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Our trust has around 10,000 staff serving 1.6 million patients. It comprises Barnet Hospital, Chase Farm Hospital, the Royal Free Hospital and more than 30 services in the community. This larger scale organisation provides an unprecedented opportunity for us to continue our pioneering work, particularly in finding ways to deliver even better care to our patients.

Our mission is to deliver world class care and expertise in our clinical services, underpinned by world class teaching and research and we will continue to measure our progress against our five governing objectives: excellent outcomes, excellent patient and staff experience, excellent value for taxpayers' money, being safe and meeting our external duties, and building a strong organisation.

Everyone is welcome at Royal Free London NHS Foundation Trust. We're proud of our diversity and we continue to undertake new initiatives to advance equality for LGBT+, BME, gender equality, staff carers and people with disabilities and lived experiences to promote good relations and understanding between our staff.

Click here to view our video Welcome to the Royal Free
Click on the logo below to see the video of the Royal Free London NHS Foundation Trust values

Job overview

The post holder is responsible for:
Supporting the Head of Quality Governance in developing, implementing and monitoring
an effective and reliable system of working to ensure robust divisional governance which
is in line with national best practice.
Managing the divisional governance staff in dealing with all activities relating to patient
safety, risk, compliance and audit and act as the lead and central point of contact for
divisional governance activities
Acting as a leader who horizon scans to ensure the divisional governance activities
remain in line with Trust standards and expectations.
Support and develop a culture of informed questioning, challenge, trend analysis and
information triangulation to ensure lessons are learned and the division changes
practice in a way which has a positive effect on patients, outcomes, patient experiences
and supports the trust ambition to reach zero avoidable harm incidents.
Ensure compliance with Duty of Candour, including responsibility for communicating
with patients requiring notification.
The post holder is responsible for developing systems and managing processes for
sharing and implementing processes to ensure organisational learning.
The post holder will work closely with the quality governance, operational and corporate
management teams and staff at all levels of the organisation.

Main duties of the job

The post holder is responsible for:
• Supporting the Head of Quality Governance in developing, implementing and monitoring an effective and reliable system of working to ensure robust divisional governance which is in line with national best practice.
• Managing the divisional governance staff in dealing with all activities relating to patient safety, risk, compliance and audit and act as the lead and central point of contact for divisional governance activities
• Acting as a leader who horizon scans to ensure the divisional governance activities remain in line with Trust standards and expectations.
• Support and develop a culture of informed questioning, challenge, trend analysis and information triangulation to ensure lessons are learned and the division changes practice in a way which has a positive effect on patients, outcomes, patient experiences and supports the trust ambition to reach zero avoidable harm incidents.
• Ensure compliance with Duty of Candour, including responsibility for communicating with patients requiring notification.
• The post holder is responsible for developing systems and managing processes for sharing and implementing processes to ensure organisational learning.

The post holder will work closely with the quality governance, operational and corporate management teams and staff at all levels of the organisation.

Working for our organisation

Click here to view our video Welcome to the Royal Free

Detailed job description and main responsibilities

1. RESPONSIBILITIES

Incident, Risk, Investigations
• Maintain professional behaviour at all times and promote a positive image of Royal Free London NHS Foundation Trust at all times, in line with World Class Care values.
• Access, monitor and review clinical incidents reported via the Trusts incident reporting system (DCIQ). Liaising with senior nursing teams and clinical governance lead to ensure investigations are completed and presented in line with Trust timescales.
• In collaboration with the Head of Quality Governance have oversight and responsibility for all aspects of the quality governance agenda, developing an effective patient safety framework that is quality centric.
• Ensure delivery of the rolling programme of governance activities in line with trust, hospital, division and service requirements
• Develop and coordinate good integrated governance practice within the business unit.
• Supporting the development and maintenance of effective working relationships, communication, co-operation and engagement with internal stakeholders.
• Support the Head of Quality Governance in interpreting and assessing the relevance of national policy and guidance, providing support to governance teams regarding implementation and evaluation.
• Liaise with the Head of Quality Governance to agree and achieve deliverables, as appropriate.
• Provide specialist advice on quality assurance around patient safety and clinical governance.
• Provide scrutiny and challenge of highly complex, technical, and sensitive clinical and non-clinical information.
• Analyse complex information from incident investigations (including patient safety incident investigations) and audits and working with performance and contracting colleagues to support the establishment of appropriate action plans to bring about positive change.
• Leading and ensuring division's compliance on the Duty of Candour .
• Work with the complaints and legal team to triangulate information from thematic reviews arising out of complaints, legal claims and incident data.
• Provide monthly, quarterly and yearly reports triangulating the information and data from clinical governance activity.
• Leading the management of patient safety events and the sharing of learning from these events. This includes reviewing and ensuring that investigations have been appropriately carried out in accordance with agreed guidelines and timeframes and to determine if the investigation is fair and/or in need of further information or interviews and providing feedback on key areas for improvement, challenge or further actions. This will include:

i. Validating SEIPS investigation methodology, AAR, MDT, and resultant action plans.

ii. Producing thematic reviews of patient safety events to identify trends and patterns for a defined population.

iii. Facilitating the dissemination of wider learning and sharing good practice and supporting quality improvement.

iv. Ensuring that recommendations from patient safety events are integrated into quality improvement strategies and plans.
• Support the Head of Quality Governance in ensuring that the Learning from Deaths policy is embedded in the hospital site, with a process for regular robust reviews.
• Encouraging a culture of openness and transparency that responds rapidly to potential or actual failures.
• Support the oversight and co-ordination of the hospital participation and implementation of recommendations from NCEPOD and NatSSIPs 2
• To conduct appraisals and ensure staff are compliant in mandatory and statutory training and records are kept up to date.
• Act as an effective role model and mentor promoting excellence through practice.

Person specification

Qualifications

Essential criteria

Professional knowledge plus additional specialist, management knowledge acquired through training and experience to Post graduate qualification or equivalent experience in clinical governance.

Desirable criteria

Healthcare professional
PSIRF approved training
Risk management qualification.
After action review facilitator

Knowledge & Experience

Essential criteria

Good working knowledge of risk and incident management in relation to the NHS Patient Safety Strategy
Knowledge of the requirements of duty of candour.
Working knowledge of PSIRF
Evidence of working in an NHS environment.
Evidence of using computer packages
Experience of working with senior managers and leaders

Skills & Attributes

Essential criteria

Strong attention to detail
Able to prioritise, balance conflicting demands and deliver to tight deadlines.
Ability to convey detailed potentially confidential information and appropriate action.
Being prepared to take action now and implement a vision for the future development of services.
The facility to embrace and cut through ambiguity and complexity and to be open to creativity in leading and developing services.
Sensitive to the needs of patients, carers and their families, whilst possessing a balanced, nonjudgmental attitude
A strong commitment to making service performance improvements and a determination to achieve positive service outcomes for user.
Communicating the vision and rationale for change and modernisation and engaging and facilitating others to work collaboratively to achieve real change.
Being committed to working and engaging constructively with internal and external stakeholders
Practical and realistic with an ability to find and implement solutions to immediate problems
Excellent interpersonal skills
Excellent oral and written communication skills
Motivational skills to lead and manage clinical governance within the Trust.
Excellent problem-solving skills
Ability to influence and operate effectively in a challenging environment Ability to develop effective relationships with a range of stakeholders internally and externally.
A leader with personal and professional credibility.
Confident and able to inspire confidence in others
Innovative and imaginative
Data analysis and interpretation skills
Development and use of information systems to support change.
Strong communications skills including report writing and presenting information.
Be able to devise project plans and work programmes
Good time and workload organising capabilities.
Excellent Presentation skills
Excellent IT skills (Microsoft Packages)
High level of personal professionalism
Capable of working on own initiative and to meet deadlines.
Ability to work as part of a multidisciplinary team as well as managing own workload.
Ability to communicate with professionals from variety of different specialties.
Ability to demonstrate and generate commitment to patient experience, public involvement and equality and diversity.

Covid-19 Vaccination
Getting vaccinated, and getting a booster, remains the best defence against COVID-19.
We encourage and support staff to get COVID-19 vaccine and a booster dose as and when they are eligible.
AT* - Apprenticeship Training. Where AT* is entered next to the job title indicates that this vacancy is for an apprenticeship role.
By applying for this role, you accept if successful, that your personal data may be transferred from the Trust to another NHS organisation where your employment transfers within the NHS. This is in accordance with the streamlining programme which aims at saving you time and improving efficiencies within the NHS when your employment transfers. Therefore we require you to complete your stat and Man e-learning modules prior to joining our organisation.
If you are an EU/EEA citizen who does not have EU Settlement or Pre-Settled status, you will require a visa to work in the UK.
Applications from job seekers who require sponsorship to work in the UK are welcome and will be considered alongside all other applications. Before submitting your application and to avoid disappointment please check that you are eligible under the UKVI points based system.
If you are offered a role with one of the NLPSS partner trusts, as part of pre-employment checks your identity and right to work documentation will be verified remotely (in most circumstances), using a certified identity verification service provider TrustID. You will be asked to capture an image of the relevant documents as well as a "selfie" using your smartphone/tablet (if available) for facial matching. TrustID will also perform a digital address check using Trunarrative and Equifax, which is a soft check and does not leave a footprint on your credit rating. For more information, visit www.trustid.co.uk
The Trust uses electronic new starter forms on Trac to collect personal details. Information collected is securely stored and used to set up the employee record on the ESR HR system.
The Trust will request a DBS (CRB) if post involves regulated activities. The Trust is compliant with the Disclosure and Barring Service Codes of practice and the Rehabilitation of offenders act.
By applying for this post you are agreeing to Royal Free London NHS Foundation Trust transferring the information contained in this application to its preferred applicant management system. If you are offered a job, information will also be transferred into the national NHS Electronic Staff Records system.
Please be aware of scams - unless specified above, we will only communicate with you via @recruit.trac.jobs or nhs.net e-mails and we will never ask you for any payments.

Applications are welcome from people wishing to job share or work flexible patterns. We are committed to equal opportunities.

Please note:

Due to the high number of applications that are received for some posts we may close this vacancy before the advertised closing date. Therefore please apply for this post as soon as you can, if you are interested and you meet the requirements of the Person Specification
Only those candidates who clearly demonstrate how they meet the person specification will be shortlisted for this job.
Interview arrangements will be communicated via email so please check your email regularly following the closing date.

Please be advised that due to exceptionally high demand, all Royal Free accommodation is at full capacity and waiting lists are being held. Average waiting times are 12 months. Please do not rely on Trust accommodation when you commence your role and ensure you investigate alternative accommodation for your arrival.

Employer certification / accreditation badges

Applicant requirements

The postholder will have access to vulnerable people in the course of their normal duties and as such this post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service to check for any previous criminal convictions.

Documents to download

BH DQGM JD (PDF, 208.6KB)
391-RFL-6510108 - PS (PDF, 208.6KB)
FR (PDF, 111.5KB)
Allied Health Professional - benefits, about RFL, values and governing objectives (PDF, 939.6KB)
Corporate, Admin & Clerical, Other - benefits, about RFL, values and governing objectives (PDF, 935.8KB)
Nursing and Midwifery - benefits, about RFL, values and governing objectives (PDF, 388.4KB)

Band 7 Quality Governance Manager

Band 7 Quality Governance Manager

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