Board Of Directors Research Articles

A Comparative Analysis of Board Qualities and Performance of Listed Deposit Money Banks in Nigeria and Ghana

Disclosure of board information is crucial for good governance, risk management, and stakeholder relations in the banking sector. The board of directors’ quality is crucial in setting strategic direction and ensuring effective governance. This study comparatively examined the qualities of the board of directors of listed deposit banks in Nigeria and Ghana and assessed the effects of the board qualities on the financial performance of banks in the two countries. The study used an ex post facto research design, involving 19 deposit money banks listed on the Nigerian Exchange Limited and Ghanaian Stock Exchange. Data was collected from audited annual reports and analyzed using descriptive and inferential statistics. The descriptive analysis includes mean, median mode, minimum, and maximum among others while the inferential analysis includes independent t-tests and panel regression. The study reveals that the board of listed deposit money banks in the Nigerian exchange group meets more frequently and is more independent than those in the Ghanaian stock exchange, and their board size is larger than in Ghana. Board female gender diversity of listed deposit money banks on the Nigerian exchange group is not significantly lower than the board female gender diversity of firms listed on the Ghanaian stock exchange. The study reveals that board gender diversity doesn’t significantly impact the financial performance of listed deposit money banks in Nigeria and Ghana. However, board independence has a negative effect in Nigeria, while board meetings negatively affect performance in Nigeria. Board size also has a positive effect in Nigeria. The study recommends that directors of listed banks in Nigeria should reduce the number of their meetings or expenses of the meeting because it is reducing the profitability of the companies. The study also recommends that the banks in Ghana should provide regular training for independent directors to enhance their understanding of the industry.

Climate change on the board: navigating directors’ duties

ABSTRACT A noteworthy trend within the surge in corporate climate litigation is the increasing focus on personal responsibility of corporate directors. In 2023, ClientEarth commenced a derivative claim against Shell and its directors in the English courts, arguing that those directors were in breach of their directors' duties under the Companies Act 2006. This article analyses the claimant's arguments, examines the basis upon which the court dismissed the claim and identifies the procedural challenges that are likely to be faced by future claimants in commencing similar claims. In light of the rising trend in shareholder activism, coupled with the ever-increasing regulatory requirements to strengthen corporate human rights and environmental performance, the article anticipates further attempts to bring derivative claims against directors for failing to take action to address climate change risks. It provides suggestions for the sorts of arguments that may have greater prospects of succeeding before the English courts.

The Impact of Promoter on Firm Value: Evidence from Emerging Economies

Using panel regression on a sample of 1,532 firms listed on the National Stock Exchange (NSE) of India and 450 firms in the Shanghai Stock Exchange (SSE) of China, this study examines the impact of promoter ownership on firm value. We find that promoter have positive impact on firm value in China while it is inversely related to India due to the entrenchment effect or opportunistic behaviour of the promoter. We provide evidence that the opportunistic behaviour of the promoter can be reduced only through monitoring by the corporate governance mechanisms such as board of directors. We contribute to the existing literature on corporate governance and corporate finance by examining the link between promoter ownership and firm value. Our results help the regulators and policy makers to formulate a regulation that reduces the opportunistic behaviour of promoters.

Exploring the synergy of corporate gender diversity, sustainability committee, and reporting ESG practices: An international evidence

This study delves into how gender diversity on the corporate board shapes the reporting of Environmental, Social, and Governance (ESG) practices. Besides, it examines the moderating role of a sustainability committee in the nexus between gender diversity and reporting of ESG practices. It analyzes an international sample of the S&P Global 1200 index from 2011 to 2022. The ESG reporting is based on the Refinitiv disclosure index of the firm ESG scores. The study utilizes various statistical models to provide precise empirical evidence, including fixed effects, a two-stage least squares (2SLS), and a generalized method of moments (GMM). The results demonstrate that disclosing ESG practices is a positive function of the percentages of corporate female board members and executive female directors. This suggests that companies with greater gender diversity disseminate more information about their ESG practices. Besides, a corporate sustainability committee strengthens the positive nexus between reporting ESG performance and corporate female board members and executive female directors. This underscores the moderating role of the sustainability committee in simplifying the nexus between gender diversity and reporting ESG practices. The results offer substantial implications for the leverage of gender diversity on ESG reporting. Policy-setters should actively support and promote greater corporate gender diversity, recognizing its pivotal role in fostering transparency. Additionally, a dedicated sustainability committee is crucial in enhancing the reporting of ESG performance and aligning business practices with sustainable development goals.

Veeraswamy Seshiah: Father of Gestational Diabetes in India

Professor Dr. V. Seshiah, MD, FRCP, DSc, (Hony), is a distinguished professor at Tamil Nadu's Dr. MGR Medical University and established the First Department of Diabetology in India at Madras Medical College in 1978. He was the patron of the Research Society for the Study of Diabetes in India and the founder patron of the Diabetes in Pregnancy Study Group, India (DIPSI). Additionally, he served as the Vice-Chair of the Executive Board of the International Association of Diabetes and Pregnancy Study Group. Dr. V Balaji and Dr. V Seshiah Diabetes Care Center & Research Institute, which he founded, received the Army Decorations "SAMAR SEVA STAR" and "SAINYA SEVA MEDAL" in 1965 with clasp HIMALAYAS. Dr. Seshiah was also the recipient of the DR. B.C.ROY National Award was given in 1988 for developing diabetology as the Indian College of Physicians provided a specialty in the country and the Master Teacher Award. Moreover, he was honored with the Lifetime Achievement Award by the International Diabetes Federation in 2017, being the first Indian to receive this award. In 2022, the President of India, Mr. Kovind, presented the Padma Shri to Dr. Veeraswamy Seshiah for Medicine.

Parenting behaviour and student discipline in public boarding secondary schools in Western region of Kenya

Discipline in schools is an issue that especially concerns educators, parents, and other stakeholders. In an environment that lacks order and discipline, it is impossible for students to learn effectively. Thus, order and discipline are indispensable for achieving positive educational results. The family assumes a pivotal role in shaping the early years of an individual. The purpose of this research was to investigate the influence of parenting behaviour on student discipline in public boarding secondary schools in Western region of Kenya. Family composition and structural-functionalism theories served as guiding principles for the research. The investigation was conducted using an ex post facto design. The study's target population consisted of 5583 class teachers and 369 deputy principals (administrators-in-charge) from 369 public boarding secondary institutions. The sample included 123 deputy Principals and 558 class teachers from the 123 randomly selected schools. Simple random sampling was used to select 558 class teachers while purposive sampling was used to select 123 deputy Principals. For the purpose of data collection from the participants, a questionnaire and an interview schedule were employed. The assessment of the instruments' reliability was conducted using the test-retest method, results of the pilot study reveal that all scales were trustworthy because their reliability values were more than the required threshold of 0.7. Data was analyzed using frequency, percentages, weighted averages, correlations and multi-regression analysis. The study concluded that parenting behavior influence the discipline of students in public secondary schools. Therefore, it was recommended that school management boards should organize for the sensitization meetings on effective parenting behaviour, this will enable curb indiscipline among students.

Corporate Boards and Firm Value: Evidence from Nigeria

Aim: The basis for the formation of the corporate board is to, among others, give strategic direction to the firm, monitor the activities of the salaried agents and reduce the likelihood of disincentive to investment. The aim of this study is to examine the efficacy of corporate boards in relation to the value of firms listed in Nigeria. Study Design and Methodology: It is a cross-sectional research design that empirically examined the influence of board mechanisms and Tobin’s Q of firms listed on the Nigerian Stock Exchange. The study used annual data of a panel sample of 85 firms from 2004 through 2023, It applied a Generalized Least Squares (GLS) econometric technique. Place and Duration of Study: This study examined the role of the boards of firms listed on the Nigerian Stock Exchange between 2004 and 2023. Results: The findings argued in favour of smaller boards, increased board independence and higher market capitalisation since they showed significant improvements in value of the firms in the sample. The findings imply that smaller boards that are highly independent tend to have better corporate governance and thus, superior firm value. Conclusion: In conclusion, the results advocate that the regulatory agencies and boards of the studied firms enact policies that will encourage minimum board sizes that are sufficiently independent.

Potential Conflict of Interest President Director PT Pacific Furniture from an Overseas Company at the Extraordinary General Meeting of Shareholders

Actions that contain conflicts of interest are prohibited in the limited liability company law because they have a negative impact on the company and shareholders. One of the actions that is prohibited because it has the potential to cause a conflict of interest is representing the votes of shareholders in voting at other general meetings of shareholders by members of the board of directors, members of the board of commissioners, and employees of the company. However, the managing director of PT Pacific Furniture actually carried out the act of representation on the grounds that the represented party was a company established abroad so that it was not obedient and subject to Indonesian law. In fact, the managing director of PT Pacific Furniture held multiple positions because he declared himself a legitimate representative because he was the president director of a company established abroad. This becomes a problem because whether the actions of the managing director who votes for himself and represents a company established abroad meet the qualifications of a conflict of interest and what are the legal consequences of the decision of the Other GMS which contains a conflict-of-interest Research using normative juridical methods with analytical descriptive specifications through literature study data collection techniques and qualitative normative analysis methods. The purpose of this research is to find out the qualifications of conflict of interest and its consequences on the decision of the extraordinary general meeting of shareholders containing conflict of interest so as to provide a basis for determining criteria regarding conflict of interest.

Factors influencing environmental and circular economy disclosure of Viet Nam listed companies

This study examines the environmental and circular economy disclosures (ECED) level and factors influencing this level of 32 Vietnamese listed companies from 2018 to 2022. The content and frequency analyses are performed to determine the level of ECED, and regression analysis is to investigate the influencing factors. Drawing on a sample of 160 sustainable development and annual reports following the Global Reporting Initiative frameworks (GRI), the study evidenced that 32 listed companies paid great attention to the GRI 300 category (on environment topics) with the top three GRI standards 302 (energy), 307 (environmental compliance), and 303 (water and effluents), respectively. In addition, the Feasible Generalized Least Square method results showed that the companies with government ownership and Big4 audit services had a higher level of ECED. In comparison, larger companies had a lower disclosure level. Meanwhile, companies in the manufacturing sector with foreign shares and the independence of the Board of Directors did not affect the disclosure information disclosure level in the studied sample.

Gender Distribution of Editorial Board Members in Palliative Care Journals: Assessment of Gender Parity.

Objective: Although the representation of women in palliative care has improved in recent years, gender inequality still exists in editorial leadership. This study aimed to characterize gender distribution in leadership positions on the editorial boards of palliative care journals. Methods: This cross-sectional study analyzed the gender composition of editorial boards for palliative care journals indexed in the Web of Science (WoS) and the factors that affect this composition. Information on the gender of editorial board members was obtained from each journal's website. Results: A total of 1388 editorial board members from 28 palliative care journals were included in the analysis. The data analysis showed that 540 (38.9%) of the editorial board members were women, while 848 (61.1%) were men. Of the 31 editors-in-chief, only 11 (35.5%) were women. Editorial boards of journals classified as social work (OR, 5.92, 95% CI, 2.29-15.30, p < 0.001) and nursing (OR, 4.20, 95% CI, 1.73-10.17, p = 0.001) in WoS coverage were independently associated with gender diversity. There were differences in gender representation between the editorial boards of palliative care journals published in New Zealand (OR, 0.49, 95% CI, 0.29-0.80, p = 0.005), Japan (OR, 0.17, 95% CI, 0.08-0.32, p < 0.001), and those categorized under oncology in WoS coverage (OR, 0.64, 95% CI, 0.05-0.89, p = 0.009). Conclusions: Our findings demonstrated that women are underrepresented among editorial board members of palliative care journals. Additional efforts are required to broaden diversity policies in palliative care.

Corporate Governance, Industry Regulation and Efficiency of Retirement Benefit Schemes in Kenya

The significance of retirement benefits arrangements has emerged in the wake of the waning traditional methods of caring for the elderly and the expected surge in the aging population, especially in developing economies. Despite the key role that retirement benefit arrangements play, there has been limited research on how corporate governance and industry regulation influence their efficiency. This study sets out to investigate the relationships among corporate governance, industry regulation and efficiency of retirement benefit schemes in Kenya. The study is grounded in several theoretical frameworks, including agency theory, stewardship theory, and financial distress theory. The study employs a quantitative research design, utilizing panel regression analysis to test the hypotheses. Data was collected from 896 observations across 128 retirement benefit schemes in Kenya, covering a seven-year period from 2015 to 2021. The results reveal that employee representatives on the board significantly and positively influence the efficiency of these schemes. Conversely, independent board members are found to have a negative effect on efficiency, suggesting potential challenges such as conflicts or slower decision-making processes. The study concludes that while corporate governance and industry regulation play significant roles in influencing the efficiency of retirement benefit schemes, their effects are interdependent and context specific. This study contributes to agency theory by providing empirical evidence that highlights the complexities of board composition in aligning the interests of managers and stakeholders within retirement benefit value-chain. The study reflects the importance of stakeholder-inclusive governance, particularly employee representation, as a means of aligning interests and enhancing organizational efficiency.

The Role Of Emotional Intelligence in The Board Of Directors and Its Impact On The Performance and Value Of Institutions and Conservative Practices In Light Of Crises (Applied Research On a Sample Of Banks Listed On ISX)

This research aims to underscore the significance of women's emotional intelligence in enhancing the effectiveness of the Board of Directors, a crucial component of internal governance, particularly during crises. Despite strides made in recent decades in appointing women to senior roles in government, business, and education, challenges persist in improving women's leadership opportunities, especially in developing countries. The study utilizes statistical methods, including Pearson's correlation, to analyze the relationships between variables within a sample of banks listed on the Iraqi securities market, comparing periods before and during the COVID-19 pandemic (2019 and 2020). The goal is to measure the impact of female emotional intelligence on the Board of Directors' ability to manage crises, focusing on variables such as conservative accounting policies, Board compensation and benefits, meeting frequency, the ratio of external auditor fees to enterprise capital, enterprise capital, share profitability, and the market-to-share profitability ratio. Findings indicate that emotional intelligence (measured by the number of females on the Board) positively influences conservative accounting policies and meeting frequency during crisis periods. Conversely, the pre-crisis period showed a negative relationship, suggesting a proactive and risk-responsive stance by women during crisis. Additionally, the study observed an inverse relationship between crisis periods and both Board compensation and external auditor fee ratios, implying a cost-reduction strategy facilitated by female emotional intelligence. The crisis period also saw an increase in the profitability of individual shares and the market-to-share profitability ratio. The research recommends expanding the study to compare the role of emotional intelligence in Boards between developing and developed economies.

Temporal and geogrpahic trends in female representation within European cardiovascular imaging among 13,436 individuals associated with EACVI

Abstract Introduction Women are under-represented in cardiology trial enrolment, specialty training, faculty, scientific authorship and board membership in cardiology journals and societies. An EACVI Task Force on Women in Cardiovascular Imaging aims to promote women’s representation and leadership, but data is lacking in this area. Purpose To characterise the representation of women in cardiovascular imaging within Europe and examine temporal and geographic trends. Methods We scraped publicly available name data from over 100 online sources including EACVI taskforces, committees, research project members, consensus and position paper authors, board membership and past presidents alongside members of affiliated cardiovascular imaging national societies and working groups. We also included names from EACVI or national accreditation records for cardiac imaging. We recorded data on country location and year of affiliation. We defined gender in a binary manner as either male or female. The previously validated artificial intelligence (AI) system Namsor assigned gender based on name morphology and geolocation data. We pre-set a confidence of gender-name matching of 95%. Results The AI was able to assign gender at 95% confidence to 12,643/13,436 (94.1%) names. The overall number of names assigned female gender was 5903/12643 (46.7%), rejecting the null hypothesis that gender was equally distributed (i.e. 50% female) [p&amp;lt;0.0001]. Among the 9712 individuals with year of affiliation we observed female representation to increase over time: 1989-2000 4/18 (22.2%), 2001-2004 107/287 (37.8%) 2005-2009 77/170 (45.3%), 2010-2014 109/203 (53.7%), 2015-2019 1063/2022 (51.3%) and 2020-2024 3352/3064 (52.2%) (Cochran-Armitage trend test 24.196 [p&amp;lt;0.0001]) (Figure 1). Female representation was lower in countries outside of Europe, compared to within Europe; 740/2654 (27.9%) vs. 5163/9989 (51.7%) [p&amp;lt;0.0001]. The lowest rate of female representation was in Saudia Arabia (15.1%), the highest in Lithuania (83.3%). Figure 2 displays a choropleth of gender representation (%) between European countries with n&amp;gt;20. Conclusion(s) There are significant limitations in this form of analysis, including that we have arbritarily defined gender in a binary format, thereby excluding individuals who do not identify with such a social construct. It is also likely that the excluded names based on the 95% confidence of the AI software disproportionately represents individuals from ethnic minorities. However, our data provides a basic understanding of the representation of women in European cardiovascular imaging over time and between countries. We observed a trend of increasing female participation but with substantial variation between countries both inside and outside of Europe. This data may be useful to refine and direct efforts to improve female representation in areas in which it is needed most.

Board of Directors

No abstract available.

Prevention of sexual exploitation of children in sport clubs and social work in Switzerland

Abstract The Convention on the Rights of the Child, ratified in 1989, provides a clear normative basis for the protection of children from violence, abuse and exploitation. Despite efforts to protect children, many children and young people are victims of sexual violence. In the extracurricular sector, clubs offer great potential for preventing sexual exploitation. However, obstacles such as the taboo nature of the topic and the clubs’ limited resources make it difficult to develop and independently implement specific prevention offers. The aim of the project was to record the activities and competencies of sports clubs, youth associations and other youth organizations in the area of prevention of sexual assault among children and adolescents in the leisure sector and to determine the need for prevention services in the canton of Zurich in Switzerland. In addition, information was obtained on the impact of existing prevention services as well as information on their further development in terms of content and organization. Together, 979 participants from sports clubs, youth associations and youth organizations (e.g. board members, coaches, leaders) as well as the parents of children who are members of these clubs were surveyed. An impact model was developed for systematic modeling, as proposed by “Health Promotion Switzerland”. The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. However, the current implementation of prevention measures also shows that there are still barriers to implementation and room for improvement in prevention work. Participants from all areas would particularly like support with advice on how to deal with suspected cases/incidents, the provision of information materials and the creation of a protection concept. Specific ideas for the further development of prevention work were also generated and will be discussed. Key messages • The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. • The study reveals that prevention measures are only partially implemented and identifies barriers and facilitators for improvement.

A methodology to map chains of general practices in the Netherlands

Abstract Background Commercial entities are increasingly interested in acquiring Dutch general practices (GPs). They see profitable opportunities in upscaling by forming chains. Chain organizations integrate business processes of GPs within one organizational unit. The governance structure of these chains can be complex, leading to opacity and difficulties to see conflicts of interest and market power. To investigate how this development may have an impact on quality and accessibility of care, it is first needed to establish the ways in which these chains are formed. By mapping the chain structure in a data-driven way, impact monitoring becomes possible. For the Netherlands we investigated how chain structures of GPs can be empirically identified. Methods Background data of approximately 4,800 Dutch GPs from the Nivel Healthcare Professional Registries was linked with data from the Chamber of Commerce’s Trade Register. This enabled the determination of the legal form, business location, ownership, and director identification for all GPs. By this data-driven manner, the variation in organizational structures of all Dutch GPs was mapped and analyzed. Results Four different chain variants of Dutch GP chains were identified based on three types of relations between the chain organization and their GPs: ownership, location and the composition of the board of directors. Based on ownership, two ‘top-down’ chain variants were identified. Two ‘bottom-up’ chain variants were found based on location and board composition: (1) a chain organization acquires a seat on the board of the GP, and (2) the GP and the chain organization share the same business address. Combining these variants provides a new typology of GP chains in the Netherlands. Conclusions Our methodology enables to empirically map chain formation in primary care. By developing a new typology in a systematic way, a foundation is created to monitor organizational developments and their impact on quality and accessibility of care. Key messages • A typology of Dutch GP chains was developed based on three relations: the ownership, composition of the board and the establishment location of the chain organization and its practices. • Our methodology was put into practice to map different chain structures of GPs in the Netherlands, but it is not limited to primary care and can also be applied in other sectors and countries.

Board Characteristics and Internal Control Risk Management in Urban Investment Companies: A Case Study of Guangxi Urban Investment Group

This study explores the relationship between board characteristics and internal control effectiveness and risk management practices in Chinese urban investment companies. Using a mixed research method combining questionnaire surveys and case studies, an empirical study was conducted on 104 urban investment companies, with the Guangxi Urban Investment Group as a case study. The study found that board characteristics are significantly and positively correlated with internal control effectiveness and risk management practices. Among these, the impact of board expertise is the most significant, followed by board independence and diversity. Board size is positively correlated with internal control effectiveness, but has no significant relationship with risk management practices. The study also found that company size has a moderating effect on the relationship between board characteristics and governance practices. This study provides theoretical and practical guidance for the corporate governance of urban investment companies, emphasizing the importance of improving the professionalism, independence and diversity of the board of directors. The study suggests that urban investment companies should adjust the composition of the board of directors according to their size and complexity, and adopt a comprehensive governance framework to integrate internal control and risk management practices. Future research can further explore the relationship between board characteristics, governance practices and company performance, as well as the impact of emerging technologies on the governance requirements of urban investment companies.

Business groups and firm-specific characteristics: influences on entrepreneurial orientation

PurposeThe purpose of this study is to investigate the impact of business group (BG) affiliation on affiliated firms' entrepreneurial orientation (EO). The authors further investigate the possible contingent factors affecting this relationship – the age of BGs and the affiliated firm’s external linkages (ratio of external to in-house interlocks) on the relationship in an emerging market context.Design/methodology/approachThe study employs a dynamic panel data framework using the system-generalized method of moments (Sys-GMM) on a sample of 670 NSE-listed Indian firms during the 2006–2019 period. EO is measured through content analysis of the letters to shareholders (LTS) issued by the companies between the period 2006 and 2019.FindingsBG affiliates have more EO than standalone firms, as affiliates can access group-wide resources and capabilities apart from firm-specific resources. Affiliates of older BG have less EO since they are more entrenched in the institutional settings of their BG. Affiliates with more external linkages of board members will have a higher level of EO, as such linkages would subside inertial tendencies by exposing them to novel sets of information, resources and strategic practices. Further, the negative effect of BG age on EO is countered by external linkages. Overall, the study shows that the effect of group affiliation is not uniform and is contingent on the factors we have theorized and tested.Originality/valueThe paper proposes the resource-based view and the institutional void theory as likely candidates for explaining the contribution of BGs towards the EO of its affiliates, especially in the context of emerging markets. The contingent role of BG age highlighted in the paper forewarns managers about the importance of establishing internal mechanisms to preserve the EO in affiliates. Our findings about the positive role played by external linkages of the board members provide one such mechanism that can be leveraged to enhance affiliated firm’s EO.

Harnessing social marketing for interdisciplinary health management: enhancing public health outcomes

Abstract Social marketing in health leverages the principles of traditional marketing to influence behaviours that benefit individuals and communities. It involves using marketing techniques to promote public health initiatives, aiming to change attitudes and behaviours towards healthier choices. By strategically framing health messages, social marketing can effectively reach diverse populations, encouraging them to adopt practices that enhance their wellbeing. This approach not only increases awareness about health issues but also empowers people to take proactive steps in managing their health, ultimately leading to improved public health outcomes. Showcasing a forward-thinking approach to public health management, this plenary session seeks to shed light on the transformative role of interdisciplinary collaboration in enhancing health outcomes. Recognising that health and wellbeing are influenced by a myriad of actors beyond the healthcare sector, there is a growing imperative to empower professionals from diverse disciplines with health management principles. By effectively ‘social marketing’ health management to those outside the traditional health sector, such as in architecture, urban planning, construction, education, transportation, and manufacturing, health-oriented decision-making can be seamlessly integrated across these fields. The session will highlight innovative approaches for engaging non-health stakeholders in decision-making processes, leveraging the expertise of health management and public health professionals. By facilitating a dialogue between health professionals and experts from other sectors, the session will explore the potential and challenges of intersectoral partnerships, and challenge policymakers, health managers, and stakeholders in the health sector to actively engage non-health professionals in their pursuit of improved health outcomes for European citizens. Case studies from across Europe where interdisciplinary collaborations have led to social programming and infrastructure developments that enhance health and wellbeing will be presented. The case study ‘Compassionate leadership’ will delve into how organisation leaders can harness their health management capacity to foster a supportive environment that prioritises wellbeing. ‘Health-centric design in public spaces’ will demonstrate the impact of designing public areas with a focus on health, showcasing how thoughtful urban planning can significantly enhance community health. The third case study, ‘Architecture for better health and healing’ will highlight the role of architectural design in promoting health and recovery, emphasising the importance of creating spaces that support healing. Finally, ‘Educating to health’ will underline the significance of educating young people to healthy habits, sustainability, and physical and mental wellbeing, illustrating how this can lead to healthier communities. By fostering broader interdisciplinary collaboration, it is possible to unlock innovative solutions to health challenges and ultimately create healthier, more resilient communities across Europe. Moderator Tiago Correia Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Portugal, and Board Member of the EHMA Speakers/Panellists Marina Macchiaiolo Rare Diseases and Medical Genetics Unit, Bambino Gesù Children’s Hospital, Italy, and President of the Italian Committee for the United World Colleges Stefano Capolongo Department of Architecture, Construction Engineering and Built Environment (ABC), Politecnico di Milano, Italy

Seeing and believing: behavioural insights from implementing an artificial intelligence-enabled stethoscope in primary care

Abstract Background • Early detection and treatment of cardiovascular disease (CVD) improves survival, quality of life and health economic outcomes (1) • Despite evidence of effectiveness, health systems fail to implement technologies for early detection of CVD sustainably, limiting their public health impact (2). This challenge may limit the full potential of artificial intelligence (AI) in healthcare (3). • An AI-enabled stethoscope can detect reduced left ventricular ejection fraction (LVEF), atrial fibrillation (AF) and structural cardiac murmurs during fifteen seconds of conventional cardiac examination (4) • The determinants of uptake, sustained use and clinical impact of implementing the AI-stethoscope in primary care are unknown. Purpose • To implement the AI-stethoscope in a UK primary care system • To measure rates of utilisation and their association with potential disease detection • To characterise the adoption patterns of an AI technology in primary care Methods • TRICORDER is a cluster randomised controlled trial and implementation study. • Clinicians in the intervention arm receive in-person training in use of the AI-stethoscope and are remunerated for this training time. • Clinicians using the AI-stethoscope in routine care are supported by a clinical guideline and data privacy approvals from the regional health service executive board. • GP practices are not remunerated for using the AI-stethoscope • Anonymised utilisation and AI disease detection rates were extracted from the manufacturer’s cloud database from 31st October 2023 to 25th February 2024. We performed linear regression to characterise use over time. Results • 59 practices were randomised and onboarded to the intervention arm between 31st October and 3rd December 2023, all using the stethoscope at least once, for a total of 1,555 unique patient examinations (3,253 total recordings), over a median of 90 days. • The mean (±SD) number of recordings per practice per week was 5.45 (±5.68). • There were 32 practices with utilisation data for at least 12 weeks. There was a weakly positive utilisation trend (r = 0.042; P= &amp;gt;0.05, Figure 1A), with no significant difference in rates of utilisation at 4, 8 and 12 weeks (Figure 1B). • There were 159 (4.88%), 89 (2.74%) and 102 (3.13%) abnormal AI flags for reduced LVEF, AF and structural murmurs, respectively. • We characterised three groups by patterns of use (Table 1). There were no significant differences between mean rates of abnormal AI findings between groups (ANOVA p = 0.43). Conclusions • Implementation of an AI-stethoscope in primary care is feasible and was associated with stable utilisation. • The proportion of abnormal AI findings are consistent with modelled detection gap of the target conditions in the UK, and would not consequentially overwhelm downstream health services. •The proportion of abnormal AI findings did not significantly differ between low and high-utilisation groups.Table 1Figure 1