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The perils of “Good” compliance results

Posted by Margaret Scavotto, JD, CHC on 10/23/18 2:54 PM

The set of NBC’s hit TV series The Office includes an office suite (where many hijinks ensue) and an attached warehouse. In Season 2, Episode 5, office manager Michael Scott visits the warehouse and causes colossal destruction with a forklift.

Then, much to warehouse foreman Darryl Philbin’s chagrin, a warehouse employee erases the “936” on a sign that reads: “THIS DEPARTMENT HAS WORKED 936 DAYS WITHOUT A LOST TIME ACCIDENT” and replaces it with a big fat Zero.

This scene raises a nuanced compliance issue. The sign touting 936 days since an accident is an example of identifying – and celebrating – a compliance success. Presumably, accidents were avoided because employees adhered to safety protocols.

But, does this sign also encourage employees not to report accidents? Daryl will be pretty unhappy the next time someone has to put a “zero” on the accident sign – and everyone knows it. Nobody wants to be known as the person who broke the winning streak. This is an unintended consequence of the Zero Accidents sign.

The same is true for compliance: healthcare organizations that have months with zero compliance reports could have a problem.

We of course want to celebrate good metrics and results – but how do we do that while still encouraging people to report problems?

A goal of zero hotline calls deters people from finding and reporting problems. The unintended message is: Don’t report. This means that if your compliance dashboard repeatedly shows zero compliance reports – you should raise an eyebrow, not a glass.

Instead, we need to discuss compliance goals in a way that encourages reporting and discovering non-compliance. Perhaps our goal should be to encourage reporting instead of having Zero reporting. You can support this goal by promoting reporting options (and your anonymity, confidentiality and non-retaliation policies). And, you will still find things to celebrate:

  • Thank those who report
  • Add compliance reporting to performance reviews
  • Recognize efforts to promptly investigate and respond to reports 
  • Celebrate improvement

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Topics: Culture of Compliance, Hotline

Compliance when nobody is watching

Posted by Margaret Scavotto, JD, CHC on 10/11/18 7:42 AM

Everyone knows an effective compliance program needs policies, training, leaders, audits, reporting, investigations, corrective action and discipline. You probably already have these elements in place.

You have policies and training to help your employees do the right thing.

You have audits to verify that your employees are following compliance policies (and doing the right thing).

You have a compliance hotline or other reporting mechanism to find out when employees aren't doing the right thing. And when that happens, you use your investigations, discipline and corrective action policies.

Many of us put these crucial compliance elements in place, cross our fingers, and hope our employees are doing the right thing.

But how do we motivate employees to do the right thing when nobody is watching? After all, most of the time, nobody is watching. And isn't the purpose of compliance to help employees do the right thing - whether somebody is watching or not?

Policies, annual training, audits and a reporting mechanism are a good start. They are essential. But they are not enough to motivate staff to do the right thing all the time. Your challenge as a Compliance Officer is to make compliance part of daily life for your team. How can we help employees understand compliance every day?

Meet employees where they are. Incorporate helpful compliance reminders into their workflow. Would a shift-change chat work? Flyers in the bathroom stalls? (There's nothing else to read in there....) Does the Compliance Officer walk the halls and take a couple of minutes to go over basic compliance concepts with staff? What about displaying short compliance messages on a digital photo frame, or compliance videos on an iPad? Training does not have to be an in-service to be effective.

In the era of social media, infotainment and information overload, compliance has to make some noise. Think outside the box for ways to keep compliance top-of-mind, and help staff do the right thing when nobody is watching.

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Topics: Culture of Compliance

Margaret Scavotto writes for HCCA: Boost your compliance culture with Corporate Compliance and Ethics Week

Posted by Margaret Scavotto, JD, CHC on 8/7/18 6:32 AM

Margaret Scavotto authored an article for the August issue of HCCA's Compliance Today: Boost your compliance culture with Corporate Compliance and Ethics Week.

An excerpt is below:

Does your compliance program have a brand, a theme, a slogan, a message, or a logo? It should. A compliance message makes staff aware of the purpose of compliance and keeps it in the forefront. If someone from the Office of the Inspector General (OIG) walked into your organization and said to the nearest employee, “Tell me about your compliance program,” what would they hear? How long would it take for that employee to explain your compliance program to the OIG? Would it be a challenging task? A clear compliance message is easier for everyone to understand and articulate.

Here’s a message that I like: “Compliance is here to help.” It’s not that snappy, and it won’t blow your mind, but it’s true, positive, and easy to remember. In a highly regulated industry like healthcare, an employee’s work can feel daunting. Healthcare employees face a daily mountain of potential HIPAA violations, mind-bending questions about arrangements with referral sources, quality assurance challenges, and ethical conundrums.

A compliance program that feels like a hammer makes this worse and makes an employee’s work harder. Compliance should make things easier. And it can!  

You can read the entire article here.

Copyright 2018 Compliance Today, a publication of the Health Care Compliance Association (HCCA).

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Topics: Culture of Compliance, Compliance Basics

Why leading a compliance program is like going to the gym

Posted by Margaret Scavotto, JD, CHC on 5/10/18 7:00 AM

This month, HCCA's Compliance Today magazine included an a Blog Highlight written by Margaret Scavotto: Why leading a compliance program is like going to the gym.

Why Leading a Compliance Program Is Like Going to the Gym

Leading a compliance program is like going to the gym. You don't set up a gym in your basement, try out the treadmill, do ten sit ups, cross the gym off your list and never go back. To thrive, your body needs you to go to the gym regularly. You might modify your gym routine, but to be healthy, it takes continuous work. An Olympian who quits the gym and never goes back will become out of shape. 

Click here to read the rest of the Blog Highlight.

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Topics: Culture of Compliance

What Recent Sexual Harassment Headlines Teach Us about Compliance

Posted by Margaret Scavotto, JD, CHC on 12/19/17 7:03 AM

Yes, there is a connection.

I suspect most individuals read the latest #MeToo news stories with a strong, sometimes complex, and personal reaction.

For those of us who chose a career in compliance, there are lessons for our professional lives as well.

I regularly read Knowledge@Wharton, an online publication by the University of Pennsylvania’s Wharton School of Business that brings Wharton’s expertise to cutting edge issues. On November 28, 2017, Knowledge@Wharton published: What Can Firms Do to Prevent Sexual Harassment? In this article, Wharton management professor and director of Wharton’s Center for Human Resources Peter Cappelli hit the nail on the head: “I think the big challenge is that we have in recent years moved power away from bureaucracies and rules in companies and toward individual leaders. So we have many institutions where the leaders are all-powerful….”

The headlines of late bolster this notion that individuals in positions of power can have a profound effect on a corporation’s culture of discovering and rectifying misconduct. And, as we have also learned from the headlines, this concentration of power can lead to and perpetuate misconduct: “He couldn’t sleep around town with celebrities or on the road with random people, because he’s Matt Lauer and he’s married. So he’d have to do it within his stable, where he exerted power, and he knew people wouldn’t ever complain.”

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Topics: Culture of Compliance

Compliance Culture Building Block #10: Celebrate success.

Posted by Margaret Scavotto, JD, CHC on 8/24/16 7:30 AM

Remember, your compliance program is only as strong as your employees. [LINK to HELP your employees]. This means when something goes right, it’s not just the Compliance Officer who deserves credit.

Recognize employees.

Train your supervisors to identify employees who go above and beyond for compliance. Did someone ask an important compliance question? Point out an area where audits might be needed? Take the time to thank these people. Make sure the Compliance Officer and HR coordinate in this area, so employees get the recognition they deserve.

Celebrate milestones.

Many compliance milestones deserve a party or newsletter recognition, such as 100% compliance training attendance, or QAPI PIP improvements. The compliance audit program can also yield many reasons to celebrate—just be careful to reward people for audits completed, not zero audit findings. The last message you want to send is that finding problems in an audit is a bad thing. But, if a department completes all of their scheduled audits on time, it might be time for a pizza party.

Compliance takes work. Take the time to reward people for a job well done. Make compliance a positive thing by constantly looking out for ways to honor employees and celebrate success. Enjoy the virtuous cycle: a culture of compliance is reason to celebrate—and celebrations help grow a positive culture.


 To read all posts in the Compliance Culture Building Blocks series, click here.

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Topics: Culture of Compliance, Compliance Culture Building Blocks

Compliance Culture Building Block #9: Don't let history repeat itself.

Posted by Margaret Scavotto, JD, CHC on 7/20/16 7:30 AM

Compliance problem? Don’t let history repeat itself. At least, not on your watch. This requires two things:

  • Fix the problem. Use your investigations and corrective action procedures to find out what went wrong, and fix it. This could involve updating policies and procedures, in-servicing staff, returning overpayments, disciplining employees, or other corrective actions. Test (audit) and re-test to make sure the problem is fixed.
  • Get better. Once the problem is fixed, dig deeper to learn why it happened. What went wrong? Do we have a supervision problem? Are we understaffed? Do some of our processes need improvement? Go beyond the standard corrective actions of policy updates, training and discipline.

Don’t lose hope.

Each compliance problem is also an opportunity to advance compliance (just be sure to consult your legal counsel along the way). Don’t be afraid to conduct more audits and find more problems. Once you start looking under the rocks, you will find more problems (nobody is perfect). Embrace these problems, and watch your organization improve. By embracing compliance failures and thinking creatively to make your organization better, your team will see that you take compliance seriously and care about doing the right thing. In other words, you will foster a culture of compliance.


 To read all posts in the Compliance Culture Building Blocks series, click here.

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Topics: Culture of Compliance, Compliance Culture Building Blocks

Compliance Culture Building Block #8 Measure (don't assume).

Posted by Margaret Scavotto, JD, CHC on 6/22/16 7:30 AM

How do you know your compliance program is effective? How do you know your employees see a culture of compliance? We use audits to measure our adherence to policies and procedures, and testing to evaluate training effectiveness. Did you know you can measure your compliance culture, too?  

Use surveys.

Anonymous surveys are a great way to find out the true tone of your organization, and how staff perceive the compliance program. Taking this step also shows your employees that how they feel about the organization is important to you.

If possible, develop a survey that can track responses by department—and therefore, by supervisor. This will allow you to identify the overall sense of culture in your organization, but also any problem areas. Are any leaders obstacles to an effective culture of compliance?

Give exit interviews a try.

Exit interviews have equal pros and cons. They take time, and an employee on the way out the door might not be candid with you. But they also might give you an earful. Exit interviews are an opportunity to measure your organization's culture and detect non-compliance.

Depending on your other compliance priorities and available resources, it may be well worth your while to give exit interviews a chance. If you do gather this data, do yourself a favor and involve the compliance department/officer so this information can be tracked and studied for process improvements--and to identify potential non-compliance. 

Address the low points.

Once you take your measurements, it’s time to address the low points. Compile your survey results and exit interviews and figure out where you have a culture problem. Is your compliance message getting across loud and clear—to everyone? Do people understand how to report non-compliance? Or did you learn of weak areas where the awareness of ethics and integrity needs a boost? Focus on these problem areas, and measure again.


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To read all posts in the Compliance Culture Building Blocks series, click here.


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Topics: Culture of Compliance, Compliance Culture Building Blocks

Compliance Culture Building Block #7: Engage leadership.

Posted by Margaret Scavotto, JD, CHC on 5/26/16 7:30 AM

In too many health care organizations, compliance stops with the Compliance Officer. The Compliance Officer implements policies, conducts training and audits, and gets the Compliance Committee together. But if little (or no) compliance activity gets reported to the board, a provider’s culture of compliance hits a glass ceiling.

Does board compliance education address each board member’s duty to their organization? Is legal counsel involved in educating the board on their liability?

Leaders and executives can’t set the tone for compliance if they don’t know what is going on. Educate them on compliance—not just once a year. The board—or president/CEO, etc.—can’t incorporate compliance into the operations and dialogue (and culture!) of the organization unless they are truly informed. How do you do this?

Yes, the board needs training on what a compliance program is and what yours look like. They also need ongoing education on changing risks and how you are responding to them. There are a lot of metrics you can report to the board, just as you report to the Compliance Committee. For example: number of hotline calls and how they were resolved; results of audits scheduled for that month or quarter; training that was done; special initiatives that address new OIG guidance; and, of course, quality assurance. QA is perhaps the most essential piece of info to communicate to the board, as providing quality care is the primary goal of every nursing home.  A dashboard can be a good mechanism for routinely sharing this information with your board.

Board members and other leaders typically are in these roles for a reason: use their expertise. These individuals can be a good source of compliance strategy if they know what is going on. If your staff, patients and the community hear about compliance from your leaders, a culture of compliance will follow. The first step is keeping the board informed.


 To read all posts in the Compliance Culture Building Blocks series, click here.

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Topics: Culture of Compliance, Compliance Culture Building Blocks

Compliance Culture Building Block #6: Pave a two-way street.

Posted by Margaret Scavotto, JD, CHC on 4/27/16 7:30 AM

Does the Golden Rule (do unto others as you would have them do unto you) play a prominent role in your compliance program? Here are four ways you can respect employees and make compliance a two-way street.

Discipline should be clear and fair.

Compliance programs require disciplinary guidelines. Compliance cultures benefit when discipline is not a surprise, and when it is consistent. Make expectations clear from day one of employment. When disciplinary guidelines come into play, be fair and objective. This means applying discipline consistently regardless of position.

Admit mistakes.

All health care providers make mistakes. A provider without an effective compliance program doesn’t know what mistakes it has made—that’s a ticking time bomb. A provider with an effective compliance program finds these mistakes, discloses them, fixes them, uses them as a teaching moment, and improves.

It isn’t easy for anyone to admit mistakes. Compliance expects employees to admit mistakes—and so should compliance leaders.

Open the door.

Employees constantly hear about the need to report non-compliance internally. But where do they go with compliance questions? A compliance officer who encourages questions as much as internal reporting will find more employees stopping by for both reasons. Establish an open door policy. Better yet, frequently leave the office, walk the halls, and talk to people about their concerns.

Follow up—and say thank you.

If possible, follow up with complainants so they know their complaint was taken seriously. Employees often sweat bullets about making a complaint. A simple phone call explaining that you looked into the matter, combined with whatever information you can share (after talking with your legal counsel if necessary), can let an employee know you took their complaint seriously. Don’t forget to thank them for making the complaint. If employees believe your organization is committed to compliance and doing the right thing, reporting will seem worthwhile. This increases the likelihood of internal reporting.  

Compliance expects a lot from employees. Compliance leaders can strengthen compliance culture by paying it forward: be fair, and give credit where credit is due.


 To read all posts in the Compliance Culture Building Blocks series, click here.

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Topics: Culture of Compliance, Compliance Culture Building Blocks

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