Job Description
Job Description
Overview and Purpose of the Role
Reporting to Director, Quality, Safety & Enterprise Risk, the incumbent will play a key role in leading, developing, implementing quality, safety, and integrated risk management programs and policies, that foster a proactive and integrated culture of continuous quality improvement, safety, and accountability.
Key Duties and Responsibilities :
Quality Improvement and Assurance and Patient Safety
- Champion a culture of quality improvement and safety by proactive reporting of quality improvement opportunities and risks and promoting use of quality improvement methods
- Develop and maintain the Centre’s Quality Assurance Program and Quality Improvement Plan (QIP)
- Analyze current practices and workflows, collect and use data to identify and implement opportunities for improvement (e.g., root cause analyses following adverse events or near-misses)
- Collaborate with clinical programs to lead quality improvement and patient safety initiatives, utilizing varying methods (i.e., Lean, PDSA, FMEA)
- Continuously monitor trends and issues in quality and patient safety
- Synthesize data and additional evidence to inform quality improvement and safety initiatives, including conducting literature reviews, analyzing hospital data and report trends to leadership
- Conduct regular audits, performance metrics review, chart reviews, and outcome analyses to monitor quality indicators and identify opportunities for improvement
- Support policy and procedure development
- Assist with facilitating safety huddles and quality, safety, and policy-related committees
- Using incident reporting system and additional tools as required, track, investigate, and report incidents, adverse events, and near misses using structured frameworks (e.g., RCA), and communicate findings to relevant stakeholders
- Support preparation and review of mandatory reporting requirements that meet governmental and organizational performance objectives
Risk Management
Proactively collaborates with all the teams to identify risks and risk mitigation strategiesMaintain and manage the Centre’s Risk Management Program, including risk register, incident tracking, and legal or regulatory incident reportingCollaborate with team members to ensure compliance with privacy regulations (PHIPA) and infection prevention and control (IPAC) protocolsMonitor trends and potential risks, escalating concerns to leadership when necessaryEmergency Preparedness
Support the development and review of emergency codes and policiesDevelop, update, and test the Emergency Preparedness and Response Plan, ensuring alignment with provincial guidelines (e.g., Emergency Management Ontario)In collaboration with other teams, coordinate emergency drills (fire, pandemic, lockdown, etc.) and debriefs with interdisciplinary teamsLiaise with community emergency services and public health authorities as neededPolicy System Administration
Serve as the e-Policy System Administrator, managing the digital policy and procedure platformOversee version control, document workflows, policy updates, and access permissionsEnsure that all staff have access to current policies and are notified of changes in a timely mannerCoordinate policy reviews and approvals with department leads and leadershipEducation & Training
Develop and deliver staff training on quality, risk, safety, and compliance topicsFacilitate onboarding of new staff in areas related to patient safety and qualityRegulatory & Accreditation Readiness
Enable compliance with all applicable regulatory requirements, inspections, surveys, and accreditation and professional oversight bodies (e.g., CPSO, Accreditation Canada, ORNAC, Ontario Health, Ministry of Health)Maintain required documentation and ensure ongoing readiness for accreditationStay current with changes to healthcare regulations and standards in Ontario and advise leadership accordinglyCorporate Responsibilities :
Participate in all mandatory training requirements and work in compliance with the Occupational Health and Safety Act and Regulations, company Policies and Procedures, as well as established industry guidelinesSkills & Qualifications :
Undergraduate degree in Nursing, Health Sciences, or a related healthcare field is requiredMaster’s degree in a related field preferredCertification in Quality, Risk Management, Lean, and / or Emergency PreparednessMinimum 3 years of recent experience in a healthcare setting, with at least 2 years in quality improvement, patient safety, or risk management, preferably in an ambulatory or surgical environmentStrong understanding of Ontario healthcare regulations, CPSO standards, IPAC protocols, and accreditation processesExperience in change management is an assetAbility to exercise significant discretion and sensitivity involving responsibility for protecting sensitive information and ensuring compliance with data security policies and oversee the development and implementation of confidentiality proceduresExperience with Meditech Expanse is an assetSuperior interpersonal skills including the ability to work effectively in a team environmentStrong organizational, critical thinking, analytical, and problem-solving skillsDetail-oriented with a focus on accuracy and complianceExcellent verbal, written and communication skillsProven ability to work in a fast-paced environment and manage multiple projects simultaneouslyProactive approach to improving processes and systems for better operational efficiencyAbility to adapt to new technologies and systems quicklyComputer proficiency in MS Office (Word, Excel, Outlook)Satisfactory passing of a criminal record check / vulnerable sector checkProvide proof of Immunization and TB recordsCompany Description
Schroeder Ambulatory Centre is a non-profit medical facility dedicated to enhancing the quality of life for Ontarians through accessible, outpatient healthcare. Opening in late 2025, the Centre will offer a comprehensive range of clinical, diagnostic, and surgical services in alignment with it's mission to reduce pain, improve mobility, and streamline healthcare delivery.
In collaboration with hospital and academic partners, Schroeder Ambulatory Centre aims to strengthen public health capacity and drive innovation in care, ensuring a more efficient and compassionate healthcare experience for the community.
Company Description
Schroeder Ambulatory Centre is a non-profit medical facility dedicated to enhancing the quality of life for Ontarians through accessible, outpatient healthcare. Opening in late 2025, the Centre will offer a comprehensive range of clinical, diagnostic, and surgical services in alignment with it's mission to reduce pain, improve mobility, and streamline healthcare delivery.In collaboration with hospital and academic partners, Schroeder Ambulatory Centre aims to strengthen public health capacity and drive innovation in care, ensuring a more efficient and compassionate healthcare experience for the community.