Quality and Patient Safety Specialist

The Quality and Patient Safety Specialist supports the organization in advancing high reliability and a culture of safety. Under general supervision, this role provides leadership, guidance, and subject‑matter expertise to clinical and operational teams to ensure compliance with policies, accreditation standards, and patient safety requirements. The specialist oversees and facilitates quality and patient safety activities, including safety event review and analysis, performance improvement initiatives, comprehensive systematic analyses, and physician peer review coordination. Education Bachelor's degree in nursing; Master's degree preferred. Experience At least 3 years of experience in a Joint Commission accredited hospital or similar healthcare environment. At least 3 years of experience in accreditation/regulatory/certification coordination and preparedness, performance improvement or patient safety (preferred). Experience with quality improvement, patient safety, healthcare regulatory compliance, and action planning. Licensures and Certifications Licensed Registered Nurse. Certification in Patient Safety (CPPS) within 1 year and/or Certification in Healthcare Quality (CPHQ) within 2 years. Skills Excellent interpersonal communication skills to interact effectively with constituents. Excellent organization, verbal and written communication, problem‑solving, and team facilitation skills. Proficiency with computer and productivity applications (Excel, PowerPoint, Outlook, etc.). Judgment in interpreting and applying standards of care, regulations, policies, procedures, and processes. Ability to review, analyze, and develop clinical summaries of patient charts and identify the need for physician peer review. Knowledge of medical terminology and navigation of electronic medical records. Skill in conducting investigations, including chart reviews and timelines, to address patient safety and quality issues. Knowledge of eCQMs and externally reported quality measures (CMS, Leapfrog, etc.) and support for accurate abstraction, validation, and submission. Consultation, coaching, and support to hospital staff. Delivery of educational and training materials to clinical and support staff teams. Facilitation of improvement, specifically comprehensive systematic analyses (RCAs, ACAs, FMEAs). Familiarity with the Model for Improvement – PDSA. Process improvement principles and ability to lead teams to fix recurring issues. Data gathering, report creation, and analysis. Principal Duties and Responsibilities Participate in onsite TJC and CMS survey site visits. Conduct orientation of new employees and nursing staff related to quality and patient safety; provide ongoing staff education and support. Regularly round on assigned units/departments, building relationships with leaders and staff. Review safety events from the incident reporting system, triage appropriately, and follow up; prepare event analyses and action items. Facilitate comprehensive systematic analyses per the Risk Prioritization Matrix and submit reports to regulatory agencies; track corrective action completion. Partner with clinical, operational, and data teams to monitor trends, identify variation, and drive sustainable improvement in outcomes, processes, and patient experience measures. Lead analysis and improvement of key quality outcomes across acute care settings, translating data into targeted improvement strategies aligned with organizational priorities and regulations. Support governance and leadership reporting by preparing clear, actionable quality performance summaries for committees, executives, and boards. Facilitate assigned committees, task forces, or improvement teams. Influence collaboration in a matrixed environment to drive accountability and measurable quality improvement. Conduct improvement activities with the Performance Improvement Team and independently using tools such as IHI Model for Improvement, PDSA, A3. Determine need for physician peer review, facilitate timely review, and communicate findings to relevant committees or the Medical Board. Serve as liaison between Nursing and Medical Staff to create alignment where possible. Provide cross‑coverage for other Quality and Patient Safety Specialist functions. All Roles Must Follow GBMC Values Respect Treat others with fairness, kindness, and respect for personal dignity and privacy. Listen and respond appropriately to others’ needs, feelings, and capabilities. Excellence Meet and/or exceed customer expectations. Actively pursue learning and self‑development. Pay attention to detail and follow through. Accountability Set a positive, professional example for others. Taken ownership of problems and act to solve them. Plan and utilize required resources effectively. Report to work regularly and on time. Teamwork Cooperate and collaborate with others for team success. Resolve conflicts positively. Seek out others’ ideas to find best solutions. Acknowledge and celebrate contributions of others. Ethical Behavior Demonstrate honesty, integrity, and good judgment. Respect cultural, psychosocial, and spiritual needs of patients, families, and coworkers. Results Embrace change and improvement in the work environment. Continuously seek to improve the quality of products and services. Display flexibility in new situations or obstacles. Achieve results on time by focusing on priorities and managing time efficiently. Pay Range $74,965.56 – $127,441.45 Equal Employment Opportunity GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. #J-18808-Ljbffr