Early Involvement Of Stakeholders Research Articles

The Human Side of Generative AI: Creating a Path to Productivity

The rapid rise of generative artificial intelligence (AI) presents both opportunities and challenges for organizations. While generative AI offers transformative potential to boost productivity through new forms of data creation, its implementation also brings significant human impacts that require thoughtful leadership. This article explores the human side of generative AI from both theoretical and practical perspectives, focusing on change management, people-centered design, and responsible implementation. Key areas include managing cognitive, emotional, and behavioral responses to AI-driven change, as well as fostering cultures of transparency, learning, and accountability. The article highlights best practices such as early stakeholder involvement, iterative evaluation, and robust governance to ensure generative AI aligns with human needs and ethical standards. Case studies, including Anthropic’s AI safety efforts, illustrate how leaders can promote responsible innovation by integrating human-centered practices throughout the technology lifecycle. By proactively addressing the human dimensions of AI adoption, organizations can achieve sustainable productivity gains while maintaining trust, well-being, and ethical integrity.

Health workers' perspectives on school-based mass drug administration control programs for soil-transmitted helminthiasis and schistosomiasis in Ogun State, Nigeria.

Soil-transmitted helminthiasis (STH) and schistosomiasis (SCH) are among the most prevalent neglected tropical diseases (NTDs), affecting 1.5 billion globally, with a significant burden in sub-Saharan Africa, particularly Nigeria. These diseases impair health and contribute to socio-economic challenges, especially in children, undermining educational and future economic prospects. The 2030 NTD Roadmap highlights Mass Drug Administration (MDA) as a critical strategy for controlling these NTDs, targeting vulnerable populations like school-age children. Despite some successes, challenges persist, indicating the need for deeper insights into program implementation. This study focuses on the perspectives of health workers implementing MDA in selected local government areas (LGAs) of Ogun State, Nigeria, aiming to identify challenges and enablers that align with the broader NTD 2030 goals. The study used a qualitative research approach involving focus group discussions and in-depth interviews with health workers engaged in neglected tropical disease control programs in Ogun State, Nigeria, between July and September 2022. A semi-structured questionnaire guided the exploration of ideas, and the data were analyzed using the QRS Nvivo 12 software package. The study found that the school-based MDA control program's efficacy largely relies on strong collaborations and partnerships, particularly with educators, community heads, and other stakeholders. These alliances and strategic communication methods, like town announcements and media campaigns, have been pivotal in reaching communities. However, the program does grapple with hurdles such as parental misconceptions, limited funds, insufficient staffing, and misalignment with the Ministry of Education. It is recommended to boost funding, foster early stakeholder involvement, enhance mobilization techniques, and consider introducing a monitoring card system similar to immunization. The MDA Integrated Control Programs for STH and SCH in Ogun State schools demonstrate a holistic approach, integrating knowledge, collaboration, communication, and feedback. Health workers have shown commitment and adeptness in their roles. However, achieving maximum efficacy requires addressing critical barriers, such as parental misconceptions and funding challenges. Adopting the recommended strategies, including proactive communication, increased remuneration, and introducing a tracking system, can significantly enhance the program's reach and impact. The involvement of all stakeholders, from health workers to community leaders and parents, is essential for the program's sustainability and success.

Getting the message across; a realist study of the role of communication and information exchange processes in delivering stroke Early Supported Discharge services in England.

Stroke early supported discharge (ESD) involves the co-ordinated transfer of care from hospital to home. The quality of communication processes between professionals delivering ESD and external stakeholders may have a role to play in streamlining this process. We explored how communication and information exchange were achieved and influenced the hospital-to-home transition and the delivery quality of ESD, from healthcare professionals' perspectives. Six ESD case study sites in England were purposively selected. Under a realist approach, we conducted interviews and focus groups with 117 staff members, including a cross-section of the multidisciplinary team, service managers and commissioners. Great variation was observed between services in the type of communication processes they employed and how organised these efforts were. Effective communication between ESD team members and external stakeholders was identified as a key mechanism driving the development of collaborative and trusting relationships and promoting coordinated care transitions. Cross-boundary working arrangements with inpatient services helped clarify the role and remit of ESD, contributing to timely hospital discharge and response from ESD teams. Staff perceived honest and individualised information provision as key to effectively prepare stroke survivors and families for care transitions and promote rehabilitation engagement. In designing and implementing ESD, early stakeholder involvement ensured the services' fit in the local pathway and laid the foundations for communication and partnership working going forward. Findings highlighted the interdependency between services delivering ESD and local stroke care pathways. Maintaining good communication and engagement with key stakeholders may help achieve a streamlined hospital discharge process and timely delivery of ESD. ESD services should actively manage communication processes with external partners. A shared cross-service communication strategy to guide the provision of information along to continuum of stroke care is required. Findings may inform efforts towards the delivery of better coordinated stroke care pathways.

Early involvement of stakeholders in mobility-related projects

Early involvement of stakeholders could help identifying potential difficulties and providing input during the development period. The involvement of stakeholders is a key criterion for sustainable urban transportation planning. Stakeholders should be able to express their opinions and concerns while also contributing creative and innovative solutions to transportation issues. Therefore, the study’s goal is to give a voice to stakeholders who are generally mute or are not participating in the early planning stages (non-expert citizens). Semi-structured interviews were conducted over a two-week period, in addition to observations of mobility patterns and street talks. The analysis is conducted in response to the following research question: How early involvement of stakeholders in mobility-related projects might aid in the development of methodologies and strategies for enhanced active mobility with a case study in Trondheim city. The results are presented from three perspectives: active mobility obstacles in the Elgeseter district, active mobility drivers in the Elgeseter district, and viable solutions as perceived from the perspectives of experts and non-expert citizens. Based on the findings, comprehensive planning procedures covering everything from land use to municipal infrastructure design will be required. Such techniques are required to persuade people to use green, sustainable modes of transportation as a lifestyle choice rather than a legal requirement and involving citizens in project development at an early stage can be extremely effective in this regard. The study contributes to our understanding of the factors influencing commuters’ desire to engage in early phase of mobility related projects.

Industry 4.0: Makes Manufacturing Factory Smatter

The purpose of this article is to present an overview of industry 4.0. The goal of this presentation is to give a brief perspective of what Industry 4.0 is, its challenges in today’s manufacturing environments. Many researchers have mentioned that implementing industry 4.0 is a response to the current challenges in fast changing environments. In this paper, I have provided a comprehensive introduction and definition about this Industry 4.0 concept, transformation steps and explain the technologies involved in Industry 4.0 ecosystem. After that, I have presented several points about challenges and issues of Industry 4.0, then the most relevant and potential benefits of this new industrial paradigm. Lastly, I have ended this presentation by drawing a conclusion. The successful path to smatter Industry 4.0 depends on having a vision and enterprise-wide strategy, rather than taking a piecemeal approach to implementing technology solutions. Focus on business drivers, tech enablers that overcome pain points, and working with the right partner ecosystem to accelerate sustainable transformation for greater business value and opportunity outcomes. Now in competitive market, it is more likely a company will be more profitable and create jobs when it produces products with higher flexibility, quality and technology content and applying Industry 4.0 than by competing on low-price products. In addition, companies can take advantage of the broad range of aspects of Industry 4.0, including smart products, smart assets, and optimized factories operating sustainably and creating optimal conditions for empowered workers. Manufacturing organizations need an enterprise-wide strategy to gain the full business value of Industry 4.0, including productivity, sustainability, and competitive edge. A smatter Industry 4.0 approach helps organizations overcome the challenges they currently face, and it also enables them to become future-ready to build anything, anytime, anywhere. The goal of Industry 4.0 implement is to enable autonomous decision-making processes, monitor assets and processes in real-time, maintaining improved quality and enable equally real-time connected value creation networks through early involvement of stakeholders, and vertical and horizontal integration.

FAMILY CAREGIVER COMFORT WITH TELEHEALTH TECHNOLOGIES: DIFFERENCES BY RACE/ETHNICITY IN A CROSS SECTIONAL SURVEY

Abstract Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of US family caregivers to understand the level of comfort using telehealth technologies among family caregivers through a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. A total of 340 caregivers were included in the analysis. Compared to Non-Hispanic White caregivers, Asian caregivers had a higher odds (OR 3.14; 95%CI 1.36, 8.02; p=0.01) of expressing comfort using computers; Black caregivers (OR 0.46; 95%CI 0.21, 0.98; p=0.04) and Hispanic caregivers (OR 0.36; 95%CI 0.17, 0.79 p=0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had a higher odds (OR 4.64; 95%CI 2.05, 11.69; p=0.001) of expressing comfort using tablets. : There are identified disparities in level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies and culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.

A conceptual framework of decentralized blockchain integrated system based on building information modeling to steering digital administration of disputes in the IPD contracts

PurposeIn the construction industry, various parties are involved in a project. Consequently, claims and disputes are inevitable in this industry. This paper aims to develop Integrated project delivery (IPD) practices including early involvement of stakeholders and multiparty contracts which its combination with advanced technologies such as blockchain can lead to better dispute management and improve the whole construction process.Design/methodology/approachBased on literature review, the alternative dispute resolution (ADR) for IPD contacts were identified, and three formats of IPD contracts were selected, and the dispute resolution process of them has been analyzed. Then, based on blockchain review, a conceptual blockchain-based dispute management (BDM) model was generated for ADR in IPD. Model validation was done by an interview. Experts were asked to compare the BDM model with the traditional system regarding the ADR duration.FindingsAnalyses of the collected data from the experts demonstrated that the BDM model has better function in terms of time and cost for ADR process when the project is facing serious and considerable number of disputes. The relation between blockchain technology (BCT) and building information modeling (BIM) has been examined through a framework, and the ability of the proposed model for administrating dispute resolution process has been verified using four different scenarios of construction claims that show the system can run successfully.OriginalityThe current study proposes a truthful model, reliable framework to address the problem of project dispute management in IPD contracts. The system combines the ability to being unchangeable and the reliability characteristics of BCT with informative and automation aspects of BIM together to improve dispute resolution issue in the IPD system.

Family Caregiver Comfort with Telehealth Technologies: Differences by Race and Ethnicity in a Cross-Sectional Survey.

Background: Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. Methods: A secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. Results: A total of 340 caregivers were included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.36, 8.02; p = 0.01) of expressing comfort using computers; black caregivers (OR 0.46; 95% CI 0.21, 0.98; p = 0.04) and Hispanic caregivers (OR 0.36; 95% CI 0.17, 0.79; p = 0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64; 95% CI 2.05, 11.69; p = 0.001) of expressing comfort using tablets. Conclusion and Implications: There are identified disparities in the level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies, culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.

The client's essential stakeholder collaboration activities at the front-end phase of a hospital construction project

PurposeThe research problem in this study is how a client (as a project owner) should organise early stakeholder involvement and integration in the front-end phase of a project. This study aims to create normative managerial statements as propositions from the client's perspective and to combine them into a set of activities enabling efficient organisation in the front-end phase of a hospital construction project.Design/methodology/approachAction design research (ADR) was carried out in a large hospital construction project where the first author acted as an “involved researcher” and the other authors acted as “outside researchers”.FindingsThe authors created seven normative managerial propositions that were verified by the case project stakeholders and developed a managerial framework describing the client's essential stakeholder involvement and integration activities in the front-end phase of a hospital construction project based on these propositions. The authors have also depicted the subphases of the front-end phase: value definition phase in the client permanent organisation, value proposition phase in the client Programme Management Office (PMO) and finally development phase in the alliance organisation ending on the final investment decision.Practical implicationsThe collaborative contract delivery model enables the early involvement and integration of stakeholders. It has been somewhat surprising to note the extent to which collaborative contracts change the client role in the project front-end. The results offer practical activities for how clients can manage front-end activities in collaborative contracts.Originality/valueThe case project offered a platform to analyse how the collaborative contract delivery model changes the emphasis of activities in the front-end of a project. One of the key benefits of collaborative contracts is that development, design and delivery occur partially in parallel, thereby enabling contributions from production to be included in the design and development. The benefit of having a real-life case under study provides the possibility to triangulate and analyse rich data, however limited by the qualitative case method.

GITHUB FOR PRODUCT DEVELOPMENT - HOW COULD THAT LOOK LIKE?

AbstractProduct development is facing new challenges due to increasingly complex and individualized products in small batch sizes and short time to markets at high quality standards. Integrated product data management along with systematic requirements engineering and early stakeholder involvement are known to be key enablers for the success of future product development. In software development, established platforms such as GitHub exist, which have been shown to improve stakeholder communication, requirements elicitation, and software design decisions. In product development, similar platforms exist with impressive functionality, but which have some drawbacks such as closed source licenses, vendor-specific data formats, and expert-level user interfaces. To overcome the current situation, we study how the ideas of GitHub can be translated to an open source solution for product development and which concepts can be reused or must be changed. Core deliverables of our work are (1) an integrated data model of requirements (or design tasks), project schedules, and revisions of computer-aided design (CAD) models as well as (2) an interface model.

Establishing a new housing cooperative sustainable accounting standard as a tool for increasing the sustainable refurbishment practices

A sustainable refurbishment is an important approach toward reaching the EU’s climate goals. Some challenges of transforming housing areas are few high-quality standards, lack of funding, and low residential interest. This paper aims to present the process of establishing the Sustainable Accounting Standard (SAS) project, led by the Housing Federation of Norway (NBBL), representing 41 cooperative housing associations with 1,186,000 members. Therefore, a need to develop a standardized process for evaluating the possibilities of sustainable refurbishment is in focus. A triangulating combination of literature review, survey, and interview is chosen. The literature review forms a theoretical basis within the field. The design and experiences of SAS are reflected through interviews with project participants from cooperative housing associations and a survey of residential board members from selected pilot projects. The project presents the findings from developing the SAS tool and various stakeholders. The SAS tool forms an improved process for sustainable development in housing co-operatives, addressing all aspects of sustainability, the early involvement of stakeholders, and the importance of residents’ participation. The SAS contributes to a smoother refurbishment process by properly prioritizing improved measures.

Delivery planning as a method to increase control over design costs

Delivery planning is a method that determines which deliveries are expected to be delivered at any given time, and the dependency between different deliveries and stakeholders. This study aims to investigate whether the use of the delivery plan increases control over projects’ design costs and how Key Performance Indicators (KPIs) are being used to increase the control over the project's design costs. It also identifies the benefits and disadvantages of early involvement of stakeholders in the planning process. The research is a qualitative case study with Livsvitenskapsbygget (LVB) project as the primary case. Supplementary data are collected through interviews from four Norwegian projects and one Dutch project. This study is limited to large construction projects and does not cover other types of projects.The study has documented results that indicate that delivery planning increases control over a project's design costs. The results show that using delivery planning reduces the need for iterations and increases predictability. Similarly, the proactive use of KPIs in delivery planning is found to be beneficial in controlling project design costs. Furthermore, the study identifies the benefits and disadvantages of early-stage broad involvement of stakeholders in the design phase. The researchers underline the need for further research in this area, as it indicates that it will have a positive impact on the productivity of the construction industry.

Sustainable accounting standard for increasing sustainable refurbishment projects

A sustainable refurbishment is a fundamental approach toward reaching the EU’s climate goals. Some challenges to rehabilitating existing housing areas are few high-quality standards, lack of funding, and low residential interest. This paper aims to present the findings from the development of a SAS – Sustainable Accounting Standard tool from different stakeholders’ perspectives and information from the testing period. A triangulating combination of literature review, survey, and interview are chosen. The literature review forms a theoretical basis within the field. Experiences with the SAS tool are retrieved through semi-structured in-depth interviews with project participants from co-operative housing associations and a survey for residential board members from selected pilot projects. The SAS tool forms an improved process for sustainable development in housing co-operatives, addressing all aspects of sustainability, early involvement of stakeholders, and the importance of residents’ participation. The project shows that the equal involvement of stakeholders is essential to reaching the goal and that commitment, trust, communication, and knowledge sharing are the basis. The established KPIs are good indicators for condition analysis and ambition plans. The SAS tool can contribute to a smoother refurbishment process with proper prioritization of improved measures.

Alignment of Construction Procurement Strategies for the Effective Implementation of BIM in the UAE

The effective diffusion of Building Information Modelling (BIM) presents strong potential to evolve the productivity and performance of the construction industry. Implementing BIM effectively requires significant changes in the construction business practices to improve communication, collaboration and sharing information among team members in design, construction and operating phases. The aim of this paper is to investigate the required reformation of current procurement methods in the UAE to enable the effective diffusion of BIM. The paper will present a conceptual framework which illustrates the needed changes in procurement methods being change in the relationship among participants, change in the contractual agreements, sharing the risks and rewards among stakeholders, early involvement of stakeholders, and involvement of new participants. The paper will report the findings of the analysis of four case studies of companies with vast experience in projects that adopted BIM and how it has impacted the procurement approaches adopted. The research findings have articulated that in order to implement BIM process effectively, it is critical for the UAE construction industry to adopt more collaborative relationships and share the risks and rewards among the participants. The findings show that the most important requisite change is for the key players at design stage to collaborate to create an effective BIM model that will save time and cost. Furthermore, contracts should oblige the participants to adopt BIM, identify the level of development in each stage and determine the responsibilities and intellectual property rights of each stakeholder.

General practitioner perspectives on factors that influence implementation of secondary care-initiated treatment in primary care: Exploring implementation beyond the context of a clinical trial.

The Beta-blockers Or Placebo for Primary Prophylaxis of oesophageal varices (BOPPP) trial is a 3-year phase IV, multi-centre clinical trial of investigational medicinal product (CTIMP) that aims to determine the effectiveness of carvedilol in the prevention of variceal bleeding for small oesophageal varices in patients with cirrhosis. Early engagement of General Practitioners (GPs) in conversations about delivery of a potentially effective secondary care-initiated treatment in primary care provides insights for future implementation. The aim of this study was to understand the implementation of trial findings by exploring i) GP perspectives on factors that influence implementation beyond the context of the trial and ii) how dose titration and ongoing treatment with carvedilol is best delivered in primary care. This qualitative study was embedded within the BOPPP trial and was conducted alongside site opening. GP participants were purposively sampled and recruited from ten Clinical Commissioning Groups in England and three Health Boards across Wales. Semi-structured telephone individual interviews were conducted with GPs (n = 23) working in England and Wales. Data were analysed using reflexive thematic analysis. Five overarching themes were identified: i) primary care is best placed for oversight, ii) a shared approach led by secondary care, iii) empower the patient to take responsibility, iv) the need to go above and beyond and v) develop practice guidance. The focus on prevention, attention to holistic care, and existing and often long-standing relationships with patients provides an impetus for GP oversight. GPs spoke about the value of partnership working with secondary care and of prioritising patient-centred care and involving patients in taking responsibility for their own health. An agreed pathway of care, clear communication, and specific, accessible guidance on how to implement the proposed treatment strategy safely and effectively are important determinants in the success of implementation. Our findings for implementing secondary care-initiated treatment in primary care are important to the specifics of the BOPPP trial but can also go some way in informing wider learning for other trials where work is shared across the primary-secondary care interface, and where findings will impact the primary care workload. We propose a systems research perspective for addressing implementation of CTIMP findings at the outset of research. The value of early stakeholder involvement is highlighted, and the need to consider complexity in terms of the interaction between the intervention and the context in which it is implemented is acknowledged. ISRCTN10324656.

Enabling AI and Robotic Coaches for Physical Rehabilitation Therapy: Iterative Design and Evaluation with Therapists and Post-stroke Survivors

Artificial intelligence (AI) and robotic coaches promise the improved engagement of patients on rehabilitation exercises through social interaction. While previous work explored the potential of automatically monitoring exercises for AI and robotic coaches, the deployment of these systems remains a challenge. Previous work described the lack of involving stakeholders to design such functionalities as one of the major causes. In this paper, we present our efforts on eliciting the detailed design specifications on how AI and robotic coaches could interact with and guide patient’s exercises in an effective and acceptable way with four therapists and five post-stroke survivors. Through iterative questionnaires and interviews, we found that both post-stroke survivors and therapists appreciated the potential benefits of AI and robotic coaches to achieve more systematic management and improve their self-efficacy and motivation on rehabilitation therapy. In addition, our evaluation sheds light on several practical concerns (e.g. a possible difficulty with the interaction for people with cognitive impairment, system failures, etc.). We discuss the value of early involvement of stakeholders and interactive techniques that complement system failures, but also support a personalized therapy session for the better deployment of AI and robotic exercise coaches.

Influencing discussions and use of neuroadvancements as professionals and citizens: Perspectives of Canadian speech-language pathologists and audiologists.

Early involvement of stakeholders in neuroethics and neurogovernance discourses of neuroscientific and neurotechnological advancements is seen as essential to curtail negative consequences. Speech-language pathologists (SLPs) and audiologists (AUs) make use of neuroadvancements including cochlear implants, brain-computer interfaces, and deep-brain stimulation. Although they have a stake in neuroethics and neurogovernance discussions, they are rarely mentioned in having a role, whether as professionals or as citizens. The objective of the study was to explore the role of SLPs and AUs as professionals and citizens in neuroethics and neurogovernance discussions and examine the utility of lifelong learning mechanisms to learn about the implications of neuroadvancements to contribute in a meaningful way to these discussions. Semi-structured interviews conducted with 7 SLPs and 3 AUs were analyzed using thematic analysis. Participants stated that their roles expected from them as professionals and as citizens indicate the importance to be knowledgeable on ethical, legal, and social implications of neuroadvancements and that lifelong learning is not used to learn about these implications. More must be done to facilitate the participation of SLPs and AUs in neuroethics and neurogovernance discussions, which would enrich the neuroethics and neurogovernance discourses benefitting patients, professionals, and the public.

Participatory and Integrated Modelling under Contentious Water Use in Semiarid Basins

Addressing modern water management challenges requires the integration of physical, environmental and socio-economic aspects, including diverse stakeholders’ values, interests and goals. Early stakeholder involvement increases the likelihood of acceptance and legitimacy of potential solutions to these challenges. Participatory modelling allows stakeholders to co-design solutions, thus facilitating knowledge co-construction/social learning. In this work, we combine integrated modelling and participatory modelling to develop and deploy a digital platform supporting decision-making for water management in a semiarid basin under contentious water use. The purpose of this tool is exploring “on-the-fly” alternative water management strategies and potential policy pathways with stakeholders. We first co-designed specific water management strategies/impact indicators and collected local knowledge about farmers’ behaviour regarding groundwater regulation. Second, we coupled a node–link water balance model, a groundwater model and an agent-based model in a digital platform (SimCopiapo) for scenario exploration. This was done with constant input from key stakeholders through a participatory process. Our results suggest that reductions of groundwater demand (40%) alone are not sufficient to capture stakeholders’ interests and steer the system towards sustainable water use, and thus a portfolio of management strategies including exchanges of water rights, improvements to hydraulic infrastructure and robust enforcement policies is required. The establishment of an efficient enforcement policy to monitor compliance on caps imposed on groundwater use and sanction those breaching this regulation is required to trigger the minimum momentum for policy acceptance. Finally, the participatory modelling process led to the definition of a diverse collection of strategies/impact indicators, which are reflections of the stakeholders’ interests. This indicates that not only the final product—i.e., SimCopiapo—is of value but also the process leading to its creation.

Implementation and sustainability of an enhanced recovery pathway in pediatric bladder reconstruction: Flexibility, commitment, teamwork

Although enhanced recovery pathways (ERP) provide a safe and effective way to improve the recovery of children undergoing bladder reconstruction, ERPs have not been widely adopted in pediatric urology. We describe a quality improvement initiative and outcomes after implementing a 24-element ERP at a single, freestanding children's hospital. Multiple stakeholder meetings were planned and executed, initially with pediatric practitioners with ERP experience to understand potential implementation barriers then with anesthesiologists, nurses, case managers, and other ancillary staff to draft our institution-specific ERP. A standardized order set was generated to improve ERP adherence. ERP adherence audits and cyclic performance evaluations held every 6-9 months facilitated continuous pathway refinement. Patient outcomes were compared with a pre-ERP historic cohort. Time from initial ERP planning to first implementation was 7 months. ERP was implemented in twenty consecutive patients undergoing bladder reconstruction (median age 11.3 years, range 4.1-21.1) who were compared to twenty consecutive pre-ERP patients (median age 11.4 years, range 7.7-25.1). Median post-operative length of stay (LOS) significantly decreased from 9 days (range 2-31) pre-ERP to 4 days (range 3-29) post-ERP (p<0.05). A median of 16 (range 12-19) of 24 institutional pathway elements were implemented for each patient. Balancing measures showed no significant increases in highest Clavien complication grade, readmission rate, or unplanned return to the operating room within 30 post-operative days. Implementation of ERP is feasible but requires commitment from multi-disciplinary stakeholders. While we were unable to consistently achieve 80% of the elements, we successfully implemented the pathway and improved our patients' recovery processes (indirectly reflected by a decreased post-operative LOS) with adherence to a median of 67% of elements. Our implementation and effectiveness results are specific to our center and may not be generalizable. However, our experience may offer some insight for others interested in ERP implementation and encourage initiation of their own institutional pathways. Successful ERP implementation at our hospital for children undergoing bladder reconstruction was facilitated by open communication, early stakeholder involvement, and monitoring ERP adherence. ERP implementation significantly decreased LOS without increasing post-operative complications and readmissions (Summary figure).

Drought Early Warning in Agri-Food Systems

Droughts will increase in frequency, intensity, duration, and spread under climate change. Drought affects numerous sectors in society and the natural environment, including short-term reduced crop production, social conflict over water allocation, severe outmigration, and eventual famine. Early action can prevent escalation of impacts, requiring drought early warning systems (DEWSs) that give current assessments and sufficient notice for active risk management. While most droughts are relatively slow in onset, often resulting in late responses, flash droughts are becoming more frequent, and their sudden onset poses challenging demands on DEWSs for timely communication. We examine several DEWSs at global, regional, and national scales, with a special emphasis on agri-food systems. Many of these have been successful, such as some of the responses to 2015–2017 droughts in Africa and Latin America. Successful examples show that early involvement of stakeholders, from DEWS development to implementation, is crucial. In addition, regional and global cooperation can cross-fertilize with new ideas, reduce reaction time, and raise efficiency. Broadening partnerships also includes recruiting citizen science and including seemingly subjective indigenous knowledge that can improve monitoring, data collection, and uptake of response measures. More precise and more useful DEWSs in agri-food systems will prove even more cost-effective in averting the need for emergency responses, improving global food security.