Director Quality Patient Safety and Risk-Forney at Texas Health Resources, Texas Health Resources 612 E. Lamar TX 76011
Director Quality Patient Safety and Risk-Forney at Texas Health Resources in Texas Health Resources 612 E. Lamar TX 76011. Full-time. Est. up to $160k. Apply with swipeandhired.
The Director of Quality, Patient Safety and Risk Management will serve as a resource for Texas Health Forney by offering value-added knowledge and expertise in improving outcomes and providing safe, timely, cost-effective, person-centered care. This position is responsible for sustaining a culture of high reliability, ongoing process improvement and continuous regulatory readiness to ensure the safety of our stakeholders.
- Work location: Texas Health Forney, Forney, TX
- Core work hours: Full Time, Monday – Friday, 08:00 AM – 5:00 PM
Key Responsibilities
Regulatory Accreditation, Certification, and Compliance
- Responsible for regulatory compliance, accreditation, and continuous survey readiness. Oversees an effective continuous readiness program, including but not limited to, mock surveys, regulatory/accreditation tracers and inter-rater reliability processes.
- Works in collaboration with hospital leadership to ensure that all required regulatory/certification submissions and follow-up, including the annual mock survey, Evidence of Standards Compliance (ESC), response to TJC, CMS or other regulatory agencies; complaint investigations, Measures of Success (MOS) and action plans are appropriate and completed in a timely and thorough manner.
- Conducts evaluations using authoritative interpretive resources in order to provide an expert analysis and synthesis of the intent, applicability and value of regulations (federal, state, local) and accreditation standards.
- Responsible for coordinating, developing, reviewing, and evaluating policy and guideline documents (policies, forms, protocols, order sets, consents, etc.) for regulatory compliance with consideration and research of evidence-based practice and current best practices.
Performance & Process Improvement
- Uses Process and Performance Improvement methodology to assess performance, sets achievable goals, uses data to initiate changes, and develops measures that will ensure sustainability of improvements.
- Promotes the use of Process and Performance Improvement methods and science throughout the hospital.
- Provides education and guidance on the purpose, use and value of quality improvement tools.
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.
Population Health & Care Transitions
- Participate in the development of population health improvement models and strategy.
- Advise leadership on the impact of evolving payment models and their associated quality metrics for strategic planning and development priorities.
- Integrate population health improvement initiatives and metrics into the hospital quality program.
- Lead prioritization activities to identify target populations for improvement of care delivery.
Health Data & Analytics
- Leverages electronic systems to input, analyze, extract, and manage data to support and drive data integrity, streamline process, innovate practices, and achieve positive outcomes.
- Develops hospital reports and scorecards incorporating clinical and business metrics tailored to strategic or operational goals.
Patient Safety
- Promote a safety culture and infrastructure that aligns with Texas Health’s strategic objectives and meets regulatory/accreditation standards.
- Identifies opportunities for improvement and continuously looks for ways to improve processes and reduce harm using the principles of High Reliability.
- Conducts and develops comprehensive risk assessments, prioritizes potential risks, and recommends evidence-based strategies for risk reduction.
- Prioritize high risk findings in order to escalate opportunities for improvement for system leadership awareness and support of risk mitigation strategies.
Quality Review & Accountability
- Provides oversight of the annual assessment and development of the Texas Health Kaufman Quality Assurance Performance Improvement (QAPI) plan.
- Develop and oversee processes for managing professional practice evaluation information across its life cycle, from capture to archive and/or destruction.
- Incorporate findings from identified trends across ongoing professional practice evaluation and peer review into performance improvement activities across the organization.
- Synthesize requirements from multiple regulatory and/or payer agencies and communicate organizational impact across various programs.
Professional Engagement
- Pursues/achieves/maintains required applicable certification and licensure.
- Pursues professional growth and development of required knowledge and skills.
- Participates in a Quality/Regulatory professional organization.
Leadership & Integration
- Utilizes the principles of influence, leadership, and change management to advance program goals and ensure changes are vetted by all stakeholder groups.
- Utilizes skills in communication, relationship-building, and facilitation to ensure that all stakeholders feel accountable for performance improvement, continuous regulatory compliance and patient safety
- Contributes to the development of other stakeholders through education and mentorship.