Kusserow on Compliance: Measuring the compliance culture

The OIG, DOJ, and other oversight agencies believe the compliance program should be a change agent in promoting a culture of compliance that creates an environment less likely to have regulatory or enforcement problems. This means establishing a culture where everyone in the work environment embraces and adheres to a set of shared attitudes, values, goals, and practices that characterizes an institution or organization when it comes to compliance with laws, regulations, rules, standards, codes of conduct, and policies. The OIG in its compliance-program guidance for hospitals states that “fundamentally, compliance efforts are designed to establish a culture . . . that promotes prevention, detection and resolution of instances of conduct that do not conform to federal and state law, and federal, state and private payor health care program requirements, as well as the hospital’s ethical and business policies.” Today, however, both the DOJ and OIG continue to encounter organizations that have a compliance program on paper, but lacking in quality, commitment, and ethics—a culture of compliance. It is therefore logical that compliance officers find means to evidence that the culture of the organization matches the compliance goals and be able to evidence this, if and when, they are challenged to do so.

One way to gain understanding of the compliance culture is through a survey which tests understanding and acceptance of the compliance program. This is among the best means for evaluating, evidencing, and benchmarking the overall compliance program effectiveness. Using surveys is also one of the two methods suggested by the OIG in its Compliance Program Guidance for Hospitals and Supplemental Guidance for Hospitals.  The OIG 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.” The OIG further reinforced this by stating it “recommends that organizations should evaluate all elements of a compliance program through “employee surveys.” In the 2018 SAI Global/Strategic Management Compliance Benchmark Survey of compliance programs, respondents indicated that one-third of organizations with compliance programs survey their work force on compliance issues. However, only a minority of them use professionally developed and tested surveys, relying upon internally generated and administered ones that do not carry the same level of credibility.

Steve Forman, CPA has been using compliance culture surveys for the last twenty years as a compliance officer and as a compliance consultant. He believes that one of the best and most inexpensive methods for evaluating, evidencing, and benchmarking compliance program effectiveness is through a compliance culture survey that measures employee perceptions of ethical culture and/or the compliance program. He likes using this type of survey, alternately with a compliance knowledge survey that tests employee knowledge of the program. Results from a professionally administered survey provide a very powerful and credible report to the compliance oversight committees, as well as to any outside authority questioning the program.  Such surveys can also identify relative strengths in the compliance programs, as well as those areas requiring special attention that are invaluable for compliance officers.

Jillian Bower Concepcion has many years experience in administering compliance surveys, as well as serving as interim compliance officer. She explained that culture surveys focus on the beliefs and values which guide the thinking and behavior of employees within an organization. They are usually presented in a Likert Scale format that offer a series of gradation where respondents are asked whether they “Strongly Disagree,” “Disagree,” are “Neutral,” “Agree,” or “Strongly Agree,” with the statement presented in each item. She notes it is highly advisable to use a valid and independently web-based administered survey that has been tested over many organizations and ensures participant confidentiality. Using a professional survey service specializing in health care compliance is surprisingly inexpensive and less costly than developing and delivering a survey in house, that doesn’t carry the same level of credibility. The Compliance Resource Center (CRC) has been using the Compliance Benchmark Survey© since 1993 and has been employed with hundreds of health care organizations and a surveyed population of over a half-million. Clients find that comparing their results with the universe to be the most beneficial information. Survey reports are typically about 50 pages in length and provide advice on each topical area and question as to how improvements may be made.

Carrie Kusserow, Managing Senior Consultant for Strategic Management, has been using compliance surveys to assist with benchmarking the progress of compliance program. Such benchmarking was called for by the OIG when it stated in its compliance guidance that “the existence of benchmarks that demonstrate implementation and achievements are essential to any effective compliance program.” She has found surveys can be used to meet that standard, two ways. First, if the survey being used is anchored in a database of users, the organization can benchmark them against that universe, viewed as very important by most organizations. Second, an initial survey can establish a baseline from which future surveys can be used to benchmark progress of the compliance program and measuring change in the compliance environment over a period of time.

Carrie Kusserow and Jillian Bower Concepcion will be available to discuss this subject in more detail at the HCCA conference in Las Vegas, booth 412


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.