Manager of Quality and Safety

Job Description

SUMMARY:

The Manager of Quality and Safety reports to the Director of Risk Management and Compliance and, in a matrix capacity, to the Chief Nursing Officer and Chief Medical Officer, and provides operational leadership for La Rabida Children’s Hospital’s quality improvement and patient safety programs. The Manager collaborates with nursing, medical staff, clinical departments, and organizational leaders to drive measurable improvements in patient outcomes, clinical quality, and patient safety.

The Manager coordinates quality measurement and performance improvement activities, facilitates the review of patient safety events, and guides corrective and preventive actions. The Manager promotes the use of evidence-based quality improvement methods and data to identify opportunities, evaluate interventions, sustain improvements, and strengthen a culture of safety and continuous learning.

ESSENTIAL FUNCTIONS:

Quality and Performance Improvement

· Provides operational leadership for hospital-wide quality improvement and performance improvement activities consistent with organizational priorities.

· Collaborates with clinical and operational leaders to identify quality improvement opportunities and develop measurable improvement initiatives.

· Facilitates interdisciplinary quality improvement teams and supports departments in the development, implementation, evaluation, and sustainment of improvement initiatives.

· Utilizes established performance improvement methodologies and tools to support systematic evaluation and improvement of clinical processes.

· Promotes evidence-based practices, standardized processes, and data-driven decision-making to improve patient outcomes and organizational performance.

· Provides consultation, coaching, and education to leaders and staff regarding quality improvement methodologies, measurement, data interpretation, and sustainment strategies.

· Supports rapid-cycle improvement activities and assists teams in evaluating whether interventions achieve intended outcomes.

Patient Safety

· Provides operational leadership for patient safety initiatives and promotes a culture of safety, transparency, learning, and continuous improvement.

· Reviews quality and patient safety concerns and provides guidance to leaders and staff regarding appropriate investigation, analysis, and improvement activities.

· Leads or facilitates structured reviews of significant patient safety events using appropriate evidence-based methodologies, including Apparent Cause Analysis (ACA), Root Cause Analysis (RCA), and Failure Mode and Effects Analysis (FMEA), as appropriate.

· Facilitates the development, implementation, monitoring, and evaluation of corrective action plans resulting from patient safety reviews.

· Identifies trends, patterns, and opportunities for improvement based on patient safety events and quality data.

· Partners with clinical leaders and frontline staff to identify potential safety risks and develop strategies to reduce preventable harm.

· Supports education and communication related to patient safety practices, lessons learned, and improvement priorities.

Quality Measurement, Data and Reporting

· Develops, monitors, analyzes, and communicates clinical quality, patient safety, core measure, and performance improvement metrics.

· Collaborates with clinical, operational, and information technology partners to support accurate and meaningful quality measurement and reporting.

· Evaluates trends in quality and safety data and assists leaders in identifying priorities for improvement.

· Develops reports, dashboards, presentations, and other communications that translate quality and safety data into actionable information for leaders, committees, clinicians, and staff.

· Monitors the effectiveness and sustainability of quality improvement interventions and communicates findings to appropriate stakeholders.

· Supports accurate collection, validation, analysis, and presentation of quality and patient safety data.

Organizational Collaboration and Leadership

· Partners with executive, physician, nursing, clinical, and operational leaders to advance organizational quality and patient safety priorities.

· Provides quality and patient safety information, analyses, and reports for leadership and appropriate hospital committees.

· Supports preparation of quality and patient safety reports for the Board Quality Committee and other governance structures as requested.

· Collaborates with Infection Prevention, Risk Management, Employee Health, Nursing, Medical Staff leadership, and other departments where quality and patient safety activities intersect with their areas of responsibility.

· Participates in organizational committees, workgroups, and improvement teams as assigned.

· Promotes staff engagement and shared accountability for quality, patient safety, and continuous improvement.

· Serves as a resource to leaders and staff regarding quality improvement principles, patient safety science, measurement, and improvement methodologies.

ADDITIONAL FUNCTIONS:

· Performs other duties as assigned.

· Participates in hospital and departmental committees as appropriate.

· Maintains confidentiality of patient, employee, peer review, quality, and other protected information consistent with applicable requirements and hospital policy.

· Supports organizational priorities related to quality, patient safety, and performance improvement.

Qualifications

Education:

Required:

· Master’s degree in nursing, healthcare administration, public health, quality, patient safety, or another healthcare-related field.

Preferred:

· Formal education or advanced training in healthcare quality, patient safety, performance improvement, or a related discipline.

· Lean, Six Sigma, or comparable performance improvement training.

Related Work Experience:

· Minimum of five years of progressively responsible healthcare experience, including experience in quality improvement, patient safety, clinical quality measurement, performance improvement, or a closely related area.

· Experience leading or facilitating multidisciplinary performance improvement initiatives.

· Experience with quality measurement, data analysis, outcome monitoring, and presentation of quality data.

· Experience conducting or facilitating patient safety event analyses and developing corrective action plans.

· Experience working collaboratively with physicians, nurses, clinical leaders, and interdisciplinary teams.

· Experience in a hospital or pediatric healthcare environment preferred.

Licensure/Certification:

Preferred:

· Certified Professional in Healthcare Quality (CPHQ)

· Certified Professional in Patient Safety (CPPS)

· Lean Six Sigma or similar performance improvement certification

· Certification by the National Association for Healthcare Quality

Specialized Knowledge and Skills:

The Manager of Quality and Safety must demonstrate:

· Strong knowledge of healthcare quality improvement and patient safety principles.

· Knowledge of RCA, ACA, FMEA, and other structured approaches to patient safety and process improvement.

· Strong analytical skills with the ability to interpret clinical and operational data and translate findings into actionable improvement strategies.

· Strong project management and organizational skills.

· Effective group facilitation and interdisciplinary team leadership.

· Strong written, verbal, and presentation skills.

· Excellent critical-thinking and problem-solving abilities.

· Ability to communicate effectively with frontline clinicians, physician leaders, department leaders, executives, and governance committees.

· Ability to manage multiple priorities and improvement initiatives.

· Ability to maintain confidentiality and appropriately handle sensitive quality, patient safety, and peer review information.

· Proficiency with electronic health record applications, Microsoft Office applications, quality reporting systems, databases, and analytical tools used for quality measurement and reporting.

Additional Information

La Rabida Children’s Hospital is very proud to be an Equal Employment Opportunity Employer

La Rabida is a place unlike any other. We understand the needs of families with children dealing with the most serious or complicated of conditions. With teams of the best healthcare providers in Chicago, we give continuous, comprehensive care, education, and support, helping families face their unique obstacles head-on.   

La Rabida Children’s Hospital is very proud to be an Equal Employment Opportunity Employer.  

Compensation: 89000 to 142000 (USD) (YEARLY)