From the Contributor’s Corner: Evidencing Compliance Program Effectiveness

A survey is one of the best, but least utilized, tools for evaluating Compliance Program effectiveness.  The OIG in its Compliance Program Guidance for Hospitals noted 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.” [1]   It further reinforced this by stating it “recommends that organizations should evaluate all elements of a compliance program through “employee surveys…” [2]

Culture and knowledge surveys [3] are derived from very different ontological traditions and perspectives. Culture surveys normally focus on the beliefs and values which guide the thinking and behavior of an organization’s members. These types of surveys can measure outcomes of the compliance program and examine the extent to which individuals, coworkers, supervisors, and leaders demonstrate commitment to compliance. This can be extremely useful tools for assessing the current state of the compliance climate or culture of an organization.  They are usually presented in a Likert Scale format that offer a series of gradation of answers wherein respondents are asked whether they “Strongly Disagree,” “Disagree,” are “Neutral,” “Agree,” or “Strongly Agree,” with the statement presented in each item.  A sixth option, “Don’t Know,” may be offered to respondents who feel they lack the knowledge needed to answer the particular question.

The compliance knowledge survey tests knowledge of the compliance program structure and operations, including the understanding of the role of the Compliance Officer, how the hotline functions, etc.   This tool can be used to provide empirical evidence of the advancement of program knowledge, understanding and effectiveness. Compliance knowledge surveys generally use only dichotomous questions that are simple questions with “Yes,”  “No,” and “I don’t know” answer choices. This approach creates the simplest of all the closed-ended questions, and as such is extremely easy for respondents to answer.

Culture surveys are useful in measuring change in the compliance environment over a period of time.  Knowledge surveys are used most often with mature compliance programs to learn about the progress of the compliance program in reaching the employee population.   In either case, surveys must be kept to a reasonable length, generally no more than 20 to 30 minutes to complete. If a survey takes longer, the employee may become apathetic and begin responding in a careless fashion.

Both surveys’ approaches can provide great insights into how effective the compliance program has been in changing and improving the compliance of an organization.  They can signal not only strengths in the compliance program, but areas of potential weakness warranting attention.  They can also communicate a strong positive message to employees.  Surveys can have the added benefit of (a) signaling to employees that their opinions are valued; (b) underscore organization commitment to them as individuals; and (c) signal that their input is being used to make positive changes.  These messages can have a powerful influence on increased compliance, reduced violations, and heightened integrity.

Although anyone can draft a survey in a matter of hours, it does not mean it will be reliable, valid and credible to an outside party.  Internally developed and administered surveys may be questioned as to potential bias or reliability. The alternative is using a vendor with a proven tool.

Surveys should be conducted no more often than annually. Culture and knowledge doesn’t change quickly.  It is also inadvisable to survey employees too often or it will lose the effect of buy-in and support.

Richard Kusserow served as DHHS Inspector General for 11 years and currently is CEO of the Compliance Resource Center and Strategic Management, which have been conducting compliance culture and knowledge surveys since 1993.  He can be reached at (703) 535-1411 for more information.

[1] DHHS Office of Inspector General Compliance Program Guidance for Hospitals, 63 Fed. Reg. 35, 8987 (Feb. 23, 1998). ; and OIG Supplemental Compliance Guidance for Hospitals,70 Fed. Reg. 4858, 4865 (Jn. 31, 2005).

[2] OIG Compliance Guidance for Nursing Facilities, Federal Register / Vol. 65, No. 52 /

[3]More explanation regarding these types of surveys and methods can be found here.

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Copyright © 2013 Strategic Management Services, LLC.  Published with permission.