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Evidencing compliance program effectiveness is a major challenge for providers seeking to meet government enforcement agency expectations. The HHS OIG calls for it, the U.S. Sentencing Guidelines expect it, and the DOJ considers it in enforcement actions. Much has been made of the benefits of evidencing an effective compliance program, including potential penalty reductions, and avoidance of legal enforcement actions. Consequently, compliance officers expend a lot of time and energy to build a program that provides and maintains sufficient evidence. Doing so has become the subject of every conference, and has appeared in all publications directed towards compliance. In recent years, executive leadership and boards have demanded evidence to reassure their organizations that they have less to fear from unwanted events or actions that could give rise to liability. This has only added pressure on compliance officers to find metrics to provide the desired evidence of the program’s effectiveness.
The problem remains that effectiveness metrics are difficult to find and produce and, despite all the pronouncements on the subject, there really has been very little concrete advice on how to best accomplish it. Most compliance program metrics relate to processes, such as the numbers produced to individuals trained, hotline reports received and resolved, sanction-screening, etc. However, process numbers relate to output, not outcome; and effectiveness relates to outcome. Relying on process numbers when reporting to executive and board level compliance committees often raises more questions and concerns than satisfaction. Presenting periodic reports summarizing results during the course of the year in terms of process may fall very short of persuading leadership that the compliance program is effective in reducing the likelihood of unwanted events that could give rise to liabilities.
How To Prove Compliance Program Effectiveness
One method to meet the challenge of evidencing compliance program effectiveness may be easier to produce than one might think: using validated employee compliance knowledge surveys. These surveys are among the best and inexpensive means for evaluating, evidencing, and benchmarking compliance program effectiveness. Surveying is one of few methods that the OIG recommends in its Compliance Program Guidance for Hospitals and Supplemental Guidance for Hospitals. The OIG notes that “as part of the review process, the compliance officer or reviewers should consider techniques such as… using questionnaires developed to solicit impressions of a broad cross-section of the hospital’s employees and staff.” The OIG reinforced this sentiment by stating it “recommends that organizations should evaluate all elements of a compliance program through employee surveys…”
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Jillian Bower, Vice President of the Compliance Resource Center, which operates the Compliance Survey Center, notes: “Results from a professionally and independently administered survey can provide a very powerful report to the compliance oversight committees, as well as credible independent evidence for any outside authority questioning the program. They can also identify relative strengths in the compliance programs, as well as those areas requiring special attention. There is the added benefit of signaling to employees that (a) their opinions are valued; (b) the organization is committed to them as individuals; and (c) their input is being used to make positive changes. These messages can have a powerful influence on increased compliance, reduced violations, and heightened integrity. The best surveys are those anchored in a large database of users that permit benchmarking a compliance program against the universe of users, both in terms of overall results as well as for individual questions.”
Carrie Kusserow, a compliance consultant with 15 years of experience using surveys with her clients, states: “Compliance knowledge surveys can test knowledge of the Compliance Program structure and operations, including the understanding of the role of the Compliance Officer, how the hotline functions, etc. This is useful in providing empirical evidence of the advancement of program knowledge, understanding and effectiveness. Using a firm specializing in health care compliance is surprisingly inexpensive. Ideal surveys provide added value if they can offer comparative data to others who have taken the identical survey. For optimum credibility, all survey reports should certify a valid and reliable survey tool was used, that it was tested over many clients, and that the administration and report development met independent and objective standards.”
Bower and Kusserow warn, “Anyone can draft a questionnaire in a matter of hours, but it likely will not produce reliable, valid, and credible results, especially to an outside party. Internally developed and administered surveys may be questioned as to potential bias or reliability, both in their preparation and administration. It is critical to use a valid and independently administered survey tested over many organizations. Professionally developed and tested surveys are less costly than those developed and delivered in house, and when administered, they must be able to ensure confidentiality of participant scoring.” Bowen and Kusserow believe there are many benefits to using compliance knowledge surveys, as they can:
- Identify areas of strength upon which the Compliance Program can be anchored;
- Identify areas that warrant attention in improving the overall compliance environment;
- Establish a benchmark against which progress of the Compliance Program can be measured;
- Measure employee perceptions and morale related to management and leadership;
- Gather employee perspective on the effectiveness of meeting Compliance Program goals; and
- Identify issues affecting attitudes and morale.