One of the biggest learning curves for early-career compliance officers is understanding how their healthcare leaders actually make decisions. In my experience, healthcare leaders operate in an environment where they must balance patient care, financial performance, workforce challenges, strategic growth, physician relationships, community expectations, and regulatory obligations.
(Oh. And, often all at the same time. )
As a result, decisions are made by weighing multiple competing priorities and determining the best path forward for the organization. Understanding this reality I think is key to your effectiveness as a compliance officer. The more you can identify with what drives leadership decision-making, the better you become at positioning your initiatives in a way that aligns with organizational goals.
This article will cover some of the key motivators behind the business decisions that your healthcare leaders make and offer some tips to help you improve this skillset.
Strategic Priorities Come First
When it comes to the decisions your leaders make, they are typically filtered through the following question that is thought, but often not be spoken:
“Does this help us achieve our top organizational goals right now?”
If the organization’s current focus includes things like: access, growth, margin recovery, physician alignment, or value-based care, then your initiative must clearly connect to one of those priorities. If it doesn’t, it will almost certainly be viewed as important, but not urgent.
For example, let’s assume you want to implement a more robust conflict-of-interest review process for your contracted vendor relationships. From a compliance perspective, the regulatory risk is pretty straightforward (e.g., Stark, Anti-Kickback, Open Payments). From a healthcare leader’s perspective though, their immediate concern may be the speed of onboarding the vendor, expanding a profitable service line, or maintaining physician relationships.
If your compliance message is: “We need to do this because it’s a regulatory expectation,” it will come across that you are asking leaders to pause their progress in order to solve your problem. On the other hand, if your message is framed as: “This process will prevent vendor contracting delays and keep projects moving forward ,” well, now we’re talking because you’re helping them achieve a strategic objective.
If this is an area you struggle with, here are some tips that will help:
Tips:
Get real familiar with your organization’s strategic plan.
Pay attention to things like capital investment announcements and service line growth targets. These provide clues about organizational goals.
Study up on the market pressures (e.g., new competitors, payer mix shifts, affiliations, competition).
Understanding this motivator will help ensure you can tie your compliance initiative to their organizational goals.
Financial Impact Shapes Their Timing
Keep in mind that even the most supportive leaders are balancing financial pressures such as thin operating margins, staffing shortages, and capital project priorities. To that end, when you present a compliance initiative, the question in their mind becomes:
“Why this, why now?”
That means every new request, including yours, is silently run through that filter. Similar to strategic priorities coming first, there is an internal filter of questions your leaders are asking themselves, such as:
“Does this affect this fiscal year or a future one?”
“Is this an operating margin issue or a cash-flow issue?”
“Will this show up in a board report?”
It’s not that your initiative isn’t important. It’s that your leaders are continually weighing timing, resources, and immediate organizational pressures with any business decision. To that end, if urgency isn’t clear, then an issue can sit on the back-burner until it becomes urgent.
If this particular motivator has been challenging for you, below are some tips that will help:
Tips:
Whenever possible, translate compliance risk into financial impact such as cost avoidance, operational efficiency, staffing resources, and prevention of rework.
When proposing a new compliance initiative, give your leaders decision-ready financial language such as: “This protects patient revenue.”
Ask yourself their question” “Why this, why now?”, and have your answer at the ready.
Most often, it’s not about whether your compliance need has financial impact, rather, it’s about how significant the impact is, and to which part of the organization’s balance sheet it connects to? To that end, understanding this motivator will help you navigate the speed with which your leaders make a decision.
Operational Reality Determines Feasibility
If your compliance initiative requires a new workflow be implemented, then time spent sitting in a training vs. generating revenue, will be evaluated by your operational leaders. Additionally, they will be weighing your need against things like competing projects, staffing bandwidth, and operational change fatigue. All of these thoughts will result in your leaders asking themselves:
“Can our teams actually absorb this right now?”
Keep that context in mind when you are proposing a new operational change related to a regulatory change or audit finding. For example, let’s assume you want to roll out a new documentation process that includes a need to train clinical front line staff. Let’s further assume, your CNO resists.
If you continue to focus on the need to conduct the training without taking into account things like understanding frontline pressures and reducing their burden, they are more likely to push back. On the other hand, if you propose that the sessions are embedded into existing department meetings instead of adding new ones, then you’re able to get somewhere.
To help strengthen your ability to understand this motivator, try the following tips:
Tips:
Before any proposal, do your homework by understanding, first-hand, how it will impact operations.
Design low-friction solutions such as rolling out a pilot, offering done-for-them education tools, or leveraging existing data reports instead creating new ones to source information.
Ask yourself the following question that they are asking themselves: “Is this initiative worth the disruption it will cause my team?” And be sure to have an answer that justifies it.
Being self-aware to how your work is affecting operations will help improve your chances of moving an initiative forward.
Reputation and Relationships Matter
Let’s face it, healthcare organizations are still run by human beings. Amongst many other things, that means the nature of all our work is deeply relational. Things like physician alignment, board or staff perception, community trust, and internal corporate political capital are being factored in by your healthcare leaders.
To that end, fortunately or unfortunately, some initiatives move forward faster because of who is affected, not necessarily because of what a regulation says. The compliance officer who has developed strong relationships early with service line leaders, senior management, and physician leaders will be better positioned to gain cooperation instead of defensiveness.
If this is an area you need to improve, try the following tips:
Tips:
Build strong relationships before you need them.
When positioning your next initiative, ask yourself: “Whose influence matters even if they’re not the decision-maker?”
Pay attention to things like which service lines generate the most political capital, which physician leaders are connected to senior leadership, and where has compliance historically had conflict?
Keep in mind that your healthcare leaders are constantly balancing fairness, optics, alignment, and organizational history. If your initiative unintentionally threatens one of these, then likely you will get pushback. The above tips ahelped me over the years in overcoming this challenge, and I’m confident they will do the same for you.
Trust in the Messenger Influences the Outcome
When it comes to compliance matters, healthcare leaders make operational decisions based on three things: credibility, past collaboration, and whether you understand the business. To that end, be mindful that when you meet with your leaders, they are subconsciously asking themselves like:
“Do they understand how we actually deliver care?”
If they hear about compliance matters from you early, with context and a plan, you naturally will become a trusted advisor in their mind. Below are some additional tips that will help.
Tips:
Meet 1:1 with operations leaders and incorporate their feedback so the formal presentation becomes a confirmation and not a debate.
Share relevant external enforcement trends before they become issues in your organization.
Know how to bring solutions to problems, and escalate matters appropriately?
Something that took me a long time to figure out is that when you’re early in your career, or new-to-an-organization, you don’t yet have positional authority. And that you build your influence through things like predictability, business awareness, and respect for operational goals.
Pulling it All Together
One of the most important lessons an early-career compliance officer can learn is that effective compliance programs are built in part from an understanding of how decisions are actually made within the organization. When compliance officers learn to view issues through a broader lens, they become stronger business partners because they can identify solutions that are tailored to their audience and earn the trust and support of leaders along the way.
Understanding what motivates healthcare leaders is about understanding people, priorities, and the realities of running a complex healthcare organization. The more effectively you can connect compliance to those realities, the more influence you will have.
