Build psychological safety to encourage a culture of compliance 

The power to question encourages compliance in a healthcare setting 

Jay P. Anstine is a compliance professional and consultant in Colorado. He is writing a series of articles on compliance culture for the YouCompli blog. This post looks at how to foster a sense of psychological safety to support a culture of compliance. 

Back in May, I defined a culture of compliance as a commitment throughout all levels of an organization to do the right thing and do things right. I think a lot about what it takes to equip people to meet that commitment in a healthcare organization. Our Training & Development colleagues often talk about developing growth mindsets as part of their efforts to shape a culture of learning.  

One thing both of our cultural pushes have in common? Both depend on creating a sense of psychological safety, so employees ask questions and engage deeply in the learning.  

According to Megan Martin, writing for Forbes, “Psychological safety is the ability to show and employ one’s self without fear of negative consequences of self-image, status, or career. In the workplace, it is a shared belief held by members of a company, department, or team that the team is safe for interpersonal risk-taking.”   

Three ways the Compliance team can help create this sense of safety in healthcare organizations. 

 1. Give people permission to ask questions 

 One way to make your compliance program a psychologically safe place is to give your employees permission upfront to ask questions. Some examples include: 

• Before I proceed with the training, please know this is a safe place to ask questions. 
• For purposes of our conversation today, upfront I want you to know I subscribe to the concept of there are no stupid questions. 
• As we go forward, if you have any questions, please feel comfortable to ask them. 

Everyone comes from different backgrounds, personally and professionally. It’s best not to assume your employees will feel safe asking questions. I once worked in an environment where leaders would become frustrated when people asked questions, or worse, they limited staff in time or the number of questions they could ask. When I changed roles, I felt a sense of culture shock when I was actually encouraged to ask questions. It was a significant indicator of safety that I was given time and space to process information in my own way, including by asking lots of questions.  

So don’t assume your staff know it’s a safe place to ask questions. They could be a little traumatized by their prior working environment. Even if you do make a disclaimer, you should reinforce the concept of safety in asking questions when staff are hesitant or reluctant. (I’m sorry, but I do have a question that may be a silly one…). You can also give staff an opportunity to ask questions offline (If there are no more questions, you can always reach out to me at xxx-xxx-xxxx or via email.) 

2. Show employees that “I don’t know” is an acceptable answer 

 Another way to make your compliance program a psychologically safe place to ask questions is to be vulnerable yourself. Simply say “I don’t know” when you don’t know the answer to a question. I think there is an unwritten expectation of newer compliance officers to know the answer to every question. I know I was guilty of it when I started. In my experience, that’s just not realistic or practical. When it comes to analyzing a compliance-related question, the regulations change frequently. Often you still have to consult them to validate your answer is still correct.  

Over the years I had to get comfortable in saying “I don’t know” when a question was asked that I didn’t know the answer. What I figured out is that the way to get comfortable is making sure those asking me the question felt comfortable in my answer. The way I did that was to say I don’t know the answer, but I will look into this and get back to you. The key to maintain trust in that answer though is to make sure you do follow-up with the actual answer.   

If you lead by example in saying “I don’t know,” you will create a ripple effect through the organization. Others will see that it is okay to say “I don’t know” to a question. This will leave staff feeling your compliance program is a psychologically safe place to ask questions. Over time, this will help you embed a sense of psychological safety. 

 4. Encourage and reward questions. 

 Finally, another way to make your regulatory compliance program a psychologically safe place to ask questions is to encourage questions and reward those who ask them.    

If you think about questions, they are critical to the work we do. In the context of a healthcare compliance investigation or audit, we can’t determine a solution until we define the problem. Questions are important tools for defining the problem. They help you figure out if there is any difference between the facts you have (e.g., compliant or non-compliant), and the ones you want (e.g., compliant). In the context of delivering education or discussing a potential issue, questions from employees signal curiosity, which demonstrates engagement with your compliance program. 

 If you want to encourage questions, don’t use closed ended questions that can be answered with yes or no (e.g., Are there any questions?) Instead, use open-ended questions. Leading with the words what or how can help you reframe a question to be open-ended. Some examples include:   

• What questions can I answer? 
• What areas are you struggling with? 
• What are your thoughts? 
• What concerns you the most about this new requirement? 
• How will this change affect your department? 
• What other issues are important to you? 
• What processes will your department need to change to remain compliant? 

 Taking this approach ensures an honest and open discussion that creates a psychologically safe place for others to ask questions and share information. On the back end, you want to reward staff for asking questions (e.g., That was a great question. Thank you for asking it.) 
When you encourage and reward questions, you are sending a message to others that your compliance program is a psychologically safe place to ask questions.    

Almost 20 years ago a supervisor told me

“I’d rather you ask questions, than not. It helps make sure we do things right, the first time.”

That wisdom has stuck with me, and I carry it forward when I’m meeting with clinical, operational, and compliance colleagues. He made me feel not only safe – but as though I had a responsibility to engage deeply with questions so I could help shape a solution.  

It’s a bit counterintuitive – to get people to be compliant, we have to give them the power to question the heck out of us. If we want them to do the right thing and do things right, we have to let them ask questions and learn so they can truly embody the policy or practice, not just go through the motions. 

Building a sense of psychological safety takes time and collaboration with your clinical and operational colleagues. YouCompli can streamline your healthcare regulatory change management efforts to give you time back to collaborate with colleagues and connect with front-line staff. And we help free you from reading and monitoring regulations. Take a look at our regulatory change management solution today.

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