Kusserow on Compliance: Focus group meetings provide valuable information about compliance program effectiveness

In the HHS Office of Inspector General (OIG) Compliance Program Guidance for Hospitals and Supplemental Compliance Program Guidance for Hospitals, the agency urges using techniques to solicit impressions of a broad cross-section of the hospital’s employees and staff regarding all elements of a compliance program. One method for doing this is conducting focus group meetings.  An employee compliance focus group involves employees who are assembled to participate in a guided discussion about compliance issues. The focus group facilitator is a critical role, and those taking it on should be well-trained on how to run the group and handle difficult situations.

Carrie Kusserow has 15 years’ experience as a compliance officer and consultant. She has employed employee focus groups frequently and found them an easy and efficient way to uncover ideas for improving the employee compliance environment.   She warns, however, that it may be easy to gather a group of employees in a room to ask a few questions and have a “discussion,” but it is quite something else to ensure that the discussion yields reliable information that can serve as a basis for decision-making. A productive focus group is much more than a chat session.  It is important that a clear purpose statement is explained to the focus group to provide a concise and clear stated purpose for the meeting and how the information collected will be used.  There are other benefits that can be derived from individuals being included in these focus group conversations. They feel honored to be able to contribute to addressing organizational problems and that management values employee input.

It is doubtful there is anyone else in the country that has more experience in facilitating compliance focus groups than Al Bassett, J.D. He is a nationally recognized compliance expert, employing this technique in evaluating compliance programs for over 15 years. It has been his standard practice to include in compliance reviews one or more focus group meetings.  He has found using this technique is best after issues have been identified and documented during the review and evaluation.   The findings may identify the “what” but not the “why” or how best to address the issues.  From his experience, Bassett says that this approach ensures that employees will be many times more engaged, because they are not being asked to identify problems but to address those already identified. As a rule, employees trust an outside facilitator more than someone from management or the compliance office, as employees feel like they can speak more freely about their workplace. He even discourages participation by anyone from management or compliance in the group for the same reason.  It is also important that the facilitator make it clear that comments made will not be identified to any individual.  Also, the meeting should be scheduled during work hours in a private room, where employees will not be overheard, and last no more than 60 to 90 minutes.  Bassett has found that the optimum size of the focus group is eight.

Steve Forman, CPA, has been facilitating focus group meetings on compliance-related issues for over 20 years. He has found that it is critical that the facilitator remain neutral and have the skills to keep the discussion on track, steer the conversation away from a general gripe session, and avoid an uninspired, silent meeting.  He has found that one of the best ways to encourage an open and useful focus group meeting is to use results of a compliance survey as the basis of discussion. The facilitator can then open the meeting by asking participants if they could shed additional light on the reason why there may be a problem, as suggested in survey response to certain questions. This can assist if certain issues require deeper probing and more nuanced evaluation. This approach relieves participants from having to identify problems. In this way, the identification is already done, and their feedback as to why opens the discussion nicely.  Potential weaknesses may have been identified, but they don’t always point to action steps for improvements.  Therefore, the group discussion can begin with the issues having been established from general employee feedback. The focus group can then be focused on providing insights as to why employees answered questions the way they did and what can be done to address those concerns.

9 tips for compliance officers

Compliance officers should heed the following advice:

  1. Consider including focus group meetings in the scope of work of any engagement to evaluate the effectiveness of the compliance program to assist in finding solutions to identified issues.
  2. Whenever there is a compliance survey administered, consider using focus groups to help explain why employees responded the way they did.
  3. Use an experienced outside facilitator to conduct compliance focus group meetings, as he or she will be considered more trustworthy and neutral.
  4. Members of management or compliance staff should not present in the group, as it has a chilling effect.
  5. Limit participants in a focus group to eight and duration of the session to 60-90 minutes
  6. Do not attach any comments made in the focus group meeting to the individual who made them.
  7. The facilitator should ask probing questions (e.g., what, why) and paraphrase or repeat back certain phrases so that ideas can be clarified.
  8. Questions presented need to be designed to solicit specific views of participants on issues.
  9. Key focus group success comes from acting on the ideas generated during the discussion.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2017 Strategic Management Services, LLC. Published with permission.