Executive Director, Infection Control & Prevention

Location

Marietta, GA | United States

Job description

The Executive Director of Infection Control and Prevention serves as the System expert for all infection surveillance and analysis activities to advance WellStar Health System operational performance related to infections. The Executive Director, ensures timely identification and disposition of infection events and supports the analysis of complex infection data and trends for the determination of improvement initiatives. Oversees hospitals/components development, implementation and evaluation of their infection prevention/control plans and assists in coordinating the programs with the larger communities. Facilitates the development, and implementation of policies and procedures that govern prevention and control of infections and communicable diseases collaborating with all areas. Ensures policies and procedures are in compliance with current regulatory standards/requirements. Works with hospitals/components to annually identify areas at risk and utilizes this information when annual system/hospital safety and quality goals are established. Establishes system tactics for infection prevention/control and monitors activities around actions. The Executive Director serves as an advisor to the Product Value Analysis Teams and liaison between the analysis teams and sites. He/She also regularly collaborates with the Infectious Disease Physician and Director of Occupational Health and OSHA oversight as indicated.

Core Responsibilites and Essential Functions

• Directs the operations and services of areas of responsibility
  * Serves as the System infection subject matter expert for surveillance and improvement activities for inpatient and outpatient services and applies an epidemiological approach to problem solving.
  * Works with hospitals/components to annually identify areas at risk and utilizes this information when annual system and site safety and quality goals are established.
  * Supports development of annual hospital acquired infection (HAI) reduction goals at system and hospital/component levels, including tactics and metrics.
  * Establishes system tactics for infection prevention/control and monitors activities around actions.
  * Works with hospitals/components to ensure timely reporting to support monitoring of goals.
  * Monitors, analyzes and reports progress towards established system and hospital/component goals; collaborates to formulate potential course corrections as necessary.
  * Oversees coordination, as appropriate, of Infection Prevention related data from disparate sources, i.e. flash sterilization reports and provides infection data and identified trends for improvement to QSC and hospital leaders.
  * Oversees the process for HAI determination.
  * Oversees data entry requirements and serves as the liaison to i.e. NHSN, DICON
  * Serves as system lead for identification and evaluation of infection related hospital acquired conditions (HAC?s).
  * Works collaboratively with various PI Committees/Service Lines on IP related initiatives.
  * Builds credible relationships across the system to facilitate the accomplishment of system goals.
  * Demonstrates and promotes a culture of teamwork and high reliability.
  * Organizes and leads System-wide Infection Prevention Committee.
• Human Resources
  * Collaborates with hospital leadership to build appropriate prn staffing pool; provides support to hospitals/components as needed, i.e. support functions during times of vacancy.
  * Selects qualified personnel to ensure competent and adequate staffing; supports sites in employee orientation as required.
  * Oversees departmental and job specific orientation of PRN staff; supports sites in employee hiring process as requested.
• Establishes, monitors and evaluates staff competency and performance, submitting evaluations by established deadlines, soliciting input from applicable customers.
  * Manages schedules and submits prn personnel time and attendance.
• Oversees continuous survey readiness (CSR) for infection prevention.
• Oversees hospitals/components development, implementationa and evaluation of their infection prevention plans and assists in coordinating the program with the larger community.
  * Oversees that a system is in place for identification, reporting, investigating and controlling infections and communicable diseases.
  * Stays abreast of changes to infection prevention related standards and requirements including various external IP initiatives; notifies sites and leadership of new standards/regulations and effective dates.
  * Serves as system Function Leader for select IP standards, overseeing routine assessment of compliance with those standards/requirements and development of action plans as appropriate.
  * Collaborates with hospitals and components on approach to CSR and related activities.
  * Collaborates with site IP to develop, review and revise Infection Prevention plans, policies and procedures.
  * Develops and coordinates dissemination of infection prevention educational materials.
  * Supports hospitals and components during on-site visits and surveys.
  * Serves as subject matter expert to hospitals and components, i.e. WellStar Medical Group, Home Care, and Hospice.
  * Participates in the internal audits conducted by process improvement analysis for surveillance and analysis.
• Supports initiatives designed to enhance improve patient/worker safety
  *Collaborates with sites and Occupational Health Director to conduct annual TB risk assessment.
  * Collaborates with employee health to promote annual employee influenza vaccination.
  *Collaborates with Human Resources on OSHA requirements.
• Supports fiscal responsibility of the division
  * Prepares operating and capital budget proposals for submission to the AVP by required deadline.
  * Ensures timely purchase of requested items working collaboratively with the Operations Supervisor.
  * Demonstrates the ability to review/analyze current/historical data relevant to budget variances.
  * Oversees and/or implements new or revised programs.
  * Serves as contact for Director of Public Reporting for completion of Leapfrog submission.
  * Prioritizes tasks to meet goals and objectives and works within established deadlines.

Required for All Jobs

• Performs other duties as assigned
• Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education

• Baccalaureate degree from an accredited school of nursing, Public Health, or Epidemiology ,Required 
• Master's Degree from an accredited school of nursing, Public Health or Epidemiology, Preferred

Required Minimum Experience

• Minimum 5 years of experience in established infection prevention program at acute care hospital, including two (2) years of program leadership experience, Required 
• Experience in outpatient/ambulatory settings, Preferred

Required Minimum Skills

• Ability to self direct and appropriately delegate.
• Ability to exercise judgment, problem solve and make decisions consistent with WellStar philosophy, goals and objectives.
• Ability to deal with management stress, change and uncertainties appropriately.
• Ability to build credible relationships across the system and lead through influence.
• Demonstrates knowledge of microbiology, laboratory procedures, aseptic technique, sterilization, and epidemiological/public health data and statistical methods and screen and interpret data results for variations/errors.
• Including knowledge of NIAHO requirements, OSHA standards, CDC recommendations, and AORN standards.
• Works in a project management environment; must have the ability to support multiple functions concurrently.
• Computer experience necessary, including MS Word, Excel, and Power Point.
• Possesses ability to communicate both verbally and in writing clearly and concisely.
• Uses effective presentation and meeting techniques (agendas, time management, etc.).

Required Minimum License(s) and Certification(s)

• National certification in infection control (CIC) is required within 24 months of hire. Required

Additional Licenses and Certifications

We’d like to invite you on a career journey like no other! In return for your contributions, we’ll help you make the most of all life’s moments – on and off the job. Wellstar Total Rewards is designed to provide for your total well-being, including: Your Wellness, Your Pay, Your Future, Your Joy. We think it’s pretty simple – we care for our team members and our team members care for the community.

Make a difference in patients’ lives… and your own! Here, it’s more than healthcare – it’s CareerCare!

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