The Director of Quality, Patient Safety & Regulatory will work collaboratively with the Vice President (VP) of Quality & Patient Safety to oversee all clinical quality, process improvement, patient safety, accreditation and licensing activities for Long Beach Medical Center (LBMC) & Miller Children’s & Women’s Hospital Long Beach (MCWHLB). The Director will promote improvement initiatives in quality and patient safety to ensure that LBMC and MCWHLB will achieve excellent evidence-based healthcare outcomes to the patients we serve. The Director is also accountable for ensuring compliance throughout the organization according to federal, state & local standards and regulations.
Principal Duties and Responsibilities:
1. With the VP of Quality and Patient Safety, the director will position LBMC and MCWHLB as a national leader in clinical quality and patient safety.
2. The Director will continuously assess, review, evaluate, develop and implement programs to expand what the organization is doing to achieve the bold goals as outlined by the MemorialCare Strategic Plan.
3. This individual is also accountable for the regulatory compliance of both hospitals on an ongoing basis for any announced or unannounced accreditation surveys including but not limited to CMS, Joint Commission, CDPH, California Children’s Services and others as assigned.
4. This position will be liaison to the external reporting groups such as Leapfrog, USNWR and others as assigned.
5. Direct quality and safety initiatives/projects that drive to Zero Harm to advance the organization’s journey to become a High Reliability Organization (HRO).
Manages and oversees daily operations and functions of the quality, patient safety & licensing accreditation regulatory compliance (LARC).
Oversees implementation and evaluation of the Performance Improvement and Patient Safety Plan.
Along with the VP of Quality & Patient Safety, oversees reporting of adverse events to appropriate agencies and monitoring of the correction/remediation plan.
Facilitates Quality Review/Continuous Process Improvement and Zero Harm Committees.
Participates in root cause analyses and other safety event reviews.
Oversees and improves data monitoring tools and metrics for analyzing and reporting data to enhance quality initiatives including but not limited to quality and safety outcomes.
Provides orientation and education on quality, safety & process improvement to all employees and medical staff.
Ensures all state and federal regulations across hospitals are met. Identify organizational opportunities to increase survey readiness for all leaders and staff.