Nurses and healthcare professionals across the world have unconsciously internalized implicit biases within their services, influenced by pervasive learned behavior, attitudes, and stereotypes. These biases can easily interfere with our understanding, actions, and decisions when healthcare services are performed. Such features can also be evidenced in healthcare organizations’ recruitment, support, and retention policies, as well as the education and training elements included in academic curricula. Initial classroom preparation for nurses is based on an environment of learning related to the nursing Code of Ethics, legal requirements, care management, quality improvement, and in the world of changing responsibilities – systems-level change management. However, opportunities to elicit perceptions of discrimination and discomfort in an unobtrusive manner from a diverse student body remains untouched. The objective of this presentation is to promote the inclusion of underlying academic policies to attract, advance and better prepare nurses by embedding building blocks of self-assessment, self-advocacy, and the identification of implicit bias into every aspect of teaching, learning, and practice for all nurses.  In order to heighten the culturally congruent understanding and performance critically required for patient satisfaction, nurses must also have continuous opportunities to effectively improve communications that enhance peer-to-peer working relationships. Nurses will emerge from professional development opportunities possessing a higher level of comfort and knowledge in their ability to demonstrate more culturally congruent communication with peers, patients, other healthcare professionals and stakeholders. In so doing, they will have the ability to facilitate the achievement of health equity, strengthened relationships, and a framework for cultural competence.

Nursing is a profession with many challenges, and we have always known this. It is also a profession of huge alternatives, opportunities for learning and growth. Even though I have been in this profession for over 40 years, I don’t think anything has challenged my abilities, my senses, my patience yet given me a great sense of achievement like being a nursing administrator in developing countries. After having spent the previous 20 years reporting to Boards as a Chief Executive Officer, yet with clinical nursing responsibility in many of those roles, I have now returned to my nursing roots as a Chief Nursing Officer and Chief Operating Officer in several developing countries. Spending 12 months in Bangladesh, 6 months in Thailand and now resident in Laos, my role is multi-faceted; one of building, commissioning and managing hospitals and developing the clinical quality perspective with a vision to lead the hospital to international accreditation. However, when you get down to it, the predominant need is always the clinical need. The need for a hospital to reach accreditation standards, the need to fight for single use device policies and the need to train nurses in basic yet critical skills of hand hygiene, infection control, prevention of antibiotic resistance. This is difficult, yet an amazing experience when the nurses you have influenced become champions as infection control trainers and educators of their patients, their community and their colleagues. Combining my experience as a clinical nurse and a hospital administrator enables me to give back to a community.  Having a role in commissioning hospitals and developing clinical and governance systems for communities that need basic health care, health literacy and essential public health measures that for most of those in modern nursing, take for granted, is both a privilege and an adventure.

In an effort to focus on a Culture of Safety and Quality, Ramsay Sime Darby Healthcare (RSDHC) commenced a “Speak Up For Patient Safety” program in January 2019. SUFPS is an innovative and evidence-based programme, based on the Vanderbilt University (USA) program delivered with the assistance of the Cognitive Institute.  The program addresses in a positive way any behaviour which undermines a culture of safety through peer-to-peer conversations and equipping staff with assertiveness training. To achieve a successful outcome there was a major focus on informing, educating and engaging key stakeholder groups.

Every healthcare professional, at every level, and across all healthcare settings, has been challenged to develop and implement programs to actively seek out risk and document harm (surveillance / reporting), to proactively design standardized processes and systems (prevention), and to create a culture where everyone with every action is responsible and accountable for patient safety (control). The presentation provides a summary /overview of surveillance and disease prevention and control of the broader patient safety challenges and their role in national patient safety efforts. Care Bundles in Infection Prevention and Patient Safety: If you know how to prevent infections, you know how to protect patients from most adverse events. Care “bundles “are simple sets of evidence-based practices that when implemented collectively, improve the reliability of their delivery and improve patient outcomes. A number of specific bundles are available that can be implemented in any healthcare setting. These packages of care contribute to infection prevention, reduce unnecessary antibiotic prescribing and may limit the development of antibiotic resistance.

What is the percentage of children vaccinated compared to the number planned for vaccination in 2016? Initial hypothesis: We have been witnessed and still are of numerous discussions among experts (scientists) and layman people about the efficiency and harmfulness of vaccines, especially MMR vaccines which were considered and still is thatit causes autism. Research goal: Determine the coverage of mandatory immunization, especially the MMR vaccine, in the Pomoravlje district. Research methodology: The research was conducted at the Public Health Institute in Cuprija from 03.09- 20.09.2018. The period from 01.01.2016 - 31.12.2016. As a research instrument I used documentation sheet, observation, analysis and a survey. Findings: there are variations in the percentage of vaccinated children from certain vaccines in certain towns in the Pomoravlje district, but the overall percentage of vaccines is satisfying in the district. Conclusion: Although mass media and social networks (where people have access to a great deal of information) have raised a great deal of concern about the correctness of the MMR vaccine, as well as others that may have unintended consequences, the number of vaccinated MMR vaccines is satisfying and it’s not below 91% for each town in the district.

India is a developing country; the needs of meeting health care demands is a challenge that India is currently facing.  Healthcare is a social responsibility, that every country must take consideration in their political agenda, give economical priority during budget allocation. Some of the innovative models are: 1)PPP model: Public private partnership is one of the health care delivery models in which we can offer health care to the rural public. There are three categories of partnership in this model. Firstly, Infrastructure model, Secondly Clinical model and third version is integrated model, in which both infrastructure and clinical care can be taken care by private hospitals. 2) Hub and Spoke design: In this model, one hub can have several spoke centers that caters the needs of the rural population. Through this model, the tertiary private hospitals can provide service to the rural areas, where accessibility, availability and affordability becomes a challenge. 3) Task shifting: This is a model in which the business strategy becomes volume based than margin based. For e.g.: A doctor who performs surgery can devote his time and plan his tasks only on the clinical aspects (surgery) without wasting time and energy for non-clinical tasks. 4) Out sourcing models: Non-clinical services like security, housekeeping, Food and Beverage, Drivers are outsourced/contracted. This in turn helps in increasing the focus on clinical service staff and reduction of capital budget expenditure. 5) Telemedicine/Telenursing: This has increased the accessibility of healthcare to the customers at the finger tips by saving the energy and time in visiting the doctors at their office. Renting-out of medical equipment: Few hospitals whose capital investment is less, are adopting the strategy of renting the costly equipment like X-ray machine, CT machine, MRI machine etc. 6) Adoption of public hospitals by Private hospitals: In this model, tertiary private hospitals are adopting local public hospitals in which they are providing healthcare services to the rural public with minimal cost. The penetration of healthcare insurance is very minimal in India. After the implementation of the governmental policy (Ayushmaan Bharath) the healthcare becomes more accessible and affordable to the rural public and this enhances the technological leverage in healthcare as well.

The application of Lean methodology to healthcare has shown important benefits for patients and health organizations. The purpose of this study is to evaluate the results of the application of the Lean Healthcare methodology in the nursing office in a Lithotripsy and Endourology Unit. The office process is the initial contact of the patient with the unit in which is made a treatment decision. One of the main steps in the office process was the implementation and systematization of a specialized nursing office. To evaluate it several indicators were designed and used. A specific satisfaction survey was designed and used for calculating the satisfaction index. On the other hand, the ISBAR communication tool was implemented as a safety measure for our patients. A total of 5510 office processes were included and analysed from 2014 to 2019. The initial organization and implementation of the nursing office into office process showed an improvement of the perception of information care quality. The posterior systematization of the tasks showed an improvement in the analysis of the office time. The percentage of patients that took more than 60 minutes for office visit was reduced significantly over the years until a value of 9% in 2018. The detailed analysis of the times by stages into the office process showed a reduction of the nursing office assessment time from an average of 14,56 in 2016 to 12,03 minutes in 2019. It allowed increasing a total of 346 visits more in the last year. There was a global satisfaction increase from 90% to 98%. The postoperative infectious complications and other variables were improved as a result of ISBAR implementation. The implementation and systematization of a specialized nursery office in a lithotripsy and endourological unit increases assistance quality and patient satisfaction. Lean methodology can effectively be applied to improve efficiency.