EXHIBIT A DUTIES AND RESPONSIBILITIES OF MEDICAL DIRECTOR, VASCULAR LAB Position Title: Medical Director, Vascular Lab Reports To: SJHVI President Administrative Oversight: VP, HVI Position Overview Medical Director, in collaboration with Administrative staff, is responsible for providing medical and operational direction to the Vascular Lab. Responsibilities include providing input for planning, development, implementation and evaluation of processes necessary to ensure optimal patient care. The Medical Director supports the mission of Saint Joseph’s Hospital and embodies the core values of the Mercy Philosophy. Principal Duties and Responsibilities: Patient Care Management/ Operations 1. Responsible for advising Administrative leadership regarding the professional care of patients treated in the Vascular Lab in accordance with recognized national standards as well as accrediting bodies, governmental agencies and Hospital/Medical Staff Bylaws requirements. 2. Assists in the development of and makes recommendations with respect to procedures and follow-up care in the Vascular Lab to ensure that patients and staff are maintained in a safe environment. Monitors environmental conditions of workspace personnel and makes recommendations on resource requirements for clinical procedures. 3. Works with Administration and other hospital staff and consultants to develop specific initiatives for improving operational performance in the Vascular Lab, including but not limited to scheduling, start times, turnover times, product utilization, staffing, etc., and then oversees the implementation of those initiatives. 4. Assists in the development, implementation, and monitoring of emergency response procedures where applicable. 5. In conjunction with Administration and CHE, routinely reviews all products in lab; works with Administration and other physicians to create methodologies of utilization. 6. Works with Administration to review and develop policies for vendor access to the Vascular Lab. 7. Co-leads monthly operations meeting (with Administration) to review operational performance and to discuss current issues affecting Vascular Lab operations. 8. Participates in the process to determine qualifications and level of competence required for hospital personnel who provide patient care services in the Vascular Lab. 9. Meets with new staff as part of their orientation process. 10. Commits to being available for staff concerns regarding physician practice issues. 11. Meets regularly, as requested, with Administrative leadership for the Vascular Lab to review operations, budget, financial performance, staffing, volumes and other current issues. 12. Assists Administrative leadership for the Vascular Lab in establishing efficient and fair scheduling of procedures and timely interpretation and reporting of studies. 13. Assists management with constant readiness for JCAHO and other regulatory surveys. 14. Invests time to become an objective, unbiased expert on different facets and options associated with vascular lab equipment and technology. Works proactively with Administration and collaborates with the SJHVI Medical Directors for Vascular Services to provide expertise and guidance as it relates to new technology in the field of vascular procedures. 15. Works in collaboration with the Medical Staff credentialing process to ensure that appropriate credentialing criteria are established for existing and new diagnostic invasive procedures, and to ensure that appropriate training and education are required for all physicians working in the Vascular Lab. Policy 16. Participates in the development of general policies relative to the operation of the Vascular Lab. 17. Responsible for physician compliance with all hospital and Vascular Lab policies, procedures and standards relating to Vascular Lab operations. 18. Assists in the annual review of current policies and procedures, and makes recommendations for change or additions as needed. Planning and Program Development 19. In conjunction with administration, is responsible for developing a three-year capital equipment plan. 20. Provides input to Administration with regard to budget and capital planning, and with regard to forecasting volumes, clinical revenues, operating costs, and capital expenditures. 21. Assists in business plan development for new services as necessary. 22. Participates in marketing development as it relates to the Vascular Lab. 23. Works to ensure that all physicians providing services in The Program are aligned under a common vision and common set of policies and procedures, regardless of group affiliation. 24. Provides talks to SJHA staff and referring physicians in the region to maintain and increase awareness of SJHVI capabilities relative to The Program. Quality Assurance and Performance Improvement 25. In conjunction with, the President of SJHVI, works to establish and support a multi- disciplinary approach to quality assurance for vascular laboratory. 26. Establishes a quality review process to ensure that regular periodic reviews of a specified number of cases are performed for each physician reading study results in The Program and ensures that this process meets applicable accreditation standards. Periodically reviews the process to ensure that it is functioning as intended. 27. Reviews current SJHA credentialing standards and benchmarks these with other organizations to determine any changes that may be needed in SJHA current standards, and recommends the same to the SJHA Medical Staff. 28. Establishes a process to ensure that all physicians who are providing services in The Program meet SJHA credentialing standards. 29. Reviews the information systems that are utilized to provide the data necessary to conduct quality assurance and quality improvement activities, including measurement and reporting of outcomes, and ensures that SJHA is aware of any deficiencies and/or needed improvements. 30. Reviews the data capture, transmission and storage requirements of The Program and recommends changes as appropriate. 31. Works with administration and the hospital’s IT department to ensure HIPAA compliance within The Program. 32. Works with Administration to achieve and maintain ICAVL accreditation. Leadership 33. Promotes a collaborative environment with management, physicians and staff. 34. Assures that Medical Staff interacts with Hospital Staff in a professional and appropriate manner in order to achieve the objectives of the Hospital and SJHVI. 35. Effectively addresses inappropriate behavior on the part of physicians, including repeated non-compliance by physicians with rules, guidelines, standards, etc. established for the safe, efficient and effective operation of the Vascular Lab.. Professional Education and Development 36. Identifies educational needs for physicians and staff and participates in teaching and training. 37. Remains current with the latest trends and attends at least one outside conference per year pertaining to the clinical area of noninvasive vascular procedures. Liaison 38. Serves as liaison to the Vascular Surgery section in order to communicate relevant information related to the Vascular Lab. 39. In collaboration with SJRI Medical Advisory Board for Clinical Research and/or CV Research Medical Director, provides guidance as it relates to vascular research. Qualifications: Education/Licensure/Certification/Other Requirements: The Medical Director must be a licensed physician in the State of Georgia; certified by the American Board of Surgery in Vascular Surgery; in good standing on the SJHA Active Medical Staff, with privileges in Vascular Surgery; and a Fellow in SJHVI. The Medical Director must have extensive experience working in the SJHA vascular laboratory, and must be familiar with the other groups and physicians working in that environment, and must be held in high regard by those physicians and by the SJHA Administrative staff. Other Qualities Medical Director should be temperate in disposition and capable of being fair and impartial. Medical Director should demonstrate respect for professional colleagues, regardless of what group they belong to, and for members of SJHA administration and Vascular Lab staff. Medical Director should be able to work collaboratively and cooperatively with other physicians and administrative and technical staff. Medical Director should have the strength of character and leadership skills to be able to enforce the policies and procedures of the Vascular Lab with other physicians and to ensure that the Vascular Lab is operated in a fair and effective manner.
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