Sr Director of Healthcare Quality and Patient Safety

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Beth Israel Deaconess Medical Center
September 13, 2021
Boston, Massachusetts
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Sr Director of Healthcare Quality and Patient Safety

Department Description: Beth Israel Deaconess Hospital−Needham (BID−Needham) is a licensed 58-bed acute care community hospital. BID−Needham has served residents in Needham, Newton, Dedham, Dover, Medfield, Sherborn, Wellesley, Westwood and other surrounding communities for more than 100 years. The hospital has been recognized by several organizations for quality and safety, including the Gold Seal of Approval® from The Joint Commission and a first-place Accountable Care Compass Award from the Massachusetts Health & Hospital Association (MHA).
BID−Needham is part of Beth Israel Lahey Health, a new health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,000 physicians and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.
BID Needham has had a direct affiliation with Beth Israel Deaconess Medical Center since 2000, facilitating the clinical integration of staff and resources in emergency medicine, hospital medicine (hospitalists), cardiology, radiology, orthopaedics, pathology, as well as many surgical services and oncology housed in the Beth Israel Deaconess Cancer Center and Surgical Pavilion.Job Location: Needham, MA

Req ID: 41383BR

Job Summary: Under general supervision of the Chief Medical Officer, the Director of Quality will lead the hospital in developing an environment which embraces quality improvement initiatives based on its strategic priorities by implementing existing programs, and developing new programs to respond to changes in the regulations and best practices, and to achieve the goals identified to meet reimbursement/pay for performance criteria. The position requires an individual with hands on experience working on performance measurement, analysis and interpretation of data as well as regulatory and accreditation requirements. The incumbent must also have a vision for patient safety and the ability to lead the staff toward changes that contribute to a culture of quality and safety throughout the hospital. In addition to the staff in the Quality function, the Director will supervise the day to day activities of the Infection Control Nurse, the Risk & Regulatory Specialist, and will provide oversight and support for the Joint Commission activities. The Director will chair and/or participate in quality meetings as determined by the CMO.

Essential Responsibilities:

  1. Trend selected data, compile statistics and report findings to the Hospital. This includes analyzing outcome criteria, identifying areas in need of improvement and developing improvement processes based on current literature for performance improvement
  2. Attend the Patient Care Services Committee. Obtain data needed to identify problems and initiate action plans
  3. Supervise the Quality Improvement Analyst role, the Risk Management role and the Infection Control Nurse Role as well as support staff
  4. Review cases selected for case review by the QA Committee to ensure adherence to selected indicators
  5. Has the responsibility to lead and support managers and directors in developing and improving operations to create optimal performance levels. Direct Reports: 4-6 Indirect Reports: 1-5
  6. Has full responsibility for planning, monitoring and managing department budget.

Required Qualifications:

  1. Master's degree in Nursing required.
  2. License Nursing License required.
  3. 5-8 years related work experience required in Minimum of 5 years experience in quality management in healthcare, preferably in a Hospital setting and 3-5 years supervisory/management experience required
  4. Requires clear and concise communication skills, written and oral as well as demonstrated leadership and interpersonal skills.
  5. Must demonstrate extensive knowledge of business and medical systems, as well as understanding of financial systems and strong analytical and problem solving ability.
  6. The ability to take initiative, be proactive in identifying problems and working towards solutions is required.
  7. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.


  1. Written Communications: Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.
  2. Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.
  3. Knowledge: Ability to demonstrate broad and comprehensive knowledge of theories, concepts, practices and policies with the ability to use them in complex and/or unprecedented situations across multiple functional areas.
  4. Team Work: Ability to lead and direct multiple collaborative teams for large projects or groups both internal and external to the Medical Center and across functional areas. Results have significant implications for the management and operations of the organization.
  5. Customer Service: Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas in a timely and respectful manner.

Physical Nature of the Job:
Light work: Exerting up to 20 pounds of force frequently to move objects. Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move through out the hospital campus


VaccinesAs a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. BILH requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement


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