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).