As compliance officers, we are continually placed in a position to influence the actions of others and shape our organization’s culture of compliance. Unfortunately, with a title like “compliance officer,” we have an image issue to overcome which makes our job that much harder. Before we even have a chance to say a word, healthcare leaders often see us a grown-up version of a hall monitor.
One way to change this perception is to avoid creating what I like to call “gotcha moments”.
In this article, I’ll define gotcha moments and take a look at how they can negatively affect your ability to influence the actions of others. I’ll also provide some strategies to help you in changing the perception of compliance so that you can successfully navigate your compliance program through the politics of healthcare.
What are Gotcha Moments?
For purposes of this discussion, a gotcha moment means trying expose or embarrass someone for doing something wrong. For example, let’s assume my six year old tells me he brushed his teeth this morning. If I surreptitiously go into his bathroom to see if his tooth brush is wet, and then confront him about it because it’s dry—that’s a gotcha moment.
In the context of the corporate world, let me give you another example. Assume a fellow employee sneaks around to find the answer to a question and then asks someone on the team the question to see if he or she knows the answer, or potentially catch a co-worker in a lie—that’s also a gotcha moment.
Compliance and The Gotcha Moment
So, what does a gotcha moment look like relative to compliance work?
Let’s imagine someone in the compliance department is conducting an audit involving the review of medical-necessity documentation to substantiate billing Medicare for physical therapy services. For funsies, let’s call this person“Schmidlap”.
Let’s assume Schmidlap holds an entrance conference with the department director, (“Laurie”), to explain the purpose and scope of the audit. After the meeting, Schmidlap goes off to review the documentation against the regulatory requirements, but never asks Laurie about how the department provides and documents the service for billing purposes. At the end of the audit, Schmidlap holds an exit conference with Laurie, and her supervisor, where he reveals that all the claims audited in his sample were missing documentation to support medical necessity. As a result, Schmidlap tells the Laurie that the organization now has to refund several thousand dollars in overpayments and implement a corrective action plan.
Since Schmidlap waited until the end of the audit to reveal the issues he was finding, it’s going to feel like a gotcha moment to Laurie. Relatedly, she is going to feel like the purpose of the audit was to embarrass her in front of her supervisor.
The problem with engaging in such behavior, as a compliance professional is that our job title alone sends a message that the very goal of our position is to do this. For that reason, being mindful of gotcha moments and avoiding them whenever possible, will go a long way to obtaining buy-in to your compliance program.
The Political Fallout from “Gotcha Moments”
The biggest downside to gotcha moments is that they signal deception. This contradicts, and can render moot, any efforts you’ve made to establish the compliance program as something to be trusted.
In that audit example above, if Schmidlap didn’t talk to Laurie about what he was finding and then delivered shocking news to her…at best,Laurie is going to feel blindsided. At worst, she is going to feel disrespected as a human being.
Gotcha moments can also cause others to question your credibility or professionalism. In the audit example, what if Schmidlap was wrong in his conclusion that the documentation didn’t exist? What if the documentation ended up living in another part of the medical record that Schmidlap wasn’t aware of, because he didn’t take the time to talk with Laurie. Such a situation would potentially raise concerns about the quality of Schmidlap’s work product and whether it can be trusted.
Strategies to Avoid “Gotcha Moments”
So, how can you avoid creating gotcha moments in compliance work? Here are four strategies that will help.
#1-Subscribe to a “No Surprises Act” Communication Plan
Whether you are consulting to employees on a matter related to the organization’s business or compliance agenda, conducting an audit, or anything in between—communicate with them. Have an open dialogue with those you encounter to make sure you understand the facts.
Also, if you identify a potential issue, bring it up promptly and be transparent. If there is one thing I’ve learned in my career, it’s that healthcare leaders do not like to be surprised. That’s true whether one of their direct reports is notifying them of a budgeting or clinical care mistake, or if you as the compliance officer are notifying them of a high-risk issue.
#2-Have a Strategy for Delivering Bad News
Unfortunately, sometimes, it’s our job to be the messenger of bad news. When faced with this situation, have a plan for how you will deliver the news that addresses two central questions:
1. How will I mentally prepare the leader to hear this news?
2. What is my proposed solution to resolve the issue and prevent a future occurrence?
Since bad news has the potential to shock, the first question will help you figure out how the news will land with your audience. The second question is intended to help you see the issue from your audience’s perspective and reduce their anxiety.
#3-Assume Neutral Intent When Consulting to Your Healthcare Leaders
When you are consulting to healthcare leaders, assume neutral intent until your facts prove otherwise. Neutral intent means that we don’t know whether a person acted with good or bad intent. When you assume neutral intent, you avoid inappropriately judging others or jumping to conclusions. (Note: Your communications also will be received with more respect.)
#4-Establish a Default Mindset of Curiosity—Not Judgment
If you are working on an audit, or advising about whether or not certain conduct is compliant, question people from a place of curiosity and not judgment. Given your role, others will assume that you are attempting to judge them. You can avoid that perception by proactively disclaiming that your intent in asking questions is merely to understand the facts.
Pulling it All Together
As a compliance officers, we work hard to foster a healthy culture of compliance and positively influence the actions of others. We also want our colleagues to have a psychologically safe place to report issues and concerns. That said, gotcha moments undermine this work and cause employees to lose trust in the compliance department.
By following the above-noted strategies, you will be more self-aware of potential gotcha moments and put yourself in a position to avoid them whenever possible. When you take this approach, it will not only improve buy-in to your compliance program, but help you successfully navigate the compliance program through the politics of healthcare.
