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36 pages, 518 KB  
Article
Director Network Stability and Corporate Green Innovation: Evidence from China’s A-Share Market
by Sen Zeng, Yuanhong Chen, Yan Gao, Yanru Li, Cao Yuan and Hanming Yang
Sustainability 2025, 17(23), 10607; https://doi.org/10.3390/su172310607 - 26 Nov 2025
Viewed by 527
Abstract
This study investigates the impact of director network stability on corporate green innovation, emphasizing the moderating roles of network position and media attention. Using a sample of Chinese A-share listed firms from 2009 to 2023, we present three main findings. First, greater director [...] Read more.
This study investigates the impact of director network stability on corporate green innovation, emphasizing the moderating roles of network position and media attention. Using a sample of Chinese A-share listed firms from 2009 to 2023, we present three main findings. First, greater director network stability is positively associated with green innovation. Second, this positive relationship is more pronounced among firms that occupy central positions within the network and receive higher levels of media attention. Third, the effect of network stability operates primarily through two mechanisms: heightened corporate social responsibility (CSR) awareness and increased R&D investment. These findings provide novel empirical evidence on how network governance fosters sustainability-oriented innovation. They also offer practical implications for firms seeking to enhance their green innovation capabilities. Finally, we acknowledge certain limitations, including potential imprecision in measuring network stability and remaining concerns about causal identification, which future research should address using richer indicators and more robust identification strategies. Full article
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26 pages, 380 KB  
Article
Impact of Digital Transformation on Enterprise Risk-Taking: An Analysis Based on Chain Multiple Mediating Effects
by Wenhui Yao, Hua Li, Qiubai Sun and Rongjian Lv
Sustainability 2025, 17(22), 10203; https://doi.org/10.3390/su172210203 - 14 Nov 2025
Viewed by 663
Abstract
Digital transformation represents a strategic imperative for enterprises pursuing high-performance growth. This study selects A-share listed enterprises from 2014 to 2023 as the research sample and empirically examines the impact of digital transformation on enterprise risk-taking, as well as its internal transmission mechanisms, [...] Read more.
Digital transformation represents a strategic imperative for enterprises pursuing high-performance growth. This study selects A-share listed enterprises from 2014 to 2023 as the research sample and empirically examines the impact of digital transformation on enterprise risk-taking, as well as its internal transmission mechanisms, using a fixed effects model. The findings indicate that digital transformation has a significant positive effect on promoting enterprise risk-taking, particularly in state-owned enterprises and those with lower media attention. The director network and economic policy uncertainty positively moderate this relationship. Results from the mechanism analysis show that digital transformation enhances enterprise risk-taking through independent mediating channels that alleviate enterprises’ financing constraints and increase innovation investment, as well as through the chain mediation channel of “alleviating financing constraints → increasing innovation investment”. This research clarifies the specific mechanism underlying the impact of digital transformation on enterprise risk-taking and provides new evidence for understanding how digitalization enhances enterprise risk-taking by easing financing constraints and stimulating innovation. It holds important significance for helping enterprises improve their risk-taking capacity and promote sustainable development. Full article
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26 pages, 1443 KB  
Article
Perception of Stakeholder Groups on Ailanthus altissima in Hungary
by András Demeter, Dénes Saláta, Szilárd Czóbel, Péter Csépányi, Tibor Limp and Eszter Tormáné Kovács
Land 2025, 14(11), 2133; https://doi.org/10.3390/land14112133 - 26 Oct 2025
Viewed by 423
Abstract
In order to tackle the problems caused by invasive alien plant species, it is important to know what the main groups that have the largest influence on the spreading of the species, know and think about them. Nation-wide questionnaire surveys were carried out [...] Read more.
In order to tackle the problems caused by invasive alien plant species, it is important to know what the main groups that have the largest influence on the spreading of the species, know and think about them. Nation-wide questionnaire surveys were carried out in Hungary between 2016 and 2019 among three important stakeholder groups (local governments, national park directorates (NPDs), and state forestry units (SFUs)) of tree of heaven (Ailanthus altissima). The aim of the surveys was to reveal the perception of the three groups about Ailanthus altissima, their experiences with eradication, and other needs for its successful management of the species. Besides basic statistical methods, the chi2 test, Fisher’s exact test, Cramer’s V value, and Mann–Whitney U test were conducted to compare groups and reveal relationships between different variables. 221 local governments, 10 NPDs, and 110 SFUs filled in the questionnaire. The response rate was quite low for local governments (8.8%) and high for NPDs (100%) and SFUs (97.5%). Our findings show that the species was recognised by only 59% of respondents representing local governments. Further results are presented regardingthis subsample.The negative impacts of Ailanthus altissima were perceived in all three groups at a higher rate (over 95% in all three groups) than positive impacts (local governments: 63%, NPDs: 10%, SFUs: 35%). The two groups managing forest areas (NPDs and SFUs) ranked the problems caused by the species high (the median was −4 for both groups on a −5–+5 scale). Ailanthus altissima was present in the areas of at least 80 percent in each examined group. In areas where the species was present, eradication was applied in a significantly higher percent of NPDs (86%) and SFUs (88%) than regarding local governments (36%), and the same tendency was found for using mechanical and chemical methods (p < 0.05). The two groups managing forest areas also applied biological methods, although at a lower rate (NPDs: 10%, SFUs: 14%). The unit costs and area of eradication varied between NPDs and SFUs, but the difference was not significant between the two groups (p = 0.073 and 0.213, respectively). NPDs used more external funding for eradication than local governments and state forestry units, mostly co-financed by European Union funds (e.g., LIFE and European Regional Development Fund). Information was required by a large percentage of respondents from local governments (75% of those who recognised the species). The need for cooperation between stakeholder groups was indicated by 78% of local governments recognising the species, and was ranked high by the two expert groups as well (medians were 4 for NPDs and 5 for SFUs on a 0–5 scale). Sharing knowledge about and experience with eradication among the two expert groups and transferring knowledge to the local governments are recommended for the successful management of the species. Further research is needed regarding the effectiveness, the environmental impacts, and the costs of eradication, as well as influencing factors. Full article
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9 pages, 375 KB  
Article
Innovation and Sustainability in the Value Chain of the Tourism Sector in Boyacá
by Juan Orlando Berdugo Morantes, Marleny Torres Zamudio and Fabio Alonso Bonilla Gómez
Sustainability 2025, 17(20), 9000; https://doi.org/10.3390/su17209000 - 11 Oct 2025
Viewed by 1024
Abstract
Boyacá, a department in the Colombian Andes, is recognized for its rich natural, cultural, and historical heritage, positioning it as an emerging tourism destination with strong potential for sustainable development. Its portfolio encompasses ecological, cultural, adventure, and rural modalities that contribute to local [...] Read more.
Boyacá, a department in the Colombian Andes, is recognized for its rich natural, cultural, and historical heritage, positioning it as an emerging tourism destination with strong potential for sustainable development. Its portfolio encompasses ecological, cultural, adventure, and rural modalities that contribute to local economies and community well-being. This study employs a mixed-methods design combining documentary analysis with fifty semi-structured interviews conducted across five provinces, engaging stakeholders such as hotel managers, travel agencies, restaurateurs, agroecological farmers, museum directors, café entrepreneurs, and ecotourism operators. The findings reveal that innovation, particularly through infrastructure, modernization, digital adoption, and service professionalization—is critical to strengthening competitiveness. However, persistent challenges include stakeholder fragmentation and the absence of a coordinated promotional strategy, both of which limit visibility and shared value generation. To address these challenges, the study proposes integrated innovation pathways, including thematic circuits (heritage, independence, and coffee routes), personalized tourism experiences, and the use of digital and experiential marketing tools. These approaches highlight the need for collaborative governance involving public, private, and community actors. The article contributes empirical evidence to the debate on tourism innovation and sustainability in emerging regions, underscoring Boyacá’s paradox: global recognition coexists with fragmented governance. It argues that innovation-driven strategies, aligned with sustainability principles, are essential for consolidating Boyacá as a competitive and regenerative tourism destination. Full article
(This article belongs to the Section Tourism, Culture, and Heritage)
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19 pages, 256 KB  
Article
Interreligious Conversations: A Sociological Analysis of Practices of Otherness and Identity in a Museum of Sacred Art
by Marco Bontempi
Religions 2025, 16(9), 1189; https://doi.org/10.3390/rel16091189 - 15 Sep 2025
Viewed by 788
Abstract
(1) Background: From a post-secular perspective, the relationship between religions in the public sphere is conceived as an exchange in which religious beliefs, when formulated as rational arguments, contribute to building a shared public culture and foster a democratic transformation of interreligious relations. [...] Read more.
(1) Background: From a post-secular perspective, the relationship between religions in the public sphere is conceived as an exchange in which religious beliefs, when formulated as rational arguments, contribute to building a shared public culture and foster a democratic transformation of interreligious relations. This article critiques this approach, highlighting its neglect of the lived experience of religion and, in particular, the situated and situational nature of processes of religious identity and religious difference formation. (2) Methods: Ethnographic observation of a performance held in a sacred art museum in Tuscany by immigrants from different religious backgrounds, four semi-structured interviews with performers, and one interview with the museum director were conducted. (3) Results: Personal and religious narratives, along with face-to-face interactions, generate dynamics of identification, differentiation, and situated identity redefinition. Interaction with the artwork, framed as a shared space, facilitates shifts in religious self and other positioning. It also reconfigures the boundaries between “us” and “them.” The artwork acts as a symbolic device that enables multiple interpretations and unexpected forms of recognition. (4) Conclusions: Relations of identification and distinction among religious identities are transformed not through abstract rational deliberation but through concrete, discursive, and performative practices. Full article
16 pages, 291 KB  
Article
General and Specific Social Trust as Predictors of Depressive Symptoms: Evidence from Post-Crisis Iceland
by Haukur Freyr Gylfason
World 2025, 6(3), 107; https://doi.org/10.3390/world6030107 - 1 Aug 2025
Viewed by 1189
Abstract
Social trust has been linked to the development and severity of depression, but trust is a complex, multidimensional construct. This study examines the extent to which two distinct forms of trust, general trust and specific trust, predict depressive symptoms. Drawing on longitudinal data [...] Read more.
Social trust has been linked to the development and severity of depression, but trust is a complex, multidimensional construct. This study examines the extent to which two distinct forms of trust, general trust and specific trust, predict depressive symptoms. Drawing on longitudinal data from the Directorate of Health’s national surveys conducted in 2007 and 2009, the analysis includes responses from 3211 Icelanders selected through a stratified random sample. Depressive symptoms were assessed using the Depression, Anxiety, and Stress Scale (DASS), while specific trust captured trust in close relationships, and general trust measured broader perceptions of trustworthiness in others. The two forms of trust together explained 7.6% of the variance in depressive symptoms, with specific trust contributing a substantially greater share. Both remained significant predictors after controlling for prior depression and physical health. These findings highlight the protective role of specific trust and suggest that general trust, an indicator of broader social capital, may also help buffer against depression. The results underscore the relevance of trust as a public health resource and support continued research into social determinants of mental health in Iceland. Full article
19 pages, 2498 KB  
Article
Examining the Cultivation of a Conservation Culture Across Zoos and Aquariums
by Joy Kubarek, Amanda Lindell, Shelly Grow and Jackie Ogden
J. Zool. Bot. Gard. 2025, 6(3), 36; https://doi.org/10.3390/jzbg6030036 - 22 Jul 2025
Viewed by 1611
Abstract
This contributed paper presents results from efforts by the Association of Zoos and Aquariums (AZA) to investigate the impact of integrating conservation into AZA members’ organizational cultures. Part of this work included AZA setting goals related to organizational and professional culture, strategic communication, [...] Read more.
This contributed paper presents results from efforts by the Association of Zoos and Aquariums (AZA) to investigate the impact of integrating conservation into AZA members’ organizational cultures. Part of this work included AZA setting goals related to organizational and professional culture, strategic communication, developing communities of practice, and promoting tools and resource-sharing. Prior to implementing the majority of these steps, a baseline assessment was administered to directors plus a random sample of AZA organizations in 2020—assessing how well conservation is integrated into the institutional culture and measures of perceived conservation impact. The same sample of organizations was re-surveyed in 2023 with the intent of a three-year cycle of surveying to monitor change and identify additional ways that AZA could support and strengthen a culture of conservation within the profession. These findings will help the zoological and broader conservation community assess opportunities to integrate conservation into organizational cultures across a broad association for the purpose of achieving the mission and impact. Full article
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22 pages, 893 KB  
Proceeding Paper
Research and Analysis of Traffic Intensity on a Street with High Traffic Load: Case Study of the City of Sofia
by Durhan Saliev, Georgi Mladenov and Plamen Petkov
Eng. Proc. 2025, 100(1), 37; https://doi.org/10.3390/engproc2025100037 - 11 Jul 2025
Viewed by 1205
Abstract
The study of traffic parameters in cities is the basis for making adequate decisions related to the organization and regulation of traffic. This publication presents a study of one of the main parameters of transport flows, namely, its intensity. The study covers one [...] Read more.
The study of traffic parameters in cities is the basis for making adequate decisions related to the organization and regulation of traffic. This publication presents a study of one of the main parameters of transport flows, namely, its intensity. The study covers one of the busiest streets in the city of Sofia, which is part of the radial connection in the radial circular street network of the city, for the evening peak period of the day. Data analysis presents the influence of the intensity of transport flows at the intersections, which are formed by the intersection with other streets, on the load of the studied street. The share of the load of each transport flow at the individual intersections on the total load of the studied section was recorded for the subsequent assessment of the existing traffic management. The results have been provided to the relevant directorates in the structure of Sofia Municipality for information and use. Full article
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7 pages, 156 KB  
Conference Report
Strengthening Vaccine Safety Systems, Research, and Regional Collaboration in Africa: A Call to Action
by Beckie N. Tagbo, Chioma S. Ejekam, Winfred Oppong-Amoako, Tene Marceline Yameogo, Afework Mitiku, Dorothy O. Esangbedo, Nelisiwe Khuzwayo, Gugu Mahlangu, Samia M. Badar, Edinam A. Agbenu, Rhanda M. Adechina and Kwasi A. Nyarko
Vaccines 2025, 13(6), 661; https://doi.org/10.3390/vaccines13060661 - 19 Jun 2025
Viewed by 1207
Abstract
The 8th meeting of the African Advisory Committee on Vaccine Safety (AACVS), constituted in 2021, convened by the Vaccine Research and Innovation Unit within the Vaccine Preventable Diseases Program, WHO Regional Office for Africa, was held virtually from 14 to 16 April 2025. [...] Read more.
The 8th meeting of the African Advisory Committee on Vaccine Safety (AACVS), constituted in 2021, convened by the Vaccine Research and Innovation Unit within the Vaccine Preventable Diseases Program, WHO Regional Office for Africa, was held virtually from 14 to 16 April 2025. The meeting brought together independent vaccine experts to provide advice to the Regional Director, WHO, on vaccine safety issues critical to the African region. Discussions focused on critical updates regarding ongoing regional outbreaks, safety data, and associated safety concerns, with emphasis on newly introduced vaccines, including the malaria vaccines (RTS, S and R21), the MenFive pentavalent meningitis vaccine, and the Mpox vaccines—MVA-BN and LC16—alongside the ongoing Mpox response. The Committee conducted a deep dive into comprehensive safety considerations for new vaccine introduction, active surveillance strategies, strengthening the responsiveness of pharmacovigilance systems, and advancing vaccine research and development in Africa. Key observations highlighted significant gaps in safety surveillance systems. These included delays in data collection, access, and signal detection; a lack of harmonized real-time monitoring frameworks; the underutilization of digital technologies; and inadequate manufacturer responsibilities and accountability in post-market safety monitoring. The meeting concluded with a call to action emphasizing the need for sustainable pharmacovigilance funding mechanisms, improved regional coordination, real-time data sharing, standardized early safety study protocols, strengthened manufacturer accountability, and investments in risk communication and community engagement to bolster public trust. Strengthening vaccine safety systems and enhancing regional collaboration were recognized as urgent priorities to support the safe and effective deployment of vaccines and protect public health across Africa. Full article
(This article belongs to the Section Vaccines and Public Health)
22 pages, 495 KB  
Article
Building a Sustainable Youth Support System: Insights from Service Providers Working with Out-of-School Youth in South Korea
by Ahram Lee, Soo Jeung Lee and Eunju Jung
Sustainability 2025, 17(12), 5493; https://doi.org/10.3390/su17125493 - 14 Jun 2025
Viewed by 2543
Abstract
This study aims to explore the experiences and perceptions of service providers working in direct contact with out-of-school youth to identify ways to build a more sustainable and responsive support system within the community. Individual and group interviews were conducted with eight service [...] Read more.
This study aims to explore the experiences and perceptions of service providers working in direct contact with out-of-school youth to identify ways to build a more sustainable and responsive support system within the community. Individual and group interviews were conducted with eight service providers, including a team leader and five directors from public out-of-school support institutions, as well as two schoolteachers from the Board of Education, who were experienced in assisting dropout students. Reflexive thematic analysis of the interview data revealed four key themes: connecting youth to the community system, diversifying programs, minimizing disparities, and increasing societal awareness of out-of-school youth. These findings highlight how various needs and access to opportunities can be provided to all youths, regardless of their school enrollment. The study underscores the importance of shared responsibility in building an inclusive, community-based approach. It also emphasizes the necessity of cross-sector and inter-ministerial collaboration to reduce structural barriers and promote equitable learning opportunities. By centering the voices of practitioners, this study contributes to the broader discourse on building a sustainable community in which out-of-school youth can receive opportunities and resources to thrive as healthy contributing members of the community. Full article
(This article belongs to the Special Issue Sustainable Quality Education: Innovations, Challenges, and Practices)
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23 pages, 1016 KB  
Article
Board Networks and Firms’ Technological Innovation Output: The Moderating Roles of Shareholder Networks and CEO Networks
by Jie Xu, Linfeng Zhong, Runshi Bi and Chongfeng Wang
Systems 2025, 13(6), 414; https://doi.org/10.3390/systems13060414 - 28 May 2025
Cited by 2 | Viewed by 1575
Abstract
In the field of firms’ technological innovation, a large body of research has emphasized the roles of interlocking directors and the associated board networks in which they are embedded. By integrating the process perspective of absorptive capacity theory with stakeholder network theory, this [...] Read more.
In the field of firms’ technological innovation, a large body of research has emphasized the roles of interlocking directors and the associated board networks in which they are embedded. By integrating the process perspective of absorptive capacity theory with stakeholder network theory, this study investigates the influence of board networks on firms’ technological innovation output, with particular attention given to the moderating effects of shareholder networks and CEO networks. The theoretical hypotheses suggest that degree centrality within board networks positively influences firms’ technological innovation output, and that this positive effect is weakened by degree centrality within both shareholder networks and CEO networks. While board networks facilitate information acquisition for technological innovation, shareholder networks and CEO networks may serve as substitutes. Furthermore, they may shape the motivations of shareholders and CEOs, potentially hindering the exploitation of information acquired through board networks. Using longitudinal data on Chinese A-share listed companies from 2005 to 2023, we construct three distinct types of interorganizational networks and annually measure firms’ degree centralities within each network type. Employing fixed-effects panel models, this study empirically verifies the proposed hypotheses. Practically, the findings offer important implications for firms seeking to align interorganizational networks with their technological innovation management strategies. We recommend that future research further explore the roles of diverse stakeholder networks in interorganizational contexts to enhance the understanding of how interactions across multilayer networks affect firms’ technological innovation output. Full article
(This article belongs to the Section Systems Practice in Social Science)
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22 pages, 292 KB  
Article
Governance, Ownership Structure, and Financial Leverage: The Role of Board Gender Diversity in UK Firms
by Dramani Angsoyiri, Fadi Alkaraan and Judith John
J. Risk Financial Manag. 2025, 18(5), 276; https://doi.org/10.3390/jrfm18050276 - 17 May 2025
Cited by 2 | Viewed by 1995
Abstract
This paper aims to investigate the relationship between governance structure, ownership structure, and financial leverage of corporations in the UK, with a special emphasis on the boardroom gender diversity. The study sample includes 484 UK firms from the FTSE All-Share Index for the [...] Read more.
This paper aims to investigate the relationship between governance structure, ownership structure, and financial leverage of corporations in the UK, with a special emphasis on the boardroom gender diversity. The study sample includes 484 UK firms from the FTSE All-Share Index for the period (2015–2023), with 4356 firm-year observations. The results show that CEO duality, gender diversity, managerial ownership, institutional ownership, and government shareholding are all positively associated with financial leverage, thus confirming the importance of these governance and ownership characteristics in determining capital structure policies. On the other hand, board size and the proportion of non-executive directors are not found to have a significant impact on financial leverage, which points to some room for improvement in UK board practices. In this regard, the study contributes to the governance-sustainability-finance nexus discussion by focusing on these dimensions in the UK corporate sector. As such, the findings of this study are important in providing policy recommendations for policymakers and corporate leaders and contribute to the ongoing wave of global corporate governance reforms and practical insights into enhancing governance frameworks at the firm level. Full article
(This article belongs to the Section Economics and Finance)
25 pages, 320 KB  
Article
Leveraging Board Experience Diversity to Enhance Corporate Green Technological Innovation
by Xin Zhao, Shuyang Wang and Xiaoyu Wu
Sustainability 2025, 17(8), 3351; https://doi.org/10.3390/su17083351 - 9 Apr 2025
Cited by 2 | Viewed by 1186
Abstract
This study examines the role of board experience diversity in fostering corporate green technological innovation (CGTI), focusing on the moderating effects of absorptive capacity and director network location. Integrating upper echelons theory with absorptive capacity theory, we explore how board experience diversity enhances [...] Read more.
This study examines the role of board experience diversity in fostering corporate green technological innovation (CGTI), focusing on the moderating effects of absorptive capacity and director network location. Integrating upper echelons theory with absorptive capacity theory, we explore how board experience diversity enhances strategic decision-making and innovation. We hypothesize that board experience diversity improves CGTI by broadening cognitive perspectives. We also examine the moderating effect of absorptive capacity on the relationship between board experience diversity and innovation. We examine Chinese A-share listing firms, finding that board experience diversity positively affects CGTI, and absorptive capacity strengthens this effect. Additionally, we show that director network location, proxied by centrality in inter-board networks, not only strengthens the association between board experience diversity and innovation but also affects innovation. Furthermore, we conducted heterogeneity and mechanism tests, confirming the robustness of these relationships. These findings contribute to the literature on corporate governance and sustainability by emphasizing the roles of board experience diversity, absorptive capacity, and network position in driving CGTI. Full article
20 pages, 2237 KB  
Article
DMOs and Social Media Crisis Communication in Low-Responsibility Crisis: #VisitPortugal Response Strategies During COVID-19
by Mariana Casal-Ribeiro, Rita Peres and Inês Boavida-Portugal
Tour. Hosp. 2025, 6(1), 49; https://doi.org/10.3390/tourhosp6010049 - 19 Mar 2025
Cited by 4 | Viewed by 2561
Abstract
Guided by the situational crisis communication theory (SCCT), this study explores how a destination marketing organization (DMO) managed crisis communication during a prolonged low-responsibility crisis. It analyzes the production process of crisis communication, the crisis communication content shared on Facebook to protect the [...] Read more.
Guided by the situational crisis communication theory (SCCT), this study explores how a destination marketing organization (DMO) managed crisis communication during a prolonged low-responsibility crisis. It analyzes the production process of crisis communication, the crisis communication content shared on Facebook to protect the destination’s image during COVID-19, and evaluates which crisis response strategies led to higher audience engagement. This study used a single instrumental case study with an exploratory sequential approach. A semi-structured interview was conducted with Visit Portugal’s Communication and Digital Marketing Director. Then, Facebook content from Visit Portugal, posted between 1 January 2020 and 5 May 2023, was collected and analyzed. By analyzing the DMO’s crisis communication workflow, decision-making processes, and content shared on social media, it was found that secondary response strategies effectively safeguarded and improved the destination’s image, leading to higher audience engagement. This study provides DMOs with valuable insights into the development of effective crisis communication strategies when navigating low-responsibility crises. Full article
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25 pages, 1360 KB  
Article
Teams, Tools, Processes and Resources to Manage Oncologic Clinical Decision Support: Lessons Learned from City of Hope’s Multistate, Academic, and Community Oncology Enterprise
by Linda D. Bosserman, YiHsuan Lin, Sepideh Shayani, Brian Moore, Denise Morse, Emmanuel Enwere, Vijay Trisal and Wafa Samara
J. Clin. Med. 2025, 14(6), 2048; https://doi.org/10.3390/jcm14062048 - 17 Mar 2025
Viewed by 2873
Abstract
Background/Objectives: Clinical decision support systems (CDSSs) consisting of Computerized Physician Order Entry (CPOE) and oncology pathways serve as the foundation of high-quality cancer care. However, the resources needed to develop and maintain these systems have not been characterized for oncology enterprises. Methods: Executive [...] Read more.
Background/Objectives: Clinical decision support systems (CDSSs) consisting of Computerized Physician Order Entry (CPOE) and oncology pathways serve as the foundation of high-quality cancer care. However, the resources needed to develop and maintain these systems have not been characterized for oncology enterprises. Methods: Executive leadership appointed a medical director and clinical pharmacist to develop and lead a Pathways and Protocols Program for the City of Hope (COH) enterprise. This involved developing a program charter and governance committee and a business case for resources to support CPOE in our Epic Beacon treatment orders. Missing CPOEs for oncology treatments were identified for treatments in COH’s Elsevier ClinicalPath treatment pathways and for those few diseases not in the pathways for medical oncology and hematology. New FDA oncology drug approvals were used to estimate ongoing CPOE build needs. Time estimates for Beacon analysts to build Beacon protocols were developed from a prior CPOE catch-up project, from informal surveys of our clinical pharmacists and Beacon leads, and surveys of staff leads at two other large, multisite cancer programs using Epic. Informal surveys of oncology clinicians and pharmacists were carried out to understand the time they were using to build Beacon orders that were not in the COH system. This information was used to build a business case for additional project management and staffing to catch up on building 400 missing Beacon orders, to maintain Beacon orders as new therapies and regimens are needed, and to provide required regulatory oversight of Beacon orders. Given these standards had not been shared by others, this work was gathered into a manuscript to help others evaluate and support needed resources to manage oncology pathway programs and CPOE to improve efficiencies, safety, and quality of care for medical oncology and hematology programs. Results: A Pathways and Protocols program was developed with a governance committee, a program charter, and a charge for disease committees to prioritize, approve, and oversee the regulation of COH’s Beacon treatment orders. CPOE resources to catch up and maintain COH’s Beacon treatment orders were developed and shared with COH’s executive leadership. Informal surveys were completed to benchmark Beacon resources with COH and two other Beacon enterprises as well as to estimate the time used by COH clinicians to build Beacon orders for orders not in the system. Conclusions: The resources for managing clinical oncology pathways and CPOE for an enterprise have not previously been published. Work components identified from our work at COH are shared so that other oncology leaders might have a starting framework to evaluate their own CDSS needs for oncology pathways and CPOE. Full article
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