Continuous improvement in compliance can proceed systematically

Provider organizations should not dread continuous improvement in compliance and can apply several techniques to simple problems to bring about simple solutions. In a Health Care Compliance Association (HCCA) webinar entitled “Continuous Improvement in Compliance,” presenter Alan Wileman, Corporate Compliance Manager at Shriners Hospitals for Children, discussed applying principles from Lean and Six Sigma to improve function and eliminate waste in company functioning.

Improvement methodologies

Wileman noted that compliance goals evolve, and that the OIG uses subjective terms for compliance matters such as “reasonable,” “appropriate,” and “meaningful.” What is meaningful or reasonable for one compliance area may not be sufficient for another area or at a later date. Overall, lowering risk is the focus of many compliance tasks, but there may be better ways to bring about that desired result.

Improvement methodologies such as Lean, Six Sigma, and project management have been proven to streamline procedures, eliminate waste, and bring value. Lean ideas and practices originally derived from industrial manufacturing, and have one main purpose: eliminating waste. Six Sigma is often grouped with Lean concepts, and focuses on eliminating error waste by removing variation in procedures. According to Six Sigma, there may be multiple ways to do the same thing, but there is always a best way to do so that reduces variation. Project management focuses on clearly defined terms, roles, and goals in order to successfully complete a project—a non-routine operation with a definite beginning, end, and goal.


According to Wileman, there are several types of waste. Among those discussed included talent, inventory, waiting, defects, and motion. Compliance departments should ensure that a particular task is being completed by the employee whose strengths play to that area. Motion waste comes from requiring employees to move around the work area too much in unnecessary ways, when communication could effectively be conducted in a non-face-to-face manner or when a workplace could be reorganized to provide a better workflow.


Reorganization also applies to employees’ personal workspaces, which should be uncluttered and only contain the necessary, crucial supplies. Wileman suggests adding the “5S” strategy to an operation’s compliance toolkit. The five elements are: sort, set in order, shine, standardize, and sustain. These elements ensure that a workspace is stocked as necessary, arranged to promote efficiency, neat, organized consistently with other spaces, and sustained in this manner. For tasks, the “DMAIC” acronym is made up of the elements define, measure, analyze, improve, and control. Once a problem is clearly defined, it is easier to map out the process, identify the cause of the problem, implement the solution, and maintain the solution over time.

High Anxiety: A Prescription for Compliance Officer Burnout from the Psychoneurotic Institute for the Very, Very Nervous

The Wolters Kluwer Legal and Regulatory Solutions U.S. Law & Health Blog periodically features posts from outside contributors who are members of our Advisory Board. Today’s post comes from Jeffery B. Miller, Esq.

High anxiety is nothing new. In the aptly named 1978 Mel Brooks classic, Dr. Richard H. Thorndyke, a renowned Harvard psychiatrist, takes over as the newest director of the PsychoNeurotic Institute for the Very, Very Nervous. Finding himself immersed in the company of some very strange colleagues, and some difficult and unsettling situations, Dr. Thorndyke struggles forward in his mission, eventually finding himself faced with saving the Institute, his reputation, and his own sanity. Sound familiar?

According a 2012 Health Care Compliance Association (HCCA) survey, 58 percent of compliance officers wake up in the middle of the night in states of high anxiety from job-related stress. Not surprisingly, the survey also indicated that 60 percent of compliance officers were considering resigning from their positions. In 2015, three years later, there is little indication that the environment for compliance officers has significantly improved. If anything, many compliance officers remain in state of high anxiety. While a 2014 PricewaterhouseCoopers (PwC) survey indicated that budgets and staffing for compliance functions have improved, compliance officers continue to consistently report high levels of stress. News reports show compliance officers taking extended leaves of absence to address stress-related issues, or quitting their positions altogether. The challenge for global compliance officers, with their extended breadth of responsibilities, is compounded. The Department of Justice’s (DOJ’s) recent movement towards individual accountability for legal violations, including for compliance officers, has exacerbated some situations.

There are many sources of stress that can result in high anxiety for compliance officers–keeping current on the plethora of laws, regulations and other legal requirements, challenging relationships with their business colleagues, insufficient authority in their organizations, and insufficient resources only to name a few. Ask almost any compliance officer and you will get a list of challenges and stress points. These sources of stress can not only hinder officers’ professional effectiveness and the success of their functions, but can weigh heavily on their personal lives, and even their health.

While there are no “magic pills” to help compliance officers address these challenges, there is a prescription for their problems–a prescription that can improve their programs, their companies, their relationships and their lives. This prescription is found, in part, in the fundamentals of how companies and their compliance officers view the role of the compliance function in their organizations. Experience shows that establishing and maintaining the right paradigm for compliance functions is essential to ensuring that compliance functions fully and appropriately integrate into their companies, and that responsibility and accountability follows. When authority, responsibility and accountability are aligned, and are supported by knowledge and expertise, organizations thrive. Combined with appropriate doses of objectivity, monitoring and reporting, and compliance functions thrive as well.

What are the root causes of compliance failures, and how did they become established in the organization? Who has the experience and expertise to best design and deliver day-to-day tasks help the company past these root causes, better ensuring business with integrity? When day-to-day tasks fail to prevent non-compliance, who should address them, and how should they be addressed? How can compliance functions use their expertise to support their organizations, and when should they use it? What are the incentives to support doing things correctly, are they aligned with company objectives, and are they effective?  This blog is the first in a series discussing a new paradigm for compliance programs; a paradigm that can help compliance officer achieve more effective and efficient compliance programs while improving their business relationships and getting more sleep. Look to early December for the next message!

Jeffrey B. Miller is an experienced attorney and compliance professional who has advised boards and led compliance functions in large and small companies across the health care spectrum and around the world. A recipient of the Yale School of Management, Millstein Center for Corporate Governance and Performance’s Rising Star of Corporate Governance Award, Jeff is an advisor, author and speaker on designing and operationalizing effective, efficient compliance programs, processes and procedures. Interested in getting help or learning more? Please contact Jeff at or through LinkedIn.