Job Description

1. NABH Compliance and Documentation

Ensure adherence to NABH standards and guidelines across all departments. Maintain and update all NABH documentation including manuals, policies, SOPs, and registers. Coordinate preparation and review of hospital-wide policies and ensure version control. Conduct regular internal audits and share findings with concerned departments for corrective actions.

2. Quality Indicators Monitoring

Track, analyze, and report departmental Quality Indicators (QIs) as per NABH norms. Ensure timely data collection and submission from all clinical and non-clinical departments. Identify trends and deviations in QIs and assist in root cause analysis and implementation of corrective measures.

3. Training & Capacity Building

Organize and conduct NABH and quality-related training programs for staff. Ensure training records and competency assessments are maintained as per standard requirements.

4. Internal & External Audits

Schedule, conduct, and document internal quality audits. Support during external audits (NABH assessment, surveillance, renewal audits, etc.). Ensure timely closure of non-conformities raised during audits.

5. Incident Reporting & RCA

Monitor incident reporting mechanism in the hospital. Facilitate root cause analysis (RCA), documentation, and follow-up of corrective and preventive actions (CAPA).

6. Committee Support

Act as coordinator or secretary for various quality-related hospital committees (e.g., Infection Control Committee, Quality Steering Committee, etc.). Prepare and circulate agenda, minutes, and follow-up action items.

7. Patient Safety & Feedback

Support patient safety initiatives and promote a culture of safety. Analyze patient feedback, complaints, and satisfaction surveys; ensure actions are taken for improvement.

8. Continuous Quality Improvement (CQI)

Identify improvement areas through audits, feedback, and data analysis. Assist in planning and executing CQI projects within departments.

9. Statutory Compliance

Ensure hospital is compliant with statutory and regulatory requirements related to quality and patient safety.

10. Data Management and Reporting

Maintain records and reports required for NABH and internal purposes. Generate periodic quality reports for senior management review.
Job Types: Full-time, Permanent, Fresher

Pay: ?18,000.00 - ?25,000.00 per year

Benefits:

Health insurance Leave encashment Paid sick time Paid time off Provident Fund
Schedule:

Day shift Morning shift Night shift Rotational shift
Supplemental Pay:

Performance bonus
Work Location: In person