Quality and Patient Safety Specialist

GBMC HealthCare • Towson, MD

6d • $74,966 - $127,441

About The Position

The Quality and Patient Safety Specialist supports the organization in advancing high reliability and a culture of safety. Under general supervision, the specialist provides leadership, guidance, and subject-matter expertise to clinical and operational teams to support compliance with policies, accreditation standards, and patient safety requirements. The role oversees or facilitates quality and patient safety activities, including safety event review and analysis, performance improvement initiatives, Comprehensive Systematic Analyses, and physician peer review coordination.

The specialist collaborates with clinical, operational, and data teams to monitor trends, identify variation and improvement opportunities, and support sustainable improvement in outcomes, processes, and patient experience measures. The role also leads analysis and improvement of key quality outcomes across acute care settings, prepares quality performance reports for committees and senior governance, facilitates improvement teams, and supports education, regulatory surveys, and physician peer review.

Requirements

• Bachelor's degree in nursing.
• Licensed Registered Nurse.
• At least 3 years of experience in a Joint Commission-accredited hospital or similar healthcare environment.
• Experience with quality improvement, patient safety, healthcare regulatory compliance, and action planning.
• Excellent interpersonal communication skills for interacting effectively with a wide variety of constituents.
• Strong organizational, verbal and written communication, problem-solving, and team facilitation skills.
• Skill using computers and personal productivity applications such as Excel, PowerPoint, and Outlook.
• Ability to interpret and apply standards of care, regulations, hospital policies, procedures, and processes using sound judgment.
• Ability to review and analyze patient charts, prepare clinical summaries, and identify cases needing physician peer review.
• Knowledge of medical terminology and electronic medical record navigation.
• Skill conducting investigations, including chart reviews and timeline development, to address patient safety and quality issues.
• Working knowledge of eCQMs and externally reported quality measures, including CMS, Leapfrog, and other reputational and governing bodies, and support for accurate abstraction, validation, and submission processes.
• Skill providing consultation, coaching, and support to hospital staff.
• Ability to deliver educational and training materials to clinical and support staff teams.
• Ability to facilitate improvement, including Comprehensive Systematic Analyses that may involve RCAs, ACAs, and FMEAs.
• Familiarity with the Model for Improvement and PDSA.
• Knowledge of process improvement principles and ability to lead teams in addressing recurring issues.
• Ability to gather and create reports, and interpret and analyze data.

Nice To Haves

• Master's degree preferred.
• At least 3 years of experience in accreditation, regulatory, or certification coordination and preparedness, performance improvement, or patient safety preferred.
• Certification in Patient Safety (CPPS) within 1 year and/or Certification in Healthcare Quality (CPHQ) within 2 years.

Responsibilities

• Participate in and assist with onsite Joint Commission (TJC) and CMS survey visits.
• Conduct orientation for new employees and nursing staff on quality and patient safety, and provide ongoing staff education and support.
• Round regularly on assigned units and departments and maintain collaborative relationships with their leaders and staff.
• Review assigned safety events in the incident reporting system, triage potentially compensable and reportable events, ensure appropriate follow-up, and prepare event analyses and action items.
• Facilitate Comprehensive Systematic Analyses designated by the Risk Prioritization Matrix; submit reports to regulatory agencies as required; ensure analyses include appropriate corrective actions and measures of success; track corrective-action completion and escalate as needed.
• Collaborate with clinical, operational, and data teams to monitor trends, identify variation and improvement opportunities, and drive sustainable improvements in outcome, process, and patient experience measures.
• Consult with leadership on follow-up action items to improve processes identified through analysis and investigation.
• Lead analysis and improvement of key quality outcomes across acute care settings, translating performance data into targeted strategies aligned with organizational priorities and regulatory requirements.
• Prepare clear, actionable quality performance summaries for committees, executives, and boards.
• Facilitate assigned committees, task forces, and improvement teams.
• Lead through influence in a matrixed environment, facilitating collaboration with operational and clinical leaders to promote alignment, accountability, and measurable quality improvement.
• Conduct improvement activities independently and with the Performance Improvement Team using tools such as the IHI Model for Improvement, PDSA, and A3.
• Determine when physician peer review is appropriate and facilitate timely peer review, including setting agendas, taking minutes, preparing, assigning and tracking cases or indicators, and communicating findings and recommendations to relevant committees or the Medical Board.
• Serve as a liaison between Nursing and Medical Staff to support alignment.
• Provide cross-coverage for other Quality and Patient Safety Specialist functions.
• Follow GBMC values, including respect, excellence, accountability, teamwork, ethical behavior, and results.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level