This position works within the Quality Improvement department to improve patient safety, reduce the risk of harm to patients and improve our systems and processes so as to reduce the likelihood of healthcare errors. Evaluates occurrences and sentinel events, coordinates root cause analysis process of events or coordinates medical staff peer review activities. Using continuous quality improvement methodology and principles acts as a consultant/ facilitator for teams working to improve clinical quality of care. Provides education for staff on clinical quality improvement processes. Assures quality improvement activities comply with guidelines and/or regulatory requirements.
Analyzing complex medical situations and events and preparing a comprehensive summary result of the analysis. Guiding teams through analysis of complex processes to the discovery of final root causes. Assuring action plans address root causes.
Influencing others to make changes that will improve patient safety without having direct management line responsibilities for employees or processes.
Coordinating multiple case reviews with multiple providers and ensuring completion prior to re-credentialing deadlines.
Major Responsibilities: List a series of brief statements describing major responsibilities or end results in the position.
Commitment – Demonstrate a commitment to Gillette’s Mission, Vision, and Principles of Care. Understand how your work is aligned to the company and department objectives and take ownership of success.
Accountability – Hold self and others accountable for actions, commitments, results and resource management. Maintain care of the work environment. Protect confidential information.
Respect – Foster a welcoming environment characterized by a high level of acceptance, cooperation, and mutual respect of individual differences. Build professional relationships with patients, families, coworkers, and others. Follow Gillette’s guidelines and Code of Conduct for resolving issues.
Excellence – Adopt practices to deliver superior clinical and non-clinical outcomes, enhance processes, and ensure excellence in daily work. Embrace change and demonstrate willingness to find and learn ways to accomplish the work.
Service – Demonstrate a passion to care for patients, families, coworkers, and others by anticipating and meeting needs.
1. Quality Improvement:
Serves as internal consultant providing expert assistance and facilitation for continuous quality improvement to QI committees and teams.
Using the organizational performance improvement model guides teams through redesign of processes and systems to reduce risks and protect patients from harm.
Assists team leader with team process keeping the team focused on aims and cycles of improvement.
Helps to build effective improvement team, assisting with problem solving and conflict resolution.
Applies systems approach, advocates for and advances positive changes.
Supports teams and program with consultation and expertise on measurement plans, data collection, analysis and integration of information
2. Performs review of medical records, occurrence reports and other information to assist in identifying variances from best practices, clinical protocols or improvement opportunities.
3. Coordinates provider peer review process, identifies and reviews records of cases identified as requiring peer review, refers cases to appropriate reviewer and supports the peer review subcommittee. Provides required reports. Coordinates the spine, orthopedic and PMR mortality and morbidity quarterly reviews.
3. Conducts Root Cause Analysis and investigation of serious events. Follows the Gillette policy and procedure for RCA, coordinates and gathers and documents information on the event from all involved. Guides team through a thorough and complete evaluation of the event, research of best practices, and identification of root causes and development of action plans. Documents the RCA and assures action plans are implemented and measurement of effectiveness of actions. Tracks progress until complete. Produces information and education on the learning’s from root cause analysis events and the process improvements.
4. Based on analysis of data, recommends at least one high risk patient safety process for proactive risk assessment (FMEA) annually and coordinates the assessment process.
5. Conducts utilization review
Completes admission and continued stay reviews. documents reviews in Affinity
Provide insurance UR staff with routine updates on patient’s condition and progress.
If insurance denies payment for care, works collaboratively with medical staff and family to appeal decision and advocate for patient needs.
Working with prior authorization staff obtains insurance information prior to patient’s admission to the Rehabilitation Program and reviews it with parents
6. Provides backup coverage for others in QIR and for rehabilitation coordinator.
Professional Development and Quality Improvement
Participate in activities that promote professional growth and quality improvement.
Complete all annual education requirements within the last evaluation cycle; demonstrate knowledge by performing all aspects of job in accordance with safety policies.
Demonstrate the skills necessary for working effectively with others in a changing organization.
American Society For Quality - 9 months ago
Gillette Children's Specialty Healthcare is an independent not-for-profit hospital headquartered in the Twin Cities, with clinics throughout...