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Lending Survey Results Reveal Recent and Dramatic Concern Due to Tariff Policy

Global consulting firm J.S. Held releases its proprietary “Lending Climate in America” survey results from Phoenix Management, a part of J.S. Held. The second quarter survey results highlight lenders’ views on important issues, including policy decisions along with their national and global impact. Each quarter, Phoenix Management, a part of J.S. Held, surveys lenders to identify important trends focused on the latest economic issues, business drivers, and credit trends in the current lending climate. The “Lending Climate in America” survey provides valuable information to lenders, attorneys, private equity sponsors, and the financial news media, exploring topics like: What factors do lenders see as most likely to impact the US economy in the next six months? Phoenix’s Q2 2025 “Lending Climate in America” survey asked lenders which factors could have the strongest potential to impact the economy in the upcoming six months. Sixty-seven percent of lenders are paying the most attention to the possibility of a U.S. recession, while 40% of lenders believe overall political uncertainty has the strongest potential to impact the economy. Lenders also expressed moderate concern regarding the possibility of constrained liquidity in capital markets. To see the full results of Phoenix’s “Lending Climate in America” Survey, please visit: https://www.phoenixmanagement.com/lending-survey/ What shifts do lenders observe in their customers’ hiring and capital improvement plans? Lenders revealed what actions their customers may take in the next six months. Over half of the surveyed lenders believe their customers will raise additional capital. Most telling was that lenders believe only 3% of their customers have plans to hire new employees (down from 56% in 1Q) and only 23% have plans for capital improvements (down from 67% in 1Q). Which industries are expected to see the most volatility over the next six months? For the first time in recent memory, the 3 industries that respondents identified as most likely to experience volatility in the next six months were different from the prior quarter - consumer products (60.0% versus 20.7%), retail trade (43.3% versus 31.0%), and manufacturing (33.3% versus 20.7%). How do lenders plan to adjust their loan structures? Additionally, Phoenix’s “Lending Climate in America” survey asked lenders if their respective institutions plan to tighten, maintain, or relax their loan structures for various sized loans. For larger loan structures (greater than $25M), the plan to maintain loan structures remained relatively constant from Q1 to Q2, decreasing by 8 percentage points. As loan sizes decrease, the percentage of lenders that plan to maintain (as opposed to increase) their loan structures increased – quite dramatically in the under $15M range. How has lender sentiment toward the US economy changed from Q1 to Q2? Lender optimism in the U.S. economy decreased for the near term, moving from 2.33 in Q1 2025 to 2.10 in Q2 2025. In this current quarter, there is heavy expectation of a C level performance (63%), with the remainder split between D and B levels. More telling, lender expectations for the U.S. economy’s performance in the longer term increased sharply from 2.11 to 2.53. Of the lenders surveyed, 57% believe the U.S. economy will perform at a B level during the next twelve months, a hefty increase from the prior quarter. The “Lending Climate in America” survey is administered quarterly to lenders from various commercial banks, finance companies, and factors across the country. Phoenix Management, a part of J.S. Held, collects, tabulates, and analyzes the results to create a complete evaluation of national attitudes and trends. To view the full results, click on the button below: To connect with Michael Jacoby or for any other media inquiries, please contact: Kristi L. Stathis, J.S. Held +1 786 833 4864 Kristi.Stathis@JSHeld.com

J.S. Held Announces the First Global Consulting Company Chief Intellectual Property Officer

Global consulting firm J.S. Held proudly announces the appointment of intellectual property (IP) expert James E. Malackowski as the first Chief Intellectual Property Officer (CIPO) of a global consulting company. J.S. Held Chief Executive Officer Lee Spirer observes, “In today's knowledge-based economy, the role of CIPO serves an important strategic and operational role both internally and in support of clients.” Protecting J.S. Held Intellectual Property and Other Intangible Assets J.S. Held experts have developed methodologies, frameworks, proprietary tools, and research that support client work. The CIPO partners across the business to ensure that these intangible assets are identified, protected, and leveraged to benefit the business. “Having dedicated IP leadership will help the company move faster in developing and deploying new methodologies, while ensuring reasonable measures of protecting our innovations,” noted James E. Malackowski. Managing J.S. Held Intellectual Property and Other Intangible Assets J.S. Held maintains a robust portfolio of patents including a “System and Method for Financing an Insurance Transaction”, trademarks, data, trade secrets, and other proprietary technologies that support client work. “As CIPO, I intend to partner with company leadership and our professional experts across the globe to manage and monetize the many patent, trademark, data, and other proprietary assets that set J.S. Held apart among our competitors, benefitting clients and our investors,” added James E. Malackowski. Industry’s Most Comprehensive Global Intellectual Property Consulting Group Ocean Tomo, a part of J.S. Held, is rooted in an expansive understanding of intellectual property (IP) value and risk, providing a foundation of Expertise for the Innovation Economy™. Built upon more than three decades of experience assessing IP in the most rigorous of venues - state, federal, and international courts, Ocean Tomo clients benefit from continuous feedback between litigation economic damage outcomes, transaction pricing, capital market valuations, debt financing terms, equity assessments, and deep technical insight. The team possesses the most comprehensive and market-tested understanding of IP value. Financial, market, and technical experts uniquely understand the contributory value of patented inventions, know-how, brands, and copyrights that permeate every business, viewing IP not simply as an isolated asset, but as an integral component of enterprise value. Multidimensional Intellectual Property-Informed Experts Benefit J.S. Held Clients Intellectual property expertise permeates the global organization. Beyond the expertise within J.S. Held’s dedicated IP practice Ocean Tomo, a part of J.S. Held, multidisciplinary experts across J.S. Held combine intellectual property expertise to core specializations, including: • Artificial Intelligence (AI) • Business Intelligence • Construction Advisory • Enterprise Risk Management • Fraud Investigations • Forensic Accounting • Insurance Claims Consulting • Restructuring, Turnaround, Receivership, and Bankruptcy Tangible and Intangible Asset Value Understanding The depth and breadth of J.S. Held’s work in the property and casualty insurance market and Ocean Tomo’s work across all forms of intellectual property and other intangible assets uniquely combine to create a strong foundation in risk assessment, data analysis, global awareness, regulatory compliance, technological adaptability, and risk mitigation. Collectively, these skills better equip J.S. Held experts to assess business risk across diverse geographies, geopolitical landscapes, regulatory frameworks, and technological advancements for the benefit of our clients. Learn more about the new J.S. Held Chief Intellectual Property Officer, James E. Malackowski: Looking to know more or connect with James E. Malackowski? Simply click on the expert's icon now to arrange an interview today. For any other media inquiries - contact : Kristi L. Stathis, J.S. Held +1 786 833 4864 Kristi.Stathis@JSHeld.com

Supply Chain Report: Logistics Leaders Predict Tight Capacity, High Prices Through Mid-2026

The Logistics Managers’ Index rose for the second consecutive month due to rising costs as the economy remains uncertain, according to researchers at Florida Atlantic University and four other schools. May’s index read in at 59.4, up slightly from April’s reading of 58.8. The reading is up 3.8 from the year prior. A score above 50 indicates that the logistics industry is expanding, while a score below 50 indicates that the industry is shrinking. Costs, particularly inventory costs, led to this month’s expansion. Inventory costs rose to 78.4, the highest level since October 2022, while inventory levels were only 51.5. The gap between the two suggests that many inventories are sitting stagnant. “The persistent uncertainty with respect to tariffs seems to be causing upward pressure on inventory costs, likely because of stockpiling effects,” said Steven Carnovale, Ph.D., associate professor of supply chain management in the College of Business. “The previous pause on tariffs opened up an opportunity to stockpile, which is also likely reflected in the rise in warehousing utilization and costs, as well as the rise in upstream warehouse utilization.” The LMI, a survey of director-level and above supply chain executives, measures the expansion or contraction of the logistics industry using eight unique components: inventory levels, inventory costs, warehousing capacity, warehousing utilization, warehousing prices, transportation capacity, transportation utilization and transportation prices. Along with FAU, researchers at Arizona State University, Colorado State University, Rutgers University and the University of Nevada at Reno calculated the LMI using a diffusion index. Warehousing readings also point to further uncertainty among firms on the direction of the U.S. economy and tariff policy. Warehousing capacity was flat at 50, while warehousing costs and warehousing utilization read at 72.1 and 62.5, respectively. The readings suggest that inventories are sitting longer amid slower consumer demand and firms have been holding goods in anticipation of future tariff changes. “At a certain point, the see-saw effect of increased/decreased tariffs is likely going to lead to firms stockpiling when tariffs come down, and likely be forced to sit on excess inventory,” Carnovale said. “In this case, the decision will be: are the holding costs of excess inventory less than the (potential) future tariffs? And to what degree will these increased prices pass through to consumers?” Overall, respondents expect inventory levels to increase in the year ahead, with capacity growing tighter and costs expanding, highlighting the overall sentiment that trade issues and uncertainty will be wrapped up by the end of the year. Looking to know more - we can help. Steven is a supply chain strategist specializing in interfirm networks, risk management and global sourcing/production networks. He is available to speak with media. Simply click on his icon now to arrange an interview today

5 Reasons "Expertise Marketing" Programs Fail.

As a company dedicated to “Expertise Marketing” we work with some of the largest organizations from higher education and healthcare, to top global corporate brands. What these organizations have in common are smart, educated professionals…and a lot of them. The types of individuals that would be valuable ambassadors, true thought leaders, helping you deliver on your organization’s reputational and revenue goals. Instinctively marketing and communications teams recognize the intrinsic value of this human capital and have created a variety of “Thought Leadership” and “Expert Marketing and Directory” initiatives. The overriding objective is how to best connect their experts to audiences that matter. Seeking opportunities ranging from acting as media sources to event speakers to providing a valuable entry-point for research and business collaboration, even lead generation. To execute on this goal, one of the most effective approaches, and starting points for any expertise marketing program starts with better profiling their experts and related insights on their website. Building out and leveraging this expert content is at the core of most expertise marketing efforts. Despite the promises these web initiatives offer, most programs don’t deliver organizations the results they were hoping for. Success most often has nothing to do with how smart your people are. Some of the largest organizations with deep rosters of expertise fail where smaller organizations consistently punch above their weight. When creating an expertise presence on your website there are important areas to consider. The following represents the top 5 reasons many expertise marketing programs fail and how to maximize your success.  Reason #1 You’re missing critical team members There is no “going it alone” when starting a program like this.  Having the following individuals onboard at the start is crucial. Don't worry, these aren't all full-time resources by any means.  As your program progresses, these individuals may come in and out in terms of importance, but having access to them over the lifetime of your program will positively impact your success. At the core, you need access to the following individuals. Program Champion - Having a senior leader as a champion is pretty much table stakes for any successful company-wide initiative such as this.  Someone who can articulate to others, both up and down in the organization as to how this initiative fits into the broader long-term goals of the organization is imperative. Failure to establish this individual upfront puts your program's future at the whim of shifting priorities and budget cuts. Marketing/Communications - You need someone with ongoing responsibility for maintaining and promoting your roster of experts and their content.  This ensures your most relevant experts are showcased at the right time to meet the changing demands of your audiences and the news cycle. Digital/Web - You need someone with the keys to the website/CMS. Ensure you have connections to people who control not only your small area of the website such as a newsroom or department level webpages but also those that have access to the layouts and navigation of the broader website.  The latter is important as it helps prevent your expert content from combing isolated and disconnected from the rest of your website. IT - The level of involvement of IT is highly dependent on how you’re looking to implement your expert content on your website. By leveraging a variety of content implementation tools from simple "cut and paste" embeds to WordPress plugins you can severely limit the necessity to involve IT. However, depending on your budget and goals, IT can leverage a platform's API, accessing advanced layouts and functionality, including integrating with other systems your organization may already be using. Engaged Experts -  Last but not least, having your experts on board is critical. By properly communicating upfront and ongoing with your experts around the goals of the program, you're helping ensure your content best represents the talents that lie within. We realize it is often difficult and sometimes cost-prohibitive to assemble such a team. It is important if you don’t have access to all these members in-house that you access them through an external partner's professional services offerings. This could include assisting with building out content such as profiles and posts or providing technical assistance in integrating this content into your website. Reason #2 You’re relying too much on IT for implementation or updating. To be successful long term, it is important that key owners of the expertise marketing program feel empowered to take control of their expert content. From creation to ongoing management, those with marketing communications roles and others closest to their organization’s expertise need the flexibility to update content in real-time to remain relevant and up-to-date. Being able to quickly log into an external platform that syncs content with your website is key.  It eliminates the need for special access to your CMS or the possible requirement for IT to be in control of your updates. It also allows for a mix of individual expert and administrator access providing the highest level of flexibility. Often left out in IT-focused builds is how you will effectively handle inquiries.  Simply showing emails and phone numbers is a recipe for missed opportunities (and SPAM) as these experts are some of the most time-constrained individuals in your organization.  Ensuring you have access to a customizable workflow feature is essential in ensuring your organization doesn't miss potential time-sensitive inquiries. When working with IT to implement an Expertise Marketing Program on your website, you will often be presented with a “we’ll build it for you option” vs using a purpose-built platform. Understanding the tradeoffs of this approach is critical. One of the greatest benefits of using a SaaS platform, besides costs, is that you constantly have the most up-to-date software, with the latest features and functionality to best showcase your expertise. To learn more, download the “True Costs of DIY” to better understand the tradeoffs and functional requirements needed for success. Reason #3 Your expert content is siloed, one-dimensional, and rarely updated. This is by far one of the biggest reasons programs fail.  Well, it's actually a number of reasons, but it all relates back to how your content will be perceived and ultimately drive connections with interested audiences.  By addressing the following you'll present not only better but more easily discoverable expert content that drives inquiries. You have boring, not engaging profiles for your experts - Before people feel comfortable reaching out they need a good sense of the person. Profiles that lack media assets such as video, publications and even podcasts are one-dimensional. Furthermore, showcasing past media and event appearances provides an enhanced level of credibility. Focused solely on a directory & profiles - Your expertise is more than just showcased through a profile found in a directory. Adding long-form posts where experts can share their insights and even expert focussed Q&A (download report on "The Power of Q&A") provides audiences additional ways to connect with your experts. Ensuring all these additional assets connect back to your profiles provides more insight into the person behind the expertise. No main website navigation - Despite adding menu navigation on a specific web page, such as a newsroom or About Us page, most organizations neglect to add navigation to their main website’s menu structure. You can never assume visitors will know where this content resides. We recommend multiple links in both headers and footers to your expert content. Names such as “Find Experts”, “Media Sources” or “Research Experts” are some of the most common, accessible from overall menu items like “About Us”, “News” or “Research”. Expert content stuck to one small area of your website - If you restrict your expert content to just one area, you’re just making discovery that much harder and limiting exposing the breadth of expertise you have in-house. Highlight your experts and expertise on your homepage or in key sections of your website. Refine your experts and their insights found in posts or Q&A by tagging them based on specific topics and showcasing just those experts in various areas of your website. Using a dedicated SaaS platform means that when you update content it updates everywhere, making changes quick and easy. Expert content never gets updated - This is a big issue for organizations that build in-house or through their CMS. Visitors can quickly understand that the content isn’t fresh and it reflects poorly on the individual and the organization as a whole. The key to ensuring content is maintained is to provide multiple access capabilities where admins (internal or external) and the experts can maintain the content. Failure to respond in a timely manner to inquiries - Displaying content that exposes phone numbers and emails of your experts is not the best approach...both from a privacy and timely communications standpoint. Without an advanced inquiry workflow that alerts multiple members of your team, you risk missing out on time-sensitive requests such as those from journalists.  Reason #4 You haven’t considered everything needed to win the SEO game. Building out content on the web without having a plan for how external and internal search engines will interact with your pages is a big mistake. Organic search can play a big role in discovery leading to valuable opportunities. Before you consider your new expert content pages ready, ensure you've taken into account the following. Proper Meta Data - Do your expert profile pages have dynamically created titles, descriptions and keywords that automatically adjust to changes in areas such as an individual's expertise? Schema Data - Do you have proper schema tags that indicate to Google and other search engines the type of content displayed as well as the credibility of both the individual and organization behind it. Sitemaps - Have you ensured all your pages have been added to your sitemap. Is it automatically updated when new experts or pieces of expert content are added? Google Search Console - Are you pushing pages directly to Google by requesting important new content is updated in the search index. For more info on better SEO read my Spotlight "Why Expertise Ranks Higher". Reason #5 You’re not doing enough to actively promote your expertise… a “they’ll just find us” approach usually fails. It's like owning a Porsche and leaving it in the garage…pretty to look at but you’re not realizing its full potential. Simply putting your expert content on a web page is only the start. Successful organizations actively distribute these assets, sharing links to profiles and other content elements like news posts or Q&A in a variety of ways. Social Media Channels - They start by promoting these assets on their social media channels, from their Twitter feeds to Facebook and LinkedIn posts. Media Distribution Software - Whether it is systems like Cision or Meltwater, including links to expert profiles and related content when reaching out to journalists adds a layer of depth to your pitches. Press Releases - Every time you reference your organization's expertise, include links to additional content and individual experts for more insights and pathways to connect with real people. It sounds like a lot, but with a bit of planning and some ongoing maintenance, a properly constructed expertise marketing program can deliver incredible results for many years. To be successful it's more than just firing up a few new web pages. However, with the advent of specialized platforms specifically designed for these programs, and a bit of guidance, it is easier than ever to create an expert content footprint on your website and deliver valuable connections for your organization.  

Video Insights: What Boards of Directors Need to Know About Tariffs

Boards of directors globally are confronting unknown circumstances as a result of the current quickly shifting tariff and trade environment. Business risks and opportunities are magnified during such times, compelling boards to seek the right strategies in order to meet these challenges. In this video, Brian Gleason, John Peiserich, James E. Malackowski, and Mariano de Alba – experts in business turnaround, supply chain, intellectual property, and political risk – outline emerging considerations for boards of directors in light of changing tariff policies, including: • Tracking the financial impact of tariffs and effects on company supply chains • Understanding changes to regulatory requirements and whether internal policies need to be modified • Planning for short- and long-term effects on intellectual property • Adjusting communications between the board and senior management To view more of our Tariffs and Trade Series expert analysis and commentary, visit: Looking to know more or connect with John Peiserich and James E. Malackowski? Simply click on either expert's icon now to arrange an interview today. If you are looking to connect with Brian Gleason or Mariano de Alba - contact : Kristi L. Stathis, J.S. Held +1 786 833 4864 Kristi.Stathis@JSHeld.com

Video Insights: What Investors Need to Know About Shifting Tariffs

Unprecedented uncertainty brought on by quickly evolving tariff policies is creating challenges and additional considerations for investors and other capital providers. In this video, J.S. Held experts Brian Gleason, John Peiserich, James E. Malackowski, and Tom Burns – experts in turnaround, supply chain, intellectual property, and political risk – pose twelve questions to private equity sponsors and their portfolio companies to explore amid the continued tariff uncertainty. Restructuring and operations expert Brian Gleason has managed or participated in more than 300 turnaround engagements over the past 29 years and applies the principles utilized in J.S. Held's work advising companies in crisis. In the video, Brian addresses three essential questions that investors should consider with their portfolio companies during this period of unprecedented tariff-policy-induced uncertainty: 1) How have tariffs impacted business forecasting and investor confidence? 2) What are the key actions portfolio company management teams should take during tariff-induced uncertainty? 3) What leadership strategies are recommended for navigating the economic stress caused or complicated by tariffs? Business intelligence expert Tom Burns has extensive experience leading intelligence collection assignments for financial institutions, law firms, and blue-chip multinationals around the world. Tom explores the additional pre-acquisition diligence essential amid tariff uncertainty in the video. He addresses three questions, including: 4) How have tariffs changed the due diligence process in acquisitions? 5) What is transshipment, and why is it a concern for investors and their portfolio companies? 6) What steps should investors take to manage tariff-related risks in acquisitions? Capital projects, environmental risk, and compliance expert John Peiserich has over 30 years of experience advising heavy industry and law firms throughout the country with a focus on Oil & Gas, Energy, and Public Utilities. In the video, John reflects upon: 7) Why is it important for investors to assess the owner-operator's understanding of supply chain risks? 8) How have tariffs introduced new challenges for large-scale projects? 9) What is the potential impact of supply chain and tariff-related delays on investment outcomes? James E. Malackowski has a unique perspective on intellectual property litigation risk, strategic management, and monetization, which benefits from his prior work at a leading private equity firm. In the video, he advises investors and their portfolio companies to consider: 10) How do tariffs influence decisions around manufacturing relocation and intellectual property? 11) What IP-related risks should companies consider when relocating manufacturing operations? 12) What steps should investors take to ensure IP is properly managed in response to tariffs? The J.S. Held Tariffs and Trade Series is a collection of intelligence, insights, and action plans that inform strategic business decision-making and foster resilience in an increasingly volatile global market. To view more of our Tariffs and Trade Series expert analysis and commentary, visit: Looking to know more or connect with John Peiserich and James E. Malackowski? Simply click on either expert's icon now to arrange an interview today. If you are looking to connect with Brian Gleason or Tom Burns - contact : Kristi L. Stathis, J.S. Held +1 786 833 4864 Kristi.Stathis@JSHeld.com

ChristianaCare Charts New Course With Nurse Robotics Research Fellowship

ChristianaCare, the first hospital system in the region to deploy collaborative robots, has once again broken new ground, this time with a nationally unique initiative that puts bedside nurses at the helm of robotics research and innovation. At a graduation ceremony April 30, ChristianaCare celebrated the first four clinical nurses completing the Nursing Research Fellowship in Robotics and Innovation — the first program of its kind in the nation. The fellowship was part of a larger three-year, $1.5 million grant from the American Nurses Foundation’s Reimagining Nursing Initiative. The grant supports ChristianaCare’s broader study on how collaborative robots impact nursing practice. Over eight months, nurses from different units and specialties participated in immersive research training and lectures designed to expand their knowledge, curiosity and professional growth. Their work culminated in national conference presentations and preparations for journal submissions. The inaugural Nursing Research Fellows in Robotics and Innovation are: Briana Abernathy, BSN, RN, CEN – case management, Christiana Hospital emergency department Elizabeth Mitchell, BSN, RN-BC – Christiana Hospital surgical stepdown unit Hannah Rackie, BSN, RN, C-EFM – Union Hospital maternity unit Morgan Tallo, BSN, RN, CCRN – Christiana Hospital cardiovascular critical care unit A ‘real seat at the table’ “When you create programs that empower nurses to lead, innovate and tackle meaningful challenges, you see real impact — not just in new skills and knowledge, but in job satisfaction, well-being and retention,” said Susan Smith Birkhoff, Ph.D., RN, program director of Technology Research & Education at ChristianaCare. “This fellowship is built on the belief that when nurses are given the space to learn and lead, they bring fresh ideas and collaborative solutions back to their clinical practice areas.” Created and led by Smith Birkhoff, the fellowship is a standout in the U.S. health care landscape: It gives bedside nurses the chance to step away from their daily routines and gain advanced research experience, an opportunity rarely available at the clinical level. While the fellowship directly trained four nurses, its reach extended well beyond thazt. Fellows shared what they were learning along the way, sparking wider interest in research across the health system. The research program was highlighted as a new knowledge and innovation exemplar in the latest evaluation by the American Nurses Credentialing Center, which in March awarded ChristianaCare its fourth Magnet designation — the gold standard for nursing excellence. Adriane Griffen, DrPH, MPH, MCHES, vice president of programs at the American Nurses Foundation, praised ChristianaCare’s responsiveness in shaping the program around nurses’ needs and building a model for future innovation. “What makes this fellowship stand out is its focus on giving bedside nurses a real seat at the table,” Griffen said. “When nurses are trusted to lead and have the right support, they develop solutions that are practical, sustainable and transformative. This fellowship shows how nurse-led innovation can grow from a local pilot into a model for improving care across the country.” Through the fellowship, nurses gained a deeper understanding of applying research methodology to advance robotics science at the intersection of nursing and hospital operations, which is groundbreaking and novel. “This is such an exciting and important moment for our profession,” said Danielle Weber, DNP, RN, NEA-BC, chief nurse executive at ChristianaCare. “Innovation is about improving care, easing the burdens on our teams and finding smarter ways to meet the complex needs of our patients. Tools like collaborative robots don’t replace the human touch, they help protect and elevate it.” Mitchell said she was initially intimidated when she saw the fellowship application because it had been years since she last engaged in formal research. Learning everything from literature reviews to abstract writing pushed her outside her comfort zone and gave her practical tools to take new ideas forward. The experience inspired her to return to school this fall to pursue a graduate degree. A ‘ripple effect’ “This fellowship reignited my enthusiasm for learning and gave me the skills and confidence to keep growing,” Mitchell said. “It’s been amazing to collaborate with other fellows and mentors, and I’m excited to apply what I’ve learned to improve patient care and strengthen our teams.” In addition to Smith Birkhoff, Kate Shady, Ph.D., RN, OCN, RN IV, served as a mentor to the fellows, bringing expertise from her hematology/oncology background. Kati Patel, MPH, provided key administrative coordination and support throughout the program. ChristianaCare continues its broader research into robotics integration, with findings from the multi-year collaborative robot study expected to be shared later this year. Shady said the fellowship is already influencing ChristianaCare’s nursing culture by expanding interest in research and evidence-based practice well beyond the initial group. The program’s ripple effect is helping build lasting infrastructure for nurse-led innovation across departments. “One of the most rewarding parts of this fellowship has been seeing these nurses step into new confidence and capability,” Shady said. “They began unsure about research, but by the end, they were reading studies, writing abstracts and mentoring peers — laying the groundwork for bigger change in how we advance nursing practice.” Learn more about nursing at ChristianaCare.

Why Simultaneous Voting Makes for Good Decisions

How can organizations make robust decisions when time is short, and the stakes are high? It’s a conundrum not unfamiliar to the U.S. Food and Drug Administration. Back in 2021, the FDA found itself under tremendous pressure to decide on the approval of the experimental drug aducanumab, designed to slow the progress of Alzheimer’s disease—a debilitating and incurable condition that ranks among the top 10 causes of death in the United States. Welcomed by the market as a game-changer on its release, aducanumab quickly ran into serious problems. A lack of data on clinical efficacy along with a slew of dangerous side effects meant physicians in their droves were unwilling to prescribe it. Within months of its approval, three FDA advisors resigned in protest, one calling aducanumab, “the worst approval decision that the FDA has made that I can remember.” By the start of 2024, the drug had been pulled by its manufacturers. Of course, with the benefit of hindsight and data from the public’s use of aducanumab, it is easy for us to tell that FDA made the wrong decision then. But is there a better process that would have given FDA the foresight to make the right decision, under limited information? The FDA routinely has to evaluate novel drugs and treatments; medical and pharmaceutical products that can impact the wellbeing of millions of Americans. With stakes this high, the FDA is known to tread carefully: assembling different advisory, review, and funding committees providing diverse knowledge and expertise to assess the evidence and decide whether to approve a new drug, or not. As a federal agency, the FDA is also required to maintain scrupulous records that cover its decisions, and how those decisions are made. The Impact of Voting Mechanisms on Decision Quality Some of this data has been analyzed by Goizueta’s Tian Heong Chan, associate professor of information systems and operation management. Together with Panos Markou of the University of Virginia’s Darden School of Business, Chan scrutinized 17 years’ worth of information, including detailed transcripts from more than 500 FDA advisory committee meetings, to understand the mechanisms and protocols used in FDA decision-making: whether committee members vote to approve products sequentially, with everyone in the room having a say one after another; or if voting happens simultaneously via the push of a button, say, or a show of hands. Chan and Markou also looked at the impact of sequential versus simultaneous voting to see if there were differences in the quality of the decisions each mechanism produced. Their findings are singular. It turns out that when stakeholders vote simultaneously, they make better decisions. Drugs or products approved this way are far less likely to be issued post-market boxed warnings (warnings issued by FDA that call attention to potentially serious health risks associated with the product, that must be displayed on the prescription box itself), and more than two times less likely to be recalled. The FDA changed its voting protocols in 2007, when they switched from sequentially voting around the room, one person after another, to simultaneous voting procedures. And the results are stunning. Tian Heong Chan, Associate Professor of Information Systems & Operation Management “Decisions made by simultaneous voting are more than twice as effective,” says Chan. “After 2007, you see that just 3.4% of all drugs and products approved this way end up being discontinued or recalled. This compares with an 8.6% failure rate for drugs approved by the FDA using more sequential processes—the round robin where individuals had been voting one by one around the room.” Imagine you are told beforehand that you are going to vote on something important by simply raising your hand or pressing a button. In this scenario, you are probably going to want to expend more time and effort in debating all the issues and informing yourself before you decide. Tian Heong Chan “On the other hand, if you know the vote will go around the room, and you will have a chance to hear how others’ speak and explain their decisions, you’re going to be less motivated to exchange and defend your point of view beforehand,” says Chan. In other words, simultaneous decision-making is two times less likely to generate a wrong decision as the sequential approach. Why is this? Chan and Markou believe that these voting mechanisms impact the quality of discussion and debate that undergird decision-making; that the quality of decisions is significantly impacted by how those decisions are made. Quality Discussion Leads to Quality Decisions Parsing the FDA transcripts for content, language, and tonality in both settings, Chan and Markou find evidence to support this. Simultaneous voting or decision-making drives discussions that are characterized by language that is more positive, more authentic, and more even in terms of expressions of authority and hierarchy, says Chan. What’s more, these deliberations and exchanges are deeper and more far-ranging in quality. We find marked differences in the tone of speech and the topics discussed when stakeholders know they will be voting simultaneously. There is less hierarchy in these exchanges, and individuals exhibit greater confidence in sharing their points of view more freely. Tian Heong Chan “We also see more questions being asked, and a broader range of topics and ideas discussed,” says Chan. In this context, decision-makers are also less likely to reach unanimous agreement. Instead, debate is more vigorous and differences of opinion remain more robust. Conversely, sequential voting around the room is typically preceded by shorter discussion in which stakeholders share fewer opinions and ask fewer questions. And this demonstrably impacts the quality of the decisions made, says Chan. Sharing a different perspective to a group requires effort and courage. With sequential voting or decision-making, there seems to be less interest in surfacing diverse perspectives or hidden aspects to complex problems. Tian Heong Chan “So it’s not that individuals are being influenced by what other people say when it comes to voting on the issue—which would be tempting to infer—rather, it’s that sequential voting mechanisms seem to take a bit more effort out of the process.” When decision-makers are told that they will have a chance to vote and to explain their vote, one after another, their incentives to make a prior effort to interrogate each other vigorously, and to work that little bit harder to surface any shortcomings in their own understanding or point of view, or in the data, are relatively weaker, say Chan and Markou. The Takeaway for Organizations Making High-Stakes Decisions Decision-making in different contexts has long been the subject of scholarly scrutiny. Chan and Markou’s research sheds new light on the important role that different mechanisms have in shaping the outcomes of decision-making—and the quality of the decisions that are jointly taken. And this should be on the radar of organizations and institutions charged with making choices that impact swathes of the community, they say. “The FDA has a solid tradition of inviting diversity into its decision-making. But the data shows that harnessing the benefits of diversity is contingent on using the right mechanisms to surface the different expertise you need to be able to see all the dimensions of the issue, and make better informed decisions about it,” says Chan. A good place to start? By a concurrent show of hands. Tian Heong Chan is an associate professor of information systems and operation management. he is available to speak about this topic - click on his con now to arrange an interview today.

Expert Perspective: The Hidden Costs of Cultural Appropriation

In our interconnected world, cultural borrowing is everywhere. But why do some instances earn applause while others provoke outrage? This question is becoming increasingly crucial for business leaders who must carefully navigate cultural boundaries. Take the backlash the Kardashian-Jenner family faced for adopting styles from minority cultures or the controversy over non-Indigenous designers using Native American patterns in fashion. These examples highlight the issue of cultural appropriation, where borrowing elements from another culture without genuine understanding or respect can lead to accusations of exploitation. Abraham Oshotse, an assistant professor of organization and management at Goizueta Business School, along with Assistant Professor of Sociology and Anthropology at Hebrew University Yael Berda and Associate Professor of Organizational Behavior at the Stanford Graduate School of Business Amir Goldberg, explores this in their research on “cultural tariffing.” They shed light on why high-status individuals, such as celebrities or industry leaders, often come under fire when crossing cultural boundaries. The Concept of Cultural Tariffing Oshotse and coauthors define cultural tariffing as “the act of imposing a social cost on cultural boundary crossing. It is levied on high-status actors crossing into low-status culture, in order to mitigate the reproduction of the status inequality.” This notion suggests that the acceptance or rejection of cultural boundary-crossing is influenced by the perceived costs and benefits. Cultural appropriation involves taking elements from a culture that one does not belong to, without permission or authority. For example, when Elvis Presley brought African-American music into the mainstream, it was initially seen as elevating the genre. However, in today’s context, such acts might be criticized as appropriation rather than celebration. This research seeks to analyze people’s modern reactions to different examples of cultural boundary-crossing and which conditions induce cultural tariffing. The Hypotheses The researchers make four hypotheses about participants’ reactions to cultural appropriation: People will disapprove of cultural borrowing if there’s a clear power imbalance, with the borrowing group having more status or privilege than the group they are borrowing from. Cultural borrowing is more likely to be criticized if the person doing it has a higher socioeconomic status within their social group. Cultural borrowing is more likely to be criticized if the person doing it has only a shallow connection to the culture they’re borrowing from. Cultural borrowing is more likely to be criticized if the person doing it benefits more from it than the people from the culture they are borrowing from. Put to the Test Oshotse et al exposed respondents to four scenarios per hypothesis (16 total) with a permissible and a transgressive condition. In the permissible condition, subjects exhibit lower status or socioeconomic standing or a stronger connection to the target culture. Subjects in the transgressive condition exhibit a higher status or socioeconomic standing and less of an authentic connection to the target culture. Insights from the Study Oshotse’s study offers four key insights: Status Matters: Cultural boundary-crossing is more likely to generate disapproval if there’s a clear status difference favoring the adopter. Superficial Connections: The less authentic the adopter’s connection to the target culture, the more likely they are to face backlash. Socioeconomic Influence: Higher socioeconomic status within the adopter’s social group increases the likelihood of disapproval. Value Extraction: The more value the adopter gains relative to the culture they’re borrowing from, the higher the disapproval. These insights are crucial for leaders who want to navigate cultural boundaries successfully, ensuring their actions are seen as respectful and inclusive rather than exploitative. Real-World Implications for Business Leaders Why does this matter for business leaders? Understanding cultural tariffing is crucial when expanding into new markets, launching multicultural campaigns, or even managing diverse teams. The research suggests that crossing cultural boundaries without deep understanding or respect can backfire. That’s especially true when the adopter holds a higher socioeconomic status. Consider the example of a luxury brand adopting traditional African patterns without engaging with the communities behind them. In this case, it risks being seen as exploitative rather than innovative. The consequences aren’t just reputational; they can also impact the brand’s bottom line. This research isn’t just about isolated incidents; it mirrors sweeping societal shifts. Over the past 50 years, Western views have evolved to embrace ethnic diversity and multicultural exchange. But with this newfound appreciation comes a fresh set of challenges. Today’s leaders must navigate cultural interactions with greater care, fully aware of the historical and social contexts that shape perceptions of appropriation. In today’s global and interconnected business landscape, mastering the subtleties of cultural appropriation and tariffing is crucial. Leaders who tread thoughtfully can boost their reputation and success, while those who falter may face serious backlash. By understanding the hidden costs of crossing cultural boundaries, business leaders can cultivate authentic exchanges and steer clear of the pitfalls of appropriation. Abraham Oshotse is an assistant professor of organization & management. He is available speak to media regarding  this important topic - simply click on his icon now to arrange an interview today.

Hiring More Nurses Generates Revenue for Hospitals

Underfunding is driving an acute shortage of trained nurses in hospitals and care facilities in the United States. It is the worst such shortage in more than four decades. One estimate from the American Hospital Association puts the deficit north of one million. Meanwhile, a recent survey by recruitment specialist AMN Healthcare suggests that 900,000 more nurses will drop out of the workforce by 2027. American nurses are quitting in droves, thanks to low pay and burnout as understaffing increases individual workload. This is bad news for patient outcomes. Nurses are estimated to have eight times more routine contact with patients than physicians. They shoulder the bulk of all responsibility in terms of diagnostic data collection, treatment plans, and clinical reporting. As a result, understaffing is linked to a slew of serious problems, among them increased wait times for patients in care, post-operative infections, readmission rates, and patient mortality—all of which are on the rise across the U.S. Tackling this crisis is challenging because of how nursing services are reimbursed. Most hospitals operate a payment system where services are paid for separately. Physician services are billed as separate line items, making them a revenue generator for the hospitals that employ them. But under Medicare, nursing services are charged as part of a fixed room and board fee, meaning that hospitals charge the same fee regardless of how many nurses are employed in the patient’s care. In this model, nurses end up on the other side of hospitals’ balance sheets: a labor expense rather than a source of income. For beleaguered administrators looking to sustain quality of care while minimizing costs (and maximizing profits), hiring and retaining nursing staff has arguably become something of a zero-sum game in the U.S. The Hidden Costs of Nurse Understaffing But might the balance sheet in fact be skewed in some way? Could there be potential financial losses attached to nurse understaffing that administrators should factor into their hiring and remuneration decisions? Research by Goizueta Professors Diwas KC and Donald Lee, as well as recent Goizueta PhD graduates Hao Ding 24PhD (Auburn University) and Sokol Tushe 23PhD (Muma College of Business), would suggest there are. Their new peer-reviewed publication* finds that increasing a single nurse’s workload by just one patient creates a 17% service slowdown for all other patients under that nurse’s care. Looking at the data another way, having one additional nurse on duty during the busiest shift (typically between 7am and 7pm) speeds up emergency department work and frees up capacity to treat more patients such that hospitals could be looking at a major increase in revenue. The researchers calculate that this productivity gain could equate to a net increase of $470,000 per 10,000 patient visits—and savings to the tune of $160,000 in lost earnings for the same number of patients as wait times are reduced. “A lot of the debate around nursing in the U.S. has focused on the loss of quality in care, which is hugely important,” says Diwas KC. But looking at the crisis through a productivity lens means we’re also able to understand the very real economic value that nurses bring too: the revenue increases that come with capacity gains. Diwas KC, Goizueta Foundation Term Professor of Information Systems & Operations Management “Our findings challenge the predominant thinking around nursing as a cost,” adds Lee. “What we see is that investing in nursing staff more than pays for itself in downstream financial benefits for hospitals. It is effectively a win-win-win for patients, nurses, and healthcare providers.” Nurse Load: the Biggest Impact on Productivity To get to these findings, the researchers analyzed a high-resolution dataset on patient flow through a large U.S. teaching hospital. They looked at the real-time workloads of physicians and nurses working in the emergency department between April 2018 and March 2019, factoring in variables such as patient demographics and severity of complaint or illness. Tracking patients from admission to triage and on to treatment, the researchers were able to tease out the impact that the number of nurses and physicians on duty had on patient throughput. Using a novel machine learning technique developed at Goizueta by Lee, they were able to identify the effect of increasing or reducing the workforce. The contrast between physicians and nursing staff is stark, says Tushe. “When you have fewer nurses on duty, capacity and patient throughput drops by an order of magnitude—far, far more than when reducing the number of doctors. Our results show that for every additional patient the nurse is responsible for, service speed falls by 17%. That compares to just 1.4% if you add one patient to the workload of an attending physician. In other words, nurses’ impact on productivity in the emergency department is more than eight times greater.” Boosting Revenue Through Reduced Wait Times Adding an additional nurse to the workforce, on the other hand, increases capacity appreciably. And as more patients are treated faster, hospitals can expect a concomitant uptick in revenue, says KC. “It’s well documented that cutting down wait time equates to more patients treated and more income. Previous research shows that reducing service time by 15 minutes per 30,000 patient visits translates to $1.4 million in extra revenue for a hospital.” In our study, we calculate that staffing one additional nurse in the 7am to 7pm emergency department shift reduces wait time by 23 minutes, so hospitals could be looking at an increase of $2.33 million per year. Diwas KC This far eclipses the costs associated with hiring one additional nurse, says Lee. “According to 2022 U.S. Bureau of Labor Statistics, the average nursing salary in the U.S. is $83,000. Fringe benefits account for an additional 50% of the base salary. The total cost of adding one nurse during the 7am to 7pm shift is $310,000 (for 2.5 full-time employees). When you do the math, it is clear. The net hospital gain is $2 million for the hospital in our study. Or $470,000 per 10,000 patient visits.” Incontrovertible Benefits to Hiring More Nurses These findings should provide compelling food for thought both to healthcare administrators and U.S. policymakers. For too long, the latter have fixated on the upstream costs, without exploring the downstream benefits of nursing services, say the researchers. Their study, the first to quantify the economic value of nurses in the U.S., asks “better questions,” argues Tushe; exploiting newly available data and analytics to reveal incontrovertible financial benefits that attach to hiring—and compensating—more nurses in American hospitals. We know that a lot of nurses are leaving the profession not just because of cuts and burnout, but also because of lower pay. We would say to administrators struggling to hire talented nurses to review current wage offers, because our analysis suggests that the economic surplus from hiring more nurses could be readily applied to retention pay rises also. Sokol Tushe 23PhD, Muma College of Business The Case for Mandated Ratios For state-level decision makers, Lee has additional words of advice. “In 2004, California mandated minimum nurse-to-patient ratios in hospitals. Since then, six more states have added some form of minimum ratio requirement. The evidence is that this has been beneficial to patient outcomes and nurse job satisfaction. Our research now adds an economic dimension to the list of benefits as well. Ipso facto, policymakers ought to consider wider adoption of minimum nurse-to-patient ratios.” However, decision makers go about tackling the shortage of nurses in the U.S., they should go about it fast and soon, says KC. “This is a healthcare crisis that is only set to become more acute in the near future. As our demographics shift and our population starts again out, demand for quality will increase. So too must the supply of care capacity. But what we are seeing is the nursing staffing situation in the U.S. moving in the opposite direction. All of this is manifesting in the emergency department. That’s where wait times are getting longer, mistakes are being made, and overworked nurses are quitting. It is creating a vicious cycle that needs to be broken.” Diwas Diwas KC is a professor of information systems & operations management and Donald Lee is an associate professor of information systems & operations management. Both experts are available to speak about this important topic - simply click on either icon now to arrange an interview today.