Senior Quality Executive

Qualification

• MHA MBA Hospital Management B.Sc Nursing Allied Health Sciences
• Certification in NABH Quality Management preferred

Experience

• Minimum 3-6 years experience in hospital quality department
• Experience in NABH accreditation and audits preferred
• Healthcare hospital experience mandatory

Key Responsibilities

Quality Management

• Implement and monitor quality assurance programs across departments
• Ensure compliance with NABH standards and hospital policies
• Coordinate departmental quality indicators and data collection
• Monitor patient safety goals and quality improvement initiatives

NABH & Audit Coordination

• Prepare departments for NABH audits and inspections
• Conduct internal audits and compliance checks
• Maintain audit reports, CAPA and documentation
• Coordinate with departments for closure of non-conformities

Documentation & SOP Management

• Prepare and update SOPs, policies and protocols
• Ensure proper documentation practices in all departments
• Maintain quality records, reports and audit documents
• Monitor document control processes

Training & Awareness

• Conduct staff training on quality standards and NABH protocols
• Organize orientation programs on patient safety and infection control
• Support departments in implementation of quality initiatives

Patient Safety & Infection Control

• Monitor incident reporting and patient safety indicators
• Coordinate with infection control team for compliance activities
• Participate in RCA, risk assessment and quality review meetings

Coordination & Reporting

• Coordinate with clinical and non-clinical departments
• Prepare monthly quality reports and presentations
• Analyze quality indicators and suggest corrective actions
• Support management during accreditation processes

Skills Required

• Knowledge of NABH standards and hospital quality systems
• Good communication and presentation skills
• Strong documentation and analytical ability
• Audit and reporting skills
• Team coordination and problem-solving ability
• Computer proficiency (Excel, PowerPoint, HIS)

Key Performance Indicators (KPIs)

• NABH compliance score
• Closure of audit non-conformities
• Timely submission of quality reports
• Staff training completion rate
• Patient safety and incident reduction indicators

Working Conditions

• Full-time hospital-based role
• May require extended hours during audits and accreditation visits
• Coordination with all hospital departments