When Compliance is the Problem: “Us” Versus “Them”  

As a former compliance professional, I have experienced how different compliance can be viewed, utilized, or integrated into various healthcare organizations. I have seen compliance and operational teams work together in a collaborative, transparent, communicative way to improve compliance objectives, decrease the number of identified deficiencies, and maintain oversight on plans of correction. I have also experienced first-hand when compliance can be its own biggest obstacle in getting buy-in, fostering collaboration, and well… being successful in getting leadership and operations on board to make meaningful changes.  

At one time in my previous experience, I had the incredible opportunity of leading a compliance program for an organization that received ZERO DEFICIENCES during an accreditation survey. Was this success mine alone? It was not! Was this success part of a solid compliance approach aimed at getting buy-in from leadership, operations, and staff at every level…absolutely! 

So how is compliance often its own biggest obstacle in achieving compliance goals and objectives?  

The “Us” versus “Them” Dynamic for Compliance in Organizations 

In my experience one of the first challenges to overcome is the “us” versus “them” dynamic that often persists amongst compliance and staff at all levels. The “us” can be staff at all levels, leadership teams, department managers, and all working clinical and administrative staff. The “them” is often anyone working outside of their immediate groups, departments, or operational functions – like compliance teams.  

Compliance teams should critically evaluate how they are perceived and how specifically their teams are integrated into the organization. This includes answering some of these questions:  

• How is compliance perceived across staff at all levels in your organization? Do you have buy-in from leadership, but run into obstacles getting department staff to engage and prioritize compliance work or objectives?  
• When your compliance teams send an email, are staff responding? Do they recognize your name, or are they familiar with who you are? Do they see you as someone beneficial to their team that they should respond to and work with? 
• Do staff view compliance as a resource or an obstacle?  
• Does your team encourage open, honest, and transparent communication about the current state of compliance? Are your teams currently getting any feedback, questions, or requests for support? 

Having competent compliance staff with the expertise and skills to support teams is certainly foundational as a first step. However, the soft skills that compliance professionals bring to the process are often just as crucial to the success of getting staff on board with the organization’s compliance plan and objectives.  

Overcoming the “Us” Versus “Them” Dynamic 

How can compliance teams overcome this “us” versus “them” dynamic? Here are some points to consider:  

• Compliance teams should regularly review their compliance plan/program and objectives. Begin with an organized approach to managing compliance within an organization, and combine that with open, honest, and transparent communication.  
• The compliance team should not solely have a plan to audit, monitor, and report on the state of compliance – it should also be visible, familiar, and regularly available to staff. This will ensure successful engagement with operations and clinical staff to meet current rules, regulations, and accreditation or certification standards.  
• Identify influential staff members at every level who can positively influence their peers to support compliance’s objectives. Compliance teams often do not have a direct line of authority over the teams they need to influence. Identifying influential individuals, and helping them become compliance allies, can help shift the perception of compliance. Instead of being perhaps an irritation or obstacle for operational teams, compliance staff can be a valuable partner, with similar goals of supporting safe patient care, identifying and reducing risk, and supporting teams to make improvements. 

While I once audited an inpatient hospice facility, I worked alongside a Certified Nursing Assistant (CNA) who had been with the organization for years. Despite her formal role, she had more sway over the staff than the CEO in many circumstances. Her dedication to patient care, hard work, and collaborative spirit made her an invaluable ally to the compliance team. During facility audits, she became my shadow, asking questions, taking notes, and becoming aware and receptive to many aspects of compliance that were overlooked. She became a champion of the facility’s compliance objectives and helped to shift the team’s perception and understanding of working with the compliance team. This staff member made such a successful impact in terms of engagement and collaboration with the entire team that forming these connections became a top priority for me in my compliance efforts moving forward. 

In your organization, who are those influential staff members within leadership, management, and operations? How can you form connections with them, and in turn demonstrate the value, resources, expertise, and support that compliance teams can provide? 

• Obtain buy-in from leadership. While identifying those influential staff members, it’s crucial to earn buy-in from executive leaders and their support teams. It seems simple, but a great first step in this effort is engaging early and often. Keep them updated regularly on compliance activities, challenges, and success stories!  
• Continuous engagement and communication. Compliance professionals don’t just need the expertise to provide sound guidance. They also need the ability to build relationships and engage/communicate effectively with staff at all levels. In addition to being visible and available, compliance teams can consider additional channels of engagement and communication such as: 
• Newsletters. Communicate and distribute information related to compliance activities and goals – like upcoming regulatory changes, state and federal survey windows, regulations the organization is currently focused on, etc. The list is endless! 
• Websites. Share compliance information, resources, tools, and guidance on upcoming compliance-related activities.  
• Workgroups. Gather staff from across the organization to tackle compliance challenges, obtain input from stakeholders, and collaborate towards achieving compliance goals.  

By bridging the gap between “us” and “them,” compliance teams can transform the perception of compliance teams from being an obstacle into being a collaborative partner and member of their team. 

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