Worker Fatigue and the Potential Negative Impact on Compliance

When workers get fatigued, what is the impact on compliance?

We all know that, during a normal workday, workers can get fatigued. Fatigue can come from a variety of sources, including personal and professional challenges or stressors. Mental fatigue specifically occurs when there is a need to process overwhelming amounts of new data or information.

The impact and stressors of working during a pandemic can make this worse. Mental fatigue is exacerbated because there is so much new information to cull through on a daily (sometimes more frequent) basis. Combine this information overload with rapidly changing pandemic recommendations and guidelines, and it’s no wonder that workers are becoming more fatigued.

Effects of Fatigue

Memory and performance both decline when a person is mentally fatigued, which can lead to non-compliant behaviors and actions. This happens because fatigue decreases the ability to make new, short-term memories. Lack of short-term memories prevents the formation of long-term memory knowledge. And a person simply cannot recall information which has not been transferred to long-term memory. In this way, fatigue decreases the ability to recall information – whether recently learned or already known.

For example, if the organization has not previously billed for telehealth visits, a fatigued coder may not remember the education that was provided regarding telehealth documentation requirements or the codes applied to these visits. Moreover, the coder may have difficulty recalling in-person visit codes or coding modifiers. When these effects of fatigue happen, coding compliance will decrease.

Mental and physical fatigue can affect worker performance in other ways. Think about the last time you did not get a good night’s sleep. At work the next day, all you can think about is drinking more coffee or taking a nap or going to bed early that night.

Signs of this kind of fatigue include decreased awareness or a general decrease in interest with respect to work or job tasks. Other signs of fatigue include changes in judgment or decision-making. Take, for example, an employee who is usually very engaged on the job, but unexpectedly shows up late for a scheduled meeting. During the meeting, the employee is unusually quiet and provides limited feedback. If that employee’s knowledge and feedback are necessary to make a critical compliance-related decision there would be not only a negative effect on compliance, but potentially a negative effect on the entire organization.

Compliance Fatigue

There is also a form of specific compliance fatigue – where people are overwhelmed and wearied by the numerous adherence requirements in healthcare policies and procedures and rules and regulations. This combines with mental fatigue, which inhibits the ability to remember and follow these policies and procedures, which is the cornerstone of good compliance.

Employees may know and understand policies and procedures addressing HIPAA. For example, they must use encryption when emailing protected health information (PHI) or personally identifiable information (PII) or payment card information (PCI). Similarly, in the course of their work, they must exercise heightened caution before clicking on links embedded in emails. If they are experiencing fatigue, the possibility of compliance failures increases.

As physical, mental and compliance fatigue increase the potential for job related mistakes, they conversely decrease worker compliance. The overall impact of worker fatigue can have very real and negative impact on compliance ranging from simple mistakes or lapses in judgment to catastrophic errors related to breach of PHI/PII or PCI.

Practice Tips

Encourage supervisors to regularly meet with their staff to evaluate the level of information fatigue or physical fatigue. If possible, conduct education and feedback sessions to help the team talk through fatigue challenges.

Utilize resources, such as youCompli, to assist the team in staying current with healthcare compliance related changes to guidelines, regulations and laws, and managing compliance-related workflows automatically.

Denise Atwood, RN, JD, CPHRM
District Medical Group (DMG), Inc., Chief Risk Officer and owner of Denise Atwood, PLLC
Disclaimer: The opinions expressed in this article or blog are the author’s and do not represent the opinions of DMG.

Denise Atwood, RN, JD, CPHRM has over 30 years of healthcare experience in compliance, risk management, quality, and clinical areas. She is also a published author and educator on risk, compliance, medical-legal and ethics issues. She is currently the Chief Risk Officer and Associate General Counsel at a nonprofit, multispecialty provider group in Phoenix, Arizona and Vice President of the company’s self-insurance captive.