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Operations and Investigation
* Provides ongoing evaluation of performance, facilitates prioritization of improvement activities, and shares knowledge as subject matter expert and prioritizes improvement work to align with organizational strategy.
* Performs initial screening and referral of safety events reported through the safety event reporting system and escalates urgent patient safety issues to the System Director of Patient Safety and Accreditation and/or Clinical Risk Team.
* Leads the safety event triage meeting and coordinates collaborative referral and assignation of safety event classification.
* Performs review of clinical documentation in the electronic medical record and performs other forms of fact gathering to ensure appropriate safety event referrals, follow-up, and loop closure.
* Leads/facilitates root cause analysis and FMEAs utilizing professional judgement regarding the most appropriate tool to determine system/process failures. Agile in providing and prioritizing project management by leading either pro-active or reactive activities related to Quality and Safety. Identifies opportunities for improvement in process, structure and /or outcome and determines the appropriate process improvement methodology.
* Leads data driven process improvement initiatives, employing systems thinking, knowledge of human factors, and the principles of Highly Reliable Organizations (HROs) in the creation of action plans designed to prevent recurrence of patient safety events. Develops and implements innovative strategies to improve patient safety, quality of work, quality of care, and clinical quality outcomes.
* Promotes the Patient Safety Program through presentations, colleague training, and applicable committees.
* Closes all events and assigns a harm classification in a timely manner after thoroughly reviewing investigator comments, and all associated action plans.
Safety Culture * Develops and implements ongoing Just Culture Training and Education core content. * Facilitates and is the change agent toward building a culture of patient safety. Understands, articulates and supports Just Culture concepts. Partners with organizational leaders to develop tactics to address opportunities identified from culture of safety surveys. Leads change in support of organizational strategies to meet expectations of national patient safety benchmarking. * Leads/facilitates structured professional development sessions focused on the principles of Just Culture, appropriate utilization of the Just Culture Algorithm, and effective actionable strategies to reduce risk and patient harm * Identifies trends in reported safety events and compiles meaningful and actionable safety program data, for dissemination to department and senior leaders. * Utilizes the Joint Commission and other resources such as the ECRI Patient Safety Organization (PSO) to inform proactive safety rounding, and collaborate with department leaders in deployment of best patient safety practices, as well as review, prioritization, and creation of action plans based on department-level patient safety event data. |
Documentation * Compiles objective event summaries and timelines, to inform our stakeholders to assist in their determination if a deviation from intended process or system vulnerability exists. * Uploads updates on safety event reviews, root cause analysis, and associated action plans and loop closure, to the safety event reporting system. |
Compliance/Safety * If required for position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates. * Completes all company mandatory modules and required job specific training in the specified time frame. * Responsible for reporting any safety related incident in a timely fashion through the Vigilanz system; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner. * Responsible for maintaining up-to-date knowledge of cybersecurity trends, developments, best practices and regulatory changes. |
Education |
Certification & Licensures |
Experience |
CALL REQUIRED: |
No |
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