How to Deliver Bad News as a Compliance Officer

The work of a compliance officer constantly challenges your ability to remain professional. When you consider the organizational risk involved in our work, combined with the politics of healthcare, you have a recipe for frustration, stress, and anxiety. For that reason, professional communication strategies can help you build stronger relationships with your healthcare leaders. This week, I wanted to focus on one of those strategies: delivering bad news—a common reality associated with our profession.

Defining “Bad News”

Before discussing a communication strategy, we need to first define “bad news”, because I’ll admit, that’s a vague term. Let’s assume you were working on resolving an identified billing and coding issue for a high dollar surgical procedure. You have conducted an investigation and determined the organization does not have documentation to substantiate medical necessity as required by CMS. In addition to addressing process changes to correct the issue going forward, you have identified a six-figure refund that must be paid back to Medicare. Given the financial impact to the organization, it is likely your leadership team, will not be too thrilled to hear this news. Additionally, let’s assume that through the investigation, it has become clear the issue could have been prevented if the one of the leaders had held a direct report more accountable. So you have the potential for a leader to take your news personally too. Awesome.

Developing a Communication Strategy

So, how would you go about approaching your discussion with the leadership team? If it were me, I would spend some time thinking about a strategy. As part of my thought process, I would make sure I have identified a communication plan around two topics:

1. How will I mentally prepare the leaders to hear the news?

2. What is my recommended solution to resolve the issue and prevent a future occurrence?

Let’s take a deeper dive into both these questions.

How will I mentally prepare the leaders to hear the news?

The first question is really aimed at softening the blow of the news you’re about to deliver. It’s no surprise that as humans we tend to have a fight or flight response when confronted with shocking news. Just think about times when you found out about a catastrophic news event. The same shock factor can apply to a healthcare leader when confronted with news of a large overpayment, an employee suspected of drug diversion, or an employee committing fraud.

If you are working on an issue that has such a shock factor, then you need to prepare for that response. Think about being in that person’s shoes and how you would appreciate hearing the information. For example, it may be best to allow the person to hear the information, process it, and then come back at a later time to discuss the topic. This approach can help ensure he or she is engaged in the discussion (and not distracted by the shock). It can also improve your chances of a more effective discussion about next steps.

You may also need to think about whether or not the leader will take the information defensively and if you can do anything counteract that defensiveness. For example, it may be helpful to lead the discussion with things the leader has done well before delivering the bad news. If multiple contributing factors were involved, you can also highlight those factors so the person doesn’t take full ownership. Every situation will be fact-specific, but these approaches may help to mentally prepare the leader to hear the news you’re about to deliver.

What is my recommended solution to resolve the issue and prevent a future occurrence?

The second question is about thoroughly thinking through the discussion. For example, giving thought to other communication strategies, such as anticipating questions, asking yourself “so what do you need from me,” and bringing a solution when you bring a problem. These are all questions you can walk through for responding to this second question and developing your overall strategy for delivering bad news to your healthcare leaders.

Pulling it All Together

Maintaining professionalism is critical to your success as a compliance officer because you need others in the organization to feel comfortable with you and trust you if you expect them to report concerns to you.

If you plan ahead for how you are delivering bad news, it will improve your chances for success because you’re taking a professional approach to an unpleasant conversation. In the short term, developing a strategy can help position you for a smoother conversation. In the long term, it will support your ability to build stronger relationships with your leaders and effectively navigate the politics of healthcare.

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How to Maintain a Calming Presence when Responding to Compliance Issues

There is no shortage of opportunities to lose our cool in healthcare compliance. Investigations into high-risk issues (e.g., fraud, drug diversion, privacy breach), all get people’s hearts pumping fast. That can lead to murky thinking, flared tempers, and unproductive trips down rabbit holes.

According to Stressaholic author, Hedi Hanna, this behavior can lead to “second-hand stress”. That is, the issue itself is stressful, but how someone reacts to the issue creates additional stress that is felt by others. Think about a time when you saw a speaker experience technical difficulties like feedback from a microphone. If the speaker fumbles around for a solution or starts yelling at the AV team in the back – what happens? You start to feel anxious for that speaker. You might even lose confidence in the speaker or resent his or her berating behavior.

Now let’s apply that concept to your work as a compliance officer. What does that additional stress do when it shows up as you’re responding to an issue? Nothing good. At best, it’s distracting attention away from your actual response. At worst, it leaves your healthcare leaders questioning your ability to take the lead in managing an issue.

I find that when healthcare leaders come to us with a high-risk issue to resolve, they are functioning in a state of uncertainty and may already feel anxious. I have found this is often the result of them not understanding the regulations as much as compliance officers do. That leaves them unable to see a path forward. If I pile on to that anxiousness, it’s not going to help anyone.

Instead, my aim has been to show up as a problem-solver—someone who can lead the organization out of a mess. A significant way to accomplish that goal is modeling a calming presence as I’m responding to an issue that has been identified.

So how do you maintain a calming presence during stressful times? First, take a deep breath and make sure you’re physically and mentally ready to lead calmly. Then, follow these four approaches which have helped me greatly over the years.

Approach #1-Assess the Threat

When faced with a high-risk issue, the first thing to do is to assess the threat.  At this stage, your focus should be on the big picture, considering questions such as:

• What is the risk to patient care?

• What is the risk to the organization from a compliance and reputational standpoint?

• Does this appear to be accidental or intentional?

• Does this appear to be an isolated incident or a pattern of behavior?

Additionally, as part of your threat assessment, consider whether you or a colleague has seen something like this before. If so, there may be prior experience you can leverage for how to respond to the issue. That can help you remove some of the uncertainty of the next steps needed in order maintain a calming presence.

So what if this situation is unique, and there is no prior experience or other resources to draw from?  If that’s the case, then the latter approaches can help you.

Approach #2: Focus on the Facts—not Opinions or Assumptions

Another way to maintain a calming presence during stressful times is to focus your attention on facts and not opinions or assumptions. That is true whether the opinions or assumptions are coming from you or someone else.

At a very basic level, when it comes to making decisions, we do so based on the information we have available to us. When confronted with responding to a perceived crisis, you have to be able to determine what information is based on fact (i.e., verifiable) and what information is based on someone’s personal feelings.  One way to ensure you are focusing on the facts is to ask yourself “is this conclusion supported by facts or personal opinion?”  

As you are gathering your facts, be mindful about how you are asking questions.  For example, if you are asking a leading question (“Isn’t it true that…”), it’s going to feel like you’re cross-examining the person you’re interacting with. Taking such an approach would only add to their stress and anxiety.  Instead, you want to frame your questions from a place of curiosity—not judgment. Some examples of the types of questions you could ask include the following:

• “I am not familiar with X; please help me understand what you mean when you say X.”

• “ X is an area outside of my expertise; can you tell me what X means?”

• “To make sure we are on the same page, can you explain X to me like you would to someone off the street?”

When you take a curiosity approach to questioning, it demonstrates your thoughtfulness to a particular situation which can lower the stress and anxiety felt by others.

Approach #3: Focus on what you can control and don’t take ownership for what you can’t control

Another way to maintain a calming presence during a time of perceived crisis is to focus on what you can control and avoid taking ownership for what you can’t control. When it comes to responding to an identified compliance issue, one way to maintain that perspective is to focus on the present and the future rather than the past. For example, if one of your healthcare leader’s has entered into a business arrangement that turns out to violate a regulation, that’s a business decision that was made in the past. You can’t control that because you can’t undo what’s been done. Also, that was a business decision that was not yours to make.

Instead, your focus should be on what you can control and the business decisions that are yours to make which lie in the present and the future. More specifically, navigating the organization to resolving the issue (i.e., the present), and taking steps to prevent a future occurrence (i.e., the future). The government recognizes regulatory violations are going to occur and compliance officers can’t be everywhere at all times. That said, once an issue is identified, the government does expect the organization to address them and take steps to prevent future occurrences.

Keeping your focus on the present and the future will help you demonstrate a calming presence through your interactions with others as you are resolving the issue.

Approach #4: Focus on the Process

With any high-risk issue, it’s “the unknown” that probably scares us the most.  That in part is due to the trap that people can fall into with assumptions and opinions that I mentioned above. 

When something has gone wrong, as human beings, it is natural for our mind to shift to a never-ending list of “What ifs” (e.g., What if a government investigation or audit gets triggered from this issue?). If you want to maintain a calming presence you have to avoid falling into the “What if” trap. Instead, make your focus on the process of resolving the issue.

How do you do that?

By keeping the big picture in mind as you approach your work to resolve the issue. That means identifying upfront what your steps are going to be as you move forward.  For example, when an issue first gets reported to you, don’t jump to problem solving. That comes later.  Instead, this is the time to gather information and be thinking about questions like:

• What questions do you need to answer in order to resolve this issue?

• What information do you need in order to resolve the issue?

• Where can you get this information?

• What are going to be your next steps to bring about resolution?

Having a big picture perspective identifies what is most important to focus on—and when it is important to focus on it. This helps you determine what is a true priority, which can aid you in demonstrating a calming presence.

Pulling it All Together

As compliance officers, we are tasked with serving as a problem-solver for the organization. Once an issue has been an identified, you will inherently enter a period of time when emotions will be running high (e.g., anxiousness, frustration, anger).

These are also the times when it becomes important to respond appropriately, so that you can maintain a positive business relationship with others. By following the approaches outlined above, you will develop your skills at self-regulating your emotions so that you create a calming presence felt by others around you. By developing this skill set you will build stronger relationships with your healthcare leaders which puts you in a better position to successfully navigate the politics of healthcare.

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How to Take a Big Picture Approach to Compliance Work

Something I have picked up over the years is that the way a compliance officer interprets the initial report of a concern says a lot about how he or she will solve the problem. What I mean by that is that very quickly, you will find out whether the person is guided by the big picture or whether they’re detail oriented.

In order to navigate the politics of healthcare successfully, you’ll be better positioned if you approach the problem as a big picture thinker. That does not mean details are not important. It’s just a matter of timing. That means knowing when to focus on the big picture, and when to focus on the details.

The Importance of a Big Picture Approach

Taking a big picture approach is important to the work of a compliance officer for a couple reasons. First, it positions you to maintain a calming presence in your communications. For example, consider conducting an investigation. Allegations involving high-risk issues like drug diversion, coordinating a response to a regulatory change or responding to a government investigation all get people’s hearts pumping fast. When healthcare leaders come to you with a high-risk issue to resolve, they are often anxious because they’re functioning in a state of uncertainty. To counteract this anxiousness, avoid making your focus on past (i.e., the conduct that occurred). Instead, focus on the present and the future—the steps you’re going to take to resolve the issue. Taking this approach will help you maintain a calming presence and demonstrate to your leaders that you’re capable of big picture thinking.

Separate from helping you maintain a calming presence, operating with a big picture mindset also helps you build stronger relationships with your healthcare leaders.

Why?

Because healthcare leaders are predominantly big picture thinkers. They operate in a world of mission and vision statements, strategic plans, and business agendas, all of which are focused on the big picture. That means a leader is not only focusing on the launch of a project, but what the exit strategy is going to be if it doesn’t work out. Big picture thinking means you’re able to see what is in the past, the present, and the future. If you take a big picture approach to your work as the compliance officer, it becomes a form of tailoring your communication to your audience. Over time, this approach will help establish rapport and develop stronger relationships with your healthcare leaders.

A Big Picture Approach to Compliance

When it comes to compliance work, a big picture approach can be carried out with many—if not all—of the Seven Elements of an effective compliance program. Let me give you three examples to illustrate how this works.

First, building off the discussion above, let’s revisit the topic of investigations. If you are investigating an issue, what does the end of the investigation look like before you get started? If the allegation is substantiated, how will that affect you, your supervisor, and the compliance program? What impact will it have on the organization and any of the individuals involved? If the allegation is unsubstantiated, could the reporter file a complaint with a government agency (e.g, state agency, CMS, OCR)—and if that happens, can you defend your investigation?

Second, consider conducting an audit. A big picture approach to conducting an audit means you’re looking at the beginning, middle, and the end of an audit before you get started. What potential outcomes will exist for you and the organization as a result of the audit. If an issue arises outside the scope of the audit, do you need to consider adding a new audit to your audit plan? Is the topic you are auditing, one that you need to conduct a follow-up audit in a year or two years?

Finally, think about conducting education & training. If you are developing content for educating your workforce members on a new regulatory change, what specific information do you want your audience to walk away knowing (i.e., the learning objectives)? How will you approach the training to ensure they will retain the information? Do you need to conduct monitoring to determine if they have retained the information? Do you foresee needing to conduct repeat training in six months or a year, or will this training be a one time thing?

These are just a few examples to demonstrate how a big picture approach can be applied to the work for a compliance officer.

Pulling it All Together

Having a big picture perspective identifies what is most important, which helps you determine what is a true priority. As I said earlier, details are important; it’s just a matter of timing. When a compliance matter gets presented to you for resolution, your initial interactions should be focused on the big picture. What questions do you need to resolve? How are you going to resolve them (if this is possible to predict)? Who do you need to talk to in order to resolve? What are the likely end scenarios going to be?

That’s a big picture line of thinking.

Over time, your professional judgment is going to be shaped by how well you can maintain a big picture view while carrying out detail-oriented work. If your goal is building strong relationships with leaders, adopting a big picture mindset will help you achieve that goal and ultimately improve your ability to navigate the politics of healthcare.

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Lead with a Mindset of "Maybe?" Instead of "No!" When Giving Advice to Healthcare Leaders

In the world of a compliance officer, a sad reality is that with some exceptions, we don’t get to be the hero. One of those exceptions can be consulting to healthcare leaders on new service lines or proposed business deals. When you’re able to allow a healthcare leader to move forward in a manner that is both business friendly and compliant, it feels as if you drained a three pointer at the buzzer in overtime.

OK, that might be a slight exaggeration, but the point is, unlike conducting an audit, these are moments when your leaders will celebrate you. Since these times infrequently occur due to our role as compliance officers, you should embrace them for what they are: an opportunity to demonstrate to a leader you are a business partner and not an obstacle.

When you are consulting to your healthcare leaders, the most professional way to approach this work is to lead with a mindset of “maybe” instead of “no!” when they come to you.

Leading with a Mindset of “Maybe” Instead of “No!”

Compliance questions are a world of gray because most regulations are intentionally written by lawyers to fit changing circumstances over time. Think about HIPAA. For those of us old enough to remember, when HIPAA was signed into law in 1996, there was barely an internet and email. Few of us had cell phones. There was no texting. No social media. No smartphones. If you wanted to coordinate a time and place to meet up with your buddies, you called each other ahead of time. If they answered, they showed up; if they didn’t, well, they missed out. The point is, even though these forms of communication either didn’t exist or barely existed in 1996, we still have to apply them to HIPAA in today’s modern communication world.

When it comes to the language of healthcare regulations, there will be circumstances when it is clear you cannot engage in certain conduct. There may also be times where workable solutions do exist, ones that do not jeopardize compliance. Finding these workable solutions is the sweet spot you should be seeking when consulting to healthcare leaders.

(Note: This is where thinking like a healthcare leader and understanding their point-of-view will help you).

Fallout from the “No!” Mindset

If you go into a discussion with a leader about a new business venture with a mindset of “No!”, you’re inhibiting your ability of finding a workable solution. Over time, it can have disastrous consequences for you and the compliance program. I say that because I have seen it happen with other compliance officers over the years. They become known in the organization as the person who only says “no.”

And then what happens?

Their leaders go around them to find someone else who will work with them, or worse, they avoid the compliance officer and do what they want anyway. The end result is a mess that could’ve been avoided had the compliance officer not taken a standoffish position right out of the gate.

Pulling it All Together

An effective compliance program takes a village of committed folks throughout all levels of the organization in order to pull that off. That means having your healthcare leaders coming to you proactively instead of reactively. If that is the type of compliance program you want to foster, then you have to encourage them to come to you. Leading with a mindset of “Maybe” instead of “No!” does just that. It sends a message to the leader that you are keeping an open mind and willing to put in the time and effort to try and help them.

Over time, this approach encourages them to come to you on the front end for advice rather than avoiding you and creating a mess on the back end. There will be times when “no” truly is the answer, but saying no should be the last word out of your mouth. Not the first.

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Are you interested in more content like this?

Check out my new book, Navigating the Politics of Healthcare: A Compliance Officer’s Guide to Communication, Relationships, and Gaining Buy-in. It’s now available at Amazon, Barnes & Noble, and most other major book retailers.

How to Get a Compliance Officer to Think Like a Chief Nursing Officer

For the compliance officer, an effective strategy for navigating the politics of healthcare is to think like a healthcare leader. This is true whether you’re consulting to leaders on a proposed business deal, conducting an investigation, or anything in between.

Last week I talked about thinking like a CMO and how position compliance to someone in a CMO role. This week we’ll take a look at another leader that the compliance officer has to interact with when it comes to clinical matters—the CNO. We’ll look at CNO’s role and responsibilities, what shapes their point-of-view (POV) and how to position compliance to appeal to a CNO’s POV.

CNO Role and Responsibilities

The CNO is the highest-ranking nursing leader in the organization. Overall, the CNO’s role is to ensure that patient care and clinical quality standards are maintained. In fulfilling this duty, CNOs have the responsibility of overseeing the daily operations of nursing staff, which may also include other clinical staff (e.g., lab techs). CNOs tend to have significant knowledge of the organization’s clinical processes and procedures as well as local, state, and federal regulations impacting clinical care services.

Similar to other senior management positions, CNOs are often excellent communicators, having spent years developing their leadership and business skills. CNOs are often highly skilled in critical thinking and strategic planning. They also have the ability to adapt quickly to unexpected changes as their clinical staff are required to do on the floor every day.

While the specific duties of a CNO will vary, they often include the following:

• Clinical operations oversight. Overseeing the daily clinical operations of the organization, including planning, organizing, coordinating, and directing clinical care services.

• Nursing leadership. Serving as a nursing spokesperson to the board, other members of senior management, and the employees.

• Physician and provider liaison. Serving as a communication link between clinical staff and physicians or other healthcare providers.

• Patient safety oversight. Ensuring any patient-safety-related issues are resolved with specific steps outlined to prevent future occurrences.

• Clinical performance. Ensuring the organization is meeting identified clinical metrics tied to quality, reimbursement, and patient satisfaction.

• Financial performance. The CNO ensures clinical departments are meeting operational budgets.

• Clinical policies and procedures. Overseeing clinical policies and procedures to ensure they are developed, implemented, and current as well as ensuring staff are trained on them.

• Organizational compliance. The CNO must ensure the organization is maintaining compliance with all federal, state, and local laws and regulations as well as supporting a healthy culture of compliance.

Thinking Like a CNO

A CNO’s POV is going to be shaped by three primary self-interests. First, what is the best interest of the patient? If a negative outcome occurs involving a patient, the CNO may be involved to oversee the matter. Relatedly, a CNO will be thinking about how best to provide leadership to ensure the issue is resolved and that steps are taken to prevent future occurrences.

Second, what is in the best interest of the organization? Here, the CNO’s focus is going to be ensuring the organization is competitive in the market and meeting certain clinical standards. For example, CNOs may implement new nursing strategies or revise existing ones to ensure patients receive high-quality, safe, and efficient care.

Finally, what is in the best interest of the clinical staff? Here, the CNO’s focus is going to be ensuring effective communication and processes exist to support clinical staff in making decisions that impact patient care.

CNO Political Pressures

A CNO’s POV is also going to be shaped by a number of political pressures. While not an all-inclusive list, some of these pressures include:

• The CEO/board and community expecting the CNO to deliver high-quality care to patients.

• The CEO/board and community expecting the CNO to keep patients safe and resolve identified clinical risk concerns involving patient care.

• The CEO/CFO/board expecting the CNO to meet quality standards tied to reimbursement.

• The CEO/board expecting the CNO to successfully pass organizational surveys and inspections tied to quality of care and patient safety.

• The CFO expecting the CNO to meet operational budget goals and do more with less.

• Department leaders expecting the CNO to keep up with the clinical staffing, equipment, and technology resources of the organization’s competitors.

• The physicians expecting the CNO is to resolve workflow concerns involving physicians and clinical staff members.

• The government and the compliance officer expecting the CNO to ensure the organization remains compliant with all laws and regulations.

Positioning Compliance for a CNO’s POV

When it comes to your work as a compliance officer, be thinking about it from the CNO’s perspective, which means there are two areas of focus. First, how does your work impact patients? Second, how does it impact clinical staff? For example, assume you were communicating with the CNO about a new regulatory change affecting operations. What impact will this change have on the communication between staff who are serving the patients? Will new policies and procedures, forms, or checklists need to be developed? Who will be responsible for implementing them? Who needs to be trained on the new changes, and who is responsible for conducting the training? These are just examples of some of the questions you need to anticipate a CNO may ask you as you work together on a compliance matter.

Pulling it All Together

Having an awareness of your CNO’s role and responsibilities, POV, and political pressures will help you understand how best to position a compliance matter for success. To help gain buy-in to your compliance program, develop a strong business relationship with your CNO. As an individual with clinical oversight for the organization, he or she is going to be deeply knowledgeable about clinical processes and procedures. For that reason, CNOs can provide you valuable insight into clinical operations and help enlist clinical staff to support your compliance program activities.

How to Get a Compliance Officer to Think Like a Chief Medical Officer

For the compliance officer, an effective strategy for navigating the politics of healthcare is to think like a healthcare leader. This is true whether you’re consulting to leaders on a proposed business deal, conducting an investigation, or anything in between.

Last week I talked about thinking like a healthcare CFO and how position compliance to someone in a CFO role. This week we’ll take a look at another leader that the compliance officer has to interact with when it comes to physician-related matters—the CMO. We’ll look at CMO’s role and responsibilities, what shapes their point-of-view (POV) and how to position compliance to appeal to a CMO’s POV.

CMO Role and Responsibilities

A CMO has the overall responsibility for ensuring that safe, effective, and high-quality care is delivered to patients by physicians on the medical staff. CMOs are typically physicians who have made a shift from clinical practice to an administrative role, either on a part-time or full-time basis. The CMO is a liaison role between the hospital and various internal and external parties. These parties may include other members of senior management, the board, and community business partners, as well as patients and their families. The CMO represents the hospital but also serves as a spokesperson for the employed or contracted physicians on the medical staff.

While the specific duties of a CMO will vary, they typically involve the following:

• Physician services operational oversight. Overseeing all clinical operations involving physicians on the medical staff.

• Established clinical performance goals. Defining and monitoring clinical performance to ensure goals are met by the medical staff.

• Quality improvement. Overseeing any quality improvement activities involving physicians on the medical staff.

• Policies and procedures. Assisting with policy and procedure development specific to the medical staff (e.g., organizational policies, medical staff bylaws, medical staff rules and regulations).

• Accreditation oversight. Assisting departments or organizations in obtaining and maintaining accreditation (e.g., The Joint Commission, American College of Radiology).

• Financial oversight. Assisting the organization in developing cost-containment strategies that involve the medical staff, in addition to ensuring that quality-based metrics tied to reimbursement are met.

• Strategic planning. Participating in long-range planning of the organization, including decisions related to equipment, budgeting, and physician staffing.

• Education. Facilitating educational offerings to physicians on the medical staff or offerings to the community.

• Resolving identified issues. Assisting with physician-to-physician communication as well as communication with patients and their families to resolve clinical care concerns.

• Organizational compliance. The CMO must ensure the organization is maintaining compliance with all federal, state, and local laws and regulations as well as supporting a healthy culture of compliance.

 In order to carry out these responsibilities, physician leaders like a CMO need to be excellent communicators, adept at conflict resolution. They also need to possess the technical skills to step in and review either a physician’s performance or a department’s clinical processes.

A CMO’s POV

The POV of a CMO is going to be shaped by three primary interests. First, what is in the best interest of the patient? As a medically trained physician, the CMO is predisposed to be thinking about all operational decisions from the perspective of the patient.

Second, what is in the best interest of the organization? Here, the CMO’s focus is ensuring the physicians on the medical staff are following the organization’s policies and procedures as well as all applicable regulatory requirements. Additionally, the CMO will be motivated by fulfilling the organization’s strategic plan by being competitive in the market and providing high-quality care.

Finally, what is in the best interest of the physicians? Given the CMO’s role, all physicians on the medical staff, regardless of specialty, are going to be the CMO’s constituency. The CMO serves as a voice for them as he or she resolves identified issues with the hospital or any external parties (e.g., patient, government agency).

CMO Political Pressures

A CMO’s POV is also going to be shaped by a number of political pressures. While not an all-inclusive list, some of these pressures include:

• The CEO/board and community expecting the CMO to deliver high-quality care to patients.

• The physicians on the medical staff expecting the CMO to fight for what they think is the right.

• The CEO/board expecting the CMO to keep the physicians aligned with policies, directives, and business goals of the organization.

• The CEO/board expecting the CMO to resolve any clinical performance or behavior-related concerns involving physicians on the medical staff.

• The CFO expecting the CMO to meet operational budget goals and do more with less.

• The physicians expecting the CMO to keep up with the clinical staffing, equipment, and technology resources of the organization’s competitors.

• The physicians expecting the CMO to resolve workflow concerns involving physicians and clinical staff members.

• The government and the compliance officer expecting the CMO to ensure the organization remains compliant with all laws and regulations.

Positioning Compliance for a CMO’s POV

When it comes to your work as a compliance officer, be thinking about it from the CMO’s perspective—which is to say, like a physician. Keep in mind that what you are telling the CMO is going to be interpreted from the vantage point of  a physician and how patients are going to be impacted. Any time you have a need to speak with a physician about a compliance matter, it is best to have a CMO, or another appropriate physician leader, involved. In my experience, physicians respond more positively to a compliance message when another physician is involved.

 Pulling it All Together

Having an awareness of your CMO’s role and responsibilities, POV, and political pressures will help you understand how best to position a compliance matter for success. Similar to the other healthcare leaders we’ve covered the past few weeks, you will understand why certain decisions are made and recognize why you are getting pushback. You will also develop a skill to anticipate future questions or decisions from your CMO.

To help gain buy-in to your compliance program, develop a strong business relationship with your CMO. The CMO can be a critical ally for you when addressing identified physician clinical or behavioral concerns impacting the compliance program. Additionally, the CMO can serve as a physician champion to help promote the compliance program to all physicians on the medical staff.

Now, that we’ve climbed into the minds of a healthcare CEO, CFO, and CMO next week we’ll take a look at one last healthcare leader—the Chief Nursing Officer (CNO). 

How to Get a Compliance Officer to Think Like a Healthcare CFO

For the compliance officer, an effective strategy for navigating the politics of healthcare is to think like a healthcare leader. This is true whether you’re consulting to leaders on a proposed business deal, conducting an investigation, or anything in between.

Last week I talked about thinking like a healthcare CEO and how position compliance to someone in a CEO role. This week we’ll take a look at another leader that the compliance officer has to interact with—the healthcare CFO. We’ll look at CFO’s role and responsibilities, what shapes their point-of-view (POV) and how to position compliance to appeal to a CFO’s POV.

CFO’s Role and Responsibilities

As the highest ranking financial official in the organization, the CFO has the overall responsibility of managing the organization’s finances. A CFO oversees the organization’s financial plans, including budgeting, taxation, and developing strategies for boosting revenue. The CFO also ensures that internal controls are in place to manage the organization’s finances in a cost-effective manner. From a staffing perspective, the CFO is responsible for managing the organization’s financial and accounting department personnel. The CFO also serves as spokesperson to the CEO and board related to the organization’s finances.

Some specific CFO responsibilities include the following:

• Financial forecasting and budgeting. CFOs develop and administer operating and capital expenditure budgets as well as manage income and expenses.

• Revenue management. CFOs oversee the organization’s revenue, including strategies for increasing cash flow, billing and claims management, and investment.

• Financial analysis and performance reporting. CFOs routinely report out on the financial performance of the organization, including any strengths and weaknesses.

• Contract negotiation. CFOs help negotiate payment for vendor contracts and reimbursement from contracted payers.

• Funding source obligations. CFOs oversee financial obligations to funding sources (e.g., banks, commercial lenders, tax-exempt issued bonds, donors).

• Tax filings and financial reporting. Whether for profit or not, CFOs ensure the organization is compliant with all applicable tax filings and other reporting obligations.

• Organizational compliance. The CFO must ensure the organization is maintaining compliance with all federal, state, and local laws and regulations as well as supporting a healthy culture of compliance.

In order to carry out these responsibilities, the CFO needs to balance the management of operations against the organization’s finances to ensure it is effectively utilizing resources. As a member of senior management within the organization, the CFO also needs to be adept at communication. Internally, he or she needs to be mindful of what information needs to be shared with others, to whom it needs to be shared, and when it needs to be shared. Externally, the CFO has to manage relationships with several parties such as business partners or competitors, payers, community leaders, government regulators and patients (and their families) to name a few.

A CFO’s POV

Generally speaking, a CFO’s POV will be focused on the organization’s overall financial health. Thinking like a CFO means that you are factoring in financial impact to the organization for any business decision you make. If you’re discussing a compliance matter with a CFO, here are some examples of the types of questions he or she may be thinking of:

• How will this business decision impact the organization’s budget?

• What steps can be taken to mitigate financial risk?

• How does this business decision impact the organization’s contracts with payers?

• How does this business decision impact patient accounts (e.g. refunds or adjustments)?

• If the organization is tax exempt, does this impact the organization’s IRS 990 filing?

 CFO Political Pressures

A CFO’s POV is also going to be shaped by a number of political pressures. While not an all-inclusive list, some of these pressures include:

• The CEO/board expecting CFO to develop and administer a budget that allows the organization to drive a competitive strategy.

• The CEO/board expecting the CFO to control costs and generate revenue.

• Department leaders expecting the CFO to ensure the organization is keeping up with the space, equipment, staffing, and technology of its competitors.

• The CEO/board expecting the CFO to meet identified financial performance goals.

• The CEO expecting the CFO to negotiate favorable reimbursement rates with payers.

• The government and the compliance officer expecting the CFO to ensure the organization remains compliant with all laws and regulations.

Positioning Compliance for a CFO’s POV

When it comes to your work as a compliance officer, be thinking about it from the CFO’s perspective. If you were the CFO and listening to me, the compliance officer, what information would you want to know? For example, if you’re conducting an investigation involving an identified billing error, the CFO is going to be asking questions about the financial component of the investigation. More specifically, how many patient accounts are involved? What payers need to be refunded? Does this billing error impact any cost-sharing amounts paid by the patient that also need to be refunded? Does this matter create a cost-reporting error that also needs to be corrected? And of course, similar to the CEO, the CFO is going to want to know what circumstances led to the error and what steps are being taken to correct it going forward.

Similar to comments I made last week about the CEO, when discussing a compliance matter with a CFO, always be mindful of potential internal reporting obligations. More specifically, if you’re addressing a compliance matter of medium to high risk to the organization, the CFO may be duty-bound to report the matter to the CEO or the board.

Pulling it all Together

Having an awareness of your CFO’s role and responsibilities, POV, and political pressures will help you understand how best to position a compliance matter for success. Similar to the CEO, you will understand why certain decisions are made and recognize why you are getting pushback. You will also develop a skill to anticipate future questions or decisions from your CFO.

As a parting tip, to help gain buy-in to your compliance program, develop a strong business relationship with your CFO. As an individual with oversight of the financial operations of the organization, the CFO can enlist support from his or her staff to assist with investigations or audits (e.g., generate claims reports, accounts receivable or accounts payable information, payer data).

Now, that we’ve climbed into the minds of a healthcare CEO and CFO, next week we’ll take a look at another healthcare leader—the Chief Medical Officer (CMO).

How to Get a Compliance Officer to Think Like a Healthcare CEO

For the compliance officer, an effective strategy for navigating the politics of healthcare is to think like a healthcare leader. This is true whether you’re consulting to leaders on a proposed business deal, conducting an investigation, or anything in between.

Last week I talked generally about how to think like a healthcare leader. This week we’ll piggyback off that discussion by focusing on one leader—a healthcare CEO. We’ll take a look at the CEO’s role and responsibilities, what shapes their point-of-view (POV) and how to position compliance to appeal to a CEO’s POV.

CEO Role and Responsibilities

As the highest-level healthcare administrator, the CEO has the overall responsibility for the organization’s day-to-day operations and fulfilling its strategic vision. CEO positions are often filled by individuals possessing business backgrounds; however, there has been an increasing trend of CEOs possessing a clinical background too (e.g., an MD or RN). While the exact CEO responsibilities will vary by organization, they likely will include the following:

• Organizational vision. The CEO must have a vision for the organization’s future, such as an identified market presence or access to high-quality healthcare.

• Strategic planning. The CEO must have an identified roadmap of future goals and objectives for achieving the organizational vision.

• Maintaining financial stability. The CEO needs to ensure the organization maintains financial health and stability. If the organization is a tax-exempt organization, there are additional responsibilities for ensuring it is meeting its charitable mission.

• Recruitment. The CEO must ensure the organization has the physicians and other clinical staff to meet the needs of providing services to the community.

• Patient safety. The CEO must ensure patients are cared for safely through established safety measures.

• Promoting high-quality healthcare. The CEO must be committed to improving the quality of healthcare provided to the organization’s patients.

• Patient satisfaction. The CEO must ensure the organization is meeting established patient satisfaction benchmarks.

• Organizational compliance. The CEO must ensure the organization is maintaining compliance with all federal, state, and local laws and regulations, and maintaining a healthy culture of compliance.

In order to carry out these responsibilities, the CEO needs to fulfill several different roles. First and foremost, the CEO is a business leader. He or she must balance the management of operations against the organization’s finances to ensure it is effectively utilizing resources. CEOs of organizations providing patient care must additionally manage the added pressure of competition from other market participants.

The CEO must also fill the role of politician. They continually have to manage communications and relationships. Since CEOs are responsible for overseeing a number of different operations, akin to those of a small town, the CEO is the face of this community, much like a mayor is for a city. That requires being adept at knowing what information needs to be shared with constituents and when it needs to be shared. Externally, the CEO has to manage relationships with several parties, such as business partners (e.g., physicians), business competitors, government regulators, community leaders, patients (and their families), and the media. Given the demands in managing all these relationships, they must be skilled in communication and conflict resolution. When it comes to a day in the life of a CEO, their schedules are typically packed from early morning meetings to business dinners lasting well into the evening.

A CEO’s POV

A CEO’s POV is going to be shaped by fulfilling the organization’s identified objectives that support the overall strategic plan approved by the board. With that said, many of the decisions a CEO has to make can be traced to one of three self-interests. First, what is in the best interest of the patient? That is true whether the matter is starting a new service line, resolving a complaint, or terminating a physician from the medical staff. Second, what is in the best interest of the organization? Whether it’s a business decision of the CEO or any of his or her direct reports, CEOs are motivated by the ones that result in the least amount of legal, financial, or reputational risk. Finally, the CEOs are motivated by acting in the best interests of their own careers. I’m not saying that to be judgmental, but rather, as a matter of fact. We’re all motivated to act in the best interest of our careers. As part of the organization’s strategic plan and objectives, the board will be evaluating the CEO on how he or she is performing based on criteria set by the board.

A CEO’s Political Pressures

A CEO’s POV is also going to be shared by a number of political pressures. While not an all-inclusive list, some of these pressures include:

• The community expecting the CEO to deliver high-quality, low cost patient care services.

• The board expecting the CEO to do more with fewer resources.

• The department leaders expecting the CEO to provide more resources.

• The physicians expecting the CEO to increase their compensation and have more control over clinical decisions.

• The employees expecting the CEO to be a great leader (inspiring and visionary).

• The community leaders expecting the CEO to be an active participant who is contributing to the community.

• The board expecting the CEO to be competitive in the market.

• The government and the compliance officer expecting the CEO to ensure the organization remains compliant with all laws and regulations.

As you approach your work as a compliance officer, it is important to keep these political pressures in mind as they may provide you with “the why” behind the decisions he or she is making.

Positioning Compliance for a CEO’s POV

When it comes to your work as a compliance officer, you should be thinking about it from the CEO’s perspective. If you were in his or her shoes, what information would you want to know? For example, let’s say you identified a potential breach of one thousand patient records. As the CEO you’re going to want to know the details of what happened and how this issue was discovered. You also want to know the risk involved with a breach (e.g., financial and reputational). Finally, you want to know what steps the compliance officer is taking to correct the issue and prevent a future occurrence.

Keep in mind that depending upon the nature of the issue, the CEO may be duty-bound to report the matter to the board, so consider his or her perspective in carrying out that responsibility. As a general rule, the level of detailed information you need to provide the CEO should match the level of risk involved. For example, if you’re addressing a six-figure overpayment to Medicaid, a high level of detail is needed; if it’s a small refund involving a few claims, an overview or summary will do.

Pulling it all Together.

Having an awareness of your CEO’s role and responsibilities, POV, and political pressures will help you understand how best to position a compliance matter for success. You will understand why certain decisions are made, recognize why you are getting pushback, and have the ability to anticipate future decisions. It will also help you in successfully navigating the politics of healthcare to gain buy-in to your compliance program.

Now, that we’ve climbed into the mind of a healthcare CEO, next week we’ll take a look at another healthcare leader-the CFO.

How to Get a Compliance Officer to Think Like a Healthcare Leader

Assume for a moment you’re not a compliance officer. You’re the chief executive officer (CEO) of ABC Hospital, and you’re looking to expand the hospital’s service line. During a recent strategic planning meeting, your chief operating officer (COO) pitches an idea: “What if we partnered with a XYZ Cardiology, P.C. (XYZ)  to open a new clinic focused on vascular services?” The idea piques your interest. With the assistance of legal counsel, you move forward. You negotiate and sign compliant agreements with XYZ and set a go-live date.

During your most recent meeting with the cardiologists, there was discussion about a need to market this new venture and who would pay for it. The physicians are asking the hospital to bear the costs of marketing because the new clinic is going to be located on the hospital’s campus. You email your compliance officer to ask if the hospital can pay for these expenses since the physicians will be benefiting from the marketing. Your compliance officer responds by saying no. She doesn’t offer an explanation. She doesn’t ask any questions about the venture or the marketing campaign. She doesn’t even offer an alternative option.

If you were this CEO, would you feel supported?

A consistent theme in all of the strategies I will cover in this blog is being mindful of your audience. This is particularly important when it comes to healthcare leaders. That means at times, you need to be thinking like a healthcare leader—not a compliance officer.

That means listening to what they’re telling you, and approaching your work with consideration of their viewpoint, not yours. If you are a leader, what obstacles or challenges do you face? What motivates you in the performance of your role? What political pressures do you face? These are just some of the questions you need to be thinking about when communicating with your healthcare leaders about compliance matters.

Always be Identifying Their Point of View

A significant step toward thinking like a healthcare leader is identifying their point of view (POV). While POV is specific to a leader’s role, personality, and the issue being addressed, there are some POVs that apply to most healthcare leaders. For example, consider the topic of change—I mean from an evolutionary standpoint, not a monetary one. Healthcare at a very basic level is a service industry. Considering that a leader’s role and objectives are to move the organization forward, leaders must continually embrace change in order to succeed. As a consequence, implementing newer, faster, or better ways to deliver healthcare will always be a factor in the mind of your healthcare leaders. As the compliance officer, you have to accept that leaders will always be pushing for change.

Another universally held POV is determining what is in the best interest of the patient. With any business decision a healthcare leader makes, that question floats across the brain. Overall, this POV is focused on what is safe and of high quality yet practical and efficient.

A final example of a universal POV among healthcare leaders is determining what is in the best interest of the organization. Here, this POV is focused on ensuring the organization is moving forward within the market while protecting it from financial, legal, and reputational risk.

Pulling it All Together

Having an awareness for how your leaders think will help you in navigating the politics of healthcare. You will understand why certain decisions are made, recognize why you are getting pushback, and have the ability to anticipate future decisions. In order to think like a healthcare leader, we need to climb into their minds. 

Over the course of the next few weeks, we’ll take a look at several different types of healthcare leaders in a typical healthcare organization providing patient care. We’ll look what shapes their POV, some of their political pressures, and how to position compliance to appeal to their particular POV.

How to Manage Your Interactions with the Usual Suspects of Office Politics

No matter what organization you work for, you will have what I like to call the “Usual Suspects of Office Politics.” Generally speaking, these folks like to engage in various forms of destructive politics that I mentioned in my article related to developing a neutral political strategy.

Since our political strategy is focused on remaining neutral in the organization, you need to know how to manage your interactions with these folks. If you don’t, you may unwittingly end up an accomplice to their cause. When that happens, you jeopardize your ability to effectively navigate the politics of healthcare.

So, let’s take a look at this cast of characters, so you know what to look out for and how to manage them.

The Gossiper

Starting with the most obvious, we have The Gossiper. This person seems to know everything about everyone and takes great pleasure in telling you about it. The Gossiper lacks discretion or a filter. Since their conduct can be destructive in an organization, it is best to identify The Gossiper, be mindful of their motives, and not enable their behavior.

The best way to manage your interactions with The Gossiper is to keep your conversations limited to business, thereby cutting off a potential food source for this individual.

The Toady

Call it what you will (“fawning,” “brown-nosing,” “bootlicking”), The Toady likes to flatter people with compliments, especially those with a superior position in the organization. The problem with The Toady is that the comments aren’t genuine. They’re purely for personal gain. When it comes to The Toady, the good news is that the disingenuous behavior is easy to detect and obvious to everyone. Everyone except The Toady, of course.

The best way to manage your interactions with The Toady is to be aware of their ulterior motive and identify the why behind the flattery. What advantage is this person trying to gain? Be cautious about how much credibility to give them. For the most part, let The Toady do their toady thing. Most healthcare leaders know when someone is being fake.

The Saboteur

Next, we have The Saboteur. Arguably on the other end of the spectrum from The Toady, this person’s objective is not to compliment for personal gain, but rather disrupt for personal gain. This individual thrives off being critical of others, especially in public settings, like a meeting or conference call. The Saboteur can also have passive-aggressive tendencies such as forwarding your email onto others without your knowledge, or replying to your email, along with a laundry list of others, including your supervisor. If throwing people under the bus were an Olympic sport, this person would be a gold medalist—every time.

The best way to manage The Saboteur is to be cautious when communicating with this individual. And think at least two steps ahead. For example, if you send The Saboteur an email, expect that it will get forwarded to others. Thinking ahead will ensure your communication is professional and defendable. Also, keep your focus on the matter being addressed, and not the individual. If you allow The Saboteur to see your frustration, he or she will seize the moment to use it against you.

 The Debater

The Debater loves nothing more in life than playing devil’s advocate. They typically are argumentative and quick on their feet. They’re also not afraid to twist facts to fit their agenda. The Debater is also one you need to be cautious with in your communications. Dialogue in a meeting that is productive to the group’s objective is healthy and should be encouraged. Where you can get into trouble is when debate becomes about the other person and not the group’s objective. The Debater loves to provoke others, so be cautious not to take the bait. Make sure the points you are making are about the group’s objective, not The Debater.

The best way to manage The Debater is to give them space; allow them to be heard. That said, to avoid a conversation spiraling into a never-ending argument, acknowledge and validate their point. Then maintain your focus on accomplishing the goal of the discussion.

 The Credit Poacher

One of my personal favorites is The Credit Poacher. Another disingenuous type, this individual will do whatever it takes to get ahead in the organization, even if it means stealing some ideas and the work of others and passing it off as his or her own.

The best way to manage The Credit Poacher is to be aware of their presence and share your ideas and work product publicly whenever possible. You can also frequently update your supervisor so he or she knows who should be getting credit for the work. If you feel there is a legitimate need to call out The Credit Poacher, the best way to do so is to discuss the matter confidentially with the appropriate leader instead of in a public setting.

The Delegator

Next up is The Delegator. To be clear, the person I’m referring to here is not your supervisor, who of course is empowered to delegate tasks to you. Instead, this particular individual delegates tasks they are not in a position to delegate. Sometimes you’ll see this surface when you volunteer a thought or idea, but rather than your supervisor or a project leader delegating a task to you, someone else on the team does. The Delegator tends to believe the act of delegation is a demonstration of power. The only problem is The Delegator doesn’t actually have the power.

The best way to manage The Delegator is to make sure the task being delegated is within the scope of your role in the organization. If it is, then the request is legitimate and you need to be a business partner by following up on the task. If it is not, then you need to communicate what tasks fall within your role. Regardless of circumstance, if you have a concern about others inappropriately delegating, it is best to confidentially communicate those concerns to the appropriate leader to address with the employee.

 The Advisor

Saving the best for last, we come to The Advisor. Now, unlike all the other characters mentioned above, The Advisor tends be engaged in productive politics. This particular individual is one to whom other healthcare leaders in your organization turn for assistance. They tend to maintain a lot of influence in the organization and have an awareness of what is going on. For that reason, The Advisor can be an asset to you and not a liability.

The best way to manage your interactions with The Advisor is to align with this individual. These folks tend to hold informal power in the organization, which can help you in advancing the compliance program’s agenda when you need leverage or support.

Pulling it All Together

Whether you are involved in a conference call, a meeting, a hallway discussion—or my personal favorite, the meeting after the meeting—pay attention to your surroundings. Pay attention to what’s being said, how it is being said, and who is saying it. These are continual opportunities to observe a wealth of information orienting you to the political landscape around you.

Now that we’ve talked about the various elements of the political landscape around you, next week we will begin talking through another strategy for navigating the politics of healthcare—thinking like a healthcare leader.

How to Develop and Maintain Political Awareness

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As healthcare industry workers, we all have our own sets of needs and emotions that drive our decisions and communications with others. Oftentimes the politics of healthcare sneaks in when there are differences of opinion or personality. For that reason, another element to understanding your political landscape is developing and maintaining what I like to call “political awareness.” Being politically aware means you’re mindful of the self-interests around you as you work on a compliance matter. This week, we’re going to take a look at two main elements of political awareness:

(1) Being Observant of the Relationships around You; and

(2) Identifying Formal and Informal Power.

Being Observant of the Relationships around You

When it comes to starting a new job, I tend to think of those first few months as similar to walking into a social gathering for the first time. When you first walk in, you’re not quite oriented to your surroundings. You don’t fully realize that some of the individuals around you are people you actually know. It just feels like a room full of strangers. At some point, though, mysteriously, you do orient to your surroundings and gain a sense of who is around you. Orienting to an organization feels very similar. At first your coworkers appear to be a group of strangers, but over time you’ll get to know them, their roles in the organization, and their backgrounds.

When you are politically aware, it will feel like you have hit the point when you know everyone in the room. You start to notice working relationships of those around you—things like which employees are a little testy with one another. You know, maybe John and Rebecca applied for the same lab director position; John got passed over and now reports to Rebecca. And John doesn’t like it. If you asked Rebecca, I’m sure she isn’t too thrilled about it either.

You may also notice which employees are a little chummy with one another. I once worked with a couple of department directors who always, and I mean always, had lunch together. They would sit next to each other during meetings, and every time there was a work event, there they were, side-by-side. Eventually, I learned they were neighbors and both had kids who went to the same school.

Whether it is a power struggle or a closely held alignment, be observant of the relationships around you. It will become valuable information for how you approach your work when it comes to things like conducting investigations. For example, if you are investigating a matter involving two people with a contentious relationship, it will factor into the credibility weight you give to their opinions about the matter or each other.

To be more obervant of the relationships around you, consider asking yourself the following questions:

• Who gets along with others?

• Who doesn’t get along with others?

• Who is involved in conflict?

• Who is a part of a group, clique, or social network in the organization?

• Which staff members seem competitive?

• Which staff members seem jealous?

• Who is respected in a department or across the organization?

Identify Formal and Informal Power

Recall back to my earlier article “Why is Healthcare Political?”where I mentioned that you will have individuals in your organization who hold formal and informal power. Another example of being politically aware is figuring out who holds these types of power.

In terms of formal power, where do certain individuals rank in comparison to others on the organizational chart? That becomes key information when determining who to pursue for support on a compliance matter.

In the context of informal power, your focus is on who in the organization has the position or ability to influence the decisions of others. It’s not always the case that it’s the person with the higher rank in the organization. A lot of work in a corporate setting is based on the groupthink model. For example, a CEO may pull a committee of individuals together with the intent of having them provide their input to help the CEO shape his or her business decisions. As you attend operational meetings, you’ll start to pick up on who has a strong opinion about a particular issue and whom the CEO relies upon in making decisions.

Informal power isn’t limited to those who influence the CEO. Across the organization, you will find that other executives, senior managers, department directors, and supervisors value the opinions of certain employees in the organization. Identifying who holds informal power becomes valuable intel during times when you need support for the compliance program’s agenda. Just keep in mind that obtaining this knowledge takes months, sometimes years as you live with the organization.

To help identify formal and informal power in your organization, consider asking yourself the following questions:

• Who holds formal power in a department and across the organization?

• Who has the most influence on decisions being made in a department and across the organization?

• Who has authority in a department and across the organization but doesn’t act on it?

• Who is respected in a department and across the organization?

• Who holds others accountable in a department and across the organization?

• Who mentors others?

Pulling it All Together

Having a sense of the political landscape around you is a key strategy for navigating the politics of healthcare. This information will be invaluable to you for several reasons. First, you will be a more informed compliance officer. This improves your ability to find solutions that accommodate your organization’s business and compliance program agenda. Second, you will better understand the why behind the decisions made in the organization. Finally, you will be in a better position to predict the political objections from your leaders and proactively address them.

Now that we’ve covered being observant to relationships around you and identifying formal and informal power, next week I’ll cover a third element, which is my personal favorite—the usual suspects of office politics.

Understanding your Political Landscape—Identifying Key Players

Last week I introduced a concept of understanding the political landscape around you in order to successfully navigate the politics of healthcare. (Note: If you missed the discussion last week, you can find it here.) This week, I’m going to focus on another element of your political landscape—key players.

For purposes of discussion, I generically define “key players” as participants in your organization’s market who shape how healthcare services are delivered in that market. More specifically, a key player could be another healthcare provider who is a business partner or competitor of your organization. For example, let’s say you are the compliance officer for XYZ Orthopedics, P.C. (XYZ). A key player could be the local hospitals that XYZ is contracted with to provide orthopedic services, or even other competing physician practices. A key player could also be the payers that XYZ is contracted with as a network provider.

Similar to identifying key leaders, you will have to define a “key player” for yourself based on your surroundings. Since defining a key player is subjective in nature, let’s take a look at some objective ways to go about approaching this endeavor.

Identifying Key Players.

At the outset, note that identifying key players is a fluid process you’ll engage in throughout your time with the organization. That is because people move onto new positions and new key players come into the picture. Additionally, as your organization evolves, service lines change and business relationships with other market participants also change. That said, some basic questions you can research to help identify your key players include:

• Which organizations are business partners to your organization?

• Which organizations are competitors in your market?

• Who are the key physicians in your market?

• Who are other key healthcare professionals in your market?

• Which payers have a presence in your market, and which ones are contracted with your organization?

• Who are the legislators in your market (federal and state)?

• Which legislators control healthcare legislation?

• Who are your community leaders (e.g., mayor, city council, planning committee)?

• Which government health programs operate in your market?

Why Identifying your Key Players is Important?

Knowing who your key players are is important for a couple reasons. First, identifying key players increases your peripheral vision of your organization and its operations. More specifically, it helps identify external pressure points that may be motivating the business decisions of your key leaders.

Additionally, having this knowledge can help you anticipate compliance-related questions or concerns your leaders may be raising related to their business decisions. This puts you in a better position to proactively develop a solution to address them.

Finally, having this information expands your knowledge of your organization’s market. This knowledge helps you establish rapport with your leaders and develop a stronger business relationship with them.

Pulling it All Together.

Similar to identifying the key leaders in your organization, knowing who the key players are outside the organization is a crucial element of understanding the political landscape around you. Once you have identified the key players in your market, you need to continually be mindful of the relationships these individuals have with your organization as you are working on newly identified compliance matters. Taking this approach will cause your leaders to see you more like a business partner, and less like an obstacle, which helps you in navigating the politics of healthcare.

Now that we have covered key leaders and key players, next week, we’ll cover another crucial component of your political landscape—developing and maintaining a sense of political awareness.

Understanding Your Political Landscape—Key Leaders

When it comes to navigating the politics of healthcare, your starting point is understanding the political landscape around you. This is true whether you are joining a new-to-you organization or encountering a new leader, department, or issue for the first time at an existing organization.

If you are new to an organization, orienting to the political landscape can easily run simultaneously with onboarding to your new role. Similarly, if you are encountering a new department, leader, or issue for the first time, understanding the political landscape should be included as part of your overall research plan. Regardless of circumstance, your approach will include one or more of the following components:

(1) Identifying key leaders in the organization;

(2) Identifying key players in your market; and

(3) Developing and maintaining political awareness.

Over the course of the next few weeks, we’ll take a look at each of these in more detail, starting with identifying the key leaders in your organization.

Identifying Key Leaders in the Organization

When it comes to starting a new job, I tend to think of those first few months as similar to walking into a social gathering for the first time. When you first walk in, you’re not quite oriented to your surroundings. You don’t fully realize that some of the individuals around you are people you actually know. It just feels like a room full of strangers. At some point, though, mysteriously, you do orient to your surroundings and gain a sense of who is around you. Orienting to an organization feels very similar. At first your coworkers appear to be a group of strangers, but over time you’ll get to know them, their roles in the organization, and their backgrounds.

Who is a “Key Leader”?

For purposes of discussion, I broadly define a “key leader” to be anyone making business decisions for the organization with whom you routinely work. A key leader could be a member of your C-suite, a medical director, or another clinical leader. It could also be a department director, manager, or supervisor. “Key leaders” will be a term you will have to define for yourself.

If you are new to an organization, I strongly encourage you to identify your key leaders shortly after your first day on the job. If the opportunity doesn’t present itself organically, then initiate a discussion with your supervisor to identify these individuals.

The Meet and Greet.

Once you have identified your key leaders, the next step is setting up a meet and greet with each one on your list. Meet and greets have several benefits as they relate to understanding your political landscape. First, you gain an understanding of the key leader’s role in the organization. Whom does this leader report to? Which departments or personnel does he or she oversee? Which departments interact with this leader’s department? This information becomes invaluable when you need to leverage a leader’s support to fulfill a compliance program need. For example, if the leader has staff who haven’t completed mandatory training, establishing a connection with the leader can make it easier to ask for assistance in ensuring the employees complete their training.

Another benefit to these meetings is that you find out how the leader operates. You get a sense of their personality, management style, and work ethic. Additionally, you can pick up any behavioral characteristics, such as communication style (e.g., a direct or indirect communicator). This can be a beneficial insight when trying to figure out how best to communicate with the leader going forward.

Finally, these meetings can also be your entry point into developing political awareness, a topic will come back to in a couple weeks. For now, note that when you set up a meet and greet, the discussion can segue into a particular topic. If it does, you may start to see some of the leader’s political self-interests come out. For example, maybe he or she will express a strong opinion about compliance risk involving an organizational process that hasn’t been resolved.

While much of the above discussion is in the context of being new to an organization, meet and greets are also effective when you’ve been with an organization for some time. Inevitably, as you are working on an investigation or other compliance matter, you will encounter a new leader or department for the first time. When you do, you can always take time to set up a meet and greet with a new-to-you leader.

Pulling it All Together.

Taking the time to identify the key leaders in your organization is your starting point to understanding the political landscape around you. The more you build connections with the key leaders, the more you will come to understand how they think and operate. This will become valuable insight as you move forward in the approach of your compliance work.

Now that we’ve covered identifying key leaders, next week we will look outside the four walls of the organization by looking at who are the key players in your market.

The Tale of Two Agendas

For any healthcare organization, there are two agendas: the business agenda and the compliance program agenda. As the compliance officer, you will find that these two agendas serve as the platforms supporting the political games played around you.

The organization’s business agenda relates to the operational and financial goals of the organization. For example, what new service lines do we want to capture in our market? What does our patient volume look like? What percentage of insurance denials are we successfully overturning? These are just some of the potential aspects of an organization’s business agenda. If the organization provides care to patients, then providing high-quality and safe care is also part of that agenda. The organization’s business agenda lies in the background of many, if not all, of the decisions that healthcare leaders make every day. For that reason, many political games played by healthcare workers relate to advancing this agenda.

Separate from an organization’s business agenda is the compliance program’s agenda. Generally speaking, ensuring the organization and its workforce remain in compliance with all federal, state, and local laws and regulations is the compliance program’s agenda. More specifically, conducting investigations in response to identified issues is part of that agenda. Advising healthcare leaders regarding proposed business deals is part of that agenda. And promoting an organizational culture of compliance that encourages ethical conduct is part of that agenda. While not an all-inclusive list, these are representative of activities that support the organization’s compliance program agenda.

There are times when these agendas are aligned. For example, if an employee has breached a patient’s PHI, such an incident impacts both agendas. On the business side, there is potential reputational risk, as patients tend to lose trust in organizations that can’t handle their health information. If the breach is large enough, the organization is required to notify local media. A breach can also cause financial risk to the organization in the form of lost revenue as well as fines or penalties associated with a government investigation. Therefore, it is in the best interest of the organization’s business agenda to diligently address the issue. For compliance departments that oversee privacy investigations, it would also be in the best interest of the department’s agenda to respond to the matter. With any PHI incident, there is the potential for a  government investigation to be triggered. If that happens, the government’s focus is going to be not only determining what happened, but also how the organization responded from an investigation standpoint. To that end, both agendas are aligned to ensure the organization responds appropriately.

There also may be times when these agendas conflict. For example, let’s say you work for ABC organization (ABC), who is seeking to do business with another healthcare provider, XYZ, P.C. (XYZ). The proposal is for XYZ offer a new physician service to ABC’s patients. In this scenario ABC is in a position to potentially increase revenue and its reputation in the community. That would advance ABC’s business agenda. If, however, XYZ is promising to inappropriately compensate ABC for Medicare or Medicaid referrals, that creates potential fraud and abuse concerns. That conduct would not support the ABC compliance program’s agenda. If ABC’s leadership just wants to do the deal and not muddy the waters by addressing the potential concerns, these two agendas are not going to be aligned. When that happens, a political battle now comes into play.

So how do you keep these agendas aligned?

Know the Business Side of Your Organization. Take time to know your organization’s business agenda. That means understanding the services offered, and your organization’s market (e.g., business partners and competitors). It also means understanding the strategic plan that has been set by the CEO and Board, Having this knowledge will help you relate to your healthcare leaders, understand the why behind the decisions they make, and anticipate questions they may be asking you.

Explain “the Why”. Another way to keep the agendas aligned is to explain the why behind your answers. If you are telling a leader “no” to a item on their business agenda, follow-up by explaining why the answer is “no.” Leaders are not as close to the regulations as you are, so you need to take the extra time needed to explain answers to them in order to help them better understand what they can and cannot do.

Treat Your Role as a Business Partner and Not an Obstacle. During times when you need to keep the agendas aligned, treat your role as a business partner and not an obstacle. That means striving to find solutions that will support both agendas instead of pointing out deficiencies with no recommended alternatives to maintain compliance. For example, if a leader comes to you seeking guidance related to a proposed business initiative and you have identified a compliance concern, you don’t want to respond by just saying “No”. Instead, respond with a proposed alternative by saying “No we can’t do it that way, but what if we did it this way…”

Another way to keep these agendas aligned and navigate the politics of healthcare is to understand the political landscape around you. Over the course of the next few articles, we will take a look into how to do just that.

How to Develop a Neutral Political Strategy in Your Organization

So where does compliance fit into the politics of healthcare?

I think of compliance officers in an organization to be similar to Switzerland. For many centuries, Switzerland has held to a policy of armed neutrality when it comes to global affairs. Like Switzerland, compliance officers have to have a similar approach in how they interact with others in the organization. Put another way, we have to develop a neutral political strategy. That means being independent and objective (i.e., nonjudgmental) in how you approach your work. That also means treating everyone, across the organization, with the same level of respect.

So, how do you develop a neutral political strategy?

Generally speaking, a neutral political strategy is one that is rooted in productive politics, not destructive ones. Productive politics are actions and words intended to promote the organization, regardless of who personally benefits. Destructive politics, on the other hand, are actions and words intended to solely promote oneself.

To help illustrate the difference, let’s say you witness a fellow compliance officer make a mistake on an investigation. For discussion sake, let’s say your colleague didn’t interview a key witness to the investigation. Destructive politics might look like reporting the mistake to colleague’s supervisor without his or her knowledge. Productive politics, on the other hand, would look like alerting the colleague to the mistake and offering insights into how it could be corrected. For example, you might suggest he or she interview the key witness and why it is important to do so.

Some additional examples of destructive and productive politics include the following…

Destructive Politics:

• Gossiping and spreading rumors at someone else’s expense.

• Taking credit for someone else’s work.

• Focusing on the person and not the issue.

• Forming alliances against colleagues with bad intent.

Productive Politics:

• Limiting discussion to the business of the organization.

• Transparently recognizing the work of others.

• Focusing on the issue and not the person.

• Forming alliances with colleagues with good intent.

In order to maintain a neutral political strategy focused on productive politics, you need underlying strategies that support that position. For example, you need to understand the political landscape around you. You also need to build strong relationships with others in the organization. Finally, you need to know how to communicate in a way that is respectful of others, yet allows you to influence them and resolve conflict. All of these underlying strategies, and more, will be covered down the road in this blog.

For now, let me leave you with three takeaways for each of the underlying strategies mentioned above…

#1-Understanding the Political Landscape Around You. Identify and be mindful of who in the organization has formal power and who has informal power. Also, identify who gets along and who doesn’t get along. This becomes valuable information for knowing who supports the compliance program and who does not.

#2-Building Strong Relationships with your Healthcare Leaders. Establish rapport with your healthcare leaders by getting to know who they are and nuts and bolts of their operations. If you want to operate an effective compliance program and obtain leadership buy-in, you have to put in the time and effort to build these relationships. That means taking an active interest in them.

#3-Using Diplomacy to Communicate and Resolve Conflict. When communicating, always be mindful of who your audience is, and their point-of-view based on their role. At times this requires thinking like a healthcare leader and not a compliance officer.

When it comes to the politics of healthcare, many of struggles that we face can be traced back to one of two agendas in the organization. The first one is the organization’s business agenda and the second is the organization’s compliance program agenda.

What factors into these agendas and how do you get them to align? Stay tuned and we’ll cover that topic next time.

Why is Healthcare Political?

So why is healthcare political?

Like any industry, healthcare organizations are run by human beings. As humans, we all show up for work with our own set of opinions, emotions, and self-interests. We are also social creatures who develop and maintain relationships. These relationships become complex—and therefore political—when we are put in a position to compete with each other for time, attention, and limited resources.

For example, let’s say a group of orthopedic physicians want more control over a hospital’s orthopedic service line. They want an increased ability to make operational decisions in how care is provided. Oh, and they also want a larger portion of the reimbursement from payers. A political game these docs might play would be to lobby the hospital CEO to partner with them in building a new facility together. If negotiations fail, their backup position may be threatening to compete with the hospital if their demands are not met.

Healthcare is also political because of individual goals (personal or professional). Throughout the organization, operational decisions are made as a result of advancing someone’s goals. Finally, the business of healthcare, like other industries, is political because of power, either of those who hold the power to make decisions or those who hold the power to influence those who make decisions. For example, a CEO sitting atop the organizational chart is going to hold more power than others in the organization to make decisions. That’s formal power. Separately, there may be others in the organization, such as a vice president, a department director, or even the administrative assistant, who have the ability to influence the CEO in making decisions. That’s informal power.

Driven by promoting their own self-interests, healthcare workers find ways to align themselves with others who hold power in the organization (formally or informally). They’ll hold secret meetings to discuss and negotiate deals, just like politicians in Washington, D.C. Whether it is senior management, physicians, employees, or patients, each group has a viewpoint on how the organization should conduct its business.

If you want to navigate the politics of healthcare successfully, always be mindful of who holds formal and informal power within your organization as you are working on any compliance matter.

Something I didn’t realize when I started in this line of work is that the most difficult part of the job is navigating the politics of healthcare. That is not to say there aren’t challenging times involved with conducting investigations or understanding the regulations. Figuring out how to effectively communicate with others though, in my opinion, requires a lot more mental energy. It is the politics, not the work of a compliance officer, that will force you to wrestle with questions like:

• “Should I raise this concern in this meeting or say something after the meeting?”

• “Who in the organization needs to know that I am working on _____?”

• “When do I need to tell others about _____?”

• “If I tell my primary audience about _____, will it get repeated to others without my knowledge?”

As we move forward, I will talk through some tips and key strategies that will help you with navigating these kinds of questions in order to operate a more effective compliance program.

So where does compliance fit into the politics of healthcare?

Stay tuned and we’ll cover that topic in the next article, along with how to develop a political strategy rooted in productive politics.

Navigating the Politics of Healthcare-An Introduction

From scheduling patients to care delivery to reimbursement, healthcare is an industry functioning on a daily basis under a mountain of Federal, state, and local regulations in the United States. To help navigate this mountain, many healthcare organizations have adopted corporate compliance programs (compliance programs) based on guidance from the Federal government.[1] A key element to the operation of a compliance program is the appointment of a compliance officer.

A common reality to the compliance officer profession is the fact that the business of healthcare is political. To be clear, when I say the business of healthcare is political, I’m not referring to the politicization of healthcare (i.e., healthcare being argued as a right or privilege). I am talking about the industry’s business environment. More specifically, the individuals working inside the industry and their various self-interests.  

As we will explore in this new blog series, there are a number of key individuals a compliance officer has to work with on a daily basis. These individuals include healthcare executives, physicians, administrative and clinical workers, government agencies, third-party contractors, as well as patients and their families.

As with any self-interest, there will be times when they align with the organization’s compliance program, and times when, well…they will not. If you have ever advised a leader not to engage in certain conduct, only to find out he or she did it anyway, then you know what I mean.

When I think back on my life before my career, I had no idea there was a whole other world that existed in healthcare unknown to the general public. A world where physicians fight with each other over patients. A world where hospitals fight with physicians over compensation. A world where healthcare workers fight with each other over workflow issues impacting patient care. And a world where everyone is fighting the government over increasing bureaucracy and decreasing reimbursement.

It is this “other world” where you find the politics of healthcare alive, impacting how care is delivered. For you, the compliance officer, it impacts how you operate the compliance program. More specifically, it affects how you advise healthcare leaders on proposed business deals. It affects how you educate staff on regulatory or policy requirements. It affects how you conduct investigations, perform audits, and implement corrective action. There is no element of a compliance program immune to the politics of healthcare.

Going forward, I will discuss some strategies and insights to help the compliance officer navigate these self-interests and become more politically adept in the organization. While not a compliance program element per se, becoming politically adept, will help you carry out each of the seven elements more effectively.

So why is healthcare political?

Stay tuned and we’ll cover that topic in the next article.

[1] See “An Open Letter To Health Care Providers”, June Gibbs Brown, Inspector General, February 1997. See also, Office of Inspector General, Compliance Guidance, https://oig.hhs.gov/compliance/compliance-guidance/index.asp

[2] See Sections 6102 and 6401 of the Patient Protection and Affordable Care Act of 2010 (Pub. L 111-152).