Director Quality

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world. In our commitment to advancing standards in an ever-evolving healthcare environment, our new McNair Campus is designed around the human experience—modeled on evidence-based practices for the safety of patients, visitors, staff, and physicians. The 27.5-acre campus represents the future of healthcare through a transformative alliance focused on leading-edge patient care, research, and education. Our strong alliance with Texas Heart® Institute and Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve.

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This position is responsible for the design, coordination, implementation and management of the Performance Improvement (PI) plan and identifies opportunities for improved patient care, incorporate evidence-based practices, and improved patient outcomes. Provides leadership in defining, implementing and integrating quality, safety, service and efficiency strategies into the plans, policies, and organizational processes that affect the organization’s operations and strategic direction.

Required Education and Experience:

• Bachelor's degree in a healthcare-related field or five (5) years of related job or industry experience in lieu of a degree.
• Minimum of five (5) years of progressive management responsibility in a health care setting, two (2) of which is related to managing an acute care organization’s Quality Improvement Program.
• Minimum of two (2) years of clinical, patient care experience or equivalent.

Required Licensure and Credentials:

• Current State License in a clinical field. Five (5) years’ experience in Quality Management can be used in lieu of state license.
• Certified Professional in Healthcare Quality (CPHQ), or Healthcare Quality and Management Certification (HCQM), or Certificate of Professional Healthcare Quality and Patient Safety (CPQPS) within 2 years of employment is required.

Required Minimum Knowledge, Skills, Training and Abilities:

• Knowledge of quality management methods, tools, and techniques and ability to create and support an environment that meets the quality goals of the organization.
• Knowledge of federal, state and local healthcare related laws and regulations; ability to comply with these in healthcare practices and activities
• Experience developing and implementing clinical, service and operational process improvement initiatives, both small and large scale.
• Knowledge and expertise in specific performance improvement/CQI methodologies (e.g. Six Sigma, LEAN).
• Current knowledge of accreditation and regulatory requirements for acute and ambulatory care services (e.g. state, federal, local regulations; Joint Commission, etc.).
• Experience with the event reporting process, root cause analyses, and event investigation/review
• Ability to manage collaboratively and coaches others to achieve optimal performance; delegate effectively; praise/reward contributions; define clear roles and responsibilities; set goals and lead initiatives; adjust plans as necessary
• Ability to anticipate, recognize, and deal effectively with existing or potential conflicts at the individual, group, or situation level; ability to apply this understanding appropriately to diverse situations
• Ability to identify opportunities and take action to build strategic relationships between one’s area and other areas, teams, department, units or organizations to help achieve business goals organization
• Excellent communication skills (oral and written), presentation style, including the ability to concisely present data to leaders, clinicians and staff at all levels of the organization.