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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.


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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.


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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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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.


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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.


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Compliance Culture Building Block #5: Money isn't everything.

Posted by Margaret Scavotto, JD, CHC on 3/24/16 7:30 AM

I frequently hear people say they think compliance is important, and are eager to move their program forward—but it’s not in the budget. This is a concern with compliance in general, but particularly with culture campaigns such as compliance week. The bottom line is: money isn’t everything, especially when it comes to compliance culture.

For example, I work with a nursing home that held a highly successful compliance week last year with a $150 budget—and this year, the Compliance Officer thinks she can pull it off with an even smaller budget.

There are some exceptions. The larger your company, the greater the OIG expectation of resources allocated for compliance. For example, if you can spend thousands of dollars a year on a holiday employee party, but can’t allocate funds for compliance week, that is probably going to raise some eyebrows. But smaller providers with a shoestring budget can absolutely have a culture of compliance if they think creatively.

Here are some ways you can advance your compliance culture with zero to little financial investment (other than staff time):

  • Ask your board/other leader to sign a commitment to compliance. Put it on your website and hang it in the lobby.
  • Leverage existing in-services by adding compliance content.
  • Leverage existing meetings (e.g. QAPI) by expanding into other compliance topics.
  • Promote an “open door” policy for the Compliance Officer.
  • Remind the Compliance Officer to walk the halls and get to know people.
  • Print your own flyers and table tents with compliance reminders.
  • Thank employees who go above and beyond for your compliance program.

These are a few of many ways you can make compliance your context without budgeting $2000 for coffee mugs or stress balls with your compliance hotline on them (larger companies might find this a worthy spend, of course).

At your next Compliance Committee meeting, brainstorm cost-effective ways to grow your compliance culture. You might be surprised at how easy (and fun!) it can be.


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Compliance Culture Building Block #4: Help your people

Posted by Margaret Scavotto, JD, CHC on 2/16/16 7:30 AM

Compliance is complicated. A compliance program that takes a hard-lined “hammer” approach only makes this worse. Yes, of course you need to discipline employees who violate the compliance program. But a “get it right or else” attitude will not motivate most people to comply—and it certainly won’t motivate people to report problems to you. A compliance program that strives to help employees do their jobs in a way that adheres to the compliance program makes things easier for employees. Where would you rather work?

Culture is in the context

You hire employees with good values and high integrity. How do you reinforce those values so employees make the right decision in a tough situation? By making compliance your context. Compliance should be part of the conversation, from line staff to leadership and executives. This can’t happen unless everyone is trained, and compliance is part of the dialogue.

Training opportunities are everywhere

In order to make compliance part of your culture, training needs to go far beyond the annual compliance training PowerPoint session or video. Your strategy should be to help employees understand compliance, every day.

Employees are busy providing patient care, documenting their work, and submitting claims. We can help our employees do these things in a way that adheres to the compliance program. This requires compliance to meet employees where they are. How can you get compliance reminders in front of your team throughout their work flow? Would a shift change chat work? Flyers in the bathrooms? Training doesn’t have to be a 30- to 60- minute in-service to be effective.

In this era of social media, infotainment and information overload, staff are constantly inundated with new information. This means you need to make some noise. Think outside the box for ways to keep compliance risks top-of-mind. Use examples so employees are prepared to respond in a tough situation.

Market compliance to your staff

If compliance feels like a hammer in your organization, it’s time to re-brand. Brand your message so people see compliance as something that helps them do their jobs—not as something confusing, or something to fear. Once you choose your message, get the word out. Launch a compliance campaign, plan a compliance week, and find ways to increase your Compliance Officer’s visibility.

Be an ally to your staff and help them participate in your compliance journey, and watch your compliance culture and employee satisfaction grow.



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Compliance Culture Building Block #3: Know your values.

Posted by Margaret Scavotto, JD, CHC on 1/20/16 7:30 AM

Values shape the culture of every organization. That sounds nice, but what does it actually mean?

A compliance and ethics program is designed to help your company adhere to health care laws and requirements—those are easy to find. But the program is also there to help the company follow ethical principles. Ethical principles help us do the right thing when the situation—or the health care requirement—is complicated. In other words, regulations aren’t enough; we need ethical principles (values) too. What are yours? Are they written down? Has everyone seen them? Much like our weekly calendar or our grocery list, if we don’t write things down, we quickly forget about them.

If you haven’t already, develop a Code of Conduct that tells your organization’s story. Yes, you can Google “Code of Conduct” and find lots of reading material. But make sure you put together a Code of Conduct that tells your values, not somebody else’s. If you aren’t sure what your organization values, ask. What ethical principles are important to your leaders? Your supervisors? The staff doing the hardest work? Getting feedback will help your Code resonate with the people expected to follow it.

Once your Code of Conduct is in place, formalize your commitment to these values with a board resolution or letter from the President/CEO. Then, it’s time to share your Code and this signed commitment from leadership with employees, with contractors, and the public (put it on your website!)

These documents are some of the first opportunities you have to show employees what matters to you. If you know your values, you can share your values, and watch your culture of compliance grow. When someone is faced with a potential compliance problem, the Code will be there to guide them.



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Compliance Culture Building Block #2: Understand your whistleblowers

Posted by Margaret Scavotto, JD, CHC on 12/17/15 7:30 AM

The whistleblowing business is growing every year. More than 700 whistleblower suits were filed in Fiscal Year 2014, generating $2.9 billion for the government, and $435 million for whistleblowers. One hospital employee brought home $20.8 million for blowing the whistle on her employer. This made national news, which means your employees might have heard about it.

Do your employees trust you to treat compliance complaints seriously?

Should they?

Whistleblowers typically resort to calling the government because they believe their employer won’t, or hasn’t, taken them seriously. In other words: the culture of compliance is weak.

Providers can’t compete with the 6- and 7- figure payout the federal government offers your employees. But you CAN create an environment where employees feel comfortable reporting internally. A prominent goal of every compliance program should be to encourage internal whistleblowing. This will allow your organization to research and fix problems as soon as possible.

Remove all obstacles to internal whistleblowing

If you don’t already have a toll-free compliance hotline, this should be a top priority. But don’t stop there. Protect your hotline with anonymity, non-retaliation, and confidentiality policies. Remove all excuses an employee (or competitor!) might use to avoid reporting internally. If your organization is small, employees might worry their voice would be recognized on the compliance hotline voicemail. Consider providing at least one alternative method of reporting, such as a lobby drop box or website form. By removing obstacles and encouraging internal reporting, you help create a culture that encourages employees to complain to you.

The next step in cultivating a culture where employees feel comfortable reporting internally is to treat complaints seriously. Every single compliance complaint needs to be documented and investigated. If non-compliance is found, corrective action must be taken consistently, every time. These steps will show employees that you take their concerns seriously. Remember: employees who feel internal reporting is futile are more likely to go straight to the government. By creating a culture of compliance and encouraging internal reporting, you can address problems without government intervention.



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Compliance Culture Building Block #1: Practice what you preach.

Posted by Margaret Scavotto, JD, CHC on 11/24/15 7:30 AM

You can also read this blog on the national Compliance & Ethics blog, here.

Time and time again, we see the same conundrum set forth in a DOJ press release or news article about a health care provider in hot water for false claims: “The provider had a compliance department,” or “This company’s compliance team included three people,” or “An anonymous compliance hotline was in place.” How, then, do providers with robust investments in compliance and a seeming commitment to ethical practices, end up signing a Corporate Integrity Agreement?

The answer is simple: compliance officers, hotlines, audits and commitments only work if they are followed. For example, in 2010, Deepwater Horizon, a BP oil rig, exploded and sank, killing 11 people and releasing 205 million oil gallons into the Gulf. An investigation revealed that BP had an operation management safety system at the core of its practices. But this system was not implemented in the Gulf. One person testified that the reason the safety system was skipped was to save costs.

Do you practice what you preach?

When things go wrong, it can be tempting for even the most ethical compliance officer, executive or board member to ignore a problem, hope it goes away, not rock the boat, and get back to work. What stops people from burying a problem? The culture of the organization. If your culture puts compliance first, your compliance staff will find it far easier to practice what you preach.

What you can do

In order for your compliance systems to work, they need to be touted, constantly. Employees need to believe your organization will respond constructively if they identify a problem. When compliance complaints are made, swiftly investigate. Follow your investigations and corrective actions procedures every time. If you are nervous about what you might find, call your lawyer first. If a problem is found, fix it, and if the complainant was not anonymous, thank them and follow up to the extent that you can. If you practice what you preach, others will too.



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