Job Description

Location: Steward Health Care
Posted Date: 6/16/2021

Position: Steward Health Care is recruiting a System Chief Quality Officer with a strong clinical background and a track record of accomplishments in clinical quality, performance improvement and patient safety. This individual will work collaboratively with enterprise and hospital leadership to ensure progressive improvements in clinical quality, and compliance with CMS, TJC and DNV regulatory standards. The ideal candidate will recognize that utilizing evidence based best practice with a steadfast aim for top decile performance will help lead our multidisciplinary teams to success.

Steward Health Care is the largest private, for-profit physician-led health care network in the United States. Steward operates 36 hospitals in the United States and operates an International division that currently includes the countries of Malta and Colombia. Steward employs approximately 40,000 employees. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, over 7,900 beds under management, and approximately 1.5 to 2.2 million full risk covered lives through the company's managed care services. The total number of paneled lives within Steward's integrated care network is approximately 2.5 million.

Steward is a physician-led company with strong physician leaders in the Executive Leadership Team.


Clinical Quality, Patient Safety and Performance Improvement:

Reporting directly to the System Chief Medical Officer, the System Chief Quality Officer (CQO) has oversight and responsibility for clinical quality and performance improvement for the system. The CQO will ensure accuracy and timeliness of regulatory reports, collaborate with nursing leadership to promote a culture of safety throughout the system and will be responsible developing and maintaining a system-wide clinical quality program.

  • Ensures implementation of Steward’s Quality and Safety Plan and annual goals through an interface with Chief Medical Officers, Chief Nursing Officers and other members of the Clinical Quality Team
  • Provides leadership in developing a culture of safety for the system
  • Has responsibility for accuracy and timeliness of quality measure reporting
  • Chairs the Clinical Excellence Committee and Pre-Clinical Excellence Committee responsible for policy management and upkeep
  • Is accountable for continuous performance improvement and achievements of goals on internal and external quality and patient safety measures.
  • Reviews events in the incident reporting system and participates in root cause analysis as needed,
  • identifying and overseeing implementation of corrective actions
  • Analyzes and acts on safety trends both at the local level and systemwide
  • Oversees the functions of the Vice President of Patient Safety and Risk Management and the Executive
  • Director of Clinical Data
  • Co-Chairs the System Pharmacy and Therapeutics Committee
  • Co-Chairs the System Antibiotic Stewardship Committee
  • Co-Chairs the System Pain Management Committee
  • Participates in monthly CMO and monthly CNO roundtable meetings
  • Monitors quality and safety, patient satisfaction, risk management, and utilization review, and works in collaboration with the System CMO to develop performance improvement plans
  • Works with clinical documentation specialists, coders, and medical staff to ensure complete and accurate documentation.

Care Coordination and Management:

  • Actively participates in care management and our PULSE process to ensure clinical quality, appropriate
  • length of stay, appropriate level of care, and minimize preventable readmissions
  • Supervises the Executive Director of Clinical Data to assess appropriateness of hospital based P4P
  • quality, patient experience and throughput metrics
  • Identifies opportunities for improvement, assists in plan development and assures successful
  • achievement of P4P quality, patient experience and throughput targets
  • Provides guidance in the implementation and function of the PULSE process

Budgeting and Financial Management:

  • Participates in developing the budget for the System Clinical Practice and Patient Safety Department
  • Contributes as needed to capital equipment allocation meetings

Medical Staff:

  • Assists in the development/reorganization of specialty-specific Clinical Advisory Panels (CAGs)
  • Co-chairs quarterly or biannual CAG meetings
  • Assists with ongoing development and deployment of Steward Medical Staff Bylaws


  • Works with the chairs, chiefs, and executive leadership team to develop operational goals and facilitates implementation of business, operational, and clinical tactics necessary for growth, improvement, and attainment of clinical, financial, and operational goals.
  • Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
  • Commits to recognize and respect cultural diversity for all customers (internal and external) in accordance with the Steward mission and vision statements
  • Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.
  • Serves as physician resource on as needed basis for nursing leadership, case management, and pharmacy
  • Participates in the implementation, staff education, and ongoing evaluation of the electronic health record
  • Assumes responsibility for administrative and clinical issues when the System CMO is not available
  • Performs other duties as assigned


  • Medical degree with board certification
  • Current licensure in the United States
  • Significant experience in clinical practice
  • Post-graduate training in relevant fields of business or healthcare administration preferred
  • Strong clinical competency
  • Contemporary knowledge of laws, regulations, Joint Commission standards, DNV standards, state licensing, and relevant payor requirements relating to medical practice within an acute care hospital setting and/or a multi-hospital organization
  • Knowledge of leading quality measurement, monitoring, and improvement programs, risk management, and utilization review
  • A solid grasp of hospital finance and the ability to effectively participate in strategic planning initiatives, including new program development and clinical services
  • Ability to use objective data to support his/her position and change behavior
  • Ability to act as a strong proponent for clinical quality – inspires others to follow
  • Ability to clearly and effectively communicate new approaches to the medical staff
  • Ability to articulate the clinical quality and regulatory implications of decisions, policies, or actions
  • Ability to command respect, clinically, administratively, and personally
  • Ability to build a collaborative, quality-oriented environment with nursing leadership
  • Ability to interact in a collegial manner with the medical staff, while also being able to effectively articulate his/her point of view
  • Ability to develop a vision for the integration and delivery of medical care and help others move towards and believe in that vision
  • Ability to Travel in the United States as necessary


  1. Education: Medical degree (MD or DO) with board certification
  2. Experience: Three or more years of progressive experience in medical staff administrative leadership. Three or more years leading clinical quality, patient safety and performance improvements for a complex organization or hospital system
  3. Certification/Licensure: Licensure in the United States
  4. Software/Hardware: Excellent Skills in Microsoft Office

Application Instructions

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