Patient Safety Program Manager

St. Luke’s Health – Memorial Lufkin is a 279 bed facility and member of CommonSpirit Health, a national nonprofit health system. Serving East Texas, St. Luke's Health-Memorial Lufkin provides more than a quarter of a million patient services annually and contributes millions of dollars in local charity care and community support. We’re the area’s first Joint Commission Certified Primary Stroke Center, with board-certified neurologists and neurosurgeons offering full-spectrum stroke care. Nationally recognized as a HealthCare Center of Excellence, St. Luke's Health-Memorial Lufkin offers compassionate, comprehensive health care, including off-campus rehab and outpatient facilities and services. In addition to its large emergency department, there are 32 private rooms, dedicated imaging and OBGYN, wound care, infusion and lab services.

As a Quality Patient Safety Professional, you will develop, implement, and monitor programs to enhance patient safety and drive continuous quality improvement.

Every day you will conduct risk assessments, analyze adverse events, identify root causes, and recommend evidence-based strategies. You will also collaborate with clinical teams and regulators, providing education and guidance on best practices.

To be successful, you will demonstrate a comprehensive understanding of patient safety principles, quality improvement, and healthcare regulations. Your analytical skills, attention to detail, and ability to influence change will be crucial for fostering a culture of safety and achieving exceptional patient outcomes.

• Assists in the design, planning, implementation and coordination of Quality Management, Patient Safety and Performance Improvement activities for assigned hospital and medical staff departments, committees, divisions, service lines and functions.
• Proactively coordinates and facilitates performance improvement teams to support key initiatives, including but not limited to, activities focused on clinical quality improvement, patient safety and risk reduction, patient experience, efficiency, FMEAS, root cause analyses and medical staff improvement (e.g. case review for peer review, OPPE, FPPE).
• Participates in an integral role to ensure compliance with CMS HIQRP/HOQRP, TJC, Leapfrog, etc., data collection and reporting of process and outcome measures.
• Facilitates development and implementation of data collection tools and processes including the ability to: identify data elements needed to complete appropriate measurement, perform data collection and abstraction per specifications, and validate data prior to submission or preview reports prior to publication.
• Facilitates meetings, presents data and reports, identifies key findings and assists with action plans and implementation
• Maintains current knowledge of accreditation and licensing requirements and must be a resource to staff on these regulations in order to improve management of outcomes and ensure compliance.

Required

• Three (3) years clinical experience in an acute care setting and
• One (1) year healthcare-related quality management/performanceimprovement experience (e.g., chart audit, PI team member, etc.) and
• Must be able to perform case reviews for medical staff peer review and medical and/or surgical Registry Abstraction
• Registered Nurse: TX, upon hire or
• Pharmacist: TX, upon hire or
• Certified Professional in Healthcare Quality, within 24 - months or
• Healthcare Quality Mgmt, within 24 - months or
• Cert Prof Healthcare Qual, within 24 - months