Director, Clinical Quality

Detailed Overview

Supporting the Vision, Values, Purpose and Commitments of Fraser Health including service delivery that is centered around patients/clients/residents and families: The Director, Clinical Quality & Patient Safety (CQPS) provides strategic operational leadership for clinical quality and patient safety strategies focused on assessment, intervention, analysis, spread and sustainment of quality improvement (QI) initiatives and reporting to improve organizational performance across Fraser Health (FH). Fosters the creation and use of high quality and meaningful QI strategies to support and drive impactful organizational decision-making and improvement. Oversees and engages others in the identification and analysis of patient safety and clinical care problems and opportunities with the goal of facilitating the rapid implementation of new processes for existing and new clients within FH. Ensures effective integration and accurate and timely delivery of clinical, administrative, operational and corporate information and requests. Partners with operational, CQPS, data, practice, patient experience, finance, organizational development, strategic transformation and infection control representatives regarding matters such as ongoing CQPS education and implementation needs, required organizational practices, patient safety incident reporting and management, and changes to standards or legislative requirements. Provides leadership and direction to a team of professional CQPS leadership and staff through coaching, mentoring, skill and leadership development, and team building. Manages assigned staff including recruitment, supervision, work assignment, performance management and professional development. Collaborates with officials from Accreditation Canada, Healthcare Excellence in Canada, BC Patient Safety and Quality Council, and other health care related organizations. Represents FH on internal and external committees, and task groups as required. Responsibilities Provides strategic leadership in the integration, implementation, evaluation, reporting, sustainment and spread of CQPS initiatives across FH in alignment with FH's vision, mission and strategic priorities through fostering the creation and use of high quality and meaningful QI strategies to support and drive impactful organizational decision-making and improvement by program and operational leadership across the organization. Fosters a culture of collaboration, knowledge sharing and partnerships across teams. Establishes systems to ensure staff skills and competencies support future organizational needs and trends. Identifies, exploits and fosters the adoption of best practices and standards around CQPS improvements, evaluation strategies and generation of insights and recommendations to drive systematic change. Leads the overall information architecture for the development, implementation, sustainment and ongoing evaluation of a comprehensive, interactive Quality Performance Management System to promote accountability for quality and patient safety at all levels of the organization and to support the Board in its governance of quality and patient safety through monitoring of and accountability for key performance measures by the Clinical Programs. Provides strategic, operational, and practical leadership for CQPS including developing actionable key performance indicators, success indicators, and strategic plans in collaboration with relevant senior leadership and other stakeholders. Provides leadership for the identification and development of various CQPS improvements for the FH Board and senior level committees. Works with various FH executive members responsible for reporting to the various committees to develop CQPS priorities and metrics, including frequency and required insights. Oversees the delivery of consulting services to clients for clinical service delivery purposes including identifying problems and engaging CQPS subject matter experts to develop effective solutions using quality improvement methodologies to support clients. Organizes, synthesizes and analyzes data on patient services, interprets information, participates in the development of recommendations for improvements and engages in a continuous improvement partnership through agile and iterative processes. CQPS clients include program teams, individual physicians, operational & corporate managers and directors, researchers, and external consultants hired by the programs. Works to build capacity into the CQPS processes and systems in FH. Oversees the creation of value added processes from existing processes based on data and provides leadership in the identification of gaps in FH clinical quality and patient safety related strategic priorities by developing business cases and overseeing project teams created to address those gaps. Directs the development and implementation of service priorities in response to client input and interprets and evaluates policies, programs, systems and procedures. Assesses the efficiency and effectiveness of the services and identifies and recommends areas for improvement in quality and efficiency. Enables and oversees the use of effective CQPS processes across the organization and works to increase integration of process improvement methodologies, information capture, reporting systems and other CQPS processes. Works with the client groups, and other stakeholders groups to evaluate and select the best methods to meet strategic organizational priorities and reporting of same. Leads the development of various CQPS teams' timelines to ensure quality services and the timely delivery of the end product according to previously defined requirements. This includes, but is not limited to, unit-based improvement programs, NSQIP quality activities, PQI education, accreditation readiness and assessment activities, creation of innovative data analysis, patient safety reporting and review of patient safety events, and FH wide quality education program. Leads ongoing quality review analysis processes, establishing best practice, documenting any resulting problems, and determining corrective actions to create and provide an opportunity for continuous organizational learning and growth with a goal to eliminating preventable harm. Supports the spread of utilization of industry standard tools such root cause analysis and failure modes effect analysis. Promotes the profile of the CQPS teams to both internal and external stakeholders; develops strategies and initiatives to brand and market high quality information products and services. Provides overall direction and supervision to the team through coaching, mentoring, skill and leadership development, and team building. Manages assigned staff including recruitment, supervision, work assignment, performance management and professional development. Working with the Executive Director, determines the allocation of resources and develops annual departmental budgets. Manages department budgets, including monitoring expenditures, analyzing variances, and regular reporting. Maintains and applies expert knowledge related to quality and process improvement, patient safety best practices, and Accreditation Canada standards and requirements. Takes leadership in disseminating this knowledge throughout the organization by creating and implementing strategies to promote knowledge translation into changes in practice and processes. Keeps abreast of new initiatives, developments and trends through literature review, contact with peers at other organizations, industry leader groups, professional associations and attendance at seminars, workshops and education programs. Works in partnership with external organizations such as the Ministry of Health, Accreditation Canada, Healthcare Excellence in Canada, BC Patient Safety and Quality Council, and other health care related organizations in maintaining effective and collaborative relationships to prevent and reduce risks, errors and harm to patients and to work together to continuous improve patient care and client services. Qualifications Education and Experience Master's Degree in Health Administration or other relevant discipline. Ten to fifteen years' progressively responsible experience working in a health care environment including five years' experience in a management/leadership role in quality improvement and patient safety development, implementation and evaluation. Competencies Demonstrates the leadership practices of the Fraser Health Leadership Framework of Clear, Caring and Courageous and creates the conditions for people to succeed. Professional/Technical Capabilities Demonstrated knowledge of application and evaluation of quality improvement and patient safety methodologies and best practices. Demonstrated knowledge of Accreditation Canada's Qmentum program and required organizational practices and processes. Comprehensive understanding of data collection analysis and interpretation methodologies in a healthcare environment. Demonstrated ability to lead and foster a motivating and respectful work environment for leadership and staff, where individual competencies can thrive. Strong understanding of effective methods for identifying and addressing various stakeholder needs and an acute awareness of the impact of actions. Demonstrated ability to lead analytical teams through implementation of new analytical models, tools, and techniques. Proven skills in critical thinking, and business analysis methods. Excellent written and verbal communication skills including the ability to write technical and management reports and communicate in a clear, engaging and convincing manner to translate and present complex information to a variety of audiences. Ability to develop and maintain strong relationships with key internal and external stakeholders including management and staff at all levels, within government agencies and other health authorities. Demonstrated skills in surfacing key insights from large, complex, high dimensional data from various data sources. Comprehensive knowledge of management principles and methodologies, and the ability to coach, mentor team members on these skills. Well-developed leadership, client relations and problem resolution abilities in order to lead a variety of complex and integrated services initiatives and to achieve desired results within critical timeframes.

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