Breaking Compliance News Blog

This blog was originally posted on the Compliance and Ethics blog, published by the Health Care Compliance Association and the Society of Corporate Compliance and Ethics.

Last week, I flew on an airplane for the first time in two years.

My family went to the beach and spent seven days soaking up the sun – with no work. I made a promise not to open my laptop, and I kept it.

But while waiting for our return flight at the Sarasota airport, compliance found me.

I was sitting in the rows of seats at Gate K8, waiting for our flight to board and listening to my eight-year-old daughter argue the merits of purchasing a neck pillow from the airport’s news and gift kiosk when compliance found me via an unattended airline kiosk screensaver.

The screensaver occupied a desktop computer normally used by airline personnel to help passengers with their flights, and it said:

BUSINESS INTEGRITY HOTLINE

ANONYMOUS AND CONFIDENTIAL

The screensaver included online and telephone hotline options, and encouraged employees to report code of conduct violations.

What a great idea!

Every single time airline employees log on to these kiosk desktops, they are reminded:

1. They should report misconduct.
2. They have multiple options for reporting misconduct.
3. They can report anonymously.
4. Reports will be kept confidential.
5. Their company thinks reporting is important enough to put on a screensaver.
6. If they ever need to report misconduct, they can easily find out how via their screensaver.

It also showed passersby at the airport that the airline takes compliance seriously (or maybe just passersby who work in compliance). Still, putting the hotline information on the screensaver shows a commitment to internal reporting and a respect for employee feedback.

Compare this screensaver example to the organization that tells employees about the hotline during new employee orientation, at annual compliance training, or via a fading poster tacked on to the over-populated bulletin board by the time clock. Which message gets noticed or remembered? Which message shows a stronger commitment to compliance? And which is more helpful to employees?

After two years of pandemic, there’s some good news. For some, vacations are back. And there is still inspiration to be found for compliance, even when you least expect it. How will you show your employees their opinion matters to you? How can you make your message accessible, easy, and helpful?

And for the record, my daughter did not convince me to buy her the pillow. I just hope she didn’t call the helpline about me.

From the archives... this week we revisit one of MPA's top blogs:

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

The Kansas Medicaid fraud and abuse complaint email inbox went unchecked for 17 months.

According to a report issued by the Kansas Office of the Medicaid Inspector General, 209 emails were unread. 95 of these emails "alleged fraud, waste, abuse, or illegal acts related to Medicaid, MediKan, or SCHIP, or were seeking information on how to report suspected fraud." 42 of these emails contained "partially or wholly substantiated allegations of Medicaid or SCHIP fraud, waste, abuse or illegal acts....

How did it happen?

The complaint inbox went unchecked from August 2, 2017 to January 9, 2019.

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

 As part of their OIG compliance programs, health care compliance officers invest a lot of time and effort publicizing the compliance hotline and encouraging internal reporting.