Director Quality Patient Safety and Risk
Director Quality Patient Safety and Risk
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Job Description
At Texas Health Resources our mission is to improve the health of the people in the communities we serve.
As part of the Texas Health family and its 28000 employees were one of the largest employers in the Dallas Fort Worth area. Our career growth and professional development opportunities are top-notch and our benefits are equally outstanding. Come be a part of our exceptional team as we improve the health of the people in our communities every day. You belong here.
Learn more about our culture benefits and recent awards.
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Director Quality Patient Safety and Risk
Are you looking for a rewarding career with family-friendly hours and top-notch benefitsWere looking for qualifiedcandidateslike you to join our Texas Health family.
- Work location: Texas Health Heart and Vascular Arlington TX
- Core work hours: Monday-Friday 8:00a-5:00p
Summary
Constant focus on promoting a culture of safety high-reliability and performance excellence while overseeing implementation and operation of Quality & Patient Safety initiatives.
Job Duties
OPERATIONS: ACCREDITATION/CLINICAL CERTIFICATION - Oversight and facilitation of data submission for TJC accreditation
activities liaise with TJC CMS and the Texas Health and Human Services Direct Chest Pain Certification programs and activities Oversight of GWTG HF and AMI registries implementation and data submission (HARP/QNet) THCIC state reporting Oversight of carotid artery stent clinical trial data submission for cancer registry. Core measure reporting (vaccination Sepsis ED) conducts chart audits and tracers with staff to determine current state of regulatory readiness and compliance identify areas of improvement and relate to senior leadership.
OPERATIONS: Quality/PI/PATIENT SAFETY - Direct and support processes and coordinate tactics that advance patient safety educate and promote HRO tactics and performance improvement - Track trend and monitor performance improvement outcomes and risk events (RL) - Work with other departments on hospital and system initiatives and support evidence-based best practices - Ensure annual completion of FMEA - Direct clinical outcomes program. As best practices and/or identified opportunities arise lead the team to conduct PDSAs and follow the process to ensure that efforts are effective and maintained. Collect and analyze continuous improvement data for contracted services including identifying opportunities for improvement and working with each department to develop a resolution Presents annual contract evaluations to the Board. Track and trend RL events manage reports handle grievances per state guidelines develop reports and presentations for senior leadership meetings.
OPERATIONS: PEER REVIEW - Oversee and facilitate Medical Staff Peer Review including Ongoing Professional Practice
Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) - Assist peer review physicians and division chiefs in
preparing and presenting case reviews and completing follow-up activities based on peer review findings. Oversee and facilitate Mortality and Morbidity Review as part of OPPE/FPPE process. Follow-up on RL events that require Peer Review.
HUMAN RESOURCES - Develop and implement strategy to create and maintain a positive employee relations environment for
departmental employees - Recruit orient and retain excellent staff - Supervise departmental staff developing standards of
performance evaluating performance and initiating or recommending personnel actions - Mentor job-related growth of staff.
LEADERSHIP - Plan and execute in collaboration with Chief Medical Officer Chief Nurse Executive the
implementation of a comprehensive quality and safety management process - Develop and maintain KPI quality dashboard -
Direct the preparation and maintenance of department reports and tracking of data for quality and safety initiatives including
preparation of reports for committees and top management as required - Monitor and supervise hospital compliance with The
Joint Commission (TJC) and governmental agencies standards and requirements acting as liaison during site reviews -
Participate in and represent hospital in system-wide quality/patient safety committees and initiatives - Take initiative and
coordinate with other departments to develop action plans for performance improvement and patient safety initiatives and
risk reduction.
OPERATIONS: ASSIST IN INVESTIGATION/RESPONSE TO SENTINEL EVENTS/NEAR MISSES - Conduct initial investigation of events
to begin information gathering process - Work with CNO/hospital staff/medical staff regarding management of event and
communication with the patient/family - Communicate with the patient/family as necessary - Coordinate and facilitate RCA
meetings and development of action plans - Monitor progress and effectiveness of RCA Action Plans - develop reports and results of action plans for Risk Medical Executive Committee/Board/Department meetings.
Required Experience:
Director
Employment Type
Full-Time