Creating a culture of willing compliance

Many large and small organizations regard compliance in the same way some patients view physicians’ recommendations to eat better and exercise more: They know they need to do it, they know they’ll feel better and look better if they do, and they know they most likely will live longer, healthier lives as a result. 

All tremendous benefits. But all too often, after an initial period of enthusiasm, these patients fall back on their old salty snacking, couch potato ways.   

For organizations, adopting compliance measures can follow that same path. When a new regulation is issued, or if an organization is found to be out of compliance, a great deal of attention is paid to the issue. Resources are dedicated, memos are issued and pronouncements are made. But within a few weeks, everything goes back to the way it was — until the next event. 

It’s no wonder that compliance issues can keep bubbling to the surface, wasting valuable staff time and practice resources. The problem is that too many practices today still treat compliance as a project or a series of individual episodes with a beginning, middle and end. 

Just as the continuum of healthcare is moving from focusing on individual encounters to taking a more holistic view of patients, so too must practices change their approach to compliance — especially given the increasing introduction of new regulations and requirements. 

The key for any practice is not just to have a compliance project mindset where it is viewed as a series of tasks to be checked off a list, but to build a culture of compliance that is seen by the staff as a better approach to the business of healthcare — something that permeates decisions and attitudes every day. 

Compliance also must be viewed as an important component of everyone’s job rather than the responsibility of the specified compliance officer (although a compliance officer is definitely necessary to help keep practice team members accountable). 

Changing the project mindset starts from the top down. Practice leadership must be dedicated to creating a culture of compliance since the rest of the practice takes its cue from them. Without that support, the practice will continue to operate as it always has — and will face the same costly consequences of noncompliance.

Drivers of noncompliance

In most cases, noncompliance is not a conscious decision. Instead, it is usually driven by:

• Willing but busy practice team members who find it difficult to keep up with changing regulations and requirements on their own
• A reluctance among staff members, including physicians, to change the way they have always worked
• Ineffective training or an ineffective process for delivering training
• Lack of a good tracking or monitoring mechanism to ensure everyone has received training

Here is an often-seen example of why the project approach to compliance doesn’t work. Everyone in a group practice has been trained on the importance of safeguarding protected health information (PHI) as well as what is and is not allowed. Then one day a practice staff member is using a software system that contains PHI. A problem arises and the staff member takes a screenshot to email to the vendor so the problem can be resolved. 

That staff member has just violated HIPAA regulations. The employee may have been trained on protecting PHI, but since it isn’t part of the culture — a way of thinking every day — the screenshot was sent anyway. That’s what happens when compliance is viewed as a burden and compartmentalized instead of being embraced as a way to improve quality. 

How does an organization build a powerful culture of compliance? There are many different avenues. Here are three that SCIO Health Analytics found to be most effective. 

1. Use data and analytics to identify common areas

The mistake most group practices make is they tend to be reactive. When noncompliance is discovered, they take an action to remedy it. 

The problem with this approach is that all sorts of noncompliance activities may be occurring in the practice every day beyond the current issue. Waiting until a noncompliance incident comes to the surface usually means a practice is in crisis management mode. That’s not a good way to operate a group practice. 

A better approach is to use data and analytics to find areas of noncompliance so they can be addressed at the root cause level rather than as one-off solutions. Your team members can benefit from having the right tools and analytics available that measure your practice’s activities against benchmark data to help identify outliers. Since these types of analytics are outside the scope of many small- to mid-sized practices, your group practice may want to partner with an organization for which analytics are a core competency. 

A good example is physician report cards. By using analytics to measure risk adjustment scores or disease prevalence against benchmarks, your practice can identify the outliers with regard to diagnosis coding. Some team members of a group practice often get used to using particular diagnosis codes and thus will tend to apply them to all situations. Yet a disease such as diabetes has multiple codes that convey different and very specific information related to the patient’s course of care. 

If the most specific diagnosis code isn’t used, it can impact the financial and long-term well-being of your practice. Payers can be fined, and the practice may have to return reimbursements. That creates cash flow as well as payer-provider relationship issues. Patient safety issues may also arise, especially for patients who see multiple providers or visit an ER at a hospital they have never visited. Sharing patient information between providers is already difficult enough; having the incorrect diagnosis code in the EHR could result in an adverse event. 

That’s where analytics can help save the day. Analytics now are being used to identify when a group practice team member uses a higher-level diagnosis code more often than the benchmark. 

Leadership can then pull the charts and examine whether upcoding is occurring. If it is, the organization can re-educate the team member and use the example to train the rest of the staff. 

2. Create a safe environment to admit compliance mistakes.

No one likes to make mistakes, and many team members worry about admitting them for fear it could affect their job security. Yet the best way for organizations to improve is to encourage employees to discover problem areas early, admit mistakes openly and then apply the proper remedies without the fear of reprisal. 

Giving workers a safe place to admit to their mistakes is critical to building a culture of compliance. One of the keys is to focus on the process breakdown rather than point fingers at the team member who committed the noncompliance incident. 

This is an area where a transparent leadership team can have a huge impact. Leaders who are willing to honestly and openly talk about their own mistakes in a way that helps the rest of the practice team learn will make it more comfortable for staff members to come forward when they may have a compliance issue. Staff meetings are a great forum to reinforce this through real-world examples from the leaders’ own careers. 

Again, the ultimate goal isn’t to lay blame on one person or group within the practice. It’s to prevent the issue from recurring. By sharing examples of how a problem was uncovered, the steps taken to remedy the issue (with emphasis on a lack of punishment for honest mistakes), and data showing how scores improved, leaders will encourage the entire organization to feel more comfortable talking about their mistakes — and quality will improve as compliance scores increase also. 

3. Make training more entertaining and engaging

No matter what the topic, training works best when staff members are enthusiastic and engaged. This is particularly important with a subject as critical to the practice’s success as compliance. 

There are a number of ways to make compliance training more fun, which will help improve long-term staff retention as well as short-term performance. Start with making sure the training is relevant to your team members’ jobs. Nothing is worse than following along on examples that have nothing to do with what they actually do. 

As far as specific techniques, one way to create some energy is to build competition into training. For example, as your practice sets up training on fraud, waste and abuse, distribute a series of quizzes that require team members to search through materials for answers. Everyone who completes the quiz correctly becomes eligible for a $5 gift card.

Gamification also helps generate enthusiasm around something that can be a rather dry topic for a staff meeting. For example, during football season, create a 17-week program where teams compete with one another to answer questions. Keep standings and post them in a staff-only common area. Simple compliance content-based games such as word searches, scavenger hunts and brain teasers can give people a reason to learn on a continuing basis as well. 

To create even more fun and excitement that drive the messages home, ask teams to participate in a role-playing game to identify sample compliance problems and the steps each member would need to take to rectify them. 

Borrow an idea from the factory world to keep compliance top of mind. But instead of accumulating days without an accident, keep track of the days without a compliance incident. Post a counter in the lunchroom to monitor progress. Just be sure everyone understands that admitting mistakes is more important than keeping the counter going. 

Look outside for training ideas

There are plenty of resources — both inside and outside of healthcare — for making training fun, including:

• The Centers for Medicare and Medicaid Services website (cms.gov). Content on this website can provide plenty of fodder for quizzes and brain teasers, not to mention core resources to use in developing other materials. 
• Contracted health plans. Health plan partners face the same issues your team does, and they may already have games or other materials you can borrow. After all, it’s in their best interest for your organization to be compliant. 
• Vendors (including consultants). Many vendors and consultants have already developed materials and ideas that can be adapted to the unique needs of your group practice. Or they may be willing to brainstorm with your team about new ideas. Take advantage of their knowledge and experience to give your practice a head start.

4 questions to ask before selecting a compliance partner

Working with a partner for data and analytics, training, education or any other aspect of compliance can help raise the quality and reduce the time needed to build a positive culture that benefits your practice over the long run. But your practice needs to be sure it has selected the right partners. After all, if there is a data breach or some other issue, patients won’t look at the partners; they will look at your practice. Here are some key questions to ask potential compliance partners before signing on the dotted line:

• Do you offer training for my team members? Partners who offer training generally make it more engaging and productive for your staff. 
• Do you normally perform background checks on employees? If employees have a history of noncompliance in previous positions, it’s likely they will continue some of those poor habits in your practice. It’s best to know that upfront so leadership can decide on the best approach to changing that behavior within your culture.
• What quality control systems are in place to monitor and track instances of noncompliance? Part of building a culture of compliance and making it sustainable is identifying what’s working and what isn’t. Don’t assume because your practice provided training on one aspect or another that it actually took root. A good monitoring and reminder system will help keep compliance problems from recurring.
• What tools are used within your group practice and what data will the practice require for analytics? How will that data be kept secure? Before you agree to share any of your group practice’s precious data, it is important to know what will be required and what steps the partner will take to keep that data secure. At a minimum, unless the data is completely generic, it should be encrypted at rest, in transit and in use within the partner organization.

Making compliance a habit

Like making healthy food choices and getting regular exercise, compliance is often viewed as a short-term project rather than a way of operating effectively over the long term. But that’s not a recipe for success. 

Creating a culture of compliance transforms a topic that can often seem punitive into a source of pride, helping practices to avoid the waterfall of noncompliance consequences and reap greater rewards for many years to come.