Quality Officer in CEO Office - TAIF HEALTH CLUSTER - Taif, Kingdom of Saudi Arabia
(2024-06)
Supports the CEO in overseeing quality systems related to the adherence to Accountable Care Organization's (ACO) Gateway requirements.
- Proposed accreditation approaches, strategies, and readiness tools to enhance THC's preparedness for ACO Gate 3 requirements.
- Contributed to the development of readiness assessment checklists, gap analysis tools, and tracking mechanisms aligned with accreditation and ACO standards or requirements.
- Provided strategic input on sequencing, prioritization, and risk mitigation to support successful Gate 3 transition.
- Participated actively in Knowledge Sharing sessions for Care Delivery (3CD) organized by Health Holding Co. onsite and online.
- Organized and provided resource support on interpreting, analyzing, and determining evidences for Gate 3 requirements.
- Conducted a comprehensive and structured review of Gate 2 readiness review recommendations and identified quick wins across all ten (10) ACO domains.
- Proposed a tool for ACO Domains' Collaboration Cross-tabulation, which showed the points of cooperation & synergy between and among different ACO domains.
- Analyzed domain-specific gaps, risks, and improvement opportunities in alignment with ACO regulatory and readiness requirements. Produced the Collaboration Cross-tabulation Analysis Report.
- Provided clear, actionable, and evidence-based feedback to each Domain Leader, ensuring alignment with Gate 2 expectations.
- Facilitated clarification meetings and follow-ups with Domain Leaders to ensure shared understanding of recommendations and priority actions.
- Designed and offered for stakeholders' review and approval the format for Corrective Action Plan (CAP).
- Actively supported and monitored the development, implementation, and follow-up of Corrective Action Plans (CAPs) for assigned ACO domains.
- Coordinated with Domain Leaders to ensure CAPs were realistic, measurable, and time-bound, with clearly defined owners and milestones.
- Tracked progress of corrective actions and provided guidance to address implementation challenges and remove barriers.
- Ensured CAPs were aligned with ACO standards, governance requirements, and THC strategic objectives.
Quality Specialist - KING ABDUL AZIZ SPECIALIST HOSPITAL - Taif, Kingdom of Saudi Arabia
(2021-09 - 2024-05)
Provides dynamic senior leadership support on healthcare quality and patient safety. Acts as a resource on performance improvement, accreditation and utilization management to clinical and non-clinical departments in the hospital.
- Active involvement in the achievement of KAASH CBAHI Re-accreditation Certification.
- Ensured sustainable compliance with Hospital Standards and Specialty-specific national standards.
- Led operational quality and performance improvements in assigned clinical departments (Oncology, Cardiology, Emergency Medicine, and Nursing).
- Facilitated Quality Improvement Projects for various hospital departments.
- Reviewed Policies and Procedures for clinical and non-clinical departments.
Quality & Patient Safety Nurse Consultant - KING ABDUL AZIZ SPECIALIST HOSPITAL - Taif, Kingdom of Saudi Arabia
(2018-06 - 2021-08)
Offers consulting and coaching on quality, patient safety, accreditation, program development and research.
- Served as Domain Coach in the Adaa Performance Improvement Project in the Emergency Department (ED).
- Conceptualized the "ED for Excellence" program to drive performance enhancement in quality and patient safety.
- Contributed substantially to the establishment of the Sepsis Management Program in the Emergency Department.
- Initiated CBAHI Accreditation Readiness Program for all staff through the Office of the Hospital Program Director.
- Mobilized Physicians' active involvement and engagement that contributed remarkably in the achievement of King Abdul Aziz Specialist Hospital's CBAHI Re-accreditation status.
Nurse Manager: Quality & Patient Safety - KING ABDUL AZIZ SPECIALIST HOSPITAL - Taif, Kingdom of Saudi Arabia
(2007-09 - 2018-05)
Oversees the effective and efficient management of the Quality & Patient Safety Division within the Nursing Department and responsible for assisting the organization with the development of the overall structure and processes relating to Quality Management Systems.
- Facilitated review and updating of the Nursing Department's Strategic Plan addressing key areas of development.
- Established mechanism for a participatory approach in the development, review and revision of Nursing Policies and Procedures.
- Forged active collaboration with other Clinical and Service Departments in the development, review and revision of Multidisciplinary Policies and Procedures.
- Designed education programs and learning activities for the dissemination of Policies and Procedures and training Nursing Staff on Quality Improvement.
- Organized Self-Survey Teams for CBAHI and JCI Accreditation Preparation.
- Conceptualized Nursing Quality Audit and designed audit tools through participatory approach.
- Periodically conducted evaluation to ensure compliance to standards such as Nursing Quality Audit, Medical Records Qualitative Review, Self-Survey, Job Satisfaction Survey, etc.
- Facilitated and led Continuous Quality Improvement (CQI) Projects both at the department level and hospital-wide.
- Ensured implementation of Nursing Quality Plan and coordinated monitoring of quality indicators including the AHRQ 2010 Patient Safety Event Monitoring for Patient Safety Organizations (PSO).
- Monitored Nursing Committees and ensured proper channeling and prompt action for committee recommendation.
- Conceptualized and established strategies for fostering active participation of frontline healthcare workers in quality improvement.
- Facilitated hospitalwide conduct of Healthcare Failure Mode & Effects Analysis (HFMEA).
- Conceptualized and implemented SALAM-PEACE Program - a competency-based leadership development program for Saudi Nurse Leaders and a self-enhancing program for expatriate nurse leaders.
- Conceptualized and ensured regular conduct of Nursing Quality Forum and coordinates with other departments for issues requiring collaborative interventions.
- Participated extensively in the Emergency Department Improvement Project (joint venture of GE Healthcare Partners & Ministry of Health) as project team member --- coordinated collection and analysis of Key Performance Indicators (KPI), facilitated Patient & Staff Satisfaction Survey and the AHRQ Patient Safety Survey.
- Participated in GE-MOH projects under the Patient Centered Pathways (PCP) Program –Inpatient Domain.
Nurse Manager: Education and Training - KING ABDULAZIZ SPECIALIST HOSPITAL - Taif, Kingdom of Saudi Arabia
(2003-12 - 2007-08)
Organizes and ensures successful implementation of Nursing Education Programmes that include Competency-based Orientation, Induction, Continuing Professional Education, Certification and Re-certification, Competency-based Skills Training Programmes and other In-Service Trainings.
- Designed and established Nursing Competency-based Orientation Programme.
- Established Competency Assessment Program for Nurses.
- Facilitated production of Competency Assessment Tools for various Nursing Practice Areas through stakeholders' participation.
- Conceptualized and conducted Training Needs Assessment Survey within the Nursing Department and utilized results to develop appropriate need-based Training Programmes.
- Maintained Resource Database of personnel skills, experience and training and ensured the regular Re-certification of all Nursing Personnel in the requisite competency areas.
- Forged cooperation with the Taif MOH Nursing Administration for the design and implementation of Nursing Education Programmes for Nurses in various MOH Hospitals in Taif.
United Nations Volunteer – Reproductive Health Specialist - UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP) MULTI-DONOR PROGRAMME PHASE 3 - REPRODUCTIVE HEALTH SUBCOMPONENT
(2001-11 - 2002-11)
Responsible for the provision of technical oversight to Reproductive Health (RH) Programme project areas/ Peace and Development Communities (PDCs).
Associate Professor - NOTRE DAME UNIVERSITY – COLLEGE OF NURSING - Philippines
(1993-11 - 2001-11)
Responsible for training and supervising Student Nurses in clinical and academic concept teaching. Exposed students in the tertiary Regional Medical Center for their clinical exposure in areas such as Emergency Department, Medical, Surgical, Obs-Gyn and Psychiatric Department.
- Administrative Assistant to the Vice-President of Academic Affairs for Accreditation (School Year 1998-1999)
- Research Associate, Institutional Research, Planning & Development Office, University Research Center (School Year 1997-1998)
