Leading the Board in a Crisis: Strategy and Performance Implications of Board Chair Directive Leadership

The COVID-19 pandemic has disrupted nearly every boardroom in the world. However, neither the extant leadership literature nor the corporate governance literature offers succinct guidance on what constitutes effective board leadership during such a calamity. To address this theoretical and practical need, we develop a moderated mediation model, in which directive leadership from the board chair promotes competitive simplification at the onset of the crisis, which in turn promotes firm financial performance during the crisis. Using survey responses from 120 directors of U.S. public firms in Spring of 2020, combined with firm-level archival data from multiple sources and time periods, we find support for this mediated relationship—but only if the chair is not CEO. If the chair is CEO, we find no evidence of a positive relationship between directive leadership and either competitive simplification or firm financial performance;rather, we find some evidence of a negative relationship. We explore the implications of these findings for the theory and practice of corporate governance and crisis management. © The Author(s) 2022.

Special Session: The University of Google? A Panel Discussion about the Disruptive Changes in Marketing Education and What Programs May Look Like in the Not-So-Distant Future: An Abstract

Amid skyrocketing costs and student debt, much has been written about the increasing skepticism of whether a traditional four-year degree is “worth it.” The general consensus among outlets such as Forbes, The WSJ, and CNBC (each citing recent polls) is that families’ attitudes toward higher education is changing, due to sharply rising costs. This change does not favor traditional college degree programs. In the midst of this transformation, branded digital marketing certificates have presented themselves as a more economical alternative. Perhaps the most worrisome of which are the recently announced “Google Career Certificates,” which are six-month programs geared to prepare workers for the digital economy. Google leadership states these new certificates are meant to be the equivalent of a four-year degree given that “college degrees are out of reach for many Americans, and you shouldn’t need a college diploma to have economic security.” The purpose of this panel session is to discuss what the traditional marketing degree program response should be to the changing perceptions of value and increased competition. The potential consequences of Google entering higher education have been further exacerbated by impacts of the COVID-19 pandemic. Disruption that many thought leaders have been talking about for years was accelerated in the span of a few months. The result was a wave of student questions and criticism of the value of online education directed against even the most renowned institutions. While pandemic-related impacts to teaching modality may not be long-term, it will likely take much longer for student sentiment to recover. Evidenced by over seventy lawsuits currently pending against colleges and universities, this confluence of factors should not be ignored. Rather, we need to view this as an opportunity for existential reflection on the most basic of marketing principles as they apply to higher education as a marketable service. As such, in this panel session, the following questions will be addressed by a diverse group of stakeholders: Will industry and prospective students/families accept these certificates as a substitute to a traditional degree? How should traditional marketing degree programs adapt or change program offerings to be more competitive/appealing? What is academia’s value proposition? How do we communicate this effectively with prospective students and their families? How do we train students on technologies many professors have never themselves used? Are there opportunities for public/private collaboration that provide technical skills, produce job-ready graduates, and lower costs? What could these look like? Student, industry, and academic representatives will discuss these questions and engage the audience in a lively conversation about the future of marketing education and the changing role of marketing academics. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The relationship between symptoms and functional physiological outcomes in survivors of severe COVID-19 pneumonia

P136 Table 1Results of correlation analysis Correlation analysis 4MGS 1STSreps SpO2% desaturation Results r p-value r p-value r p-value Pre-COVID mMRC dyspnoea score 0(0–1) -0.267** <0.001 -0.285** <0.001 -0.108 0.094 Post-COVID mMRC dyspnoea score 1(0–2) -0.442** <0.001 -0.457** <0.001 -0.143* 0.025 NRS breathlessness 3(0–5) -0.287** <0.001 -0.406** <0.001 -0.490 0.445 NRS fatigue 3(0–5) -0.315** <0.001 -0.379** <0.001 -0.190* 0.003 NRS cough 0(0–2) -0.660 0.292 -0.153* 0.017 0.083 0.194 NRS pain 1(0–4) -0.278** <0.001 -0.346** <0.001 -0.188* 0.003 NRS sleep difficulty 2(0–5) -0.246** <0.001 -0.386** <0.001 -0.122 0.057 Data are presented as median (interquartile range) or frequency (proportion%;95% confidence interval). SpO2% desaturation = SpO2% desaturation from baseline during 1 minute sit to stand test;1STSreps = repetitions per minute during 1 minute sit to stand test;4MGS = 4 metre gait speed;mMRC = modified Medical Research Council;NRS = 0 – 10 numerical rating scale;r = Spearman correlation coefficient. *indicates statistical significance at 0.05 level. **indicates statistical significance at 0.001 level.ConclusionRespiratory symptoms were not strong predictors of 4-metre gait speed and 1-minute sit-to-stand test performance. These data highlight the importance of face-to-face testing to objectively assess functional limitation in patients recovering from severe COVID pneumonia.

Clinical, functional and psychological characteristics of survivors of severe COVID-19 pneumonia: a comparison of outcomes from the first and second waves

P135 Table 1Patient demographics, self-reported scores and functional test results by wave 1st wave 2nd wave p-value Demographics n=167 n=141 Age 59±13 58±12 0.564 Female 60 (35.93;28.94–43.40) 62 (43.97;35.97–52.22) 0.15 BMI (kg/m2) 30.5 (26.6–35.2) 32.1 (28.5–37.9) 0.009 ** BAME 115 (69.7;62.39–76.32) 72 (59.5;50.62–67.94) 0.073 Number of comorbidities 2 (1–3) 2 (1–3) 0.144 Patients Receiving Drugs Dexamethasone 11 (6.63;3.57–11.17) 138 (97.87;94.43–99.40) <0.001 *** Remdesivir 18 (10.84;6.79–16.24) 81 (57.45;49.20–65.39) <0.001 *** Other Immunomodulator 2 (1.20;0.25–3.81) 31 (21.99;15.76–29.35) <0.001 *** Questionnaire Scores n=164 n=132 NRS Breathlessness 2 (0–5) 3 (0–5) 0.153 ≥4 56 (34.78;27.75–42.36) 52 (37.14;29.47–45.34) 0.67 NRS Cough 0 (0–2) 0 (0–3) 0.439 ≥4 17 (10.56;6.52–16.00) 18 (13.64;8.59–20.26) 0.419 NRS Fatigue 3 (0–5) 3 (0–5) 0.867 ≥4 65 (40.63;33.24–48.35) 48 (36.92;28.99–45.43) 0.52 NRS Pain 0 (0–5) 1 (0–3) 0.682 ≥4 44 (27.50;21.03–34.78) 30 (23.08;16.48–30.86) 0.39 NRS Sleep disturbance 2 (0–5) 2 (0–5) 0.558 ≥4 52 (32.50;25.61–40.02) 49 (37.40;29.47–45.89) 0.382 Pre-COVID-19 mMRC 1 (0–2) 1 (1–2) 0.478 Post-COVID-19 mMRC 0 (0–1) 0 (0–1) 0.329 Post-COVID-19 mMRC ≥2 66 (40.99;33.61–48.70) 49 (38.58;30.45–47.23) 0.678 PCFS 2 (0–3) 1 (0–2) 0.055 PCFS ≥2 80 (50.00;42.31–57.69) 51 (42.15;33.62–51.05) 0.191 PHQ-9 ≥10 32 (20.38;14.66–27.19) 29 (23.02;16.33–30.92) 0.592 GAD-7 ≥10 34 (21.38;15.56–28.24) 16 (12.80;7.81- 19.49) 0.059 TSQ ≥6 43 (27.56;21.01–34.94) 27 (22.31;15.60–30.33) 0.319 Functional Tests n=160 n=139 4MGS <0.8 (ms-1) 67 (42.41;34.89–50.19) 47 (35.07;27.38–43.40) 0.201 1STS repetitions 18 (12–23) 17 (12–21) 0.460 <2.5 percentile 96 (60.00;52.29–67.36) 108 (77.70;70.25–84.00) 0.011 * Desaturation ≥4% 52 (34.67;27.40–4 .52) 42 (32.31;24.73–40.67) 0.677 Parametric data are presented as mean ± standard deviation, non-parametric data are presented as median (interquartile range) or frequency (proportion;95% confidence interval). Statistical significance indicated by * (p<0.05), ** (p<0.01), *** (p<0.001). BMI = Body mass index, BAME = Black, Asian or minority ethnic, NRS = Numerical rating scale (0–10), mMRC = modified Medical Research Council for dyspnoea (0–4), PCFS = Post-COVID-19 functional status scale (0–4), PHQ-9 = Patient health questionnaire 9 (0–27), GAD-7 = General Anxiety Disorder-7 scale (0–21), TSQ = Trauma screening questionnaire (0–10), 4MGS = 4-metre gait speed, 1STS = 1-minute sit-to-stand.ConclusionDespite shorter admission duration, and less frequent IMV, the burden of symptoms and functional limitation experienced post-hospitalisation for severe COVID-19 pneumonia was at least as severe during Wave 2 as in Wave 1. Identification of contributing factors and impact on post-COVID rehabilitation outcomes requires further study.

Remote delivery of care to people with cystic Fibrosis during covid-19 shielding is not Detrimental to patient outcomes

Introduction and Objectives Intensive surveillance of lung function (FEV1), body weight and airway microbiology is central to good cystic fibrosis (CF) care. National standards recommend people with CF (pwCF) are reviewed at least three monthly by specialist multidisciplinary teams. COVID-19 'shielding' precautions, set to protect clinically extremely vulnerable people, terminated all but essential face-to-face clinical contact for over four months. Many pwCF remain apprehensive as restrictions ease. The King's Adult CF Unit delivers care to 250 pwCF across south-east England. We discuss the immediate service changes in response to COVID-19, and the effect on patient outcomes of limited clinician review. Methods At the start of shielding the entire patient cohort was reviewed and grouped as stable or of concern. Telephone and/or video clinics were implemented, and patients identified as high risk were prioritised for remote self-monitoring (FEV1 with Bluetooth home spirometers, weight, postal sputum samples). Home visits or ward reviews, by specialist nurses or physiotherapists, were arranged if clinically essential. We undertook a cohort review of consecutive patients emerging from shielding to compare clinical parameters before and after lockdown. Results Since shielding ended, 24 consecutive patients (see table 1) have been reviewed, at a median (IQR) of 167 (155, 180) days after pre-COVID assessments. At review, 2 patients had a clinically significant fall in lung function (10%), however no statistical difference in FEV1, weight or BMI (n=21) was seen overall following shielding when compared to measurements immediately (29 (21, 46) days) before lockdown (ppFEV10.0 (-0.1, 0.1), BMI 0.5 (-1.0, 1.6)). 11 (45.8%) patients sent sputum samples, 1 identified a clinically insignificant new microorganism. 13 (54%) patients required treatment for pulmonary exacerbations, 8 (33.3%) with intravenous, 5 (20.8%) with oral antibiotics. Conclusions Unpredicted changes to CF care delivery at our centre was not detrimental to patient outcomes. In this cohort, key CF clinical indices remained stable over a short period of shielding, supporting safe remote delivery of care. Modulator therapies likely contributed to the stability in lung function seen.

Clinical, radiological, functional and psychological characteristics of severe covid-19 pneumonia survivors: A prospective observational cohort study

Introduction The 'Long COVID' syndrome, where symptoms persist beyond the acute illness with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2/COVID-19), is anecdotally described. However, a comprehensive report of clinical, radiological, functional and psychological recovery from COVID-19 is currently lacking. We present a detailed radiological, patient-reported and physiological characterisation of patients attending face-to-face assessment following hospitalisation with COVID-19 pneumonia. Methods Prospective single-centre observational cohort study at an inner-city South London teaching hospital. All patients admitted with severe COVID-19 pneumonia (admission duration-48 hours, oxygen requirement-40% or critical care admission) were invited to attend Post-COVID Clinic 6-8 weeks following hospital discharge. Primary outcome: Radiological resolution of COVID-19 pneumonitis. Secondary outcomes: Demographics and anthropometrics, inpatient clinical course, patient-reported and physiological outcomes at follow-up (symptoms, functional disability, mental health screening, 4-metre gait speed (4MGS), 1-minute sit-to-stand (STS) test). Results 119 consecutive patients attended clinic between 3rd June and 2nd July 2020, at median (IQR) 61 (51-67) days post discharge. Baseline characteristics are presented in table 1. Despite apparent radiographic resolution of lung infiltrates in the majority (RALE score <5 in 87% of patients), patients commonly reported persistent fatigue (78/115 (67.8%;95%CI 60.0-76.5)), sleep disturbance (65/115 (56.5;47.3-66.1)) and breathlessness (37/115 (32.2;25.2-40.0)). mMRC breathlessness score was above pre-COVID baseline in 55/115 (46.2;37.8-54.6). Burdensome cough was less common (8/115 (7.0;3.5-10.4)). 56 thoracic computed tomography scans were performed, of which 75% demonstrated COVID-related interstitial lung disease and/or airways disease. Significant depression (PHQ-9-9) or anxiety (GAD-7-9) were present in 20/111 (18.0;11.7-23.4) and 25/113 (22.1;15.0-29.8), respectively. The Trauma Screening Questionnaire was positive (-6) in 28/113 (24.8;18.1-31.9). Post-COVID functional scale was-2 in 47/115 (40.9;33.0-47.8). 4MGS was <0.8 m/s in 44/115 (38.3;29.6-46.1), 39/109 (34.5;26.5-41.6) desaturated by-4% during STS, 25/32 (78.1;62.5-93.1) who desaturated also had abnormal CT findings. Conclusions Persistent symptoms, functional limitation and adverse mental health outcomes are common 8 weeks after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery. Physiological testing to identify oxygen desaturation is useful for triaging patients for further investigation. Face-to-face or virtual clinical assessments are recommended to facilitate early recognition and management of post-COVID sequelae in this vulnerable cohort.

P123 Remote delivery of care to people with cystic fibrosis during COVID-19 shielding is not detrimental to patient outcomes

P123 Table 1Baseline characteristics and lung function pre- and post- shielding. Data presented as mean ± SD, or median (IQR). *At start of shieldingAge, years* 28 (22, 30) Male, n (%) 10 (41.7) CFTR modulator therapy, n (%)* Ivacaftor 1 (4.2) Lumacaftor/ivacaftor 1 (4.2) Tezacaftor/ivacaftor 10 (41.7) Best measurements in last year FEV1 percent predicted,% 70.8 (23.4) Body mass index (kg/m2) 28.0 (3.6) Patients identified as ‘high risk’*, n (%) 5 (20.8) Pre- and post- shielding FEV1 percent predicted,% 67.2 (27.3) 66.9 (26.3) Weight, kg (n=21) 66.0 (15.1) 66.9 (12.9) Body mass index, kg/m2 (n=21) 23.3 (3.8) 24.0 (3.5) ConclusionsUnpredicted changes to CF care delivery at our centre was not detrimental to patient outcomes. In this cohort, key CF clinical indices remained stable over a short period of shielding, supporting safe remote delivery of care. Modulator therapies likely contributed to the stability in lung function seen.

S55 Clinical, radiological, functional and psychological characteristics of severe COVID-19 pneumonia survivors: a prospective observational cohort study

S55 Table 1Baseline characteristicsAge (years) 58.7 ± 14.4 Sex Female 45 (37.8;29.4–46.2) Male 74 (62.2;53.8–70.6) Ethnicity BAME (Yes/No) 83 (69.7;61.3–78.2) White 36 (30.3;22.6–37.8) Black 52 (43.7;36.1–51.3) Asian 18 (15.1;10.1–20.2) Mixed race 5 (4.2;1.7–6.7) Other 8 (6.7;3.4–10.9) Index of multiple deprivation score (n=115) 26.6 ± 9.7 Body Mass Index (kg/m2) (n=118) 30.0 (25.9–35.2) Charlson comorbidity index 2 (1–4) Admission PaO2:FiO2 168.8 (105.9–272.3) Critical care admission 41 (34.5;26.9–42.9) COVID-19 complications None during admission 49 (41.2;33.6–48.7) Venous thromboembolism 27 (22.7;16.8–29.4) Pulmonary embolism 23 (19.3;12.6–26.1) Deep vein thrombosis 6 (5.0;2.5–7.6) Acute kidney injury 41 (34.5;25.2–43.7) Deranged liver function 17 (14.3;9.2–20.2) Delirium 18 (15.1;10.1–20.2) Data presented as mean ± SD, median (IQR) or frequency (%;95% confidence interval). Abbreviations: BAME = Black, Asian or Minority Ethnic, PaO2:FiO2 = ratio of arterial partial pressure of oxygen to fraction of inspired oxygen.Results119 consecutive patients attended clinic between 3rd June and 2nd July 2020, at median (IQR) 61 (51–67) days post discharge. Baseline characteristics are presented in table 1. Despite apparent radiographic resolution of lung infiltrates in the majority (RALE score <5 in 87% of patients), patients commonly reported persistent fatigue (78/115 (67.8%;95%CI 60.0–76.5)), sleep disturbance (65/115 (56.5;47.3–66.1)) and breathlessness (37/115 (32.2;25.2–40.0)). mMRC breathlessness score was above pre-COVID baseline in 55/115 (46.2;37.8–54.6). Burdensome cough was less common (8/115 (7.0;3.5–10.4)). 56 thoracic computed tomography scans were performed, of which 75% demonstrated COVID-related interstitial lung disease and/or airways disease. Significant depression (PHQ-9 ≥9) or anxiety (GAD-7 ≥9) were present in 20/111 (18.0;11.7–23.4) and 25/113 (22.1;15.0–29.8), respectively. The Trauma Screening Questionnaire was positive (≥6) in 28/113 (24.8;18.1–31.9). Post-COVID functional scale was ≥2 in 47/115 (40.9;33.0–47.8). 4MGS was <0.8 m/s in 44/115 (38.3;29.6–46.1), 39/109 (34.5;26.5–41.6) desaturated by ≥4% during STS, 25/32 (78.1;62.5–93.1) who desaturated also had abnormal CT findings.ConclusionsPersistent symptoms, functional limitation and adverse mental health outcomes are common 8 weeks after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery. Physiological testing to identify oxygen desaturation is useful for triaging patients for further investigation. Face-to-face or virtual clinical assessments are recommended to facilitate early recognition and management of post-COVID sequelae in this vulnerable cohort.