The Quality Improvement Specialist supports programs, departments, leadership and medical staff by providing consultation and guidance in supporting a quality and patient safety culture, coordinating quality activities, establishing measurements to monitor performance, insuring high data integrity, role-modeling quality improvement principles and rapid cycle change, and teaching and training others to promote the message of quality.
Essential Functions:
- Abstracts both qualitative and quantitative information from health records, surveys and other key data sources and uses the information for data entry and studies, trending reports, and identification of areas for prioritization and improvement.
- Reviews the health record retrospectively and/or concurrently and collects information to identify opportunities for improvement and initiates or refers follow-up as appropriate including presenting to quality committee, facilitating root cause analysis, failure modes and effects analysis, and other performance improvement tools.
- Assists management/medical staff in formulating requests for data and supports development of prioritized studies that fully use the system databases to address operational issues.
- Supports use of databases and registries by utilizing electronic data when available.
- Designs and follows data collection methodology, including defined data definitions and study parameters before initiating focused studies.
- Responsible for data management and support: analyzes, interprets, formats and presents clinical data for a variety of users; identifies services and/or cases for clinical studies and may support analysis of data through development of an internal database of activities.
- Uses basic statistical techniques to analyze outcomes to determine special or common cause variation.
- Provides expert knowledge to determine best display to support analysis. Utilizes graphics and visual aides whenever possible to improve data analysis.
- Demonstrates fundamental knowledge of healthcare regulatory and licensing agency requirements and applies requirements in identifying, referring and problem solving.
- As appropriate, provides feedback to departments on compliance with requirements.
- Provides consultation and education in performance improvement and CQI processes so that clinical practice improvement and service quality is enhanced.
- Participates as the facilitator or informal leader in process improvement teams.
- Addresses disruptive behaviors and recommends appropriate interventions to improve group dynamics.
- Uses problem solving methods and CQI tools to guide process-improvement-team progress.
- Selects, uses, and teaches the CQI tools which correspond to the problem solving process.
- Facilitates the development of action plans to address identified opportunities for improvement.
- Uses knowledge of process improvement, etc. to facilitate simplifying and standardizing process and equipment whenever possible.
- Supports a commitment to a culture of safety by establishing a safe, blame-free committee environment for team process activities.
- Maintains confidentiality. Encourages 'near miss' reporting.
- Utilizes standardized Root Cause Analysis methods to address near miss and adverse outcomes.
- Evaluates team meeting process to continually improve methods for addressing identified root causes and contributing factors.
- This job description is not all encompassing.
Qualifications:
Basic Qualifications:
- Minimum three (3) years of direct nursing care experience.
- Minimum three (3) years of applicable quality improvement experience, such as participating as a quality committee member, involvement on problem-solving teams, management of data, and use of CQI tools and techniques.
- Experience must include demonstrated problem-solving skills, data abstraction and analysis, facilitation skills and use of CQI tools and techniques including root cause analysis methods and tools and use of benchmarking concepts and tools.
- Critical Care experience preferred.
- Bachelor's degree or equivalent experience required.
- Registered Nurse in Oregon at time of hire.
- Certified Professional in Health Care Quality (CPHQ) required within twenty-four (24) months of hire for new employees, or by August, 2009 for current HQPS employees.
- Current certification in basic life support / CPR.
- Demonstrated knowledge of systems and data collection/analysis.
- Excellent written/oral communication skills, demonstrated ability to facilitate teams and serve as a consultant to diverse groups.
- PC computer skills.
- Demonstrated use of CQI principles and techniques including RCA, data abstraction and analysis, and work team facilitation.
- Demonstrated critical thinking, knowledge of medical service delivery in an acute care and/or outpatient setting. Familiarity with CQI techniques and principles.
- Demonstrated use of Quality processes and tools (Root Cause Analysis, FMEA, etc.), Utilization Management, and/or Risk Management principles and practices is preferred.
- Demonstrated ability to develop successful interpersonal and professional relationships with diverse populations (administrators, physicians, nurses, aides, technicians and other personnel) preferred.
- Demonstrated self-motivation and ability to work independently or as a contributing team member is preferred.
- Proficient in PC based computer skills preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.