Pay range: $49.72 - $74.58 per hour ($103,417 - $155,126 annually), based on experience.
About St. Charles Health System:
St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture.
What We Offer:
Competitive Salary
Comprehensive benefits including Medical, Dental, Vision for you and your immediate family
403b with up to 6% match on Retirement Contributions
Generous Earned Time Off
Growth Opportunities within Healthcare
ST. CHARLES HEALTH SYSTEM
JOB DESCRIPTION
TITLE:RN-Patient Safety & Risk Management
REPORTS TO POSITION:Director of Risk Management and Patient Safety
DEPARTMENT: Risk Management and Patient Safety
DATE LAST REVIEWED:March 12, 2024
OUR VISION: Creating Americas healthiest community, together
OUR MISSION: In the spirit of love and compassion, better health, better care, better value
OUR VALUES: Accountability, Caring, Teamwork, and Safety
DEPARTMENT SUMMARY: The Risk Management and Patient Safety Department protects and enhances clinical services, patient, employee, and visitor safety associated with the health system operations, through the development and implementation of a clinical risk management and patient safety program. This mitigates risk and promotes patient safety improvement and compliance with applicable clinical standards and best practices to promote a Just Culture in the organization. The department works in collaboration with legal, claims, quality, safety, and entity leadership.
POSITION OVERVIEW: The RN provides leadership for the design, implementation and coordination of the organization wide Risk Management and Patient Safety program across the facilities and service areas within St. Charles Health System with the objective of maintaining patient safety. The RN develops, coordinates, and facilitates implementation of effective systems for risk identification, investigation, and mitigation of both potential and actual patient safety concerns and risks. This position promotes and facilitates the transition from a retrospective and reactive model of risk management to a prospective and proactive approach for patient safety models consistent with the concepts expected of Enterprise Risk Management (ERM) and a High Reliability Organization (HRO). The RN serves as Subject Matter Expert for Root Cause Analysis, Safety Culture, National Patient Safety Goals, and other evidence-based programs as needed. This position is responsible for reviewing policy operational changes and making recommendations to the Director of Risk Management and Patient Safety. This position does not directly manage any other caregivers.
ESSENTIAL FUNCTIONS AND DUTIES:
Maintains oversight of the Safety Alert System (SAS) reporting and response process, including severity rating and evaluation of all safety events, the investigation and identification of risk exposures; risk analysis using selected tools, RCA and apparent cause analysis; risk evaluation and monitoring using algorithms and review criteria; and risk treatment including establishing a potential claim file, working with medical malpractice and general liability carriers follow-up and performance of trending analysis for assigned facilities/service areas. Stops the line to mitigate potential patient safety conditions and maximize learning.
Facilitates cross-functional/site process improvement endeavors to support elimination of errors and other factors that contribute to potential or actual adverse patient outcomes.
Uses trends obtained from safety reports, patient safety rounds and other sources of patient safety data to focus on areas for further analysis, risk management, patient safety, and loss prevention activities.
Identifies potential and actual sentinel events or serious safety events with prompt notification and debrief to key stakeholders including senior leadership, and site administration for conducting investigation of event and root cause analysis.
Leads investigation for a Sentinel or serious safety event investigation and analysis. Leads RCA process and failure effect mode analysis (FMEA) to identify opportunities for system and process improvements. Supports the preparation of documents for reporting serious harm events to State and accreditation agencies.
Develops and provides education/communication to leadership, physicians, colleagues and other stakeholders on patient safety needs, initiatives, activities, and for shared learning. Participates in assigned Medical Staff and Hospital Quality and Safety Committees.
Proactively performs surveillance and evaluates patient safety risks in a uniform and consistent manner for assigned facilities, service areas and affiliated joint ventures.
Collaborates with internal legal counsel to support their investigation and defense of claims against the Health System. Provides external defense attorneys requested information to prepare for pending litigation and/or claim review. Prepares and submits PCE (potentially compensable event) reports for potential claims.
Provides caregiver and provider guidance and support for patient care issues with patient safety/risk or legal implications, i.e. consent issues. Works in collaboration with the compliance department for potential EMTALA and HIPAA violations.
Provides guidance to leadership as to acceptable bill adjustments under CMS stipulations. Initiates bill adjustments to mitigate potential claims in collaboration with claims management and in congruence with policy and CMS limitations.
Reviews and supports the completeness of patient complaint and grievance response letters.
Provides guidance to caregivers and providers for disclosure of unanticipated events to patient and their families.
Proactively conducts failure mode and effect analysis for high risk or problematic care processes across System facilities and joint venture businesses, at minimum as required by The Joint Commission for continued accreditation.
Provides for 24/7 Patient Safety/Risk Management coverage and response for assigned areas of responsibility.
Collaborates with Subject Matter Experts to develop and spread learnings via Safety Alerts, Advisories, and key learnings based on best practices and evidenced based medicine.
Refers clinicians and caregivers to Critical Incident Stress Management (CISM) when appropriate. Understands the basic model of event management and being sensitive to frontline caregiver emotional needs.
Supports the vision, mission, and values of the organization in all respects.
Supports lean with goal of continuous improvement with energy and enthusiasm, functioning as a champion of change.
Provides and maintains a safe environment for caregivers, patients, and guests.
Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organizations corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.
May perform additional duties of similar complexity within the organization, as required or assigned.
EDUCATION:
Required: Bachelors degree in related field.
Preferred: Masters Degree in related field.
LICENSURE/CERTIFICATION/REGISTRATION:
Required: Current Oregon RN license. Ability to travel to business functions/trainings/meetings and all SCHS worksites required. Certified Professional in Health Care Risk Management (CPHRM) required within three years of employment or Certified Professional in Patient Safety (CPPS) within two years
Preferred: Certified Professional in Patient Safety (CPPS) or Certified Professional in Healthcare Risk Management (CPHRM.
EXPERIENCE:
Required: Three years experience with direct patient care. at a health system, hospital, or other health care facility. Use of an occurrence reporting system and Microsoft Excel, PowerPoint and Word programs.
Preferred: Three years experience in quality, regulatory, healthcare risk management and/or patient safety at a health system, hospital, or other health care facility. Proficient in use of an occurrence reporting system and Microsoft Excel.
PERSONAL PROTECTIVE EQUIPMENT:
Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.
PHYSICAL REQUIREMENTS:
Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
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For customer service issues, contact us at info@nahq.org or call us at (847) 375-4720. The team is available Monday-Friday from 8 AM-4:30 PM CT.
Important Information for CPHQ Recertification
The recertification process has been streamlined. Unlike previous years, you don’t need to list out your CE activities at the time of completing your application. Instead, you will be asked to attest to having met the requirements, further aligning with the honor-based system of recertification. In the event that your application is randomly selected for audit, you may be required to list your CE activities and submit supporting documentation.
While you may participate in NAHQ learning opportunities (Learning Labs, JHQ articles, etc.), you can only claim CE credit once for each activity. Therefore, if you’ve previously earned CE from a NAHQ learning opportunity, you can’t claim it again, nor will you see the repeat CE appear in your “My Learning� tab. This includes activities used in previous recertification cycles.
Remember, if you’re recertifying during the grace period (1/1/24-1/31/24), you already had to earn your CE hours by Dec 31, 2023.
You still have time! Register today for a multi-day virtual event that addresses the most urgent and important issues facing healthcare today that offers a full schedule of educational sessions organized around NAHQ’s twice-validated healthcare quality competency framework.
We are excited to announce the release of the book “UNSTOPPABLE: Inspiring Stories of Perseverance, Triumph and Joy from Trailblazing Women in Healthcare“.
Be inspired by nine leading healthcare trailblazers, including our own CEO Stephanie Mercado, who empower us all with their vision and passions.
You’ll notice we’ve simplified the application process to recertify. You will not have to list your CE activities at the time of applying*. Simply attest that you met the requirements to complete the application.
*In the event of an audit, CPHQs may need to list activities and upload documentation in their NAHQ account.
Quality Education Resources
Join this informative session, “Quality Education Resources� Thursday, June 22 from 11-11:30 a.m. CT. You will learn about the range of NAHQ quality education resources available to you and hear directly from universities about the benefits they realized from implementing NAHQ’s content within their courses.
Maintain a Pulse on the Latest Quality & Safety Benchmarking Data
Learn more about NAHQ’s enhanced Quality and Safety Benchmarking Program, which provides timely insights to help U.S. hospitals and health systems create data-driven business cases for their quality and safety resourcing.
Understand the Variability Among Your Quality Team Through Workforce Accelerator
Join us Tuesday, May 2, at 11 a.m. CT, to learn more about the different options available to engage with NAHQ’s enterprise-wide solution, Workforce Accelerator®. Options range in size and scope and are designed to meet the various budgetary and timing needs of health systems as they embark on their quality journeys. Register today!
Healthcare Quality and Safety Workforce Report: New Imperatives for Quality and Safety Mean New Imperatives for Workforce Development
The National Association for Healthcare Quality® (NAHQ) has conducted groundbreaking research on the advancement of the quality and safety agenda and has published the results in a new workforce report. NAHQ’s Healthcare Quality and Safety Report answers the question: “Is today’s healthcare workforce doing the work that will advance critical priorities of quality, safety, equity, value, and system sustainability?� The answer is no.
Updated Maintenance Dates: Sunday, February 5, 2023
Maintenance is planned for Sunday, February 5, from 11 p.m.-4 p.m. CT. During this time, you will not have access to the “My Learning” section of your NAHQ account. We apologize for any inconvenience this may cause and thank you for your patience.
NAHQ’s Organizational Membership Subscription will serve as a one-stop shop for healthcare quality and safety training and education. Attend the February 2, at 11 a.m. CT, info session to further understand the new offering that will continue NAHQ’s focus of “Quality in Action.�
NAHQ has published an updated version of the CPHQ exam content outline.
The new exam content will take effect on March 15, 2023. Candidates planning to take the exam before March 15, 2023, can access the current CPHQ exam content outline and related resources on our website.
Missed NAHQ Next? Don’t worry, you can purchase NAHQ Next on-demand and receive access to all content for 60 days from purchase. Benefit from actionable content that addresses issues head-on and features “how-tos” and results. Buy now and have the opportunity to receive 40+ CEs.
Healthcare Quality and Safety Workforce Report: New Imperatives for Quality and Safety Mean New Imperatives for Workforce Development
Member Briefing Workshop and Healthcare Quality Week Webinar
October 7, at 12 p.m. CT
NAHQ will host an exclusive member briefing workshop where NAHQ CEO Stephanie Mercado and NAHQ President-Elect Nidia Williams will review the workforce report in-depth and prepare you to discuss it with your team and leadership during Healthcare Quality Week.
October 17, at 12 p.m. CT
To kick off Healthcare Quality Week, (HQW) NAHQ will host a complimentary webinar with NAHQ leaders to discuss the report, its impact and how you can leverage the report to your advantage.
You still have time! Register today for a multi-day virtual event that addresses the most urgent and important issues facing healthcare today that offers a full schedule of educational sessions organized around NAHQ's twice-validated healthcare quality competency framework.