• Identifies, implements, and monitors safety management needs, guidelines, regulatory standards, policies and established goals related to the Environment of Care and Life Safety. • Develops, implements and evaluates all programs, policies and procedures necessary to comply with applicable Federal, State and Joint Commission requirements and best practices related to the Environment of Care and Life Safety. • Manages the TJC electronic Statement of Conditions. • Provides problem solving, consultative, advisory, and regulatory interpretive services to others as applicable within the EOC/Life Safety scope. • Chairs the Environment of Care Committee meeting per TJC regulation including agenda preparation, recording of minutes, and timely follow up on open action items. • Collects information from diverse sources, applies professional principles in performing various analyses and summarizes information and data in order to solve problems or design systems and programs required while being mindful that systems and programs cross department lines. • Provides regular updates to Leadership, facilitating collaboration and compliance with TJC and other regulatory agencies. • Conducts pre-construction risk assessments and site inspections to maintain the integrity of life safety and infection control measures, as well as proper documentation retention. Participates in construction/renovation/repair based meetings, as appropriate, to actively address EOC/Life Safety issues or concerns. Ensures any ILSM is properly implemented and documented. • Actively conducts EOC/Life Safety surveillance of OGHS facilities to identify safety hazards that pose a risk to the organization. Develop action plans to resolve and or mitigate the identified safety risks. • Maintains and updates accurate records of functions as required by local, state and federal regulatory bodies; presents and reviews records with TJC surveyor, Local Fire Marshall, and/or OSHA inspector for required follow-up, as needed. • Coordinates investigations related to EOC/Life Safety and maintains associated documentation. • Participates in the tri-annual TJC survey by accompanying the Joint Commission Life Safety Specialist, recording findings, answering questions, providing documentation, initiating immediate solutions whenever possible, collaborating with Quality Management & Plant Operations on the response to TJC report, corrective action and implementation follow up. • Establishes and maintains professional, cooperative interpersonal relationships with healthcare workers, physicians, nurses, and patients while assuring confidentiality of all department information. • Understands organizational structure and utilizes appropriate channels of communication; seeks guidance / input as appropriate utilizing resources and/or chain of command. • Assists with special projects and performs other duties as requested by COO.
Education: Associate's degree in Healthcare, Business or Engineering/Fire Science required. Bachelor's degree preferred. Experience: 3 years experience in EOC/Life Safety if Associates degree.
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