Megaan Lorenzen
Healthcare Quality and Patient Safety
Arden,NC
Summary
High-performing compassionate leader with in-depth and diverse knowledge of healthcare operations at all levels. Energetic, patient centered and results-focused with success in developing and leading diverse teams to achieve outstanding sustainable results.
Overview
26
26
years of professional experience
12
12
Years as an IHI Patient Safety Executive PSO
9
9
Years as a Just Culture trainer
7
7
Years as a Certified Professional in Healthcare Quality CPHQ
Work History
Director of Acute Quality Services/Infection Prevention/Interpretive Services and Patient Safety Officer
UNC Health Pardee Hendersonville 222 beds
Hendersonville, North Carolina
03.2022 - 10.2025
- Served as an active participant on the utilization review committee, and readmissions reduction committee in strong collaboration with case management with a focus on case reviews and community relationships with skilled nursing facilities, assisted living facilities, and local behavioral health facilities.
- Active participant on the inclusion committee with the focus on healthcare equity for underserved communities and celebration of diversity with community and staff members.
- Represented Pardee at the UNC system level committee for the improvement of social drivers/determinants of health (SDOH).
- Performed SDOH data analysis, caregiver education and facilitated performance improvement at the local level.
- Responsible for supporting ASC in quality improvement activities, infection prevention and control, regulatory compliance, and preparedness for certification and accreditation applications for centers of excellence.
- Responsible for ambulatory offices infection prevention programs and regulatory compliance.
- Delivered on improvements to quality management system resulting in CMS 5-star rating.
- Achieved and sustained Leapfrog A rating since Spring 2023.
- Restructured daily leadership safety huddle to align with best practice.
- Chair of UNC System Patient Safety Council.
- Patient Safety Champion for Press Ganey PSO 2024.
- Structured and operationalized the Serious Safety Event Classification Committee.
- Deployed standard work for Cause Analysis: Apparent, Common, and Root.
- Provided Apparent Cause Analysis Leadership Training and proctoring.
- Initiated Culture of Safety and High Reliability education to department heads.
- Restructured quality and safety reporting to the Board to increase transparency and educate on ZeroHarm.
- Facilitated the implementation and sustainment of evidence-based practice for CAUTI and CLABSI prevention resulting in facility 1st time achievement of >365 days without a Hospital Acquired Infection for both.
- Facilitated the implementation and sustainment of Fall precaution initiative leading facility in 1st time achievement of > 365 days without a fall with major injury.
- Implemented an interdisciplinary fall reduction and prevention committee which led to a significant sustained improvement over 3 years from a rate of 3.58 to 0.68.
- Led efforts for Mortality index reduction with improved outcomes from January 2025 at 1.09 to August 0.24 Mortality index. Accomplished this by introducing an interdisciplinary mortality review committee, improved provider documentation with the aid of new software program, collaboration with palliative, hospice, and medical staff to start general inpatient hospice services and collaboration with coding staff.
INTERIM-Patient Safety Risk Management Officer
Mount Carmel East Hospital 419 beds
Columbus, Ohio
09.2020 - 03.2022
- Proactively performs surveillance and evaluates patient safety risks in a uniform and consistent manner.
- Oversight of incident reporting and response process, including evaluation of all incidents, investigation, identification of risk exposures, follow-up and performance of trending analysis.
- Coaches/mentors leadership and colleagues on use of Safety Behaviors.
- Provides information on potential safety events and recommended Serious Safety Event Classifications.
- Responsible for identification of potential and actual sentinel events with prompt notification of key stakeholders including senior leadership, and site administration for conducting investigation of event and root cause analysis.
- Collaborates to support investigation and defense of claims against the Health System.
- Provides guidance and support for patient care issues with patient safety/risk or legal implications, i.e. consent issues, adoption, guardianship, EMTALA, HIPAA.
- Track, trend, and escalation of patient safety event data.
- Facilitation and support of both root cause analysis and apparent cause analyses.
- Work in collaboration and integration with Clinical Services, Accreditation and Quality.
- Management of RL Solutions Risk Management Software.
- Facilitation of process mapping for improved outcomes.
INTERIM- Accreditation and Patient Safety
Cabell Huntington Hospital 303 beds
Huntington, WV
12.2019 - 04.2020
- Performed routine tracer audits for at all affiliated ambulatory offices and within the acute care hospital.
- Worked with ambulatory and hospital leadership to devise process improvements to meet regulatory requirements.
- Led patient safety initiatives to enhance compliance with regulatory standards.
- Conducted thorough investigations of safety incidents, identifying root causes and preventive measures.
- Developed and implemented training programs for staff on safety protocols and best practices.
- Collaborated with multidisciplinary teams to evaluate and improve patient safety policies.
- Facilitated risk assessments to proactively address potential safety hazards in clinical settings.
- Drove continuous improvement efforts by implementing evidence-based practices in patient care environments.
- Maintained up-to-date knowledge of industry best practices, guidelines, and regulations to ensure compliance within the organization.
- Mentored new regulatory department team member and organizational leadership team.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked well in a team setting, providing support and guidance.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Strengthened communication skills through regular interactions with others.
INTERIM- Director of Quality Management
Stanford Medical Center 613 beds
Palo Alto, CA
05.2019 - 11.2019
- Led quality management initiatives to enhance compliance with industry standards and regulations.
- Developed and implemented strategic quality improvement plans that increased operational efficiency.
- Collaborated with cross-functional teams to identify root causes of quality issues and implement corrective actions.
- Oversaw training programs for staff, fostering a culture of continuous improvement in quality practices.
- Accountable for oversight of the peer review program for the medical staff
- Performed thorough Gap analysis of peer review process, OPPE, FPPE with bylaws and regulatory requirements.
- Created current state and future state process map for increased efficiency, effectiveness, and focus on performance improvements.
- Developed peer review tool kit to educate medical staff on peer review.
- Revised medical staff policy and procedure to streamline, efficiency, and effectiveness.
- Overall and coordinated organization, wide quality, assessment, performance improvement program (QAPI), and plan evaluation and redesign.
- Developed quality management, government, education, and structure for ongoing QAPI operationalization.
- FY 19 QAPI evaluation completed with executive summary to board of directors.
- Comprehensive FY 20 QAPI developed for presentation and approval by the board of directors.
- Responsible for the oversight and guidance of the policy and procedure process redesign.
- Assisted with the rollout of RCA process.
- Provided consultative support during triennial TJC survey in the command center and facilitated unit sweeps for readiness.
Chief Quality Officer- Director of Quality
Munroe Regional Hospital-AdventHealth 425 beds
Ocala, Florida
05.2017 - 04.2019
- Oversee and coordinate all facility efforts to monitor and maintain compliance with all regulatory, state, and federal requirements (including but not limited to ACHA, TJC, CMS).
- Successful Primary Stroke Reaccreditation Survey with The Joint Commission.
- Successful Lab Survey with The Joint Commission.
- Accountable for oversight of a comprehensive infection control program for surveillance, prevention, data analysis, and reporting, also control of infections within the hospital.
- Effective launch of TJC Targeted Solutions Tool for Hand Hygiene compliance.
- Reduction of Hospital acquired CAUTI, CLABSI, and C-diff.
- Facilitates and supports medical staff peer review, OPPE, and FPPE process.
- Supervise all quality assurance activities with various multidisciplinary clinical teams, developing measurable strategic goals, that are cost-effective, efficient, and evidence based, aimed at improving quality and patient care outcomes.
- Reduction of falls with and without injury
- Increased compliance with Sepsis core measure
- Provided leadership education series on Just Culture, Change Management, and RCA2
- Performed case reviews, data analysis, and project implementation working towards high reliability.
Director of Nursing Quality Outcomes
Self-Regional 326 beds
Greenwood, South Carolina
02.2016 - 05.2017
- Led clinical teams in the delivery of evidence-based care to promote improved outcomes.
- Educated leaders on regulatory rules and regulations for safe outcomes and compliance.
- Coordinated Quality Improvements Activities to identify opportunities for improvement; via Lean Methodologies: Kaizen, process mapping, and root cause analysis.
- Implemented strategies to increase program effectiveness; Diabetic Education Program.
- Executed contracts in a timely and accurate manner; Nursing education.
- Led Clinical Ladder program, New Graduate Residency Program, Inpatient and Outpatient Diabetic Education Program, Nursing Education, Wound Ostomy Continence Nurse Program, and Nursing.
Director of Endoscopy- Director Clinical Outcomes
Mission Hospital 763 beds
Asheville, North Carolina
05.2011 - 11.2015
- Responsible for clinical outcomes of all surgical and procedural related areas including but not limited to: CVOR, OR, Cath Lab, Endoscopy, Interventional Radiology, Sterile processing, and ambulatory surgical center.
- Led reduction of immediate use steam sterilization; from 7.58 % to 0.6%
- Served as Quality Expert on system value analysis oversight committee, saving 1.9 million dollars in surgical services from October 2014-april 2015, while improving patient outcomes.
- Deployed National Surgical Quality Improvement Program (NSQIP) for hospital system
- Served as a Patient Safety Officer resulting in measurable improved outcomes
- Led teams in the reduction of incorrect surgical counts, specimen errors, skin tears, positioning injuries, and sharps injuries
- Actively served on teams: sterilization and disinfection, nursing quality council, disaster management, regulatory readiness and environment of care teams, sedation oversight, consent team, do not resuscitate team, system faculty for disclosure training for medical errors and root cause analysis, CAUTI and CLABSI teams, Endoscopy expert for hospital and system, facility redesign team, partner with risk management and infection prevention, care process model and clinical program development, hospital value stream mapping teams for: material management, sterile processing, surgical services, endoscopy, and multidisciplinary rounding.
- Responsible for quality contract oversight and support for physician service agreement practices and employed physician practices, and partnership with the office of patient experience in the resolution of patient and family grievances.
Director of Endoscopy and PACU
Emory Midtown & Emory University Hospital 587 beds
Atlanta, GA
12.2007 - 05.2011
- Developed policies and procedural competencies per the society of gastroenterology of nurses and associates (SGNA).
- Provided education for advanced procedures: ERCP, EUS, PEG insertion, EBUS, and bronchial navigation- super dimension.
- Collected data of procedural outcomes for process improvement
- Hardwired bedside handoff report from PACU staff to the receiving nursing unit staff.
- Led day to day operations of a nine (9) room Endoscopy department to include specialty interventional services for: Ear, nose, and throat, Pulmonology, and Gastroenterology.
- Emory midtown 458 Beds
Assistant Director of Gastroenterology
Gainesville LLC
06.2006 - 12.2007
- Led strategic initiatives to enhance operational efficiency and streamline processes.
- Developed and implemented training programs for team members, fostering skill development and growth.
- Collaborated with cross-functional teams to improve service delivery and client satisfaction.
- Analyzed performance metrics to identify areas for improvement and implement actionable solutions.
- Managed day-to-day operations of ambulatory gastroenterology center.
- Provided education and processes to enhance and comply with endoscope rep processing and disinfection standards.
- Performed daily customer service phone calls to evaluate care received and prepare next day patients for a successful procedure.
Charge Nurse Endoscopy
Northeast Georgia Medical Center 773 beds
05.2003 - 06.2006
- Supervised nursing staff, ensuring compliance with safety protocols and quality patient care standards.
- Developed and implemented patient care plans in collaboration with multidisciplinary teams.
- Mentored junior nurses, enhancing clinical skills and promoting professional development.
- Streamlined workflow processes, improving patient throughput and satisfaction rates.
- Conducted regular training sessions on best practices and updated medical procedures for staff.
- Evaluated patient outcomes, identifying areas for improvement in care delivery methods.
- Managed inventory of medical supplies, ensuring availability while minimizing waste and costs.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Optimized patient satisfaction through timely response to concerns and effective communication among staff members.
- Promoted a safe working environment by adhering to infection control policies and regularly reviewing safety protocols.
Endoscopy Nurse
Gwinnett Medical Center 553 beds
05.2002 - 05.2003
- Administered patient care during endoscopic procedures, ensuring safety and comfort.
- Collaborated with physicians to develop individualized care plans for patients undergoing endoscopy.
- Monitored vital signs and assessed patient conditions pre- and post-procedure for optimal recovery.
- Educated patients on procedure preparation, expectations, and post-operative care to enhance understanding.
- Trained junior nursing staff on endoscopy protocols and best practices to ensure compliance with standards.
- Implemented process improvements that enhanced workflow efficiency in the endoscopy unit.
- Led quality assurance initiatives focused on infection control measures within the department.
- Coordinated interdisciplinary team meetings to address patient care challenges and streamline communication.
- Achieved timely patient discharge by efficiently completing post-procedure evaluations and implementing appropriate recovery plans.
- Streamlined patient flow by effectively coordinating schedules with the endoscopy team, reducing wait times and increasing overall efficiency.
- Facilitated seamless handoffs between shifts ensuring clear communication among colleagues regarding patients'' status updates.
Endoscopy Nurse
North Broward Medical Center 409 beds
05.1999 - 05.2002
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
- Administered patient care during endoscopic procedures, ensuring safety and comfort.
- Increased team morale through active participation in staff meetings, sharing ideas for process improvements and providing constructive feedback to colleagues.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Achieved timely patient discharge by efficiently completing post-procedure evaluations and implementing appropriate recovery plans.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
- Continuously improved nursing knowledge in the field of endoscopy by participating in relevant conferences, workshops, and training sessions.
- Minimized risk of infection by adhering to strict infection control protocols for cleaning, disinfecting, and sterilizing endoscopic instruments and equipment.
- Mentored new nurses joining the unit fostering a supportive learning environment that promoted professional growth.
- Maintained a sterile environment, ensuring proper preparation and disposal of endoscopic equipment to prevent crosscontamination.
- Educated patients on procedure preparation, expectations, and post-operative care to enhance understanding.
- Monitored patient reactions after administering medications and IV therapies.
Education
Graduate Certificate- May 2014 - Healthcare Innovation Management
Western Carolina University
Cullowhee, NCMaster Of Science - Nursing
South University
Savannah, Georgia05.2010
Bachelor of Science - Nursing
Florida Atlantic University
Boca Raton, Florida04.1995
Skills
- Well-Developed Listening Skills
- Coaching & Mentoring
- Building and Leading Teams
- Critical Problem Analysis/Resolution
- Organizational Re-Engineering
- Quality and Productivity Improvement
- Training and Development
- Organizational Needs Assessments
- Strategic planning/Accomplishment
- Written and Verbal Communication
- Decision-making
- Project management
- Strategies and goals
- Organizational development
- Rules and regulations
- Attention to detail
- Critical thinking
- Risk analysis
- Root-cause analysis
- Workflow Analysis
- Compliance analysis
Personal Information
MSN, RN, CPHQ
Certification
- 2023 LEAN six sigma Yellow Belt certification
- 2019 Patient Safety Academy, AdventHealth
- 2018 RCA2 Human Factors
- 2018 CPHQ, Certified Professional in Healthcare Quality
- 2016 Certificate in Workplace Accountability- Just Culture
- 2015 CBSPD, Certified Board for Sterile Processing and Distribution
- 2014 Graduate Certificate in Healthcare Innovation Management, Western Carolina University
- 2014 SCR, Surgical Clinical Reviewer for American College of Surgeons
- 2013 Patient Safety Executive, Institute of Healthcare Improvement
- 2012 Bronze Certification, Mission Health System Quality Academy
- 2011 CGRN, American Board of Certified Gastroenterology Registered Nurses
LEAVE OF ABSENCE- COVID
MAY 2020- AUGUST 2020
Timeline
Director of Acute Quality Services/Infection Prevention/Interpretive Services and Patient Safety Officer
UNC Health Pardee Hendersonville 222 beds
03.2022 - 10.2025
INTERIM-Patient Safety Risk Management Officer
Mount Carmel East Hospital 419 beds
09.2020 - 03.2022
INTERIM- Accreditation and Patient Safety
Cabell Huntington Hospital 303 beds
12.2019 - 04.2020
INTERIM- Director of Quality Management
Stanford Medical Center 613 beds
05.2019 - 11.2019
Chief Quality Officer- Director of Quality
Munroe Regional Hospital-AdventHealth 425 beds
05.2017 - 04.2019
Director of Nursing Quality Outcomes
Self-Regional 326 beds
02.2016 - 05.2017
Director of Endoscopy- Director Clinical Outcomes
Mission Hospital 763 beds
05.2011 - 11.2015
Director of Endoscopy and PACU
Emory Midtown & Emory University Hospital 587 beds
12.2007 - 05.2011
Assistant Director of Gastroenterology
Gainesville LLC
06.2006 - 12.2007
Charge Nurse Endoscopy
Northeast Georgia Medical Center 773 beds
05.2003 - 06.2006
Endoscopy Nurse
Gwinnett Medical Center 553 beds
05.2002 - 05.2003
Endoscopy Nurse
North Broward Medical Center 409 beds
05.1999 - 05.2002
Bachelor of Science - Nursing
Florida Atlantic University
Graduate Certificate- May 2014 - Healthcare Innovation Management
Western Carolina University
Master Of Science - Nursing
South University