Governance and Compliance Manager

Job description

Job responsibilities

Role summary:

The role holder is part of the senior management team and will oversee all aspects of clinical governance throughout Peninsula Dental Social Enterprise, including managing matters of regulatory compliance and governance, to ensure clinical operations that meet the needs of both patients and students are effectively delivered across multiple sites.

Key accountabilities:

Work with senior management and clinical staff to ensure high standards of service delivery that meet the requirements of students and patients, through the development and oversight of policy frameworks.

Oversee regulatory compliance with industry bodies including, but not limited to, the CQC, HSE and ICO

Oversee organisational health & safety (H&S) frameworks, including: policies and SoPs; audit frameworks; and risk assessment matrixes.

Represent PDSE at the termly UoP H&S Committee meetings, acting as the link between PDSE and the University.

Oversee PDSEs organisational incident reporting system, liaising with relevant mangers and team leaders to ensure appropriate investigation procedures.

Oversight of Serious Untoward Incidents and Never Events and the PSIRF informing governance procedures and analysing trends to inform training needs.

Manage positive and negative patient feedback streams, including patient satisfaction surveys, monitoring, and responding to patient complaints within the required time frames and escalation to the indemnifier as required.

Manage aspects of radiography and workplace radon compliance throughout PDSE clinics, chairing the termly Radiation Safety Lead meetings and annual Radiation Protection Advisory meeting, liaising with the RPA and reporting to HSE as required.

Operational oversight of safeguarding procedures, policies and processes, including chairing the termly safeguarding coordinator meetings.

Ownership and ongoing review of internal policies and their implementation, working with the directors, senior management team, team leaders and clinical staff, to ensure consistent standards of compliance across all sites

Liaise with PDSE managers, clinic staff, academic staff and students on clinic organisation related topics.

Work with PDSE Senior Management Team, Operations Group and other committees to plan and manage DEF operations

Create an innovative, motivational and high performing working environment to deliver the best possible services to patients and students.

Measures of success:

Successful outcomes for items listed in the role summary and other delegated tasks

Successful delivery of key priorities and objectives agreed with manager as part of the performance development review process

Positive customer feedback

Manage competing demands and meet deadlines

Create a positive working environment

Improved corporate performance in terms of financial and non-financial measures

Knowledge, Education and Training:

Excellent numeracy and literacy skills (minimum GCSE grade C, or equivalent, in maths and English)

Clinical or managerial qualification (may include a degree or professional qualification)

Computer literacy, including competence with Microsoft Office

Understanding of a training establishment is desirable

Knowledge of clinical procedures and outcomes, preferably dental (desirable)

Understanding of the expectations and accountabilities of a manager in a multidisciplinary environment

Overall understanding of healthcare and education and ability to successfully deliver services within those constraints, whilst recognising and overcoming those challenges

Understanding of the delivery of public services in a small business environment

Experience:

Evidence of work in a management role in a clinical (or similar) environment (desirable)

Evidence of effective staff management

Working independently in a team environment

Working alongside other managerial and multi-disciplinary clinical professionals and being able to effectively meet the aims of the organisation

Evidence of successfully meeting objectives in relation to efficient and appropriate service delivery

Skills:

Excellent interpersonal, communication and presentation skills, both verbal and written

Understanding of how internal processes can impact on organisational performance

Able to prioritise and move between tasks to meet deadlines

Able to demonstrate effective managerial skills such as delegation, influencing, decision making etc.

Able to travel independently within the Peninsula

Behaviours:

Demonstrates self-leadership and leadership of others

Demonstrates enthusiasm and commitment at all times

Demonstrates commitment and support to PDSE, to PDSE managers and to colleagues

Takes ownership of tasks

Develops own expertise and is willing to share expertise with others

Supports others to achieve goals

Forms good working relationships with colleagues to achieve successful outcomes

Ability to manage multiple tasks and competing demands

Demonstrates a commitment to Continuing Professional Development

Demonstrates an ability to manage and participate in a changing environment with a positive attitude

Additional information for all posts

The post holder is required to comply with all relevant policies and procedures pertinent to their post. Failure to follow correct policies and procedures may result in disciplinary action.

The organisation works within the requirements of the Equality Act 2010 and proactively manages equality and diversity, as all employees are expected to do

Risk Management:

In Accordance with the Risk Management Strategy, employees will participate, whenever required, with the risk management process.

They will support line managers by attending mandatory and statutory training, completing incident/accident forms for every adverse event or near miss that occurs, report all defects and complaints, and communicate any dangerous situation to individuals potentially at risk.

Health and Safety at Work:

You must co-operate with those in authority and others in meeting the statutory requirements and in following policies and procedures.

A copy of the Health and Safety Policy is available.

You are reminded that in accordance with the Health and Safety at Work Act 1974 you have a duty to take reasonable care to avoid injury to yourself and to others affected by your work activities.

You will be notified where your post carries a requirement for immunisation.

Infection Control:

Peninsula Dental Social Enterprise is determined to eradicate healthcare-acquired infection and puts a great deal of emphasis on the responsibility of all staff to ensure their own personal and others compliance with Infection Control (including Hand Washing) Policies.

All staff must comply with infection control policies and guidance, attend relevant updates and report issues of concern to their immediate line manager (if no action or explanation received, then it is the individuals responsibility to escalate their concerns to the Business Performance Manager, or the Board).

Safeguarding:

All employees have a duty for safeguarding and promoting the welfare of children and vulnerable adults and are required to act in such a way that at all times safeguards the health and wellbeing of children and vulnerable adults.

Familiarisation with and adherence to national and local Safeguarding policies is an essential requirement of all employees as is participation in related mandatory/statutory training.

Other:

This job description provides a general reflection of the key accountabilities associated with the post; it is expected that the role holder will undertake any other reasonable activities to assist in efficient service delivery.

This job description is not exhaustive and may change as the post develops, but such change will not take place without consultation between the post holder and their manager.

Normal working hours are 08:45 to 17:00 Monday to Friday, however on occasions to meet business need you will be required to work revised hours, typically between 08:00 and 18:00.

The Working Time Regulations apply to all employees of Peninsula Dental Social Enterprise (CIC) In particular, Peninsula Dental Social Enterprise (CIC) will not permit staff to work more than 48 hours in any one week except where there are exceptional service needs where an absolute limit of averaging over a reference period of 17 weeks would apply.

Person Specification

Experience

Essential

• Evidence of effective staff management
• Working independently in a team environment
• Working alongside other managerial and multi-disciplinary clinical professionals and being able to effectively meet the aims of the organisation
• Evidence of successfully meeting objectives in relation to efficient and appropriate service delivery

Desirable

• Evidence of work in a management role in a clinical (or similar) environment (desirable)

Behaviours

Essential

• Demonstrates self-leadership and leadership of others
• Demonstrates enthusiasm and commitment at all times
• Demonstrates commitment and support to PDSE, to PDSE managers and to colleagues
• Takes ownership of tasks
• Develops own expertise and is willing to share expertise with others
• Supports others to achieve goals
• Forms good working relationships with colleagues to achieve successful outcomes
• Ability to manage multiple tasks and competing demands
• Demonstrates a commitment to Continuing Professional Development
• Demonstrates an ability to manage and participate in a changing environment with a positive attitude

Knowledge and Skills

Essential

• Computer literacy, including competence with Microsoft Office
• Understanding of a training establishment is desirable
• Understanding of the expectations and accountabilities of a manager in a multidisciplinary environment
• Overall understanding of healthcare and education and ability to successfully deliver services within those constraints, whilst recognising and overcoming those challenges
• Understanding of the delivery of public services in a small business environment
• Excellent interpersonal, communication and presentation skills, both verbal and written
• Understanding of how internal processes can impact on organisational performance
• Able to prioritise and move between tasks to meet deadlines
• Able to demonstrate effective managerial skills such as delegation, influencing, decision making etc.
• Able to travel independently within the Peninsula

Desirable

• Knowledge of clinical procedures and outcomes, preferably dental (desirable)

Qualifications

Essential

• Excellent numeracy and literacy skills (minimum GCSE grade C, or equivalent, in maths and English)
• Clinical or managerial qualification (may include a degree or professional qualification)

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Employer details

Employer name

Peninsula Dental Social Enterprise CIC

Address

Peninsula Dental School

20 Research Way

Derriford

Plymouth

PL68BT

Employer's website

https://peninsuladental.org.uk/ (Opens in a new tab)