Job Summary

The Director of Quality and Patient Experience responsible for planning, organizing, leading, directing, and controlling quality, patient safety, risk management, clinical audit, accreditation and performance improvement efforts in the hospital setting. Providing organizational direction and oversight of quality program and quality metrics reporting. Providing oversights of the hospital patient safety program including the reporting and analysis of sentinel events, the development and implementation of patient safety plan. Leading the continuous readiness efforts across the hospital including policy development and review, tracer activities, staff education, and accreditation survey preparation. Responsible of the day-to-day management of the Quality, Patient Safety, Risk Management and Patient Experience directorate processes and activities.

Duties & Responsibilities

1. Contributes to the management of Abdali Hospital staff development and success
2. Assists the executive team of the hospital in developing Abdali Hospital policy and procedure in collaboration with the leadership and management team.
3. Lead all accreditation and re-accreditation programs.
4. Ensures the organization meets all accreditation, regulatory and quality standards for accreditation and licensing.
5. Proactively maintains the organization in a “constant survey readiness mode”.
6. Coordinates all survey activity within the organization.
7. Collaborate with Senior Leaders, Managers and Medical Staff to develop and achieve highest possible quality standards,
8. Develop the risk management structures and processes including hospital wide risk register. Act proactively to control risks z.
9.  Supervise the Quality team in managing patient/visitor relations and occurrence reporting and follow-up programs (i.e., patient perception of care surveys, complaints, etc.).
10.  Develop the quality system, clinical audit, risk management and performance processes and indicators to establish and implement processes for selecting criteria, data collecting monitoring and analysis for concurrent and retrospective reviews of key indicators identified by the organizational quality leadership to monitor and evaluate clinical care, safety and service
11. Proactively identifies and implements quality indicators to drive performance improvement. 
12. Drive the performance improvement activities at the level of the organization and in alignment with the hospital’s strategic objectives and goals.
13. Develop the Data Analysis system to manage the quality, risk, and patient safety program’s data collection, analysis and reporting.
14. Manage the hospital key performance indicators including collecting data, analyzing, trending and reporting the results to the Quality Management Council and relevant departments.
15.  Lead the comprehensive medical record audit review to identify quality of care risks, compile case summarizes and prepare cases for committee review.
16. lead the education and training on quality and patient safety and advance the culture of patient safety across the hospital settings and departments
17. Coach different department across the hospital to develop their performance improvement activities
18. Review all reports generated by the Quality, patient safety and experience department
19. Manage the department within the departmental annual approved budget allocation budget.

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Qualifications, Skills and Experience 

• Bachelor's degree in healthcare related field, master’s degree is preferred. 
• CPHQ holder or any equivalent international certification in health care quality management.
• Strong experience in international accreditation (JCIA) and local accreditation (HCAC).

Experience

• A minimum of 15 years of experience, 5+ of which is in a leading position in accredited hospitals.

Skills (Desirable):

• Fluent English writing and speaking.
• Advanced computer skills.
• Data analysis, displaying and managing.
• Documents managing.
• Project Management
• Presentation Skills
• Strategic thinking and planning