more so than a hospital delivery. You know, I think the hospital itself is a complex, but what Civil Works does, that's even more complex, but they're willing to try different models. And so if our partners here at Metrolinx, or other organizations are looking at different models, why can't we apply that? That's kind of also why I'm driving this idea. Like, let's look outside the box of what we've traditionally done here, Ontario. Riccardo Cosentino  27:06Yeah, I couldn't agree more. Okay. So jumping on, I wanted to maybe ask you more of a broader question, which, if you have actually had the chance to look at some case studies when you were doing your research, and if there's anything that that jumped out, you might you might have not actually looked at case study, because I know your literature literature review was a bit broader than that. But any, any anything that jumped out and key successes that jumped out,   Racheal Patel  27:34you know, IPD, in general, is permanently used in the US, but I think other countries are looking at it. So when I was doing this study, specifically, I was trying to find public hospitals or public systems that have applied integrated project delivery. The one organization I found was an I'm going to pronounce this wrong, because there is a lot over one of the letters, but it's in Norway, is the Songa project. And so the Norwegian government decided they've had enough with cost overruns, scheduled delays, adversarial relationships. And they actually implemented integrated project delivery in the redevelopment of hospitals, specifically one in this specific region and can't remember the name, but I can get you the reference or anybody that wants to know it after. And so they applied integrated project delivery, because they wanted more of a collaboration and a different approach to public infrastructure, it's probably the closest thing that you would see to a true definition of integrated project delivery, with the exception is that there is no multi party contract. So in integrated project delivery, all the individuals are under a multi party contracts, you all signed together. And so in this public project, that was the only key characteristics of a true IPD. That wasn't in there. But all of the risk sharing the reduced liability, not waiver of liability was there, you know, the the key concepts were there, with the exception of the multi party agreement. So that was probably the only one. There's still in the middle of the build stages. And if you do look it up. It's multi phase project. It's very complex redevelopment in this system. But they've just started issuing case studies or publishing case studies are starting to talk to the public or the global public about this specific example. And it's successful because they have delivered and they've achieved what they've wanted to they've had innovations through the process. But it's the first example of public system using integrated project delivery for health infrastructure. Riccardo Cosentino  29:43Interesting. Okay, I'll try. I'll try to get the details. We'll put in the shownotes. Search it up. Okay, so I guess, as maybe as a final question, probably quite a challenging question but are going to have Is there any way? What will be your recommendation to Ontario policymakers? entities like MOH, or Infrastructure Ontario? To what what would they have to do to embrace IPD for future projects? How can they navigate these challenges? Effectively?   does. I think, I think if I can paraphrase. I mean, there's a there's a need for a shift for a fundamental shift in the policy, because as you describe the fact that hospitals are risk averse, and they can't really absorb too much or cost overruns, or, you know, as lower risk. But that's a funding issue. Right? That's a policy issue there. I mean, at the end of the day, hospital are a creature of the Ministry of Health, right. So ultimately, the governance could allow could be put in place to allow a hospital to to have a different approach a different commercial approach. So it is it is within the gift of the policymaker and the politicians. Racheal Patel  33:45Yeah. And 100%. And I think, you know, when you're paraphrasing it better than I wrote it, I think, but I'm trying to put, you know, 60 pages into small answer. But if you look at you know, just even the allocation of how hospitals have funding for resources to do infrastructure. In the study, a lot of individuals brought up that thing that goes, there's not even enough money to do the current projects that we have with the lack of funding, you know, because they get a certain percentage of ancillary funding in order to pay their staff. But in this situation, when we do IPD, you're going to have a plethora of individuals and experts and stuff that have to sit in the hospital organization to do this. And a hospital isn't an infrastructure professional, right? They bring in the resources to do what they need to but they're they're there to deliver service and care to their community. And so they need to bring all these specialists in but if our if our ancillary costs are how until your cost is given and or funding is given to the hospitals to have the resources doesn't meet the need of these comp, this type of project delivery, you're never going to be able to add execute it. Right now, it supports more of the transactional. So yeah, to your point that also has to be done from a ministry level saying we need to look at how money is given the allocation of funding for these types. Riccardo Cosentino  35:15Okay, so I mean, if I gonna, I'm going to try to summarize I mean, I think my three takeaways is having the there needs to be a change in changing culture, and environment. In order to bring a different type of behaviors to the table, there needs to be a change in the way that risk is allocated, or better, we need to find a better way to share risk. We need to we will need to change some of the policies associated with procurement and project development. And if all this was to happen, then potentially we could have a rich IPD market in Ontario.  Yeah, I think you separated and I think maybe IPD, just in its and probably negate everything I just said about why I'm passionate about IPD. But I, I, I think this would be true for any relational type of contracting like Alliance, Alliance, as well as IPD. They have similarities as we talked about earlier. But what you've summarize are critical for our marketplace to allow for different models. And I think that's kind of the crux of the issue is that we have a marketplace that's set up for one specific type of delivery model. And if we need to look outside the box, we need to look at these issues. Okay, now, you said it better than me, well, Racheal Patel  36:44play off of you. Riccardo Cosentino  36:47Okay, I think I think that's all we have time for today. Thank you very much for joining me today. Racheal. This was a fascinating conversation about our own province, our own in our own country. So thank you for joining me and all the best for your future endeavors. Racheal Patel  37:02Thanks, Riccardo and thank you for the platform to talk about this right now. Riccardo Cosentino  37:08That's it for this episode on navigating major problems. I hope you found today's conversation as informative and thought provoking as I did. If you enjoyed this conversation, please consider subscribing and leaving a review. I would also like to personally invite you to continue the conversation by joining me on my personal LinkedIn at Riccardo Cosentino. Listening to the next episode, we will continue to explore the latest trends and challenges in major program management. Our next in depth conversation promises to continue to dive into topics such as leadership risk management, and the impact of emerging technology in infrastructure. It's a conversation you're not going to want to miss. Thanks for listening to Navigating Major Programmes and I look forward to keeping the conversation going  Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.DISCLAIMER: The opinions, beliefs, and viewpoints expressed by the hosts and guests on this podcast do not necessarily represent or reflect the official policy, opinions, beliefs, and viewpoints of Disenyo.co LLC and its employees.

We recorded a Quest 3 impressions segment, but audio from the background video played over our voices and made it unlistenable. In summary, the lenses are awesome with unmatched edge to edge clarity, the IPD setting is nearly unnecessary because of them, the horizontal FOV is pretty much the same as Index, there's a lot less glare/god rays than Index, Josh says it's like the Gear VR lens mod without the drawbacks, the built-in audio is good enough for Justin, it's comfortable with the BoboVR M3 Pro strap, the BoboVR B2 batteries are keeping it fully charged, Virtual Desktop wireless streaming is working very well, and Justin is going to stop using his Index in favor of the Quest 3. MR passthrough is cool, but it looks pretty low res and grainy, and there are distortions are warping, so it needs some work. Justin did a video on his channel demonstrating all of that. 0:00 Intro 2:41 The 7th Guest VR 19:57 Dungeons of Eternity 30:04 The Burst Demo 34:11 Widow's Walkabout DLC 37:38 Rooms of Realities 40:22 Does Justin want to F Alex & Josh? 45:20 IEYTD3 Co-op 50:58 Outer Wilds VR Mod 1:01:50 The Riese Project - Prologue 1:04:34 Gunheart 1:10:46 Crossfire Sierra Squad Update 1:11:43 Super Mario Wonder 1:15:56 Upcoming Games Lots of discussion about what we've been playing in VR. Justin's YouTube channel: https://www.youtube.com/mamefan Alex's YouTube channel: https://www.youtube.com/virtualinsider Nick's YouTube Channel: https://www.youtube.com/BuffaloPinball VR Gaming Podcast Discord link: https://discord.gg/Kbg44ADPD2 Justin's email: mamefanyt@gmail.com --- Support this podcast: https://podcasters.spotify.com/pod/show/vrgamingpodcast/support

“Projects get delivered by people and how we do things in our day to day life and how we make big decisions around our day to day life, whether it's small or big, are actually very relatable on how we make decisions in the business world when funding, approving and delivering projects.”– Dr. Diana Nada Dr. Diana brings over 20 years of experience advising public and private sector clients on strategies and toolkits for best practices in improved capital project delivery and informed decision making. She is a regular industry contributor, a published scholar educator with over 25 speaking engagements. She is the current AAC Canada Region One director, and is a member of the ULI Public Development and Infrastructure Council and the UK APM Project Assurance SIG. Diana is one of the contributing authors to the 2023 first edition for A Guide to Auditing Programmes and Projects, published by APM. She was shortlisted as one of the 2020 A Woman Infrastructure Network, emerging leaders in Canada. Key Takeaways: The importance of qualitative research in major projects, where social sciences intersect with major programmesBasing major project success on a rocky foundation, the deflation of estimates and unrealistic expectationsHow PMBOK (Project Management Body of Knowledge) and PMP (Project Management Professional) certification can evolve to encompass broader strategic considerations and better prepare major programme implementersCollaborative contracting and identifying collaboration (regardless of delivery method) as a key component for success in major programmesPerformance measurement and how not aligning incentives can influences decision-making and team relationships Links Mentioned: Dr. Diane Nada's Project Approval Decisions: Exploring Success FactorsCurbing Optimism Bias and Strategic Misrepresentation in Planning: Reference Class Forecasting in Practice by Bent FlyvbjergThinking Fast and Slow by Daniel Kahneman  If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. The conversation doesn't stop here—connect and converse with our community via LinkedIn: Navigating Major Programmes on LinkedInFollow Riccardo Cosentino on LinkedInFollow Dr. Diana Nada, PhD on LinkedIn Transcript:Riccardo Cosentino  00:05You're listening to navigate major problems, the podcast that aims to elevate the conversations happening in the infrastructure industry and inspire you to have a more efficient approach within it. I'm your host, Riccardo Cosentino brings over 20 years of major product management experience. Most recently, I graduated from Oxford University's day business school, which shook my belief when it comes to navigating major problems. Now it's time to shake yours. Join me in each episode, as I pressed the industry experts about the complexity of major program management, emerging digital trends and the critical leadership required to approach these multibillion dollar projects. Let's see where the conversation takes us. Dr. Diana nada is a project management expert and advisory mega capital projects, a civil engineer by background with a PhD in project management from the University of Calgary. She brings over 20 years of experience advising public and private sector clients on strategies and toolkits for best practices in improved capital project delivery and informed decision making. She is a regular industry contributor, a published scholar educator with over 25 speaking engagement. She is the current AAC Canada region one director, and is a member of the ULI public development and infrastructure Council and the UK APM project assurance SIG. Diana is one of the contributing over to the 2023 first edition for a guide to auditing problems and project published by APM. She will show listed as one of the 2020 A woman infrastructure network, emerging leaders in Canada. Hello, everyone. Welcome to our new episode on navigating major programs. today. I'm here with Diana nada PhD. Diana did a dissertation a few years ago. And I was very intrigued by her dissertation. And so I asked her to join us today in the on the podcast. How are you doing, Diana? Great. All right.Diana Nada  02:15Thank you, Riccardo for having me.Riccardo Cosentino  02:17Nice to have you. Yeah, I took a lot of joy in reading your dissertation. And it's was quite interesting for me because it was written a few years ago. And some of the topic is still extremely relevant. But you know, maybe you can tell us a little bit more about your dissertation, why you picked it, and what do you learn from it?Diana Nada  02:37Okay, so it's very interesting that we're having this conversation right now. Actually, I did defend the PhD, exactly 10 years ago, around October 1. So if it's been 10 years, and every time I check it, then you've made me go and look into it again. And and remember some of the reasons why I picked this or that. So it's very interesting to reflect after all of those years, maybe a bit about myself. I'm a civil engineer by background, but got very intrigued by project management early on, in my degree. Coming in, as a third culture kid with parents who are engineers, I decided to go into engineering, just probably not by choice, but expectation. My career has been very interesting that I grew up in Dubai. And by the time I graduated and finished my masters, it was very booming in Dubai early 2000s. And I ended up working in a lot of mega projects, a lot of big projects in with a lot of multinationals. In you see how projects get executed get funded. And for me, it was more of I've seen it from the side of delivery and working with a project management consultant. But then I worked also as a developer, and this gave me a bit of like, okay, I've worked on the same project on both sides of the table. And I could see things differently. So I wanted to step back and know more why, why projects go over budget, why there are scheduled delays. And I wanted to explore that and know more about it because project management is a very applied field. I felt that there is a lot in literature and research that actually doesn't get translated into the industry. And that's when I decided to move to Canada and did my PhD at the University of Calgary. Big thanks to my late supervisor, Professor Francis Hartman. I have to say when I started my degree, I presented a specific research interest And then the first day I met him, I said, I don't want to do that. And he was a great mentor. And I don't think I did my research, the outcome of it. And where I was few years later was what I anticipated. It was more of a journey, and a learning experience and a reflection of what I saw in Dubai, what I was seeing in Canada, it was the recession, the financial crisis has just started. By the time I graduated, there was the oil crisis in Calgary. So it's always an opportunity to just reflect on how things around you impact our projects get delivered. So what was your dissertation about? As a research topic, it was called Project Approval decisions exploring success factors, when I mentioned it, the first thing that most people think of is okay, this is about is this is very quantitative, it's about economic analysis, or value for money, etc. But I took a very different perspective, I took it from a qualitative aspect. It's a it's a qualitative research. At that point in time, I didn't know what is qualitative research. As an engineer, you're like thinking about numbers. So it was very intriguing, and I didn't think it applies. So what, as time went by, I learned that qualitative research is very interested in the project management field just because it's an interpretation of why we do specific things, how we solve complex problems. And and I think, in that sense of mega projects, or capital projects, you're dealing with a number of stakeholders, you're dealing with complexity, you're dealing with a timeframe that could be decades. Qualitative research gives you an opportunity to study this from a research base that is based on how people think I had to read a lot of psychology. I've learned a lot of terms like neuro economics, biases. And I remember when I was reading all of this, besides the academic research, part of like, what is qualitative research, I was very intrigued with the psychology and how our brain works. And I remember having conversations that I think it's very applicable to my day to day life, rather than to project management. And this was, for me a very eye opener, because projects get delivered by people, and how we do things in our day to day life and how we make big decisions around our day to day life, whether it's small or big, are actually very relatable on how we make decisions in the business world when funding approving delivering projects.Riccardo Cosentino  07:50Yeah, it's very interesting. Yeah, I, you know, I also learned, when I did my master's degree, in major program management that major programs are treated, the research in major program is treated as a social science. It's very, very interesting, as well as yourself. I'm a civil engineer. And to me, mega projects were always concrete and rebar and, you know, ashphalt and numbers and, and then, you know, when you actually look at the research, you learned that no, it's more about the people. It's more about the biases. I think your your I can't believe how still relevant to your researches in today's world. You know, optimism bias, strategic misrepresentation is still a very relevant topic when it comes to understanding why major programs get delayed and over budget. And it doesn't seem but however, even though that's a well established cause nowadays, it doesn't seem to be a way, especially in the public sector to tackle that issue. You know, I think you mentioned in your research, Bent Flyvbjerg, and you know, is, you know, he's done the most work in translating the Daniel Kahneman research Prospect Theory from the field, the Kahneman and Treviski did into major programs. So they're in you  talk about that. And, you know, I'm new to this academic field. And it's interesting to see that, even after 10 years is still relevant and still not being fully addressed.Diana Nada  09:30Yes, I totally agree with you, even when I was doing it, and I was you read stuff that are 20 years ago, and you're like, oh, this didn't move. We didn't move the needle much in 20 years. And after I was done my PhD and actually before it, I went to the AAC conference and presented it as a pilot to just see how people are gonna react and then presented it few times after that point. When you talk about social sciences, soft skills, trust biases, It was a very different conversation. And people were very skeptical on what that means to project management, to design to construction. And now 10 years later, I think the conversation has shifted, there's more talk about what you've mentioned, like optimism, bias, strategic misrepresentation, the research by Professor Bent. And I remember reading, Thinking Fast and Slow, and was like, wow, really, this is applicable in how amazing or how much we actually need to do this things differently. Because the success rates of projects is really bad. And we all talk about how we should deliver differently and how we should do things in a different way. And only maybe the last few years. I can say maybe for the first time, there is an acceptance of maybe doing but it's it, we're going to see how this movement or how that shift in mindset will will, will take place.Riccardo Cosentino  11:06Yeah, that that's, that's a very, very interesting point, and how, you know, the social science is actually at the core at the core of the success of major projects. And as an engineer, I always wondered, you know, because I know how projects are estimated, and I could not quite rationalize, if you're estimating a project, we're all very smart human beings, we can all determine we have all the statistical tools, we have all the past data, we have all the information, how can you how can we get this so wrong? How can we get the budget so wrong? I mean, we're smarter than that. And so it was refreshing when I learned, you know, the Bent theory about prospect theory about applying to mega project. And that to me was that, to me was the answer. It is like, okay, it's not about not being able to adapt the number to the right budget is just all these biases in these alternative ulterior motive, like strategic misrepresentation in the public sector. In order for in order for project to move forwards politician cannot afford to have the real budget, share publicly, because the sticker shock will stop the project for going forward. So there's always going to be a deflation of the project estimate, even at decision or the point of decision making, or the point of approval, because politicians and the public is not really prepared to accept the true cost of the project. And but then, then you end up in situation where there's there's a big confusion is five years, 10 years after the project was approved? Why is the budget not enough and you know, and then nobody looks backwards to why it was, you know, what happened at the decision making point, they all looked at? Oh, well, you know, the project was mismanaged. And sometimes that's the case in my experience, but it's not always the case. Sometimes you never had a chance to begin with, because if you're not given the proper resources to begin with, you're never going to be on time and on budget.Diana Nada  13:32Yeah, yeah. And I had the same, I'd say a epiphany I was looking as like, yes, we are. How do we get the budget that wrong? And how do we get the schedule as well, because we are building something like we're putting a schedule, that's unrealistic, and a budget, that's not going to be met. A and that was the point in time when I was very curious, is this the environment I am working in? Is this the industry like construction? Is this different teams? And the research was mostly around, okay. It's not related to the industry, the most of the industries that are plagued with the same issues, whether you're looking at infrastructure, healthcare, it oil and gas, any any you name it, and it's not by the location across the world. And that's why the interesting part you mentioned is this critical point and when you make the decision to invest or want or approve the project, and that's what and that was a point when I wasn't very appreciative. Our what could go wrong at this point. And the fact that we actually start on the wrong footing, like right from that point, you approve a budget and a schedule that no one believes If you ask anyone they would know that this number is I would, in an extreme sense, a, an educated guess, the schedule. And later on you are evaluating the success of this project, like you said, by the people by the management of the people, the teams. Other factors, what you're actually not looking back to see, did we approve, did we do this right? Was this business case, fully representative of of all factors that we need, but then later on, I appreciated that you actually cannot predict the future at that point in time. And I think embracing this risk and change is important. Because no matter how much you learn at that point in time, you are trying your best. And it's based on limited or less information that you will know as you actually design and have a project because there is no project at that point in time. It's all numbers. And and I think that's why the qualitative part is important. Because the quantitative part takes the attention as a doc as a business case, and everything. But that qualitative and how we actually go about that decision and deliver on font is what, what actually we need to pay more attention to. And I think even right now, this aspect of the how we approved the project in to get the funding and to get it approved. And to get that signature and to get it sanctioned. I think this is where we will struggle for a bit. Because even though I'm going to speak about the environment in Canada, we are now in a phase where we are considering other models, this number still, we have not went back to see this this number, the right number we start from or not the right schedule or not. And that's even without considering that you're making this approval or this schedule 20 years, and then by the time you're actually on the ground, it's 20 years later, by the time this number is approved by a specific politician. This number probably stays the same for 10 years without inflation and escalation. And then you don't visit it, because you can't at that point in time, and you just keep going. Yeah,Riccardo Cosentino  17:33I mean, they are according to Bent Flydjerg. I mean, part of the problem is, is that yes, I mean, it's correct that these numbers, once he's approved, it doesn't get changed. But I think the reality that the main, the main problem is that sometimes the number is is strategically deflated. Because if you actually calculate the right number and present the right number are gonna get is not going to get approved. And because in you know, there is, you know, there are, you know, Kahneman talks about it and Ben Flybjerg talks about it, you know, you can you can have an outside view. So you can you can do a benchmarking, you know, usually you can do bottom and bottom up estimate, which is not going to be perfect, because you don't know, as you said, you cannot. But, you know, by by also having a bottom up estimate a benchmarking estimate using an outside view, you could triangulate a better number. But so I don't think that predicting the future is the main issue, I think, is that the true cost of a project and the decision making, or the point that the shoe making point is just never something that politician can stomach. So there's always going to be a tendency to deflate it in order to get through.Diana Nada  18:55Yep. Yeah. And, and even the sense of like, you cannot predict the future, but you can get better at it. Yes. And that's why Professor Bent talks about reference class casting and how you can actually look at how you have been delivering projects and making it and, and working out backwards and see how you can make that estimate better. But we're not doing that. We can get better, but we're not thereRiccardo Cosentino  19:20Let me let me take you to another part of your dissertation that I found quite interesting. And hopefully, hopefully you still remember it. But you know, I think is in the original introduction in the literature review, you actually do a critical assessment of the PMBOK Yeah. And and the and the you know, the the PMP and I found a found that is quite interesting. I think I think your your findings were probably the PMBOK is not is not a deep enough tool to help keep project on time and on budget. Can you. Do you remember Can you elaborate?Diana Nada  19:55Yeah, I do. I do. Remember that. I tackle it all the time. So I first learned about the PMBOK. Actually, during my undergrad, there was a course that was on the PMBOK. For me, at that point, it was like, wow, there is a project management, body of knowledge out there. And I think it was maybe second, third addition. And then at that point in time, you're like, you have to get the PMP, you have to get the PMP. This is important. And the PMP, I think, is important because it gives you the basics, the jargon, and I'm talking, I'm now moving into a term that a lot of people would not appreciate. But I don't think so I finished my degree. When I when I, when I finished my literature review, it was 2012 2013. So at that point in time, the PMBOK did not yet touch the PMI, triangle strategy business, it was still very focused on project management. From a technical perspective, the edition in 2013, or 14 has, like, if you look at it 10 years later, there has been a big shift, the PMBOK has changed quite a bit. So my analysis at that point in time was very much based on this is not enough, you're only talking about 10 bodies of knowledge. You're not talking about external factors, you're not talking about the style, which socio political economic factors. You're not talking about the business case and the strategy. And you're also not talking about, you're talking about human resources, even from very, like HR, but not you're talking about that you can't find resources or supplies or challenges around that. So I found that very limiting at that point, and that's why I have that, that view, and I would go even an extra step and say that the PMP on its own, it's like talking about education versus experience versus studying for an exam, it's a mix of things, you can't say that just because someone has this experience, or this degree or this certificate that they know it all, it's a bunch of things. So that's why I addressed it from from this point. But I also then learn that that journey about the APM, the Association of project management in the UK, and and I found that the that there are aspects there and research based aspects that I think is worth. US including in North America, mind you, the jordanelle, the Project Management Journal of the PMI is, is huge. It most of the research is out of the PMI, I think is just how we can embrace some of this research in that the PMI hosts to into the PMBOK And in I think that's that's where the the issue is. Yeah, I have a similar, I have a similar so I used to have a PMP designation, I kinda lead a lapsed, and a you remember? So this was probably around even before 2013 Yeah, and I found it was very, very rigid, very rigid structure. And I agree with you now that I've been exposed to novel theories, like major programs that cause complex adaptive systems, right. And you know, treating major programs or temporary organization and designing designing major programs as organization. So applying, you know, the, what we typically apply to businesses to project a major project. I mean, we talk about major projects, because those are more complex. And so, you know, the same way you apply a porter five forces to, to a corporation, you should be able to also apply, you know, maybe not Porter, but a different framework that, you know, we apply to Galbraith star to a major program, and adopting the PMBOK goes into that level of organization design, and, you know, and as managing external stakeholders, and, you know, applying system thinking to major programs. So, yeah, I don't know if now PMBOK got there. But yeah, at the time, it wasn't there. And it probably is not there today, either. Yeah, there has been a shift and change in the last seven years. There are some aspects I still go and like I'm curious to see how much it has changed. But I don't think it has changed yet. But but the most important thing is that for me that when I did it, it was very, compared to maybe it Two years later, after I defended, there was a change in the PMBOK. But I don't I think there it is critical that the pm Bock embraces some of those factors given that it is the basis of, of how, like, it's basically okay. Do you know project management? Do you have a PMP? which is… I put the question mark.Riccardo Cosentino  25:29is more complex than that? Yeah, yeah. Okay. So, you know, I know, we talked about your, your dissertation and how you defend it, you know, in a few words, how would you how would you characterize the findings of your research?Diana Nada  25:46So I think the biggest finding that I kind of put out there is that the documentation or the approval for funding or the sanctioning that critical point is not documented well? And is is that that what we talked about at the beginning that we start on the wrong fitting, that I think wasn't what a major or a big finding out of it, there were the other ones where I studied how executives make decision making making and how project I called them project implementers, not project managers, basically, the delivery team. And even you can think of it of a context of an organization where there's executive slash staff. So there is the difference in how teams make decisions. And this difference is mostly around, their priorities are different. When you're making a decision, as an executive, you are thinking about specific priorities, and you're thinking about the company interests, you're thinking about profit, you're thinking about shareholder value, you're thinking about different aspects. And then when you're making a decision as a delivery team, you're actually thinking about cost, schedule, budget scope. And these are two different worlds, or two different realities. In a lot of my data collection was around making sense of how those two teams interact, and what are their priorities, and how they share information, or not share information, transparency, trust, communication, and all of these factors that come into play, once you actually start delivering the project. So the findings were around that how we make decisions as teams is very different. There are different priorities and acknowledging that this is a big factor that will continue. But I think, to bridge this gap, is to actually share why we're doing this project. Because we're, why we're doing the project from each team's perspective is very different. And the way I've termed it is like a project intent. Getting alignment on this, from the different stakeholders that are involved is key, so that we're working towards the same success. Outcomes are the same, the definitions of how we want to proceed. And then I take examples of how teams change make a decision around the change in scope, around priorities, etc. Part of this big research was also a big picture of at that point in time, collaborative contracting at that point in time, and that was the big research group. So each one of us had had a specific aspect, in like my contribution at that point in time was around those the teams are different. And how we can make sure that the teams work together from a success outcome, and other team members were taking it from procurement from risk, etc. So that was kind of how sharing information trust communication, and biases impacts how actually projects get delivered. And how do they actually make or break a project and cause delays or overruns.Riccardo Cosentino  29:14Very interesting. So this was 10 years ago. Yeah, already looking at collaborative contracting. We now talking about collaborative contracting in Canada. Yeah. On the largest scale, and we have authority started to exploring I don't want to say embrace because nobody's embrace collaborative contract. That definitely exploring but yeah, it's been it's been out there for a while. And yeah, I've I've had, you know, my dissertation was about that as well. Obviously, not a PhD dissertation, but, and I've had other colleagues coming on the podcast to talk about IPD alliances in different sectors. Yeah, it's, yeah, I mean, I'm I anecdotally I I believe collaboration is a significant player is a key component of success in delivering major programs. I always said that, you know, I think it was my anecdote that lawyers, you know, money that you spend on legal fees don't get to pour concrete faster. So if you are able to remove the litigation from the day to day running of the project, and you focus that those resources on actually moving the project forward, you have a better chance of achieving success and completion on time and on budget.Diana Nada  30:32Yes, yeah. And at the end of the day, a contract, whether it's an IPD, or an alliance, or a P3 or a design build is a contract, you will find issues with the contract. It is how you interpret the contract and how you work together, and collaborate. So even if you change the type of contract, and you're not doing all those things that you need to do from a success, like collaboration and how you share information, you're still gonna might get the same result.Riccardo Cosentino  31:06The contract is I defined a contract myself has, you know, that's, that's, that's the ultimate back stopper, right? Yeah. So ultimately, when when relation breakdown and or the working level contract, you go and look at a contract, right. And so I believe that you can have collaboration within even like, contract with, with litigation built into it. However, you have less room for maneuvering, right. So if you have not enough budget, because you never would never price the correctly or you never had to write rewrite budget at the decision making point. And then you have another adversarial contract, eventually, with all the best will in the world, is going to come to a clash at the working level, and you're going to go back to the contract, and then it is going to become litigious. So I think you can have collaboration, but without without a collaborative contract. But then you need to have the right resources available. Because if when there's scarcity of resources, you go back to the contract, and then you find a way of getting the money that you loosing.Diana Nada  32:25court. Correct? Correct. And that's probably why my my research was very, was not tied to a specific contract as well, because I believe that that collaboration is key, regardless of how you're delivering the project. Some of my recommendations were around, okay. How do you enhance this collaboration regardless of of the contract in, in any project in in, and I think this is applicable, like some of the stuff that I talk about is our rules of engagement, how you would do partnering meetings, that you're not talking about the project that design the cost and schedule, but you're talking about all of us as a team, how we're working together, what behaviors we need to change, what what decisions we need to make, because a lot of the time that you go into litigation or you go to that stage, when actually you have failed in, in having a proper communication or a decision or resolution of a of an issue. So how will you share that bad news and make a decision, because that a lot of the times, even not making a decision is a decision. So how you would have that environment where we are working in a in a in a transparent, relatively transparent environment where you could say this went wrong. Or you could share and, and most of the time, I remember that the best projects that we all remember are the teams and people we worked with. Not that the schedule was over budget, or the schedule was was delayed, or it was an overrun, but you remember your relationships that you've built in that project. And that's why building this relationship, and even how you form a team, you're not gonna start a team and trust each other from day one. If we take like marriage, you're not like or if you meet someone, this this is something you're investing in, and it's the same as a project. So so how you build that, so that you are all working towards the same success outcomes. I also talk about how you can bridge this gap between how teams, executives or project managers think Think or prioritize differently. And I say, well, we need to be in each other's shoes. So I call it correct courier swaps. Give the opportunity for project team members to understand why you are making decisions from a business perspective this way, share with them more information. And vice versa. The project team is not sharing the right budget, or the schedule with your design consultant, or the contractor. So, so try to find opportunities where you would actually learn from each other because your realities are different. And you're also governed like, performance measurement for each one is different. So you're actually going to make decisions differently. So if you are, if your performance is going to be measured by profit, that's different if your performance is going to be measured by meeting a project deadline, and I've seen it firsthand when, when I work then and I usually give this example. I worked on one project where I was part of the project management team. And there was sales there was strategy team. And this sales and marketing team were able to sell the apartments or the or, or the basically go on sale like and meet their priorities in terms of, okay, we sold X number of apartments, and they got their bonus. But the project team was putting a budget and schedule that was not favorable. So they didn't get a bonus. But we're all working on the same project. But we're measured differently. That was for me, an aha moment that if we are measured differently, then there are our outcomes will be different. And that's not even talking about job security, by individual biases, and all of that. So and that's why I talk about company interest, Project interest and individual interest and they are different.Riccardo Cosentino  37:13Yeah, I mean, that's why I mean, I mentioned earlier, the Gerber f star right, aligning processes, people remuneration, strategy, culture, like that's what you do in any organization. However, we don't seem to do it when it comes to project. And this is the perfect example. You know, you've got a sales team, who's focuses on selling the project management team is supposed to construct and build and it's one team, right. And then so you've now by not aligning the the incentives and aligning the compensation, you now created. Diverging interest. Yeah, it'sDiana Nada  37:51point two fingers.Riccardo Cosentino  37:53But it's interesting how there is so common knowledge and common practice in business, right, I've done an MBA. So I mean, that's, you know, you go to MBA, and you study all of this. And in yet, when it comes to project management or major program management, there's not the same level of understanding, but it's it's it's, it's there it's hobbyists, major projects is an organization.Diana Nada  38:18Yeah, I still find it very fascinating. It is, when I see projects, and how team members interact, and how a project or when looking at documents and all of that, it is a very fascinating field.Riccardo Cosentino  38:36So the No, this was a really, really interesting conversation, I think, I think we're coming to an end of the podcast. You know, I think you've, you've now defended your dissertation. 10 years ago, you seen some changes? I just, I've asked this question in the past to our guests, and I'm going to ask you as well was, Do you have any hope for the industry? Do you have any hope for the field of project management?Diana Nada  39:03I do. I do. And then in it's interesting, you asked the question. And I myself went through a learning curve. So the when I got asked, I actually got I got asked that question differently. It 10 years ago when I was like, oh, Diana, then you're saying there is no hope. And at that point in time, you're still fresh from your PhD, you don't you have not tested it again, like you did. You you worked. You did the research, and you want to go back to industry and actually test okay, because the research was mostly testing what you've seen. That's how I saw it. And I think there is there is hope. I think the conversations that we are all having in the interest in the sharing of knowledge across the different borders. Is there as simple as The research by an in, in us having that conversation when we first met about Professor bent and all of all of that, I think there, there's more talk about it. So I think there is hope. And I think there's some how, and appreciation that okay, we need to stand back and see what we're doing wrong. Because we're getting the same results. It's basically I was Einstein scoring six, yeah, Insanity is doing the same thing over and over again and expecting different results. And we've been doing things over and over again, expecting different results. So I think there is an appreciation that we need to do some something about it. We are trying to do things differently. And I think this is good in that sense. And I think for me, it's more of an appreciation that actually projects are not unique. You can learn from past projects, and you can come up with better schedules and better budgets, you can make decisions at the right time, you should also acknowledge that there will be changes on the project. We had the pandemic, no one expected it. It's a black swan event, things could go sideways. And I think the governance in how the teams work together is what's the hope that we could actually do projects differently and better. And if we study the projects that were successful, they did something that we should learn about.Riccardo Cosentino  41:34No, I could No, I could not agree more. I think you touching upon or very, very relevant topic. You mentioned uniqueness bias. I mean, bent, always says that your project is not unique. So uniqueness bias is a problem. A lesson learned from successful projects. I posted an article a few weeks ago about OPG here in Ontario, learning from from what went wrong in nuclear and changing for the refurbishment of Darlington and now their project is going very well. So yeah, I mean, there is hope. There is hope. It's not all doom and gloom, but I think yeah,Diana Nada  42:12and don't rush into execution. Yes.Riccardo Cosentino  42:15What does Ben say? Glance thing lands? Execute fast.Diana Nada  42:20Yeah, yeah. So plan, you have to plan. And then you have to execute, but don't rush into execution and break ground.Riccardo Cosentino  42:31Well, and on that note, thank you very much they and it was it was a pleasure to have you on the podcast. And I look forward to to meet you again. Some somewhere in Toronto. And maybe we'll have you back for season two to explore other topics.Diana Nada  42:47Thank you, thank you Riccardo for this opportunity and actually giving me the opportunity to reflect on on this in a way that I have not had the chance to actually go back and revisit and read. So thank you for for that and pleasure beings.Riccardo Cosentino  43:04Thank you. Bye now. That's it for this episode on navigating major problems. I hope you found today's conversation as informative and thought provoking as I did. If you enjoyed this conversation, please consider subscribing and leaving a review. I would also like to personally invite you to continue the conversation by joining me on my personal LinkedIn at Riccardo Cosentino. Listening to the next episode, where we will continue to explore the latest trends and challenges in major program management. Our next in depth conversation promises to continue to dive into topics such as leadership risk management, and the impact of emerging technology in infrastructure. It's a conversation you're not going to want to miss. Thanks for listening to navigate the major programs and I look forward to keeping the conversation going Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.DISCLAIMER: The opinions, beliefs, and viewpoints expressed by the hosts and guests on this podcast do not necessarily represent or reflect the official policy, opinions, beliefs, and viewpoints of Disenyo.co LLC and its employees.

Watch on Youtube.Howard Ashcraft is the most recognized and most honoured currently practicing lawyer in the Lean Design and Construction Community.  He has been thinking about and drafting collaborative contracts (most usually IPD) since 2005.  Join us for a thoughtful chat on where he started, where he's been and where he wants to go.

INDIGENOUS PEOPLE'S DAY, OHIO URANIUM & RISING LABOR POWER We begin GREEP #152 with the great LIBBE HALEVY, creator of the Nuclear Hotseat, who tells us about the triumphant debut of the award-winning documentary SAN ONOFRE SYNDROME.  This SOS masterpiece by MARY BETH BRANGAN & JIM HEDDLE of the Ecological Options Network join us later in the call to explain the great grassroots victory in shutting the two San Onofre reactors….followed by the horrific struggle to deal with their atomic waste. In honor of Indigenous People's Day, ANDREA MILLER shares some her amazing native brilliance rooted in her Cherokee background. Introduced by MYLA RESON, we hear from ANNA RONDON of the southwestern tribes who are fighting to protect our Earth from the horrors of uranium mining. TATANKA BRICCA reminds us of our Star Origins as well as our Indigenous roots amidst the struggle to call in powers of the Four Directions, and in hopes of freedom for the wrongly imprisoned LEONARD PELTIER.. From PAT MARIDA in central & southern Ohio we hear a brilliant dissection of the catastrophic Portsmouth/Piketon uranium enrichment/Bomb-making disaster in Shawnee/Miami land. Legendary KPFA Flashpoints host DENNIS BERNSTEIN brings us the news from Alcatraz, and mourns the horrifying slaughter now proceeding in the Middle East. From DAMACIO LOPEZ we hear about the 2024 Uranium Film Festival, which will criss-cross the nation with its powerful message aimed at free our Earth from the nuclear curse. AARON WAZLAVEK of the United Auto Workers rejoins us to describe the fantastic rise of the labor movement throughout the nation. And the great STEVE DANZIGER comes again to tell us again of the horrors rained down on the Amazon regions of Ecuador, along with his own struggles to regain his law license and win justice for both his Indigenous clients and his own family. Steve shows us IN THE COURTS OF THE CONQUERER by Walter R. EcoHawk, which he terms the most important law book he ever read. DOROTHY REIK, LYNN FEINERMAN, JUSTIN LEBLANC, BRIAN STEINBERG and WENDI LEDERMAN add in their always-valued perspectives to a truly memorable IPD gathering. https://grassrootsep.org

Bodi obveščen/a, ko novembra izide AIDEA knjiga: https://aidea.si/newsletter-knjiga ============================= V epizodi 119 je bil moj gost Tomislav Kuljiš, priznan hrvaški terapevt in ustanovitelj IPD centra. Kot avtor programa Integralne telesne psihoterapije, se Tomislav trenutno intenzivno posveča prenosu svojega znanja in veščin na bodoče psihoterapevte preko izobraževanj in mentorstva. V epizodi se dotakneva naslednjih tematik: Zakaj je, tako kot je Izvor težav in osebna rast Travme Razvoj otroka in vedenje staršev Prisebnost in meditacija Vrste terapij Delovanje terapevta Nevzdržno stanje in samomor Vpliv izkušenj na delo terapevta Sodobna družba Hipersenzitivnost Digitalna zasvojenost Vprašanje prejšnjega gosta

In this week's episode, Riccardo and guest co-host, Corail, sit down with fellow alumna, Carol Tansley to discuss her Oxford Saïd Business School dissertation on the institutional barriers to adopting integrated project delivery (IPD) on a nuclear mega project. Carol's impressive career, spanning two decades, is rooted in executing major programs for the UK Government Department for Work, HMRC, and DTI. As a recognized authority in large-scale IT and business transformations, her expertise took her to the Middle East, notably participating in the groundbreaking nuclear project in Abu Dhabi, marking the inauguration of the first nuclear power plant in the Arab world. Ninety-seven percent of nuclear major programmes go over time and over budget, so how did Carol (with no nuclear background) participate in delivering one two days early? This is a conversation you won't want to miss.“IPD may represent a methodology that would work has been proven to work in first of a kind environments. And while we have the field conditions now to embrace that, we need people that are willing to go out and embrace these new ways of working and seek to implement them.” Key Takeaways: The role Eternal Beginner Syndrome plays in complex nuclear programmes.The perceived barriers against adopting new models and how cultural and cognitive biases can masquerade as genuine obstacles.Carol's experience at Nuclear Week in the UK parliament and the future trends of the nuclear industry—energy security goals, securing affordable supplies and tackling climate change.Attracting the younger generation to the nuclear sector to support climate solutions and the expected 40 percent growth rate. If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. The conversation doesn't stop here—connect and converse with our community: Carol Tansley on LinkedInCorail Bourrelier Fabiani on LinkedInRiccardo Cosentino on LinkedIn Transcript:Riccardo Cosentino 00:05You're listening to navigate the major programes, the podcast that aims to elevate the conversations happening in the infrastructure industry and inspire you to have a more efficient approach within it. I'm your host, Riccardo Cosentino brings over 20 years of major product management experience. Most recently, I graduated from Oxford University's Day business school, which shook my belief when it comes to navigating major problems. Now it's time to shake yours. Join me in each episode, as I press the industry experts about the complexity of major program management, emerging digital trends and the critical leadership required to approach these multibillion-dollar projects. Let's see where the conversation takes us. Carol Tansley was appointed Vice President X energy UK new build projects in September 2022. In this role, she oversees all x-energy's activities towards establishing the XE 100 as the prominent I temperature gas reactor technology in the United Kingdom. Prior to joining IX energy, Carol served as the operational readiness Control Center Director for the early successful Emirates nuclear energy cooperation startup of the Barakah nuclear plant in the UAE. She was also the new Newa energy company director of strategic programs. Prior to this, she served as a senior director for PwC in the UK and UAE, as well as working at Accenture delivering some of the UK is largest public sector change programs. She recently graduated with distinction from the University of Oxford, with an MSc in major program management. Carol's research focuses on causes of poor performance on nuclear mega project, and potential benefits of adopting relational contracting models. Corail 02:05Hello, Carol Heller, Ricardo, I'm super happy to talk to you today. And thank you so much for the opportunity to interview Carol on your podcast, Ricardo, I think we all met in Oxford during the MMPMcourse. And it was wonderful to learn about Carol's experience about the nuclear industry, which is one of the most complex industries, you can find say, I think the listener will be so happy to hear about Carol's story and what you have to say are all about the future of this industry. First of all, I was wondering if you could tell us a little bit more about your background and how you fell into the nuclear sector. I know that there is a little value at the start of this episode to talk about your career, but it would be great to hear from your words how how you got into that very complex industry. Carol Tansley 03:05Okay, thank you very much corral. And thank you, Riccardo. I really appreciate the opportunity. One to both be back together again, because we haven't seen each other for a little while and to to talk on your podcast. So thank you very much. And just in terms of my background, my professional career has all been in delivering major projects and programs. The first I'll call it almost 20 years was in the UK, delivering major programs for the UK Government Department for Work in pensions HMRC. What was DTI. A lot of the large transformation programs that came with large scale it development programs and the business transformation that sat around that in around 2010. I moved to work on a project in the Middle East. It was for the Ministry of Interior in Abu Dhabi, a large transformation program that we're doing now it was a joint Middle East UK project and it covered the police Abu Dhabi police that covered Civil Defense prisons borders. And I was there for a couple of years. I then went to Saudi Arabia and worked for on a big transformation program for Ministry of Labor. And it was when I'd been there for a couple of years that I was asked to join the nuclear project that they were delivering in Abu Dhabi, you may be aware that they are they've delivered the first nuclear power plant in the Arab world. It was a new to nuclear country, what they've achieved there is quite phenomenal with the vision of the leaders of that country. So they pass their legislation to become a nuclear country and to get my program moving in 2009 They broke ground if you like so poured first concrete and 2012 and they got their first unit online by loading fuel for the first unit right before COVID Hit actually And two days ahead of schedule on the 17th of February 2020. And I was privileged to be part of that program, I was asked to join that program because of my background in major program delivery, not because I had anything to do with nuclear. So it was really, it was an amazing journey, great learning curve, an amazing sector to be part of, particularly now that it is going to play such an important role in the energy transition, the drive to net zero and energy security goals for countries around the world. Corail 05:33Absolutely is really impressive as well that you delivered two days early this project, which is so unusual in I think, in your research somewhere, you said that there is a study that said that over 97% of nuclear major projects are delayed, that cost overruns, etc, all across the globe. So it's quite unusual. Isn't that very unusual in that industry? How on earth did you make this happen? Like how did you manage to deliver early such a complex program? Carol Tansley 06:08Yeah, well, you're absolutely right about what you say its nuclear mega projects, I'll call them particularly nuclear new builds are recognized as being one of the most complex type of program to deliver. In fact, there are people who say Charles Perot, for example, in his textbook says that nuclear mega projects are the hardest to deliver harder and more complex than something like the International Space Station. And you're also right in what you said that one of the datasets I looked at 97% of the nuclear new build projects had gone over time and over budget. So in terms of what happened at Baraccah, it certainly wasn't me alone, it was a huge effort by a huge number of people working together over many years to achieve this. I think a lot of it came from the vision and the determination of the leaders in Abu Dhabi, they were determined to be at the forefront of clean energy. And they saw the drive for nuclear. As a critical part of that. I think we the fact that we chose a design that was in Nth of a kind if you like, so what that means is multiple units have been delivered before. So the South Koreans Catco, who delivered the units, it was proven reactor design had been delivered before, albeitin a different environment. So that created with a very experienced team. So that was a big foundation. There were many, I'll call it first of a kind variables, as we've already said, new to nuclear country, new elements of the supply chain. But the critical thing was having a really important integration function that sat across all of the teams, including the supply chain, that worked very closely with all of the internal and external stakeholders, including the regulator, that was a critically important part of what we did, and making sure that we had a schedule that was fully scoped, that we did our best to make sure it was realistic from the start, we kept assessing our past performance as we were moving forward to make sure that the schedule took account of that. And we tried to eliminate any optimism bias in our forward forecasting. It wasn't always a smooth journey. There were a few bumps in the road along the way, as you'd expect with something that complex over so many years. But I think, as I've said already the the drive and the passion of the leadership there. And you know, quite honestly, the the work ethic of all the teams that were involved, because everybody realized quite what was at stake here that just kept driving to deliver. Corail 08:49Yeah, that's, that's amazing. And so I read your paper recently that you published in nuclear industry, congratulations. Carol Tansley 08:57Okay. Thank you very much. Corail 09:00And in there, you talk a lot about this, first of a kind issue in the in the nuclear industry. Can you explain to us what are the complexities associated with this first of a kind? Program? Carol Tansley 09:17Yeah, I think so. Yes. Thank you for the question. So, on a nuclear new build program, you have so many elements of complexity uncertainty at the beginning. So you have the technology, the reactor itself, which is obviously highly technically complex, you've got all of the support systems that sit around that they delivered in highly complex institutional frameworks, I'll call them within, you know, in any particular country in any particular location, because of all of the safety levels that you have to achieve. And all of the environmental levels that you have to achieve to make sure that you're safe in that environment that you're not disturbing that environment and all So the regulation that sits around it, so lots of stakeholders that have to be engaged in that. So all of that every time you go and deliver one of these in a new environment, you have all of that complexity. And if you are using a new reactor design, in the middle of all of that, you've got all of the technical complexity as well. So first of a kind refers to any of those variables that have never been used on the delivery of a project, whether it's a nuclear project or any project in the past. And typically, because a lot of these reactors, the nuclear power plants that have been delivered over the last sort of two decades, we haven't actually done that many of them that and they take so long that it's very difficult to keep the learning on a project that's that big and takes so long. And then if the next one happens in a totally different environment, in a different country, it's very difficult to replicate what you've had in a different environment with a different supply chain with different stakeholders. So it almost means that you permanently into eternal beginner syndrome. And I think this is why, you know, in places like China, in South Korea, they've done a really good job because they have kept building their power plants. So they have very exercised andexperienced supply chains, they have stable reactor designs, they have a stable regulatory system. And all of that means that you've got a lot fewer first of a kind variables, and the fewer of those variables you have, the easier it is to deliver your project. Riccardo Cosentino 11:35So Carol, as Carell mentioned earlier, you you know, we met at Oxford, during the master image of program management, and a lot of your research was connected to the dissertation that you picked. And so my my I'm curious to know what why did you pick that topic? What what I mean, obviously, you were involved in the project, but why did you specifically wanted to research that topic? I mean, maybe introduced the topic, we don't actually have introduced the topic up to now. Carol Tansley 12:08Okay. All right. Thank you, Riccardo for the question. So my dissertation title was institutional barriers to adopting integrated project delivery on a nuclear mega project. And just to unpack that a little bit. So my experience coming as a non Nuke, shall we say, somebody with no nuclear background into the nuclear sector. One of my observations is that many people have been in that sector for many years, and very familiar with ways of working. And in some respects, not everybody, but in some respects, I find some reluctance in people to adopt new ways of thinking and different approaches to doing things. And that sort of from a theoretical point of view is looked through institutional theory. So looking at things from a regulative. So what are the rules around things, obviously, highly regulated environment in nuclear looks at the laws and the specific safety regulations. So that's one lens, looking at through normative lens. And that really is about your traditional practices, your typical work practices, the way you you do business on a daily basis, and the way people get used to it. And then the cultural cognitive piece, which is about how people perceive change, at what the mindset is generally how people look at things and think about adopting changes. So institutional theory, the institutional lens was regulative, normative and cultural cognitive. So I was interested in looking at if I brought a new idea, a new way that I thought might help to improve performance on nuclear mega projects. What would people think about that? And if they perceived barriers, which lens would they perceive it through? So that was part of it, coming back to the integrated project delivery. So this was a project delivery methodology and commercial approach that was founded, if you like, in the US in the civil construction sector, after decades of poor performance on large infrastructure projects, and what it has proven where it was adopted there, that it did improve performance. And it did this through driving inter party collaboration and using relational contracting approaches. So it wasn't the traditional contracting adversarial contracting approach. And they found that adopting integrated project delivery really did improve performance, particularly where it was a complex one off of a one of a kind project. However, I also found that that approach had never been used on a nuclear mega project. And I thought it would be really interesting to say, well, if it's improved, project performance on those kinds of projects, why I couldn't we use that in the nuclear sector. So I started to look at, you know, what, what are the facets of IPD integrated project delivery? And how do they map onto the problems that the root causes, if you like, of poor performance within nuclear mega projects, and I found there was quite a lot of symmetry there. So so what I mean by that is the root cause of poor performance, and the the items or the challenges, if you like that IPD was proven to improve. So I found a lot of overlap there. So the way I did my research was to take that case, if you like to a whole load of executives from the nuclear sector, explained to them about IPD. And get them to explain to me the challenges they'd had in delivering nuclear mega projects to sort of bring the whole concept to life, and then ask them what they foresawas potential barriers to its adoption. So a bit of a long winded answer, but that was the the underpinning of my dissertation research. Corail 16:03Yeah, thank you, Carol. I thought it was fantastic. The way you showed that exactly. The issues were potentially all resolved by the IPD. And I was wondering, now, you recently came back to the UK? Also now Modular Reactor today? Are you trying to implement IPD? In the way you're going to deliver this reactors? Carol Tansley 16:29Well, it's a great question. And the reason or one of the reasons I was asked to join extended GE, where I work now, and you're right, it's a Advanced Small Modular Reactor company, we design and develop the reactors, as well as the fuel that powers those reactors. It was actually through my dissertation research, because I contacted one of the executives who actually works the text energy. And I was trying to explain a little bit about the basis from a research to see if you'd be interested. And as I was explaining that, so he said to me, you're not talking about IP are you. And, and I was astonished because nobody else I've spoken to, I'd heard of it. And he said, Oh, he said, were trying to implement it here because and the background to it was one of their customers in North America had wanted to have an active role in the project, and asked X energy to go away and research commercial models that would enable them to do that in a collaborative way. And in going and doing that research, they'd come across IPD, and we're then implementing it with that client. And and it actually reached a point where they decided they were going to mandate it on their projects. So it was through the research and that contact that I actually ended up coming to extend ng so again, a bit of a long winded answer, but that that is what we're trying to do. Not on all of our projects, but on some of our projects within X energy. Corail 17:53That's amazing. And I'm sure your research, like looking at what would be the barriers to implementing IPD on these programs is really helpful in your work today. Are there any barriers? Actually? Are there any issues that you foresee? Or do you think it's it's simply a cultural shift to make? Carol Tansley 18:13I think it's a number of things? Um, my, I think most of them are actually fall in the cultural cognitive arm if you like, and I think but I think what happens is people express reasons that give you potential barriers that are not real, if you see what I mean. So I get I got feedback about, you know, I don't think the regulator would like it, or, you know, I don't think we'd be able to find insurance to underpin this model, or I'm not sure the procurement rules, you know, the public sector procurement rules would allow it. But when I sort of unpicked that I found out, you know, that a lot of it stemmed from the way of thinking that people had just got used to, you know, and again, just some some normative ones that came up about, again, people not they're so familiar with the the traditional contractual models that they'd rather use that even if they don't think it's going to work, or they know it doesn't work, then pick something new that they're not familiar with. Yeah. So I think it's, you know, kind of change management issue or cultural cognitive issue if you like. Corail 19:25Absolutely. I think it's also super interesting that you're working on Modular Reactor now because obviously next fall, we talk a lot about how modularity improves the performance of the complex programs. And you're right there with the with the nuclear and it's fascinating because it's, it's, we've always thought of nuclear does be the reactor that takes so many years to build, and you're trying to do it completely in a new way by creating something that can be almost like the solar panels atSome points, you know, you installed. Carol Tansley 20:01Yeah, absolutely. Corail 20:03Can you tell us a little bit more about this? And this this new technology? And how you, you, you came to get interested in that field as well? Carol Tansley 20:12Yeah. Yes. So thank you for the question. And you're absolutely right. And what I will say is the big Giga watt reactors absolutely have their place. And as I said at the beginning, they are successful, where they can be replicated and are delivered as a series. The issue is, particularly in the West, we haven't built many reactors over the past two decades. And if you think about what I was saying earlier about trying to drive out first of a kind variables and get to Nth of a kind. So that means once typically, once you get past four, or sorry, four or fifth of a kind, you've started to drive out those first time variables, and you get, you get the benefits of replication and learning by doing that if, and that's where the series effect becomes important for performance improvement, as you see in China, as you see in South Korea. But the thinking is that these small modular reactors, the kind of modular from two perspectives, they're modular in the fact that they're small. So in our example, our XC 100 reactor is an 80 megawatt reactor. And we can modularize those so that you could have a four pack, which is the ideal size of a power plant, that gives you 380 megawatts, or if it was a remote location, you might just have one, or if you wanted 12 of them together. So the idea is that you can increase capacity based on local needs. So the modular from that perspective, they're also modularized, from the perspective of the intention is that we build them so that they're built in units, that you will effect you making a factory and then you click them together, you assemble them on the site. So they're not the traditional, huge, what they call stick build, that you build a piece at a time from the ground up actually, on a on a site. So they are two benefits of it. But also, the critical benefit is because they're smaller, and simpler to construct, you get from the first of a kind to the ends of a kind a lot faster. And therefore you gain the efficiencies of the replication, the learning by doing, which means you build them faster, they're cheaper, and you can get them on the grid a lot faster. For both the power and it, like in ours, the high temperature heat and steam to decarbonize heavy industry. Corail 22:31Yes, that's amazing. And I think during with the issue with we've been through recently, with power supply, etc, we could see that the nuclear industry, I think, you know, sort of regaining funding, and people were more and more thinking that this was so important for the environment and what we're trying to achieve and reduce our carbon emission, etc. So you're definitely working on on an amazing program. You just you've just been at the Nuclear week in Parliament. So I imagine you, you, you werethere to talk about the trends in nuclear, did you see that this type of modular reactor are coming up in different ways, or is your industry still quite niche? With what? You know? Carol Tansley 23:28It's a great question. And I don't think it is considered niche anymore. I mean, you mentioned solar panels a little while ago. And obviously, one of the things that we've seen in terms of the benefits of renewables is the fact that they are easy to construct, you know, your solar panels, your wind farms. But that's where we're now getting to with nuclear. And I think there's a lot of recognition now that the scale of the challenge is so big, to help us with energy security goals, securing affordable supplies and tackling climate change, that there's a role for everybody, you know, that we've got, we need the wind, we, you know, renewables we have to have, but we need nuclear as well, to give us that reliable 24 hour a day baseload and that also can keep the grid stable alongside the renewables. And certainly from nuclear week in Parliament. You may be aware that we've now got our first minister for nuclear in the UK. He was appointed back in February, very energetic, Andrew Bowery and is very passionate about the sector very committed. And we've seen a huge increase in I would call it confidence and optimism in the in the sector this year. A lot of excitement at nuclear week this week, a lot of Parliamentarians so members of parliament and members of the House of Lords fully engaged in understanding what's happening, but an awful lot of vendor technologies there such as x energy ourselves alongside other large scale people are developing micro reactors people are developing small modular reactors as well as our advanced Modular Reactors. So I think there's recognition that we can't achieve Net Zero without nuclear. And it's got to be part of the mix. And I think we're, you know, we're starting to get the message out there. And we're starting to get a lot of traction in the UK with delivering more projects. And I think there's gonna be some announcements in the next sort of six to 12 months around that in the UK. Riccardo Cosentino 25:25Yeah, that's interesting. And just to give the North American perspective, like, you know, we are in Canada, Ontario, where I'm from, we also seeing a resurgence of nuclear, in parliament in Canada is now not a swear words, it used to be something you couldn't say out loud when you were in, in Parliament. And it's, you know, in the last 12 to 18 months, we see that the pendulum has swung the other way. Yeah. Now, it's all about nuclear. And it's, how fast can we do it? And, you know, something that was even pause, as you said, there's been decades since we built up a brand new reactor in the West. And now we're talking about new new reactors. Yeah. Beyond small modular, but even just standard nuclear reactors is something that has been contemplated, which is, which is refreshing? Carol Tansley 26:23And, yeah, yeah, I think it's good that you mentioned Canada, that because you've got a another tradition of building the CANDU reactors, I think you've built 22. All together, I mean, it's got one of the cheapest electricity prices in the world because of the amount of nuclear power that you've got in Canada. And I know that one of the things that's supporting this is regulatory harmonization between countries to try to make sure that we can bring nuclear effectively and efficiently to the market. And in terms of new builds, we've we've got four of our reactors, working with Dao, at their Seadrift site in Texas, that we're underway with constructing now. And so people are genuinely interested and, and heavy industry as well coming because they recognize that they've gotten the very hard to abate sector challenges that need nuclear to help them, you know, and these advanced technologies will also helpus with hydrogen production, and with also production of clean fuels for aviation and maritime, if you look at where all of the greenhouse gases are coming from 20% is coming from electricity, but 25% comes from transportation, and 55% comes from heating, and processes, industrial processes. So I think this combination of nuclear, with the renewables is exactly where we need to go. And I think Canada is one of the countries that's at the forefront of this alongside US, UK, France, UAE and the the Asian countries. Riccardo Cosentino 28:02Yeah. And it's, it's interesting that, you know, because obviously, if you fully understand power, you know, nuclear provides the base load. And I think what we're seeing with the renewable is that it's great. However, the renewable puts a lot of strain on the network, and the distribution network. And so, you know, I think I was researching a couple of weeks ago, about how long does it take to get a connection into renewable touring into a renewable cluster of generation. And it takes years. And, in fact, I was actually, I saw last week that there was a the auction for the contract for difference. Were in the UK. There were no bidders for, which is now correct. Yeah. So it's because it's really I'm assuming, and among might be wrong, but I'm assuming is just difficult to get the connect the connector into into the grid? Carol Tansley 29:03Yeah. And I think you Yeah, yes, that is correct. And you raise a great point, because we all need the grids upgrading as well. Because the volume of electricity we're going to need, it's not as though that staying stable was a doubling of that over the next couple of decades. And we have to be able to meet that demand. And certainly, you know, we believe that nuclear is the way to achieving that to get the base load, the stable base load that we're all going to need. And it's not just about Western societies, you know, we have to remember that democratizing energy is really important for quality of life. You know, power and energy are really important for remote communities, for countries that, you know, not maybe as privileged as ours at the moment in having readily accessible electricity and we have to help those countries as well. So that that's something we're also looking at, you know, in places like Africa that we have to allow those communities to come up and enjoy the standard of living that we all enjoy through, you know, cheaper electricity. Riccardo Cosentino 30:03It's interesting. You mentioned that because you know, you think of you don't you don't think of Canada as a place where democratization of energy is a big issue, but it's actually a very big issue in Canada, because we have remote communities in the North. The majority of these remote communities are on diesel generators. Corail 30:22Yes, no, that's absolutely right. And I think, yeah, and going back to what Corail asked a few minutes ago, I think this is another reason why these small modular reactors are so so attractive, because they can be put in those remote locations and help those communities. So they don't have to have these diesel generators anymore. Yeah, absolutely. I think in France, in my home country, we've been being a nuclear force. That unfortunately, we work very hard on developing what you said, dispatch, first of a kind, very large reactor, and then I feel for a while, we didn't really maintain or build a new one. And I feel like the capability has been lost in the in the process, you know, and I'm quite worried about thefuture of nuclear in France, and they feel like the smaller reactor as would be so amazing, because then you can build back also the capability much more quickly. Also, you don't lose it, because every time you're building very fast, and yeah, I'd love to see our government invest a lot more into that type of type of reactor, although I completely understand that all of them are very, you know, can support the future of power in our countries. Carol Tansley 31:42Yeah, so and I know France is well underway with having its own small modular reactors as well. But the point you make is really good one about the supply chain. And I mean, that in terms of the people that provide the the capability to build these nuclear reactors on all levels, and one of the things that's happened across the West, because we haven't built that many, or in some cases any, that supply chain has gradually dwindled. And now we're having to stand it back up quickly. So countries are trying to work together to invest to do that. We've got now the nuclear skills task force in the UK, we've got joint agreements between the UK and France, to leverage experience and to build that supply chain and across different countries, because I think we recognize that it's a multinational challenge, and we've got to work at it collaboratively. Corail 32:30Yeah. On the on the personal note, would you recommend people to join this industry, like, exciting for, you know, we should encourage the younger generation T's to join in? Carol Tansley 32:44Yeah, absolutely. I mean, I think, you know, I heard something the other day that said, if the younger generation now was in charge of nuclear, it would be everywhere. They're not the people blocking this, a lot of young people recognize the challenge that we're facing from a climate emergency point of view, and are really behind nuclear. They're some of the most passionate advocates. But I think nuclear is a fantastic sector to get into. And it's not, of course, there are engineers here. But it's not all about engineering and physics. And one of the things that we're launching, I think a bit later this year, early next year, is a campaign to attract more people into the sector. Because yes, attracting young people in to develop the pipeline for the future is really important. But that doesn't solve the situation we're in now. I heard a statistic the other day that said, we've got 91,000 People in the nuclear sector in the UK, and I believe that's across civil and defense, and that needs to grow by 40%. Over the next few years, well, you can't achieve that just with the young people coming in. As important as that are, we need to attract people in from other sectors across all disciplines. So that's what we're really working to try and encourage and I will just put a plug in, it's a fantastic sector to work in. I've had a brilliant time here. And I'm just encourage anybody to join. Riccardo Cosentino 34:02Second, a second day, we you know, even in Canada, it's there was a resurgence. And I think we're a bit more lucky in Canada, especially in Ontario, where, because we've been refurbishing reactors, we can look at the supply chain, and be more engaged. So we're not starting from scratch. But you know, going from a refurbishment to a new build of either traditional nuclear or more modular is going to require an injection of workforce in the in the supply chain. But as we teased the listener with your with your research, and with the dissertation, the paper that you published, and I think you covered most of the conclusion, but maybe just to reiterate, what were you find when we will what were your findings inthe from the research that you conducted in terms of implementing IPD nuclear, any any insight that you can offer? Yeah, so my overall conclusions were that Carol Tansley 35:00You know, the the root causes of poor performance traditionally, or nuclear mega projects are very complex, you know, is technical is technological, its environmental, its organizational, its institutional. But one of the things I found was that first of a kind, projects have got the worst performance. And that might sound like a statement of the blindingly obvious. But what I found, the real conclusion I drew was it wasn't the first of a kind variables per se, it was the fact that we were choosing Commercial, contractual and project delivery models that were not resilient in a first of a kind environment. So they didn't cope well, where there was a lot of emergence and uncertainty. And that was where when I looked at IPD, integrated project delivery, I found that it did perform better in environments where there was uncertainty and emergent change. And hence, as Corail mentioned earlier, that mapping between the challenges and the root causes of poor performance on nucleon mega projects, and the challenges if you like, the benefits that IPD can bring, in terms of what I found about resistance to IPD. In the sector. I found that while people raised barriers, there was one example, the one I gave earlier with the company, I now work for, where they'd gone off and, and found that the client had actually come to them, none of those barriers emerged in practice. There were sort of theoretical barriers, not realistic barriers or barriers in reality, but of course, that was only one data point. So while I think IPD can, you know, may help to improve performance on nuclear mega projects, it still needs to be proven. And I think the final piece about the institutional barriers, one of the things I discovered was that even if the field level conditions, I'll call it change, to enable new ideas to be embraced. And I'll give an example of that in the nuclear sector. Now, the climate change emergency would be considered a change in field level conditions, because everybody's interested in nuclear again. And that might be sufficient of a driver to get people to consider new approaches. And that in itself is not sufficient. What you need is what the academics was called institutional entrepreneurs. So that means people that are willing to go out and find new ways of working to solve traditional problems in new ways and actually implement those changes. So they were the conclusions it was, first of a kind, but because we choose project delivering contractual models that don't work in first of a kind environments, IPD may represent a methodology that would work has been proven to work in first of a kind environments. And while we have the field conditions now to embrace that, we need people that are willing to go out and embrace these new ways of working and seek to implement them. Corail 38:05Thank you so much, Carol, that was so fascinating. So interesting. And thank you for keeping us at the top of the trends in your sector. That's a really amazing, Carol Tansley 38:15no, it's a pleasure talking to you and and getting your perspectives as well. Riccardo Cosentino 38:20Yeah, thank you very much, Carol, this this has been fascinating. I mean, I read, I read both your dissertation, the paper that you published, and I still learn something today from you. So I'm really lightening conversation and, you know, there's going to be other opportunities. I hope to have you on the po Carol Tansley 38:44Fantastic. Well, thank you, as I say for the opportunity. It's a pleasure seeing you both again, and to have the opportunity to talk on your podcast. Riccardo Cosentino 38:52That's it for this episode on navigating major problems. I hope you found today's conversation as informative and thought provoking as I did. If you enjoyed this conversation, please consider subscribing and leaving a review. I would also like to personally invite you to continue the conversation by joining me on my personal LinkedIn at Riccardo Cosentino. Listening to the next episode, we will continue to explore the latest trends and challenges in major program management. Our next in depth conversation promises to continue to dive into topics such as leadership risk management, and the impact of emerging technology in infrastructure. It's a conversation you're not going to want to miss. Thanks for listening to navigate the major programs and I look forward to keeping the conversation going Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.DISCLAIMER: The opinions, beliefs, and viewpoints expressed by the hosts and guests on this podcast do not necessarily represent or reflect the official policy, opinions, beliefs, and viewpoints of Disenyo.co LLC and its employees.

In this week's episode, Riccardo switches chairs and guest host, Jim Barnard, asks all the questions. Riccardo shares insights from his Oxford Saïd Business School dissertation on the use of collaborative contracting into major programmes, specifically PPP structures. Riccardo and Jim delve into the complications and complexities of risk management, adversarial situations, stakeholders and shareholders and private financing.   “When you have collaborative contracting, you almost waive your legal rights or your rights to pursue legal remedies. And so, all of the parties are around the table. There are many advantages of collaborative contracting, but the simplest one is, instead of hiring lawyers to sort out disputes, you're redeploying those resources to actually solving project problems.” Key Takeaways:  The price of winning contracts in the PPP market and how the public sector entity comes into playWhy collaborative contracting provides better odds for finishing on time and on budget, but equity has to take more riskPPP and politics, how do we navigate it?  If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. The conversation doesn't stop here—connect and converse with our community: Riccardo Cosentino on LinkedInJim Bernard on LinkedIn Transcript:Riccardo Cosentino 00:05You're listening to navigate the major problems, the podcast that aims to elevate the conversationshappening in the infrastructure industry and inspire you to have a more efficient approach within it. I'myour host, Riccardo Cosentino brings over 20 years of major product management experience. Mostrecently, I graduated from Oxford University Said business school, which shook my belief when itcomes to navigating major problems. Now, it's time to shake yours. Join me in each episode, as I pressthe industry experts about the complexity of major program management, emerging digital trends andthe critical leadership required to approach these multibillion-dollar projects. Let's see what theconversation takes us. Hello, and welcome to a new episode of navigating major programs. Todaywe're going to be doing things a little bit differently. My friend, and one point guest of the show asagreed kindly to be hosting this podcast. And we'll do a role reversal where I'm going to be doing thepresenting and Jim Barnard is going to co-host the show. And today we're going to talk about a topicthat is very close to my heart, which is the use of collaborative contracting into major programs,especially into PPP structures. I've done a full dissertation at Oxford as part of my master, majorprogram management, and I decided that it'd be good to walk you through my findings and myconclusion. Anyway, let me introduce the host for today. Jim Bernard. How you doing? Jim?Jim 02:00I'm great. Riccardo, thanks for having me. Big fan of the podcast, obviously had the chance to be on apreviously so very much appreciate the opportunity to be host this time.Riccardo Cosentino 02:11So today, as I said, I'll be a be doing the talking. And you'll be doing the asking. Maybe I can start? I'lljump right into it unless you have a specific question for me. And maybe I can give a bit of a bit of anoverview of my research thesis and some of my findings and some of my conclusions.Jim 02:34 2Transcribed by https://otter.aiYes, summary will be great, a perfect place to start. But some of our folks listening may not becompletely familiar with even the concept of collaboration. And I know having read your dissertationthat you get into some fairly technical and detailed topics relative to finance and how structures are setup and that type of thing. So for those of us either less familiar or kind of new to the topic, if you don'tmind, let's start as basic as possible.Riccardo Cosentino 03:03Okay, well, let's start with, let's start with what prompted me to research this specific topic, the probablya good place to start here. I you know, I'm a professional the work in public private partnership over thelast 20 years. So again, a lot of knowledge about the topic, I have structured and finance manytransactions that use non recourse financing. And a couple of years ago, my company decided to exitthe what we call the lump sum turnkey business, which is the type of contracting where a private sectorentity commits to deliver a project on time and on budget and every any cost overruns. And at any cost,and any time overruns are absorbed by the entity that has committed to deliver the project. So mycompany has been losing a lot of money with the stock form a contract. So in 2018, we decided toexited. However, this type of contract is the cornerstone of non recourse financing, recourse financingis financing that doesn't, doesn't lean on the asset of the parent company, but the only leans on theasset of the other special purpose vehicle that is delivering the project,Jim 04:26basically. Project.Riccardo Cosentino 04:29Yes. Right. So it's basically the future revenues, that that's the only recourse available to lenders debtand equity lenders is access to, to project revenues rather than corporate revenue associated with theentity that is delivered project.Jim 04:49Right.Riccardo Cosentino 04:50And because my company exited this business lumpsum turnkey, indirectly we also exited theconstruction portion of public private partnerships were where entities or companies, contractors arehired to deliver the project under the structure. However, we still wanted to stay involved in contracting.So what we started researching is different types of contracts and collaborative contracting, came upalliances IPD all forms of contract that they include a large component of collaboration. In this type ofcontracts, the risk is not transferred to the product to the contracting entity is the risk of on timecompletion and on budget completion stays within the project sponsor. There is a Pain Gain sharingmechanism, where the contracting entity, the contractor that is delivering the project puts their fee risk,but they're not taking on the cost of around burden that is typical of lump sum turnkey. So once westarted researching this, the question that I was asked many, many times, being the expert in publicprivate partnership is can we convince clients and lenders to use collaborative contracting within thenon recourse PPP structure? And intuitively, I didn't think it was possible, I did some preliminary 3Transcribed by https://otter.airesearch as part of my job. But I couldn't really find conclusive answers of why collaborativelycontracting could or could not be used within a PPP structure,Jim 06:45where I take a step back down, how did you do your preliminary research was at a qualitative research,quantitative research and kind of benefits of both detriments of both How did you choose what methoddid you use and how did you choose it.Riccardo Cosentino 06:58So during what while I was still working, so before I use an academic method, I, I just looked at thecommercial parameters, I just look at the commercial framework and in the legal framework, and I justtried to see if the economic principle of the commercial principle would support these type ofcommercial and legal structure, right. And based on my understanding of the commercial principle, nonrecourse financing, where risk has to be transferred, and where lenders that especially debt lenders,needs to be kept whole in the PPP structure, the only entity that can keep the lenders or is thecontractor delivering the work? I mean, no, it's not the only way. But it's the most economical way. Andthe cheapest way of implementing a project finance structure is to have the contractor guaranteeing thedelivery of the project by putting up the balance sheet and by taking on the cost of Iran in a lump sumturnkey model,Jim 08:07but the fee, the fees at that point are fixed, right. So you're really talking all downside, fixed upside inthat structure. I mean, it sounds not just unpalatable, but somewhat dangerous for the contractor to getinto that arrangement.Riccardo Cosentino 08:23It is and they think he has worked in the past to a certain degree where Contractor have been able tomanage that risk the took on. But I think over the last 15 years, the market got so competitive, thatcontractors have been racing to the bottom sometimes fixing the cost of the project to a level too low toactual deliver and then end up absorbing all of the losses at the back end or the contraction period. Imean, that's definitely what happened to our company we overcommitted in order to win the contract,and then we ended up with a lot of the losses. However, there are instances where the model works.It's just you know, I think you the model can work if you have a healthy competitive process, if you havean unhealthy race to the bottom is probably dangerous, dangerous territoryJim 09:23that can open up even getting into different ways of gaming. Bidding processes itself is a massive topic,I'm sure that gets into behavioral economics and how people bid and upsides and downsides andpsychology and all this other stuff. So we probably want to table that for a future episode because wecould spend hours just on that aspect of it. I'm sure. So, but I guess the conclusion is at some point inthe market, the bids got so tight in the market, the fees got compressed, so low that the people who arewinning the bids were just really behind the eight ball at the beginning. I mean, it was it was almost Iwant to say it was, you know, failure was baked into the to the process. But it sounds like you're in areally tight spot straight out of the gate. 4Transcribed by https://otter.aiRiccardo Cosentino 10:13That's correct. And it's not unlikely It's not unlike the, you know, bid low claim high model that westudied in, at Oxford, right, I think there was a case about how the it's, we live in an industry wherethere's a lot of, you know, contractors make their money through the claims. And then and I think that'swhere the PPP market got to where, you know, companies bid low in order to secure the contract, andthen then trying to deal with the consequences afterwards,Jim 10:46by claim process, you're talking going to court litigation,Riccardo Cosentino 10:50eventually. Yeah, that's where he ends up. I mean, you can try and settle. I mean, there are settlementalong the way that you can do there are but you know, ultimately, yeah, you go to court, and, you know,20 to 30 cents on the dollars if you're lucky when you play.Jim 11:05So that whole system sounded like from the day that they decided to race to the bottom of the wholesystem seems like it's building upon a weak foundation to start. And it's crumbling from there. I mean, ifyou're going to court to deal with inevitable complexity of a major program seems like somethingstarted wrong. I mean, it's not in it's not within the project itself, which obviously has its own complexityfrom a cost standpoint, engineering standpoint, and construction execution stakeholders, and then wehave this whole network of influencers within any major program. But this is like on top of that, this is awhole kind of external integration challenge. That, before you even get to the complexity of the project,you're kind of off off center to begin with that fair.Riccardo Cosentino 11:58That's, that's very fair. And, and but that's probably not something caused by the PPP structure or thenon recourse financing structure is more caused by, you know, public sector entity, especially beingsubjected to optimism bias and strategic misrepresentation in order to get these projects off the ground.And I think we PPP that problem is accentuated by the fact that there's a bit of heuristics, which is theprivate sector can do it better. So we don't have to develop the project to you know, 50% 60% design,in order to get to get bids in, we're gonna put out a 5% design, the private sector will take a developergive us a fixed price. And, and we'll go from there, which breeds a situation where you have contractorcommitting to a fixed price contract with only 15 20% design done. Because that's the nature of PPPwhere, you know, the government or the public sector doesn't want to develop the project, becausethey don't want to stifle the innovation that the private sector could bring. But on the other hand, theydon't really give a lot of opportunity to the private sector, to develop the design, to you know, 60 70%,which is what you need to have certainty, and then an ability to commit to a fixed price.Jim 13:28So are sort of back to that master, the opposite of the master builder heuristic. We're not planning longand or planning slow and building quickly, we're planning quickly and just accumulating delays and costoverruns. 5Transcribed by https://otter.aiRiccardo Cosentino 13:41Absolutely, absolutely. And then, you know, and you know, we seen this, because these projects are solong. And by the time that all the problems actually materialize, it's probably six, seven years down theline. So nobody worries about that at the beginning, and you will worry about that at the end. And youalways people somehow scratch their heads is that how do we get here, but pretty simple how we gothere.Jim 14:07So not to not to necessarily prompt a sales pitch for collaborative contracting. But how do you see orhow what did your research determine the benefits of collaborative contracting? We're, and then howlikely is it that it's going to become part of part of the industry?Riccardo Cosentino 14:31So my research was wasn't so much about collaborative contracting. So I took I took the benefit ofcollaborative contracting as a given and I said, you know, if collaborative contracting is such a goodway of delivering projects, How come is not used in PPP structures? What are the limiting factors thatdon't allow the implementation of collaborative contracting into PPP P. So my starting premises wascollaborative contracting is good. It is the way forward, and how do we how do we roll it out in differentparts of the industry?Jim 15:12Can we explore that just for a second? What is it about collaborative contract? And what benefits? Doyou believe that delivers to the industry?Riccardo Cosentino 15:21Well look, to me, just the fundamental principle that when you have collaborative contracting, youalmost you're almost waive your legal rights or your rights to pursue legal remedies. And so all of theparties are around the table. So the, you know, there are many advantages of collaborative contractcontracting, but the simplest one is, instead of hiring lawyer to sorting out disputes, you redeployingthose resources to actually solving project problems. So if you think of the litigation costs in thesemajor, major programs, if you just take those costs, and you were to use that financial resource toactually solve actual problems on the project, I mean, it doesn't take a lot of research to know thatanecdotally, that that's a good thing. Developed with all due respect to our attorney friends out there,your role may not best to be solving problems after the fact. Right? I mean, that's kind of the idea.Yeah, I mean, look, I mean, a claim against the client doesn't get concrete poured faster. Right. Okay.Fair point. You know, a few extra engineers and a few extra project resources could get that concretepoured faster, or figure out a way to pour the concrete faster.Jim 16:56Yeah, have the magic communications better to when you're not having to run it through attorneys andlegal filings?Riccardo Cosentino 17:02 6Transcribed by https://otter.aiYeah, I mean, I use I use that example. Because it's, you know, we just talked about claims we justtalked about, you know, ended up in court. So that's, that's the thing that comes to mind. But, you know,in general, I think we can all agree that a non antagonistic environment is more conducive to betterworking relation and better outputs. It's just anecdotally, we intuitively we can all see thatJim 17:34Sure.Riccardo Cosentino 17:35That we all want to work in a collaborative space, because, you know, when you bring the intellect ormultiple people together, and you foster that, you definitely want to get a better outcome.Jim 17:47Right, more rewarding toRiccardo Cosentino 17:48Yes. So that's, that's why I've took that I took it as a dogma, I said, collaborative contracting, is the rightway forward,Jim 17:58okay.Riccardo Cosentino 17:59So, okay, so why can we use that in PPP structures. And so, this is where it gets a little bit technical.Where, you know, PPP are really know nothing more than non recourse financing or project financing.That was it was a financing mechanism that was developed in the 70s. for oil exploration in the NorthSea, there weren't enough oil and gas company, there wasn't a big enough oil and gas company toabsorb the risk of oil exploration in the North Sea. So, they came together and came up with thestructure, which basically insulate the parent companies for the loss from the losses of the project. Andso, you know, if you take all exploration, and you lend him money into oil exploration Norh sea lenderscan only go after the asset to the oil platform or the future revenues associated with the asset. And thatbasically insulate the parent company for wo po things go really wrong,Jim 19:11but is there is there a completion guarantee built into this? I mean, the contractor can't just walk awaywithout recourse, can they?Riccardo Cosentino 19:18So, sorry, what I was describing is the is the is the structure or the client level? Yes.Jim 19:25Got it.Riccardo Cosentino 19:26 7Transcribed by https://otter.aiSo at the at the contractor level, yeah, absolutely the contractor. So that's what I was saying that inthese non recourse structures, the completion guarantee comes from the contractor. So ultimately, theback so although the project itself is non recourse, the contractor does put up guarantees becauseultimately the guarantees are in favor of the project sponsor and the project lenders right debt thatlenders, right? So the equity lenders is typically the developers, obviously they take equity risk, so Theyhave high amounts of risk or high amount of returns. So the first one, they get wiped out if the projectdoesn't do well. However, the debt lender has less, you know, these are big institution, they don't likerisk, they want to be insulated. So if the project was in to reach substantial completion, the contractorwould keep the lenders whole up to a point. And there's this is, this is why collaborative contracting isnot quite easy to implement in the structure, because the debt lenders always looking to recover themoney, right? And if the risk hasn't been transferred to a contractor, where the lender is going torecover the money for right,Jim 20:47where does it go, because it doesn't leave the project, just because nobody raised their hand to take it,it's not going away.Riccardo Cosentino 20:55So it's a Series is brought by non recourse financing PPP, these a zero sum games, where either thecontractor loses money, or the client loses money. And so that that creates the adversarial situation,especially if you haven't bid the job properly, you're going to be losing money, you're going aftersomebody because nobody likes to lose money, you're going to go after the client, and then theadversarial scenario sets in.Jim 21:24So the most important relationship, the most important relationship between the client and thecontractor for the project success is immediately set up on a weak foundation, like, yes. Okay. Thatexplains anything.Riccardo Cosentino 21:40And it will be, you know, is not impossibly, you could implement a collaborative contract between theclient and the contractor. However, the lenders need to get repaid, and the lender is only going to getrepaid when you reach substantial completion, you start extracting oil, you start selling the oil, and thatgenerates the revenues that are then used to repay the debt lenders, right? Yeah, so we couldimplement collaborative contract between the contractor and the project developer. However, in case ofcost overruns, the developer would pick up those costs. And because obviously, the lenders are still,you know, they still have debt service that you have to repay. And so somebody's got to pick up theircosts. And if he's not, there is not the contractor for a lump sum turnkey, then is the developer. Andhowever, that is not then becomes a more expensive structure, got a sense that you now have to putthe equity in. So now, it's very, very technical.Jim 22:55So maybe complex is that is that a good way to put it? 8Transcribed by https://otter.aiRiccardo Cosentino 22:59Is the well yes, complex, as actually complicated. It's very mechanical, there's no complex, it's theJim 23:07Swiss watch. It's not the flock of birds,Riccardo Cosentino 23:11which is basically, you know, when you inject equity, you know, when lenders lend you manage for aproject, that lenders lend you money for a project, they want to know that they're going to get paid back,right? And so they are going to look at the cost overruns. And they're going to look at who's going toabsorb the cost overruns. And so if the contractor is not going to pick up the cost overruns, becauseyou now have a relational contract in place, then the sponsor will, however, the sponsor has norecourse, there is no recourse to anybody above, right, typically, the contractor provides a parentcompany guarantee, and as the recourse to the parent company, but a developer because there's norecourse is not providing that they're there for they have to actually inject all of the equity upfront, rightto cover potential cost overruns. So you now have cash injected into the project, even though you mightnot need it, which makes it very, very expensive.Jim 24:08But you also have the benefit of big contingency.Riccardo Cosentino 24:11Absolutely. Absolutely. So, again, it's not is not impossible, this is just gets to the conclusion of mydissertation, which is it's possible to have relational contracting, it's going to be more expensive.However, the flip side, if we believe that collaborative Contracting is the way forward, you're going to bemore likely to finish on time and on budget, through collaboration that adversarial relations.Jim 24:38It's a funny, it's a funny perspective, to me having been involved in some complex projects, and itseems a little bit short sighted that somebody would really object to a 200 basis points or 2% increasein their cost of capital. Over massive cost overruns in the back end, huge attorney He's fees, delays,which we know costs money, I mean, time is actually money in a major program. So it's always justshocked me how everybody wants to bid to be as low as possible. Everybody wants to make sure thatthat interest rate is just as thin as they can possibly get it without giving any consideration to the factthat you're not saving anything. Because when you set up the program, that way, you're justguaranteed you're going to be over budget far more than you would ever save, and then add thelitigation on top of it that delays everything else. I mean, it just seems short sighted to me,Riccardo Cosentino 25:35unfortunately. So I'm, I specialize in public sector infrastructure. So I deal mostly with municipal, stateand federal government projects. And unfortunately, in the public sector, you have to demonstratevalue for money. And, you know, I think PPP is, it's particularly, the value for money analysis makesthings even worse, because what you end up now with is, private sector financing is more expensive inthe public sector financing a public, they know, the United States government can borrow at a cheaper 9Transcribed by https://otter.airate than any other corporation. So if you have a federal project, you're now adding, you know, 100 150bips to the cost to the cost of that because you have the private sector taken. So you now have a valuefor money analysis that already starts with you being in a hole. Because you now they Yeah, are goingto do it for a PPP are going to use private finance, but it's more expensive. So how do I balance thevalue for money? How do I justify that this is good value for money. And, you know, that's where youare starting play with risk transfer, you start quantify, the more risk you transfer, the more able you'regoing to be to show value for money, the lower the cost, the better because then again, you're going tobe able to show value for money. And as I said, The problem is that you're starting in a hole, right,because you already have to demonstrate why are using private finance. And then, and thencompound, the problem is, the way you justify private finance is by transferring risk, that are going totransfer more risks to the private sector are going to pay them more, you know, are going to pay theirhigher cost of capital. But that will bring me benefit because I have transferred to them the risk ofcompletion.Jim 27:37So you've got a, you've got a problematic paradigm may not be the it's a bit overused word, but you'vegot a problematic equation at the front end, which is creating some pretty significant adverseconsequences at the backend. Before you even get in to start talking about planning fallacy andstrategic misrepresentation. I mean, it, it sounds like the entrenched thought process behind howprojects should be evaluated, needs some work. And a fundamental understanding of the flaws in valuefor money might help. Because we know the results. I mean, there's plenty of data out there that showsI mean, independent of structure, how badly these projects perform. It's astronomical. But but it seemslike there's still some pretty heavy resistance to changing a perspective or methodology on the frontend to try to make up for some of that stuff. Is that fair?Riccardo Cosentino 28:35Yeah. I mean, you're also dealing with politicians right at this point. So it makes things even morecomplex. I think it's important that we talk about the I have other theory evidence, I guess it's furtherarea research, maybe for my PhD. But in my mind, PPP is our Chem, there is a role for PPP. So whenyou have low complexity projects, where you can actually define what you want, and you have very fewstakeholders. It's not it's not a bad model. So in Canada, various jurisdictions have had a lot of successwith hospital building, procuring them and building them using the PPP structure and as being as beingpositive as being a positive experience for all stakeholders. And this bill because it's a box, right, youbuilding a building, and it's any, you know, you can define what you want, and contractors are fairlyexperienced. And you know, it's a it's a Vertical Box. I think we're a falls apart where the PPP falls apartis when you have linear project and you start having more complexity in terms of many morestakeholders Many more moving parts in terms of you know, if you're building a railway, you now needto choose the technology, you go for different jurisdictions. And so the PPP, so having the privatesector lenders into a PPP structure creates more complexity, because he adds an additionalstakeholder and shareholder into the project. And it makes things a bit more complex, especially whenyou when you hit in problems.Jim 30:30 10Transcribed by https://otter.aiSo there's a every program has got a certain complexity threshold, that it cannot pass, it sounds like soif it's going to be, or if it's simple, from an engineering design perspective, single site, you know, squarepiece of property, whatever it can tolerate, and maybe even benefit from a certain addition ofcomplexity on top of, you know, in this case, the private sector provides access to resources thatmaybe the public sector doesn't have or can't appropriate. So the project can kind of hit that threshold.Whereas a complex project, just in the engineering and design side, may already be at that threshold orpast it. So adding another layer of financing complexity sounds disastrous,Riccardo Cosentino 31:18that's certainly the anecdotal evidence I have that especially so the way we differentiate is linear versusvertical. Right? When you have a linear project, yeah, the complexity is too high. And the benefit is,because you remember, the argument of bringing private sector lenders is that you have additionaloversight, you have an additional layer of oversight, you're going to use, the private sector lender isgoing to keep all the other stakeholder honest. So we're going to keep, let's say, the hospital ownerhonest, in terms of change order, they're not going to be able to halfway through the process, that issuechange order change in their mind, or what the scope of the project is, right? There's, you know, withthe with the design, build, finance, maintain and operate, you're actually maintaining the hospital for 30years. So you have now forced the Minister of Health to ring fence, the money required to maintain theproject for 30 years, because you're sending up a contract upfront, right. And if you if you know, publicsector, you know that the first thing the public sector cuts is operating budgets, right, so the PPP bringsbenefits. So the additional layer of complexity brought in by the private sector lenders iscounterbalanced by all these other benefits that a private sector lender brings in on a linear projectwhere the complexity is much higher, the benefits are outweighed by the negative of adding additionalcomplexity to something that cannot absorb it like you describe it very well.Jim 32:50So what conclusions did you draw from the research? I mean, PPP, the resistance to PPP,collaborative contracting, and PPP sounds fairly high. Yet the benefits seem fairly easy to argue. Andcertainly, anecdotally, we've got enough evidence where things don't work that you'd like to think afresh approach might be warmly received. But what are the impediments? What are the realistic optionsas they are today, relative to how successfullyRiccardo Cosentino 33:19I you know, can be my conclusion was pretty straightforward. It's actually it's the money issue, right? Imean, it's you, you could have collaborative contracting, it means equity has to take more risk. Andtherefore the project is going to be a little more expensive to finance because equity is taking more risk.However, if truly collaborative Contracting is the way forward and can actually deliver better on timeand on budget outcomes, then the additional cost of the private finance, to have collaboratedcontracting is, is insignificant. I haven't quantified it. But you know, you know, several basis points,compared to hundreds of millions of cost overruns. Yeah, I think if we were to do a back of theenvelope, we'll probably come to the conclusion that it's the cost benefit analysis, justify the additionalcost of financing,Jim 34:20 11Transcribed by https://otter.aiwhat's there, there's some and I'm going to get it wrong, but there's some colloquialism about steppingover dollars to pick up pennies kind ofRiccardo Cosentino 34:30Pound Foolish Pennywise PoundJim 34:32Foolish Yeah, the British the British version of the same sentiment. I keep having to remind myself thatwe went to went to graduate school in the UK, butRiccardo Cosentino 34:42yeah, so that's, you know, it'd be interesting it'd be a be interesting. The problem is PPP is a politicalbeast. I mean, the reason PPP was created, it's a political tool.Jim 34:55I mean, it to your point, it serves a purpose. It is a tool that has An application. But they the othercolloquial, I mean God, there's so many colloquialisms we could use. But if all you've got as a hammer,everything starts to look like a nail. I could go on, I'll spare the listeners, too many mixed metaphors andbad analogies. But the it sounds like your research is, or the conclusion is, it's got its place, it can bevery effective. But don't over rely on and the industry really should be open to a candid and evidencesupported discussion about alternatives.Riccardo Cosentino 35:32And it's admitting that to private finance, add an additional layer of complexity. And then the private Jimis that most practitioners don't understand complexity don't understand my major program is complexsystems. So it's not understood that you can't keep adding complexity and, and not not having negativeoutcome. Right, the more complexity you add, the more likely you have to have negative outcome, andadding a private sector lender is adding. So if you if you understand that, then you can manage andmitigate it. But if you don't even understand that private sector lending is additional complexity, thenthen you findJim 36:17that that may be the message or the beginning of the next research project or the next mission,understanding the level of complexity and how major programs are, in fact, complex adaptive systems,maybe we can take that step to your point, everything else will start to improve as well.Riccardo Cosentino 36:35So maybe we should start published, shared that complexity tool that we used complexity assessmenttool,Jim 36:46I'm sure Harvey Mahler would be thrilled if you would post a link to his research on complexity. Well,this has been fascinating. Riccardo, I certainly appreciate it. I've learned a lot. I really enjoyed readingyour research. I do think that there are opportunity. I mean, we've got enough evidence that the PPP is 12Transcribed by https://otter.aidon't work that well outside of some pretty specific application. So I think the work that you've done willcertainly push that conversation forward. And I, you know, I appreciate the opportunity to talk with youabout it.Riccardo Cosentino 37:21Thank you very much, Jim. And thanks for hosting the episode today. And hopefully, I'll have you backover guest in the foreseeable future.Jim 37:28That'd be great. I'd certainly appreciate the chance. Thank you.Riccardo Cosentino 37:32Thank you. That's it. For this episode, we'll navigate the major problems. I hope you found today'sconversation as informative and thought provoking as I did. If you enjoyed this conversation, pleaseconsider subscribing and leaving a review. I would also like to personally invite you to continue theconversation by joining me on my personal LinkedIn at Riccardo Cosentino. Listening to the nextepisode, where we will continue to explore the latest trends and challenges in major programmanagement. Our next in depth conversation promises to continue to dive into topics such asleadership, risk management, and the impact of emerging technology in infrastructure. It's aconversation you're not going to want to miss. Thanks for listening to navigate major problems. And Ilook forward to keeping the conversation going Music: "A New Tomorrow" by Chordial Music. Licensed through PremiumBeat.DISCLAIMER: The opinions, beliefs, and viewpoints expressed by the hosts and guests on this podcast do not necessarily represent or reflect the official policy, opinions, beliefs, and viewpoints of Disenyo.co LLC and its employees.

Our host Gareth McGlynn, sat down with Mark Sands Founder of Building CATALYST, which applies a management philosophy that is grounded in systems thinking - which is inspired by the work of W. Edwards Deming, the father of quality and process improvement. Discussed in this episode of the Preconstruction Podcast: - Mark's journey from VP / Partner at The Christman Company to starting Building Catalyst in 2013 - The reasons behind starting Building Catalyst what was the mission at the time and how has that mission changed - What is Building CATALYST and why Owners and Contractors need it - The Psychology around change within our industry, what will it take for real change in our processes - How his customers reacted in 2019 when he integrated all the data from every customer - Building methods and how they can shape the change (IPD and Design & Build) - Wh0 uses Building Cataylst? And how it felt in 2022 hitting the milestone of 600 projects and over $10 Billion - The difference between the Silo approach and the System approach. And why we must adopt the system approach. - How structured data and a systems approach can all but automate the preconstruction process (example of the Mary Free Bed Rehabilitation Hospital) - And much much more - including the terrible Grand Rapids winters :-) As always our guests are incredible advocates for the Preconstruction space and are open to any follow up questions. The best place to get Mark is at the Building Catalyst website: https://www.buildingcatalyst.com/ Alternatively here is Mark's LinkedIn profile: https://www.linkedin.com/in/marksands/ As always folks please subscribe, share and comment across your preferred platforms. Stay in touch for more incredible episodes of The Preconstruction Podcast.

In this episode, Briana Contreras, an editor with Managed Healthcare Executive, and Peter Wehrwein, managing editor of MHE, got to chatting with the newest editorial advisory board member, Jeffrey Casberg, who is vice president of Clinical Pharmacy at IPD Analytics.  In the discussion, Casberg shared the most pressing or prominent issues on his mind, he explained what the drug life-cycle is at IPD, and what the latest is on drugs in the pipeline. Casberg also shared his predictions for Sarepta Therapeutics' DMD drug for young children and Mounjaro's Type 2 Diabetes Drug, and even touched on some common misconceptions he notices about drug approvals, pricing and cost.

In this episode, we're talking about Spartan Invest's IPD. Our Investment Property Description outlines all the numbers needed to assess the purchase opportunity of our turnkey properties. Follow along with our IPD!Transcript--To learn more about our full-service turnkey operations, check us out online at www.spartaninvest.com.Connect with Spartan!Facebook: @spartaninvestInstagram: @spartaninvestTwitter: @spartaninvestConnect with Lindsay!Facebook: @spartanlindsaydavisInstagram: @spartanlindsaydavis

Aura Robinson, Manager of Enhanced Project Delivery at ISL Engineering (Canada) shares her experience with integrated project delivery (IPD) and emphasizes the importance of collaboration and valuing people in an IPD setting. She also provides tips for those considering implementing IPD, such as starting with a smaller project and finding the language of IPD and Lean Construction strategies that work for one's project and client. The conversation highlights the benefits of IPD, including decreased email volume, focus on building and experience, and increased value for all team members. This podcast interview can help construction professionals looking for insights on IPD and Lean Construction strategies for immediate use on their projects for higher collaboration and team performance.   Change-maker Aura Robinson is a Gold Seal certified Constructor with extensive experience in architecture, engineering, and project management. Aura finds new techniques and strategies to enhance project delivery in the design and construction industry. She has a passion for developing teams tailored to the industry's emerging trends, and has managed high-performing teams and projects to great success. Aura's search for a better way led her to Integrated Project Delivery (IPD). Her experience with IPD and dedication to improving the industry and helping owners realize their vision has led her to ISL Engineering. At ISL, collaborative approaches and Lean Construction strategies are at the core of their day-to-day operations, and Aura leverages her construction knowledge and unique perspective to help project owners and teams achieve their goals. Aura uses her experiences with IPD and Lean strategies to make project management easier, better, and faster.   Connect with Aura Robinson via LinkedIn at https://www.linkedin.com/in/aurarobinson/  Website at https://islengineering.com/  Email at arobinson@islengineering.com     Connect with Felipe via Social media and Free Lean and Scrum Training Resources at https://thefelipe.bio.link  RSM Podia Course Link: https://store.theebfcshow.com/rsm Subscribe on YouTube to never miss new videos here: https://rb.gy/q5vaht      --- Today's episode is sponsored by Bosch RefinemySite. It's a cloud-based construction platform. Bosch uses Lean principles to enable your entire team, from owners to trade contractors – to plan, communicate, document, and execute in real-time. It's the digital tool that supports the Last Planner System® process and puts it all together in one simple, collaborative ecosystem. Bosch RefinemySite empowers your team, builds trust, creates a culture of responsibility, and enhances communication. Learn more and Try for free at https://www.bosch-refinemysite.us/tryforfree     Today's episode is sponsored by the Lean Construction Institute (LCI). This non-profit organization operates as a catalyst to transform the industry through Lean project delivery using an operating system centered on a common language, fundamental principles, and basic practices. Learn more at https://www.leanconstruction.org  

Design-build, design-assist, IPD, hybrid approaches—what's the difference between each of these delivery methods, and how do owners determine which approach is right for them? Join Govan Brown's Colin Gray, Structure Tone New York's Stephen Soviero, Layton Construction's David Burton, and LF Driscoll's Ed Hanzel as they compare their experiences leveraging alternative delivery models in markets across North America.

We're coming at you LIVE from MEP Force 2022 in San Antonio, TX. Our great friends of the show, Nathan Wood and Travis Voss joined us for this exclusive look at the conference and the theme: Stronger Together. In this episode, the trio puts their finger to the pulse of the MEP industry as a whole looking at leadership, workflows, and what happens after you throw a bunch of tech at something and nothing improved. Nathan is the founder and CEO of SpectrumAEC and Executive Director of the Construction Progress Coalition. He has had a reputation as an industry thought leader for nearly a decade. His specialties include BIM, collaboration, coaching, digital fabrication, VDC, and IPD. Travis Voss is a Leader of Innovative Technology at Helm Mechanical. He uses his background in the tech field to explore, adapt, and perhaps develop technologies and workflows for the construction industry as it is thrust into its digital transformation. Helping Mechanical, Inc. stay on the cutting edge.

Columbus Day commemorates the explorer's arrival in the New World. Indigenous Peoples Day reminds us of the Native People who greeted him. Representatives from IPD Philly and the Native American House Alliance join us on the Corner to discuss the erasure of these people's history and culture. It's a “pow wow” you don't want to miss.The Behavioral Corner Podcast is made possible by Retreat Behavioral Health. Learn more - https://www.retreatbehavioralhealth.com.

Happy International Podcast Day! Today is a very special episode all about celebrating YOU and your fellow educational podcasters.  Though originally a national holiday, it quickly rebranded to become International Podcast Day to celebrate the incredible power of podcasts. And I just couldn't pass up this opportunity to celebrate all of you podcasters out there!  In this episode, you'll hear from over a dozen educational podcasters about their show and what they love most about podcasting. Oh, and I also share some podcast stats that I found particularly interesting, why representation matters, and how we need more women in podcasting. Because your voice matters. Show Notes: https://podcastingforeducators.com/episode64 (podcastingforeducators.com/episode64) Use my special link https://zen.ai/educators (zen.ai/educators) and use educators to save 30% off your first three months of Zencastr professional! #madeonzencastr Download my FREE podcasting launch guide: https://podcastingforeducators.com/launchguide (https://podcastingforeducators.com/launchguide) Join the Podcasting for Educators Prep-School: https://podcastingforeducators.com/prepschool (https://podcastingforeducators.com/prepschool) Sign up for my podcasting guesting mini-course: https://podcastingforeducators.com/guesting (https://podcastingforeducators.com/guesting) Mentioned in this episode: International Podcast Day Flash Sale Join the Podcasting for Educators Prep School for 30% with code IPD at checkout. Valid through 10/2/22 at 11:59 pm EST: https://podcastingforeducators.com/prep-school

This Friday is International Podcast Day and we thought we'd do something to celebrate the occasion (and maybe get a special IPD episode out of it!)   Sarah and I are going to log into Zoom for a few hours starting at 2:00PM EDT and we welcome you to join us for a brief chat about music and the podcasts we love. And if you're a podcast host, we'd love to hear what you have coming up on your show! So stop by this Friday when you have a free moment!   Meeting ID: 862 9697 2203 PW: 593127

Am I Consuming Too Much? Creation vs. Consumption and 5 Steps to Optimizing Your Personal Consumption! 2 Types of Information Consumption & Stef's Personal Consumption Breakdown Revealed   Type 1: Casual Personal Development (CPD) This type of personal development is best done ‘in addition to'! Finally, permission to multi-task! This personal development can be done while driving, doing laundry, or doing dishes. It is usually unplanned and doesn't take much 'brain space'. Examples are podcasts and audible books. Type 2: Intentional Personal Development (IPD) This type of personal development is intentional. It is planned into your work blocks. These usually take lots of focus and need your full attention. Examples of this include a course you are taking, meeting with a coach, dietitian, doing a mastermind, or bible study.   Here are some Simple Tips for More Production and Less Consumption as a Work From Home Mom Zero wasted tv time Zero social media scrolling Got rid of news No notifications   5 Steps to Optimizing Your Personal Consumption based on the 80/20 Rule. 80% production and creation and 20% IPD. This is based on Stef's example revealed inside today's episode! Inventory your CPD and IPD. What do you want this to look like? Schedule it in Live it out Revise I pray this episode blesses you! Enjoy. XO, Stef   All the things -> www.stefaniegass.com   Free Female Christian Entrepreneur Community-> www.stefgasscommunity.com Ready to get clear on your calling so you can start an online business? Join my Free, 4-Step Clarity Framework Workshop! Instant access at-> www.freeclarityworkshop.com Need a step-by-step blueprint on how to start your online business? Download a Free, 14-Step Biz Blueprint Checklist!-> www.completebusinessblueprint.com Wondering if you should start a podcast? Take this quiz and find out! -> www.startapodcastquiz.com   Wanna work together, friend!? Step 1: Get Clear on Your God-led Calling so You Can Start an Online Business-> www.clarifyyourcallingcourse.com Step 2: Grow an Organic, Evergreen Audience using Podcasting-> www.podcastprouniversity.com  Step 3: Monetize & Scale your Podcast Using Courses and Coaching-> www.podcasttoprofitmastermind.com    Contact us at-> support@stefaniegass.com