Accomplished Healthcare Executive with a verifiable record of propelling effective quality/performance improvement strategies resulting in positive organizational change.
Poised problem-solver with expertise in quality and regulatory accreditation compliance with federal, state, and Joint Commission.
Exceptional verbal and written communication skills with all healthcare professionals including medical executives and governing board members.
Highly-motivated employee with desire to take on new challenges and responsibilities.
Strong worth ethic, adaptability and exceptional interpersonal skills.
Adept at working effectively unsupervised and quickly mastering new skills.
Recognized local and national public speaker. Delivered a TEDTalk presentation regarding sepsis awareness/best practices at local L2E hospital event. Also presented Rapid AI project at Stroke International Conference.
• Served as the inaugural Quality Department Director at Methodist Midlothian Medical Center, leading the implementation of new processes and initiatives to ensure the department's launch and ongoing success.
• Successfully led initiatives that improved Methodist Mansfield Medical Center's Leapfrog score from a “C” to an “A”, enhancing overall patient safety and care quality.
• Spearheaded a new clinical data analytics program, improving patient outcomes by 15% through precise data interpretation and actionable insights.
• Restructured the MMMC Quality Department layout, focusing on patient safety and PI opportunities throughout the hospital.
• Serve as the sponsor for the hospital's performance improvement project workgroup (Silver Fellowship program), providing guidance and feedback to drive innovation.
• Develop and implement corrective action plans to address identified root causes and prevent recurrence, while incorporating High Reliability Principles.
• Implemented patient safety programs, reducing adverse events by 25% through innovative safety protocols.
• Partnered with interdisciplinary teams to enhance patient safety, leading to a 20% reduction in hospital-acquired infections.
• Leads Safety Stand-Down initiative, maintaining over 200 days without central line infections.
• Optimized sepsis treatment protocols, reducing sepsis-related mortality by 10% in the first year through targeted clinical interventions.
• Facilitates Sepsis Collaborative for five years, achieving top quartile performance in sepsis mortality (0.75).
• Conducted comprehensive data analysis on patient care metrics, driving a 12% improvement in overall hospital efficiency.
• Oversee compliance with regulatory requirements and accreditation standards for disease-specific care (i.e. Joint Commission, CMS, Primary Heart Attack Center, Stroke, Bariatric, Hip/Knee, and Maternal).
• Develops Joint Commission Health Equity Plan, ensuring compliance and improved patient outcomes.
• Serve as an active member on Medical Executive Committee, ensuring that patient care is delivered safely, effectively, and in alignment with the hospital's mission, goals, and regulatory requirements.
• Serve as an active member on Policies & Guidelines Committee, dedicated to modifying/updating patient safety indicators and health system policies/guidelines.
• Currently serve as the Neuroscience Collaborative Facilitator for the Methodist Health System.
• Collaborate with the SAM physician group to explore the development of a Robotic Center of Excellence.
• Implemented the Mortality & Morbidity review group for Surgical Associates of Mansfield.
• Contributed to quality departmental excellence recognized by the ROSE Award (2024), honoring outstanding service, collaboration, and impact across the organization.
• Train over 1500 employees in high reliability principles to enhance safety and performance.
• Teach nurse residents/interns evidence-based practices for stroke and sepsis patients, emphasizing early recognition and proper medical record documentation.
• Develop and lead “Lunch and Learn” sessions with the hospital's Nursing Clinical Coordinators, facilitating discussion on current “hot topics” in quality improvement.
• Mentored new quality assurance staff, fostering a culture of continuous improvement and achieving a 95% team retention rate.
• Incorporate age-friendly practices for Trauma and CMS requirements.
• Conducted rapid cycle assessments, pinpointing issues and implementing improvements to meet CMS standards.
• Developed and executed action plans, successfully re-opening a Neonatal Intensive Care Unit post-outbreak.
• Secured AAAHC designation for an ambulatory surgery center, enhancing operational standards within 11 months.
• Designed and implemented a Quality Assurance plan, significantly boosting compliance at Rhode Island Hospital.
• Led quality improvement initiatives, reducing healthcare-associated infections across multiple hospital systems.
• Led quality improvement initiatives, reducing healthcare-associated infections by 20% across multiple hospital systems.
• Conducted comprehensive compliance assessments, identifying critical gaps and developing tailored corrective action plans.
• Secured Accreditation Association of Ambulatory Healthcare Center designation, enhancing operational standards within 11 months.
• Designed and implemented a Quality Assurance and Performance Improvement plan, significantly improving compliance with CMS standards at Rhode Island Hospital.
• Drove hospital-wide initiatives, cutting patient readmission rates by 15%, enhancing patient satisfaction.
• Conducted data-driven root cause analyses, identifying inefficiencies and recommending actionable solutions.
• Refocused and restructured Quality and Risk Performance Improvement Plan for 350-bed acute care hospital.
• Enhanced patient safety protocols, reducing hospital-acquired infections by 20%.
• Developed high-level quality reports for C-Suite and Medical Executive Committees.
• Led successful TJC surveys for hospital and offsite locations.
• Implemented new electronic health record system, improving data accuracy by 30%.
• Coordinated with various departments to streamline patient discharge processes, reducing average discharge time by 15%.
• Developed a predictive analytics model to identify high-risk patients, improving early intervention rates by 25%.
• Executed a hospital-wide training program on compliance, achieving a 95% adherence rate within six months.
• Spearheaded initiatives that enhanced patient safety protocols, resulting in a 20% reduction in hospital-acquired infections.
• Initiated a patient satisfaction survey program, leading to a 10% increase in positive feedback scores.
• Conducted root cause analyses on adverse events, reducing the occurrence of repeat incidents by 15%.
• Led quality, infection prevention, and risk departments, achieving top performance and patient care.
• Reported to VP and CMO, managing 7 direct reports, aligning goals with 11-hospital division.
• Improved Core Measure scores from last to first in 4 quarters using PDSA PI model.
• Achieved 13% reduction in PSI-90 cases, ensuring value-based purchasing incentive reimbursement.
• Chaired Physician-led Process Improvement Safety committee, driving measurable quality improvements.
• Led cross-functional teams to achieve 13% reduction in Patient Safety Indicator cases, aligning with value-based purchasing incentives.
• Improved Core Measure scores from last to first in 4 quarters, utilizing PDSA PI model to drive significant quality enhancements.
• Chaired Physician-led Process Improvement Performance Safety Committee, fostering a culture of continuous improvement and patient safety.
• Developed and implemented RED TEAMS for regulatory survey compliance, ensuring readiness and high standards across departments.
• Revived Physician Mortality Review Committee, integrating IHI initiatives to enhance clinical outcomes and reduce mortality rates.
• Spearheaded hospital-wide quality initiatives, reducing patient infections by 15% and boosting patient satisfaction scores.
• Led the launch of a 16-bed NSICU and a 32-bed NSPCU, managing 180+ staff and daily operations.
• Achieved 100% staff engagement in cross-cover initiatives, reducing contract labor by 10%.
• Ensured compliance with TJC and regulatory standards, maintaining 100% PLUS productivity.
• Chaired Neuroscience Physician meetings, optimizing NSICU and Stroke Program.
• Developed business plans aligned with TMCP's strategic goals, enhancing multi-department collaboration.
• Led a multidisciplinary team to develop evidence-based protocols, improving patient outcomes by 15%.
• Facilitated cross-departmental training programs, enhancing staff skills and reducing error rates by 20%.
• Conducted detailed performance audits, identifying key areas for improvement and optimizing resource allocation.
• Implemented quality assurance protocols, achieving a 98% patient satisfaction rate and reducing readmission rates by 12%.
• Coordinated interdisciplinary team meetings, fostering a collaborative environment that improved overall patient care efficiency by 20%.
• Streamlined NSICU workflows, leading to a 15% reduction in patient transfer times and enhancing overall unit performance.
• Directed Neuro ICU Step-Down and Hemodialysis units, managing 75-80 staff, achieving top 10% Leadership Scorecard.
• Implemented 'Go-For-Nurse' project, cutting overtime costs and boosting morale.
• Increased patient satisfaction scores from 3.31 to 3.68 over 18 months.
• Reduced RN vacancy rate from 22% to 9%, ensuring consistent staffing levels.
• Developed a mobile app for nurse scheduling, improving shift adherence by 30% and reducing conflicts.
• Provided ongoing support and training to new nurses, resulting in a 30% reduction in onboarding time.
• Led multi-disciplinary teams, enhancing patient care protocols and achieving a 15% improvement in treatment outcomes.
• Facilitated cross-departmental initiatives, streamlining processes and reducing patient discharge times by 20%.
• Spearheaded quality improvement projects, resulting in a 25% reduction in medical errors and improved patient safety.
• Introduced a telehealth program, increasing patient access to care and reducing no-show rates by 40%.
• Mentored junior staff, fostering professional growth and decreasing turnover rates by 15%.
• Developed and led Critical Care classes and staff training on Hemodialysis, Neurology, EKG, ACLS, NIHSS, and stroke education, enhancing team proficiency.
• Coordinated CCRN and PCCN review courses and hospital stroke audits, improving patient outcomes.
• Managed annual competencies for ICU Step-Down staff and orientation for new hires, ensuring high standards.
• Created a critical care internship program, significantly boosting staff skill levels and patient care quality.
• Conducted computer documentation training as a member of the hospital documentation committee, streamlining processes.
• Led multidisciplinary team meetings to enhance patient care and streamline treatment protocols, resulting in a 15% increase in patient satisfaction.
• Designed and implemented a comprehensive stroke education program, significantly reducing the hospital's stroke-related mortality rate by 10%.
• Facilitated cross-departmental training sessions, improving interdepartmental communication and reducing patient transfer times by 20%.
• Spearheaded a quality improvement initiative that decreased ICU readmission rates by 12%, enhancing overall patient outcomes.
• Developed an automated documentation system, reducing manual entry errors by 30% and increasing nursing efficiency.
• Partnered with interdisciplinary teams to develop patient care plans, enhancing coordination and reducing treatment delays by 15%.