Head of Quality

Job Purpose and scope The Head of Quality will lead and deliver a robust, integrated governance and quality framework that drives continuous improvement in quality, safety, and effectiveness across the Hospice. Working closely with clinical and non-clinical leaders, the post-holder will ensure services are evidence-based, patient-centred, and compliant with all regulatory and statutory requirements. The role provides strategic and operational leadership and management across governance, quality assurance, risk management, patient experience, information governance, and continuous improvement. The post-holder will also contribute senior clinical leadership, supporting a positive culture of quality, learning, safety, and innovation.

Key Responsibilities Include

Developing and implementing a comprehensive Quality Framework and strategy that aligns with regulatory requirements and industry best practices. Overseeing quality assurance programs, policy and procedures, including audits, risk management, and continuous improvement initiatives. Strengthening effective governance structures and processes to ensure compliance and accountability. Ensuring alignment of all quality systems and evidence with the CQC Single Assessment Framework, including mapping evidence to quality statements and evidence categories. Collaborating with the Senior Leadership and Executive Team to drive strategic quality objectives. Providing leadership and support to clinical staff in complying with Governance and Quality standards. Monitoring and analysing quality metrics to identify trends and areas for improvement. Leading the preparation for external regulatory inspections and audits. Fostering a culture of quality, safety, and continuous improvement throughout the organisation. Participation in an on-call rota to support effective operations 24/7 1. Main Duties & Responsibilities Governance and Risk Lead and maintain effective clinical governance systems across the organisation. Embed quality, safety, and risk management into all aspects of Hospice operations. Act as a core member of the Board-led Clinical Governance Committee, contributing papers, reports, and expert advice. Prepare and present high-quality assurance and quality reports to the Board of Trustees and Senior Leadership Team. Lead the development, delivery, and evaluation of the annual quality improvement and audit programme. Maintain oversight of the organisational risk register, ensuring risks are appropriately assessed, mitigated, monitored, and escalated. Support the Director of Infection Prevention and Control in the delivery and assurance of the infection prevention and control programme for the hospice, ensuring compliance with mandatory standards. Promote a proactive safety culture by leading and supporting investigations into serious incidents and complex concerns under PSIRF principles. Deliver analytical reports that move beyond individual blame to identify systemic learning, ensuring robust Duty of Candour and sustainable service improvements. Monitor, analyse, and report trends in incidents, accidents, near misses, and safety data, ensuring learning leads to service improvement. Support medicines management governance processes to ensure safe and effective practice. Lead the production of the annual Quality Account and attend external scrutiny meetings as required. Support delivery of annual priorities and organisation-wide improvement projects. Quality Assurance and Improvement Develop and implement a comprehensive quality strategy aligned to the Hospices mission, values, and strategic objectives. Lead preparations for CQC inspections and ensure ongoing compliance with registration requirements including continuous readiness aligned to the CQC Single Assessment Framework and quality statements.. To lead on and support preparations for inspection and review visits by external monitoring bodies including the Care Quality Commission, which will include the gathering, analysing, interpreting and presenting extensive and complex data and information. Drive progress towards achieving and sustaining an Outstanding CQC rating. Ensure implementation of national and local clinical guidance (e.g. NICE). Promote and embed quality improvement methodologies and a culture of continuous improvement and learning across all services. Lead the collection, analysis, benchmarking, and interpretation of quality and performance data, including KPIs and Hospice UK submissions ensuring insight drives decision-making, risk identification, and service improvement. Provide assurance and recommendations based on insight from quality data and patient outcomes. To represent the governance and quality agendas at external local, regional and national meetings on behalf of the hospice and communicate outcomes. Patient Experience and Engagement Lead a comprehensive patient, family, and carer experience strategy, ensuring feedback is systematically captured, triangulated with other data sources, and used to drive measurable improvements. Ensure patient experience data is integrated into governance reporting, contributing to organisational learning and CQC evidence. Ensure systems are in place for collecting, analysing, and responding to patient, family, and carer feedback. Oversee effective management of complaints, compliments, and concerns, ensuring timely responses and organisational learning. Promote meaningful involvement of patients and families in service improvement and quality initiatives. Research and Innovation Lead the development of a research-active culture within the Hospice. Support research activity including journal clubs, poster presentations, external research collaborations, and internal project delivery. Strengthen the organisations capacity and governance for research and innovation. Information Governance Provide clinical oversight for information governance arrangements. Oversee effective use, development, and clinical integrity of the EMIS clinical database with the support of the informatics team. Ensure appropriate management of Data Subject Access Requests. Leadership and Management Contribute to the development and delivery of the Hospices clinical strategy, ensuring quality and governance are central. Foster positive, collaborative relationships internally and externally. Provide leadership, direction, and support to Patient engagement, Informatics, Risk and Compliance & Administration teams. Ensure effective people management, including recruitment, supervision, appraisals, and performance management. Manage departmental budgets and resources effectively. Maintain professional registration, CPD, and revalidation requirements. Undertake additional responsibilities aligned with skills and organisational need. Ensure alignment between quality governance and workforce governance, including oversight of training compliance, safe staffing risks, and workforce-related quality indicators. Promote a culture of continuous learning, psychological safety, and high performance across teams. Promote a Just Culture and Freedom to Speak Up environment, ensuring staff feel safe to raise concerns and that learning is embedded across the organisation. Participate in the senior on-call rota as required to support 24/7 operations.