An exciting opportunity has arisen for an experienced Governance Manager to join the newly formed private healthcare subsidiary of the SELDOC Group based in Norbiton.
This new dynamic and forward-thinking subsidiary organisation provides Corporate Health and Wellbeing services by combining new state-of-the-art technology with the highest quality healthcare.
Our mission is to make workforces healthier and happier the world over and we want you to be a part of it.
Salary: £36k FTE
Location: SELDOC Offices – Norbiton / Remote working
Reporting to: Associate Clinical Director
Contract: Permanent – 22.5 hrs per week (3 days)
Job Summary
The post holder will ensure that the SELDOC Group (which includes Verve Healthcare) has innovative and robust clinical governance systems to support the delivery of high patient quality care. This will include developing, implementing and maintaining effective patient participation strategies, providing effective and efficient handling of incident reporting systems and complaints that comply with the NHS and best practice standards.
The successful applicant will develop the Patient and Public information and clinical governance systems to ensure Care Quality Commission (CQC) registration is maintained. The post holder will also provide administrative support to the Clinical Governance Committee to develop policies, maintain clinical databases, conduct quality audits and deliver against the annual operating plan. The post holder will be a member of the Clinical Governance Team.
Role Responsibilities
Patient and Public Participation
• Maximise the opportunities for patient response/feedback and develop processes that support this.
• To develop and lead on a process that allows the organisation to engage and work with users or potential users of the services in the development of future services.
• Work with local focus groups to enhance SELDOC/VERVE’s profile and understand the expectations of stakeholders.
• Develop a repository of patient information media to support effective communication with patients about health, self-care and appropriate access to services, for example, improve information for patients on when and how to use services.
• Link with GP practice Members to identify how to best meet the needs of their practice populations.
Complaints and significant incidents management
• To establish and maintain an effective process for obtaining patient feedback in line with commissioning and National quality requirements and to contribute towards overall improvement of services.
• To provide expert liaison and correspondence with patients, relatives and their representatives.
• To lead in the investigation and handling of complaints received ensuring that these are entered into a database and handled in accordance with the complaints procedure within agreed timescales.
• To prepare and issue timely, accurate, professional and sensitive correspondence in response to complaints.
• To maintain an effective database of all complaints, feedback and incidents, flagging SIs, undertaking communication of actions and lessons learned.
• Work with the Group Medical Directors and their deputies to undertake Root Cause Analysis.
• To produce the Clinical Governance reports, Commissioners reports and Annual report for the Clinical Governance and Operations Committees. This should include details of all Clinical Governance activities including complaints, incidents, SI’s, quality audit, patient engagement, safeguarding, medicines management and performance against NQRs. The reports should also include proposed actions and feedback on progress.
• To develop an effective method of feedback on compliments and complaints for clinical and operational staff that enables learning across the organisation.
• To provide other ad hoc reports as required for the Medical/Clinical Directors, CEO, Board and commissioners.
Performance Management
• To work closely with the Group Medical Director, their deputies and the management team to agree and enable regular quality audit process to ensure SELDOC/VERVE provides a high quality service, meets the requirements of commissioners, quality standards (NQRs) and the CQC.
• To improve and implement a robust and useful system of regular feedback to staff on productivity and quality of their performance.
• To work in conjunction with the management team to implement and review performance management systems across the organisation.
• To review complaints, incidents, feedback, results of quality audit and provide feedback to relevant staff on their performance.
• To make recommendations for further training where this need is identified from the review process.
Medical Records Management
• To be responsible for medical records management, in accordance with Caldicott principles and information governance processes, including secure call sheet storage, patient’s notes, patient’s notes reviews, access to patients’ records.
Database Management
To be responsible for database management by overseeing and ensuring:
• Patient’s notes reviews, including duplicated information/amalgamation.
• That all users are adhering to the requirements of summary care records, end of life care and special notes handling systems.
• Providing supervision, monitoring and assistance in the uploading of data such as the safeguarding database, special patient notes, as required.
• Uploading and maintaining any other patient information sharing system working collaboratively with service users and stakeholders to ensure that patients information is shared appropriately and according to IG principles.
• Checking Smartcard data.
• Ensure safe storage and disposal of patients records in line with NHS guidance.
• To maintain a database of all safety Alerts, ensuring onward communication of information received to clinicians and operational staff, operations team, medical/clinical director as appropriate.
• To maintain clinician databases which will include performance data, relevant documents and correspondence.
Policy development and maintenance
• To review and develop policies as required by the clinical governance committee to meet the needs of the service and requirements of CQC.
• To support the Medical Director and their deputies in preparing policies relating to clinical governance work streams.
Quality Reporting
• To produce the Clinical Governance reports, Commissioners reports and Annual report for the Clinical Governance Team and Quality Committee. This should include details of all Clinical Governance activities including complaints, incidents, SI’s, quality audit, patient engagement, safeguarding, medicines management and performance against NQRs. The reports should also include proposed actions and feedback on progress.
• To provide performance reports for GPs and any other front-line staff.
• To produce board and committee reports in accordance with meetings timetable.
• To produce reports for commissioners in accordance with commissioners meetings timetable.
• To produce any additional reports required for the purpose of quality and patient safety.
Training & Educational meetings
• To arrange resuscitation training and maintain a database of staff who have attended training.
• To coordinate and implement any new training programmes as agreed with the Medical Director or duputies.
• To undertake training of operational staff and clinicians as agreed with the Medical Director or deputies.
• To be responsible for coordinating and contributing to the clinical newsletter ensuring regular production according to timelines agreed with the Medical Director and clinical governance team.
New Business Opportunities
• To assist, as required with the co-ordination of developing new business and contracts including the production of PQQs, tender submissions and business cases, ensuring that deadlines for submission are met.
• To provide support for projects as directed by the Group Medical Director and duputies.
Corporate responsibilities
• To work as part of the day time management team to ensure a positive and productive team environment is developed and maintained at all times.
• To attend internal and external meetings as requested.
• To produce written and verbal reports with appropriate data to support such meetings.
• To support colleagues in ensuring operational and management cover is available. across all work streams.
• To work in line with SELDOC/VERVE values
Objectives and Personal Development
• Agree annual objectives and review progress during the year with the Associate Clinicial Director
• Agree a PDP with the Associate Clinicial Director
Other duties
• Provide cover for the Quality Manager and other Quality Administrators when they are on leave.
• Any other duties, as agreed, to meet the needs of the organisation.
• The role may span across services operated by both SELDOC Ltd, and VERVE Healthcare services.
This job description is not definitive or restrictive in any way. It will be regularly reviewed and may be amended in the light of changing circumstances following consultation with the post holder.
Ideal candidate
The ideal candidate will have:
Experience of working in an organisation or team with a strong patient-centred focus
In depth knowledge of NHS complaints handling procedure, Clinical Governance frameworks, legislative frameworks, relevant patient safety guidance and frameworks, NQRs
Experience of successfully and proactively handling sensitive and difficult situations
Experience of working with IT databases and systems, and in using Microsoft Office to produce reports and presentations
Experience of managing projects and coordinating multiple work streams under tight deadlines
Experience of working with IT databases and systems, and in using Microsoft Office to produce reports and presentations
A university degree