Consultant

• Aug 2020 - Present

Healthcare Consultant

• Jan 1996 - Present

Vice President Of Quality

• Mar 2019 - Jul 2020

Vice President Of Quality

• Mar 2019 - Jul 2020

Chief Quality Officer

• Sep 2016 - Mar 2019

Reporting directly to the President/ CEO leads the Quality Department in infection prevention, patient experience, patient safety, regulatory readiness, performance improvement, and collection and analysis of data for internal and external audiences. Responsible for planning, organizing and directing the operation of initiatives across the organization. Accomplishments include developing a structure to support performance improvement across the organization, which includes a… Show more Reporting directly to the President/ CEO leads the Quality Department in infection prevention, patient experience, patient safety, regulatory readiness, performance improvement, and collection and analysis of data for internal and external audiences. Responsible for planning, organizing and directing the operation of initiatives across the organization. Accomplishments include developing a structure to support performance improvement across the organization, which includes a rigorous Peer Review and Quality Medical Staff Committee, a Board Quality Committee, and a Quality Operations Committee. This structure facilitates data and information flow from point of care to senior leadership and the Board of Directors. Implemented a structure for regulatory readiness across the inpatient, and outpatient settings. Developed position of Patient Experience Coordinator to provide education and coaching for delivering exceptional experience. Develop a detailed dashboard to provide near real-time performance data, and supplemental graphs showing performance over time. Clinical performance improvement results include 12 months without CAUTI, and greater than a year without any hospital onset CLABSI, C-diff, or MRSA; and Surgical Site Infections of less than 1%. Implemented a structure for Focused and Ongoing Professional Practice Evaluation, as well as a process and structure for rigorous peer review based on rules, rates, and triggers. Implemented electronic safety event reporting software and summary reports. Developed new employee orientation and staff education on performance improvement, High Reliability Organization (HRO) principles and patient experience. Organization obtained Remote Stroke Treatment facility status (1 of 8 in Georgia), and Level 3 Trauma Center designation during my tenure. Show less Reporting directly to the President/ CEO leads the Quality Department in infection prevention, patient experience, patient safety, regulatory readiness, performance improvement, and collection and analysis of data for internal and external audiences. Responsible for planning, organizing and directing the operation of initiatives across the organization. Accomplishments include developing a structure to support performance improvement across the organization, which includes a… Show more Reporting directly to the President/ CEO leads the Quality Department in infection prevention, patient experience, patient safety, regulatory readiness, performance improvement, and collection and analysis of data for internal and external audiences. Responsible for planning, organizing and directing the operation of initiatives across the organization. Accomplishments include developing a structure to support performance improvement across the organization, which includes a rigorous Peer Review and Quality Medical Staff Committee, a Board Quality Committee, and a Quality Operations Committee. This structure facilitates data and information flow from point of care to senior leadership and the Board of Directors. Implemented a structure for regulatory readiness across the inpatient, and outpatient settings. Developed position of Patient Experience Coordinator to provide education and coaching for delivering exceptional experience. Develop a detailed dashboard to provide near real-time performance data, and supplemental graphs showing performance over time. Clinical performance improvement results include 12 months without CAUTI, and greater than a year without any hospital onset CLABSI, C-diff, or MRSA; and Surgical Site Infections of less than 1%. Implemented a structure for Focused and Ongoing Professional Practice Evaluation, as well as a process and structure for rigorous peer review based on rules, rates, and triggers. Implemented electronic safety event reporting software and summary reports. Developed new employee orientation and staff education on performance improvement, High Reliability Organization (HRO) principles and patient experience. Organization obtained Remote Stroke Treatment facility status (1 of 8 in Georgia), and Level 3 Trauma Center designation during my tenure. Show less

Director

• Jun 2012 - Sep 2016

Responsible for providing leadership support for clinical organizational performance improvement, patient safety, risk management, infection control, medical staff services, regulatory readiness, and patient experience. Partnered with Mercy leadership to prioritize and address opportunities and create a culture of continuous improvement. Worked with Centura corporate offices to coordinate improvement projects, education, and strategic goals across the 17 member hospitals. Accomplishment… Show more Responsible for providing leadership support for clinical organizational performance improvement, patient safety, risk management, infection control, medical staff services, regulatory readiness, and patient experience. Partnered with Mercy leadership to prioritize and address opportunities and create a culture of continuous improvement. Worked with Centura corporate offices to coordinate improvement projects, education, and strategic goals across the 17 member hospitals. Accomplishment highlights include building a highly competent team to provide robust data analysis across the system, establishing a structure to integrate High Reliability Organizational tenets into the hospital’s work; Led a team to develop a unique care delivery method to integrate providers throughout La Plata County to address the needs of high utilizers; identified discipline-specific indicators for OPPE for Mercy, which were later adopted across all Centura hospitals; Managed transition of policies, procedures and guidelines to Policy Tech software, facilitated physician training engagement with University of Missouri which included simulated patient interactions, initiated and managed participation in Own the Bone registry, and American Joint Replacement registry, facilitated initiation of patient reported outcomes for Orthopedic and Spine service lines. Show less Responsible for providing leadership support for clinical organizational performance improvement, patient safety, risk management, infection control, medical staff services, regulatory readiness, and patient experience. Partnered with Mercy leadership to prioritize and address opportunities and create a culture of continuous improvement. Worked with Centura corporate offices to coordinate improvement projects, education, and strategic goals across the 17 member hospitals. Accomplishment… Show more Responsible for providing leadership support for clinical organizational performance improvement, patient safety, risk management, infection control, medical staff services, regulatory readiness, and patient experience. Partnered with Mercy leadership to prioritize and address opportunities and create a culture of continuous improvement. Worked with Centura corporate offices to coordinate improvement projects, education, and strategic goals across the 17 member hospitals. Accomplishment highlights include building a highly competent team to provide robust data analysis across the system, establishing a structure to integrate High Reliability Organizational tenets into the hospital’s work; Led a team to develop a unique care delivery method to integrate providers throughout La Plata County to address the needs of high utilizers; identified discipline-specific indicators for OPPE for Mercy, which were later adopted across all Centura hospitals; Managed transition of policies, procedures and guidelines to Policy Tech software, facilitated physician training engagement with University of Missouri which included simulated patient interactions, initiated and managed participation in Own the Bone registry, and American Joint Replacement registry, facilitated initiation of patient reported outcomes for Orthopedic and Spine service lines. Show less

Senior Improvement Advisor

• Jan 2009 - Jun 2012

Responsible for enterprise-wide, clinically focused improvement initiatives using quality improvement methodology and tools; Organizational expert in improvement and patient safety concepts. Accomplishments include Project Management and staff training for Implementation of enterprise-wide automated Incident reporting system - Safety Net; Development and implementation of Surgical Safety Checklist throughout 17 Operating Rooms, 2 Cardio Thoracic OR’s, 3 Ambulatory Surgical Facilities, and… Show more Responsible for enterprise-wide, clinically focused improvement initiatives using quality improvement methodology and tools; Organizational expert in improvement and patient safety concepts. Accomplishments include Project Management and staff training for Implementation of enterprise-wide automated Incident reporting system - Safety Net; Development and implementation of Surgical Safety Checklist throughout 17 Operating Rooms, 2 Cardio Thoracic OR’s, 3 Ambulatory Surgical Facilities, and patient care units; Facilitating Operating Plan initiatives including prevention of Surgical Site Infections, Blood Stream Infections (interim), and Improving Medication Safety(including development of infrastructure and measurement, and oversight of improvement projects); Certified Trainer for Safety Behaviors for Error Prevention; Development and delivery of an internal training program for unit-based resources; ongoing of mentoring staff in unit-based improvement roles. Show less Responsible for enterprise-wide, clinically focused improvement initiatives using quality improvement methodology and tools; Organizational expert in improvement and patient safety concepts. Accomplishments include Project Management and staff training for Implementation of enterprise-wide automated Incident reporting system - Safety Net; Development and implementation of Surgical Safety Checklist throughout 17 Operating Rooms, 2 Cardio Thoracic OR’s, 3 Ambulatory Surgical Facilities, and… Show more Responsible for enterprise-wide, clinically focused improvement initiatives using quality improvement methodology and tools; Organizational expert in improvement and patient safety concepts. Accomplishments include Project Management and staff training for Implementation of enterprise-wide automated Incident reporting system - Safety Net; Development and implementation of Surgical Safety Checklist throughout 17 Operating Rooms, 2 Cardio Thoracic OR’s, 3 Ambulatory Surgical Facilities, and patient care units; Facilitating Operating Plan initiatives including prevention of Surgical Site Infections, Blood Stream Infections (interim), and Improving Medication Safety(including development of infrastructure and measurement, and oversight of improvement projects); Certified Trainer for Safety Behaviors for Error Prevention; Development and delivery of an internal training program for unit-based resources; ongoing of mentoring staff in unit-based improvement roles. Show less