This quality specialist role is responsible for monitoring, analyzing, and doing in depth clinical chart review of key quality metrics foundational to OHSU’s ability to deliver high quality, safe care to our patients and achieve progress on the Healthcare Quality and Safety Priorities. Examples of the type of chart reviews are mortality, AHRQ Patient Safety Indicators, Surgical Site Infections, other Hospital Acquired Conditions, concerns from insurance companies, and other metrics/requests as they arise. 

This role is a member of the quality management team and responsible for providing expertise in quality improvement, performance improvement, change management through OHSU Performance Excellence System (OPEx), and OHSU’s Problem-Solving Tenets. They teach, coach, provide consultation on metric development and methodology, goal setting, analysis (including root cause and risk assessment), problem solving, corrective action, evaluation of the effectiveness of action taken and change management. They guide leaders through project work, facilitation, consultation, coaching, education, and reporting in a complex healthcare environment in service of aligning and integrating improvement work under the OHSU Health Quality and Safety Priorities umbrella. They work closely with team members throughout quality management as collaborators, supporting root cause analysis facilitation of safety events, and coaching teams on implementing change. 

They promote a culture of diversity, equity, inclusion, and belonging through their interactions and commit to decrease systematic racism and healthcare disparities.  

Daily Work

Bring the intention to deliver quality patient care in a safe environment for employees, achievement of the Healthcare Quality and Safety Priorities and commitment to a climate of diversity, equity, inclusion, and belonging to every relationship and interaction in the workplace.

The underpinnings of the QS role are patient centered, quality improvement, performance improvement, change management, and specific healthcare accreditation and program certification requirements.

Assignments vary and are adjusted, based on the needs of the organization, scope and complexity of assignments, available resources and balancing the workload of the QS team. The following responsibilities and standards apply to all assignments:

• Builds relationships that result in trust and addresses conflict effectively
• Earns and maintain credibility in role
• Owns personal performance, goals, and education needs 
• Brings a lens of diversity, equity, inclusion, and belonging
• Applies critical thinking skills ·
• *Prioritizes and manages work to meet expectations and asks for help when needed
• Informs manager when the workload of assignments decreases and seeks opportunities to increase assignments, in turn informs manager if the workload is becoming overloaded
• ** Obtains and maintains relevant knowledge and skills and applies it to daily work to include, but not limited to:
  • Tenets of Problem Solving at OHSU and performance improvement methods
  • OHSU Performance Excellence Infrastructure Maturity Matrix
  • Familiarity with ISO and NIAHO QM regulatory requirements (does not include Regulatory Affairs responsibilities)
  • OHSU Management System (OMS) reporting structure and processes 
  • OMS required evidence (documentation) and tools 
  • Data sources
• Evaluates OMS required evidence/documentation and addresses gaps
• Applies project management fundamentals
• Uses effective strategies to navigate ambiguity in the role and workplace 
• Facilitates productive meetings
• Creates and maintains documents that captured and distilled information in a concise and meaningful way

*Depending on the level of experience upon hire, a new QS must be able to juggle multiple projects and tasks in a dynamic healthcare environment. It requires attention to and tracking details, priority setting, coordinating activities, anticipating, and solving problems, while collaborating with individuals in roles from front-line staff to senior leaders with the first year.

** Depending on the level of experience upon hire, a new QS must demonstrate understanding of the Tenets of Problem Solving at OHSU, OHSU Management System (OMS) reporting structure and processes, OMS required evidence (documentation) and tools, OHSU Performance Excellence Infrastructure Maturity Matrix and ISO and NIAHO QM regulatory requirements, their interconnectedness and apply this to daily work within 9 to 12 months of hire.

Teach, Coach, and Consult

Teaches, coaches, and provides consults to stakeholders applying the underpinning of the QS role and embeds foundational content:

• Tenets of Problem Solving at OHSU and performance improvement methods
• OHSU Performance Excellence Infrastructure Maturity Matrix
• OHSU Management System (OMS) structure, and reporting processes tools and evidence requirements.

Education:

• Bachelor's degree in healthcare related field and a master’s degree or evidence of progression toward an advanced degree.

Experience:

• Minimum 3 years recent experience in healthcare setting.
• Experience that demonstrates expertise in performance improvement, regulatory standards in healthcare.

Job Related Knowledge, Skills, and Abilities (Competencies):

• Knowledgeable about the role of racism and bias in healthcare and other root causes of health inequities.
• Excellent knowledge base of quality/performance improvement processes and tools.
• A proven record of accomplishment of strong leadership skills to ensure that improvement processes are sustained, priorities established, and performance goals are met.
• Systems knowledge and experience in identifying root causes and developing reliable and safe systems.
• Excellent knowledge understanding of statistical analysis and reporting practices pertinent to stable and high performing systems.
• Evidence of leadership, creativity, initiative and a diplomatic communicator. Ability to effectively work with and communicate with staff in all levels of the organization.
• Expertise in presenting technical reports and leading group discussions with clinicians and senior leaders.
• Evidence within last 2 years of working with teams requiring self-direction and excellent written and verbal communication skills.
• Proficiency in office software including the Microsoft Office Suite of products.

Education:

• Bachelor of Science in Nursing
• Hold a license in healthcare (i.e., physical therapist, physician, advance practice provider)
• Current Oregon Nursing Licensure
• Certification in Healthcare Quality

Experience:

• Health care provider in healthcare setting

Job Related Knowledge, Skills, and Abilities (Competencies):

• Experience in teaching and/or working with others in the mitigating of structural racism and the disparities that result from it in healthcare.
• Knowledge, experience in Lean, Six Sigma, Project Management and other performance improvement tools
• Experience with statistical flow diagram programs
• Leading group discussions with medical clinicians and administrators