Healthcare compliance culture means doing the right thing at all levels 

Jay P. Anstine, JD is a compliance professional and consultant in Colorado. He is writing a series of articles on compliance culture for the YouCompli blog. This post establishes a working definition of compliance culture and puts it in the context of overall healthcare priorities.

Last I checked, Google serves up ~113 million results for – compliance culture healthcare. We’re all trying to build one – but have we settled on what it is and why it matters? 

I’m kicking off a monthly series of blog articles on building a culture of compliance in healthcare. To start, I want to be clear about how I’m defining “compliance culture” and how an organizational culture of compliance helps healthcare organizations serve patients and ensure healthy finances.  

The consequences of a noncompliant culture can be devastating, regardless of industry. Just look at the rampant, unreported fraud that took down Enron in the early 2000s. Or the case of biotech company Theranos, which falsely claimed it could perform a rapid blood test involving a small drop of blood. Leaders there raised over $700 million from investors based on falsified claims. In both cases, the alleged fraud could not have gotten as far as they did in an organization that valued regulatory compliance and ethical behavior. 

Indeed, if these organizations had a culture of compliance, perhaps their leaders would not be imprisoned, their customers would not have been misled, and their investors would not have lost billions. They’d likely still be in business today.  

Definition of compliance culture in healthcare  

A culture of compliance is a commitment throughout all levels of an organization to do the right thing and do things right. So, what does that look like? It looks like leadership and the board of directors demonstrating this commitment through their actions, words, and behaviors. For example:  

• When a business transaction is being discussed, people ask questions about whether the transaction is in compliance with all Federal, state, and local laws and regulations.  
• When answers to those questions are uncertain, the organization acts to clear up confusion before the transaction proceeds.  

A culture of compliance also looks like having a set of corporate values that includes ethics and integrity, memorialized through the organization’s code of conduct.  

Finally, a culture of compliance looks like those values being a focal point in corporate messaging and education throughout an employee’s tenure. More specifically, it looks like employees feeling encouraged, supported, and rewarded by their supervisors when they do speak up about a concern. It looks like supervisors holding all staff accountable, including themselves. Finally, it looks like leadership making business decisions that are sound from an ethical and business perspective.  

The importance of a culture of compliance in healthcare 

When an organization’s culture of compliance is weak, the overall work environment is negative. There are higher levels of distrust and internal conflict, leading employees to feel anxious about their own job security. For example, when employees see their leaders making unethical decisions, they question the leaders’ professional judgment and wonder what else the leader is not being honest about. Employees also see their leaders not following the same policy requirements that apply to them, failing to attend trainings, or speaking negatively about compliance (e.g., “Ugh. Compliance is making us do this.”). In these types of environments, the compliance program tends to not be supported. The end result is an unhealthy culture of compliance. Employees see their leaders behaving poorly and mirror that behavior (e.g., “Well, if he doesn’t have to follow the rules, why should I?”)  

When an organization’s culture of compliance is strong, the overall work environment is positive. Communication among employees is honest, leaving the employees to be appreciative of their leaders, and feel secure about the future of their job. For example, when employees see leaders making decisions in the best interest of the organization, regardless of circumstance, they trust the leader more. Employees see their leaders making business decisions based on policy requirements, attending required training, and speaking positively about compliance (e.g., “Please check with compliance to make sure we can move forward with this business initiative.”). In this environment, compliance programs tend to be supported and there is a healthy culture of compliance. Employees see their leaders acting ethically and are encouraged to model that behavior.   

Measuring compliance culture 

So how do you know if you have a culture of compliance? And how do you communicate gaps and wins to your colleagues? For starters, be observant to your surroundings, asking yourself questions such as: 

• Are employees and leaders proactively or reactively reporting issues to me?  
• When leaders do respond, do they support the need to investigate and resolve, or are they trying to minimize the concern?  
• Are employees utilizing the hotline?  
• Have employees appeared fearful about retaliation?  

Measurement also helps. Healthcare compliance consultant Ken Zeko shared the metrics he uses to assess culture in a recent YouCompli blog post. I appreciate how he encourages us to measure activity in employees’ day-to-day work and to look at where we’re spending our time. As Ken notes, “Being prepared for a regulatory or strategic change starts with compliance officers being visible across the organization. This ensures that compliance officers realize where the impact needs to be and can effectively partner with the affected operational areas to make reasonable changes and mitigate risk.” 

A culture of compliance is not just a platitude. It really does exist, though it will take different shapes in each organization. In my experience, it takes a village to effectively implement since the compliance officer cannot be everywhere at all times. Those organizations with a strong culture of compliance and an effective compliance program are the ones with engaged clinical and operational leaders. 

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