compliance at the strategy table
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3/18/2014
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Deann M. Baker, CHC, CCEP, CHRC Sutter Care at Home Compliance Officer, Sutter Health
Dwight Claustre, CHC-F, CHRCDirector, Aegis Compliance and Ethics Center, LLP
Deborah Smith, PHD,MBB,MCACOO Administrator Zwiebel Center
Compliance at the Strategy Table
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Discussion Topics
Strategy and planning methods.
Alignment of compliance with corporate goals and metrics.
Methods to weave compliance into the fabric of the organization to impact culture and create sustainable results.
Building trust and partnerships through collaboration.
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Why Does it Matter? It’s important we are all working from the same plan or we
will have communication challenges.
Compliance Leadership present during strategic planning mitigates risks to the organization including potential rework.
Strategic goals and initiatives need to align with regulations, accreditation standards, and other requirements.
Establishing an alliance between corporate strategy and compliance ensures sustainable results.
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Audience Poll
Roles in the audience?
CEOs, CFOs, CIOs, CMOs, CNOs, COOs, CQOs ?
Department Directors/Managers? Nursing& Physician? Chief Strategy Officer or Strategy Dept.? Consultants?
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Quote
“Even small Healthcare Institutions are complex, barely manageable places…Large Healthcare Institutions may be the most complex organizations in Human History.”
“What you can measure you can manage.”
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Peter Drucker
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Transitioning from Today to Tomorrow
Reimbursement
Venue
Records
Treatment
Volume based
Hospital based
Paper
One size fits all
Performance based
Integrated, Outpatient, Community
Electronic
Personalized, Population Health
1990 2000 2012 2020
Service Local Reporting National Reporting
Combating Illness Improving WellnessHealthcare
Directors of Care Collaborators of CareProviders
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Assumption
The main thing that is controlling the rate at which a company grows, and it’s strength and stability, is how much attention Executives can put on:
1. The quality of the decisions they make2. The speed they can respond to issues inside and outside of the company
The current state of any hospital is an effect of the decisions of human beings.
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Question for Your Executives
Have you asked your Executives how many things they are working on?
Question #1: How many initiatives has your Executive Team been ask to complete over the last 1-3 years?
Answer: The actual answer is 10-100-1000.
Question #2: How many of the initiatives produced results and impacted the bottom line?
Answer: Rarely did anyone answer more than 1% of the initiatives actually produced true results. It was most common to hear the enthusiastically answer of “Almost all were to complex and still being worked on.”
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Executive StrugglesAt the same time, I have to ensure profits by managing my costs. I can’t hire more people so I must limit my initiatives.
Manage CostLimit/Reduce
Initiatives
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Executive Struggle
Improving ResultsAdd MoreInitiatives
Manage CostLimit/Reduce
Initiatives
Provide World Class Service
Executives think: “I’m paid to ensure the Hospital thrives, but I’m in a bind because I can’t do both!!”
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We Build It By Starting With a Blue Print….A Plan
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Strategy Terminology
MISSIONWhy we exist
VALUESWhat we believe in and how we will behave
VISIONWhat we want to be
STRATEGYWhat our competitive game plan will be
BALANCED SCORECARDHow we will monitor and implement that plan
The BASIC ELEMENTS of Strategy
OBJECTIVE = How / ends
MESAURE= item tracked to determine achievement
TARGET = desired level of performance
INITIATIVE = funded activities and plans for achieving objectives
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Process Deliverables
• Facilitation of Planning Session…Translation of vision to prioritized requirements
• Current State Assessment Operational Clinical- Service Line Market Master Planning
• Presentation of Key Findings / Gap Analysis from Session
• Facilitation of Action after Session…Translate strategy to action
• Facilitation of Strategic Partnering Session…Critical Success Factors / Action Steps
Translate Vision To Strategy
Translate Vision To Strategy
Discuss Future State Vision
Discuss Future State Vision
Translate Strategy to Delivery
Requirements
Translate Strategy to Delivery
Requirements
Assess Current State CapabilityAssess Current State Capability
Gap Analysis & Action Plan
Gap Analysis & Action Plan
Strategic Partner Relationship
Strategic Partner Relationship
Strategic Planning Session
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The Right “Intelligence” ToolsSuccessful strategy implementation depends on:
Market Intelligence (MI) = Market Share: Demographics, Disease, Population, Census, Spend
Business Intelligence (BI)= Analytics, Monitoring, Reporting
Strategic Intelligence (SI) = Planning, Schedule, Execution
Performance Intelligence (PI) =Gap Analysis, VSA, Constraint Analysis, Waste, Defects, Errors
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Planning Process Schedule-Are you Connected?
EnvironmentalAssessment
GrowthAssessment
FinalizeAssessments
TechnologyAssessment
ClinicalAssessment
ExecutiveRetreat
BoardRetreat
LeadershipMeetings
CascadingEvents
Q1Reports
Q2Reports
Q3Reports
Q4Reports
Monthly Meetings to Celebrate Green, Review Yellow and Fix Red
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Strategy Introductions Strategic Planning is designed to provide the outline and
initiative of gathering the necessary information to develop a Strategic Plan for Your Company. It is to be the stimulus for the development of your company's actual Strategic Plan.
“Any plan is only as good as the effort and commitment that is put into it.”
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Functions Strategic planning is the method that determines what things need to be
done. It provides the goals and objectives of business.
Without strategic planning your company is operating without clear purpose and direction.
Strategic Planning and goal setting are essential parts of every business. A plan of action must be established with definite goals and objectives so that the work effort and resources are directed in a controlled and coordinated manner.
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Functions A good Strategic Plan establishes goals and objectives that can
be achieved. Good Leaders direct their personnel. They make decisions and changes as required keeping the business progressing
toward its present goals and objectives.
Without a plan, a business tends to run on historical experience or on a crisis management basis. Leaders reach in different directions due to lack of clear common goals.
This creates confusion, inefficiency, excessive costs and reduction of profits. The lack of a plan also limits growth. Efforts are based on day-by-day
situations without planning for growth.
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Basic Process The first part of the process is to develop an accurate assessment of the
company and the people involved. This involves the gathering of information from within Your Company and
some evaluation of the skill and ability of its personnel. The purpose of this is to examine where the company is now. What is its condition? What assets are available? What are its weak points (internally)?
The second part of the process involves an examination of factors outside the company. These are things that can affect the success of the plan and are not under the control of the company. What about government regulations? What about new technology, and the new product lines they generate?
These questions need to be answered along with others that are related to the proposed plan.
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The Strategy Process
MISSION
STRATEGY•Board expectations•Environmental assessment•Market analysis•Trends / regulations•Facts / assumptions•Stakeholder buy-in
VALUES
Business Intelligence•Performance management•Strategy execution and management•Focus & alignment with strategy•Strategic feedback and learning
BUDGETS•System & Division Operational Budgets •Capital Budgets (equipment & facilities) – New Business & Replacement/maintenance•Strategic Initiative Budgets
BUSINESS PLANS•Environmental drivers•Resource requirements•Cost / Benefit analysis•Key priorities•Measures, Targets & Action Plans
ObjectivesMeasuresTargets
Continuous Process
STATIC1-3 YEARS
ANNUAL
VISION\
STRATEGIC INITIATIVES
•BSC performance drivers•Time-bound•Requires resources•Actions that provide focus & alignment with strategy
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Outline for Strategic Planning Mission Statement narrowly defines its purpose and should be
considered a guidepost. It is the company's reason for existing and carefully defines the business.
Strategies are specific methods that will be used to accomplish the goals. Strategies are the "HOW" in the plan.
Action Steps are the step by step plan of how to accomplish the stated goals. It assigns the necessary assets, authority, and responsibility along with a timetable including completion and reporting dates.
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Long Range Goals are usually done for a period of 3 or 5 years. Management must ask itself the following: Where do we want to be in the long range as we have defined it? What profit levels can we reasonably expect to achieve? What resources do we need to achieve the stated goals? At what time periods will we need the resources? How will we finance the plan? What will the capital requirement be? What are our profit goals and profit strategies?
Outline for Strategic Planning
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Market Forces are carefully analyzed to determine and categorize those factors that will generate demand for the company's services now and in the future.
This is market segmentation and is useful because it may: Uncover previously overlooked markets. Be helpful in deciding where to concentrate the company's increased sales
efforts. Identify specific new target markets.
After identifying the market segments, a decision should be made to target some of the segments. Using a "What If?" scenario, determine the effects of potential decline, increase, etc., and what the company must do to meet its goals in these market segments.
Outline for Strategic Planning
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Market Potential is reviewed across Markets available to determine how Your Company can effectively service them with its existing capacity.
• After determining the market objectives for each of the three years of the plans, plans must be formulated for the Personnel, Facilities, and Financial Requirements to support the projected growth.
• Labor: Do we have the personnel available to support the growth, or will we have to increase staff? If we increase, from where will they come? Are our compensation programs competitive? What will the training needs be?
•
Outline for Strategic Planning
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• Facilities: Do we have the equipment and space to support the volume forecast? What replacements will be required? What new or expanded facilities will be required?
Financial: What are the three-year cash requirements necessary to support the projected growth? Will major capital expenditures be required? Will long-term borrowing be required? Is it available? At what costs? How will cost of living factors affect our costs? Do we have administrative personnel and facilities to support the volume figures? Where do we acquire them? At what cost?
Strategy and Tactics: Formalize your strategy and tactics. Strategy comprises the long-range objectives to be achieved in the long-range plan. Tactics are measures taken to reach short-term goals.
Outline for Strategic Planning
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Financial, People, Equipment, Facilities
Finances: What are our Revenue Goals What is our Revenue Strategy Projected increases from an inflationary and partially from expanding
the customer base and new types of business
People: Executives, Leaders, Supervisors, Employees
Equipment and facilities improvement costs required for the next several years for improvements.
Source of funds
Profit strategy
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Competition Awareness is as important as knowing your company. Know your competitor's strengths and weaknesses,
Market Share, Geographic coverage, etc. A "Competitor's Library" is a useful base. Additional
information can be obtained through Trade Associations, Chambers of Commerce, Trade Journals, Dunn & Bradstreet Reports, and other Compiled Business Analysis.
Outline for Strategic Planning
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Strategy Prioritization MatrixCriteria: At multiple times throughout the strategy life cycleconsideration will be given and assessed for impact, level of difficulty, risk and prioritized accordingly
Levelof
Impact
Degreeof
Risk/Difficulty
High Impact, Low Risk/Difficulty
Low Impact, High Risk/Difficulty
Low Impact, Low Risk/Difficulty
High Impact, High Risk/Difficulty
Low
High
High
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When the basic analysis both inside and outside the company has been completed and all relevant factors considered it will be time to put the plan in writing.
The following steps should be taken: Write a detailed plan
Assign a plan administrator.
Prepare a master calendar with deadlines
Assign assets, authority, and responsibility
Review, Evaluate, take corrective action or change as determined by events.
Monitor with reports and meetings as necessary
IMPLEMENTATION, MEASUREMENT, FOLLOW-UP
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Failure to achieve a specific goal or action step requires a review of the plan. Learn from your efforts and make corrections that will improve your planning process. The goal may have been wrong Poor effort or execution Wrong timing Conditions may have changed Wrong strategy Inadequate assets
IMPLEMENTATION, MEASUREMENT, FOLLOW-UP
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Development of Goals and Objectives What business are we in?
What business do we want to be in?
What services do we currently offer?
Why do our customers use us?
What are we doing right?
What are our strengths?
As I see them? As our customer sees them? As our competitor sees them?
What is our target market?
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What is our market share?
Who and/or what is our competition? List the strengths and weaknesses of the top three.
Did we grow in the past year? What factors contributed to the growth (or lack of growth?)
What portion of our business for each type of service provided produce?
What portion of our profit is produced by any of these services?
Which expenses have increased as a percent of sales over the last three years?
Which expenses have decreased as a percentage of sales over the last three years?
Development of Goals and Objectives
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Site 2
Divisions Goals Strategies Initiatives Metrics/Goals
Communication
Finance
People
Growth
Community
QualityEvidence Based
Medicine
Increase Corporate
Responsibility
Improve Operating Efficiency
Invest in Our People
Build Strategy around
Regions
Develop System
Awareness
Build Partnerships
Case Mgmt Model
EMR
Physician Alignment
Mission
Process Improvement
Cost Containment
Staffing Excellence
Satisfaction
Leadership Development
Care Coordination
System Awareness
Report Never Events
CMS indicators
Metric Tracking
MortalityProcess Improvement
Physician Sat
IP Sat
ED Patient Sat
Physician Sat
FTE/AOB
EBITDA
Capital
Annual Turnover
Associate Sat
IP Market Share
Adjusted Admissions
New Business
Community Commitment
VP/Exec Involvement
Palliative Care
Community Participation
OP Market Share
Interdepartmental Sat
Day in AR
DNFB
Billing Accuracy
Vacancy
90 Day Turnover
OP Sat
Corporate
Site 3
Site 4
Site 1
Critical Alignment for Monitoring
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Compliance Involved in Design & Validation of Strategy
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Summary
A well-developed, three-year plan will take a lot of effort and commitment to develop.
Planning and setting goals is the first function of a company. Whether documented or not, there must be a purpose to be accomplished by the business.
Naturally, the first goal of any company is to survive, the second is to grow.
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Strategy: “a carefully devised plan of action to achieve a goal, or the art of developing or carrying out such a plan”
Weaving Compliance Into The Fabric of Your Organization Through Strategy
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The Executives and Compliance Officers are a Team
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Compliance Alliance With Strategy
Costs that come with crisis, choices, and chances.
Is the compliance program aligned with the organization strategy?
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Demonstrating Our Value
Risks to fulfilling the organizations mission: Departments
Processes
People
Roles and…
Rules
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Demonstrating Our Value
• Organizations are required to comply with certain rules when they participate.
• Is your organization considering the risks?
• How is that done?
• New line of business? Did they include compliance at the table?
• Are they walking a fine line?
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Leadership needs to prepare for STORMSHealthcare Storm is coming!!! Take Cover! Strategy has to be Flexible!Typical operating and regulatory challenges are concerning Executives
Revenues & InvestmentIncomes Decline
Operating CostIncreasing
PerformancePublicallyReported
Labor Cost & Shortages
Access toCare limited
Rising CostOf Capital
Aging Population
Rising Technology & Supply Cost
CMS predicts 15% HospitalsClosed by 2014
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Compliance Conditions Met Through An Organizational Plan
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Compliance Resources “we can build it”
Standards that support the compliance cause: Federal Sentencing Guidelines (FSG) OIG Work Plans (OIG) Compliance Program Guidance (CPG) Corporate Integrity Agreements (CIA) Conditions of Participation (CoP) Patient Protection and Affordable Care Act (PPACA) More…
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High Level Oversight(Compliance Officer Role &
Compliance Committee)& Governance
(Board of Directors)
Create Fair & Ethical Culture
(Incentives for Performance “Create a Do The Right Thing” Tone )
Open Lines of Communications
(Confidential Message Line , Surveys and Exit Interviews)
Education/Training (Role. Values &
Risk/Regulatory Based)
Detection, Remediation & Enforcement
(Timely response to misconduct, Screening, Sanctions and Corrective Action Plans)
Risk Assessment (Large Scale Evaluation and Prioritization of Risks and Identification of Mitigation
Strategies )
Auditing &Monitoring (Ongoing Testing of
Controls to Address Risk)
Assessment of Effectiveness
(Compliance Program Evaluation)
Compliance elements in place
Leadership commitment to
participate
An effective compliance program
Elements of An Effective Compliance Program
Establish Standards (Develop and Disseminate
Policies & Standards of Business Conduct)
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Our Landscape Organizational Plan
(to live up to the “Code” & fulfill and protect the mission)
Strategy: How to influence workforce to meet the mission, vision, goals
Risk: Regulations, laws, accreditation and organizations policies.
Resources: Internal expertise, external needs, costs & allocation
Accountability: Metrics, evaluation, reporting, and incentivizing completion and create just culture.
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Risk Assessment
Risk assessed through discussion, interviews and evaluation and the areas to consider when establishing a plan: Risk impact Risk likelihood Internal controls Internal trends External trends Corrective Action Plans
Risk Assessment defines the compliance annual work plan
How can that help with working with our partners and align with strategy?
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Controls Environment
• A process affected by an organizations board of directors, management, and other individuals, designed to provide reasonable assurance regarding the achievement of the objectives.
• It must be part of the strategy to develop a plan that will last the storms.
Risk Assessment & prioritization help identify how to reach objectives
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Controls Environment
• Preventative
• Directive
• Detective
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Controls Environment
Hard Controls
•Formal
•Objective
•Measurable
•Documented “plan”
Soft Controls
•Informal
•Subjective
•Subtle
•The environment
The Federal Register Compliance Program Guidance from the OIG address the internal controls environment
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Departments + Processes + Requirements = Risks to the Organization’s Mission
• Departments:• Human Resources• Contracting & Procurement• Medical Staff Office• Risk Management• Legal Department • Quality • Information Technology
• Processes:• On-boarding & Exiting• Exclusions Screening• Payments/Agreements• Licensing• Credentialing/Privileging• New Technology• New Services• Regulatory Changes
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Accountability.. ..through compliance metrics and defined responsibilities
and alignment with the organization’s strategy and our “compliance map”.
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Data Analysis Cycle• Compliance goals include:
• Identification of measures• Collection• Evaluation• Learning• Improving• Monitoring• Reporting• Rewarding (incentivize)
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Incentives
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• FSG = (6) The organization's compliance and ethics program shall be promoted and enforced consistently throughout the organization through (A) appropriate incentives to perform in accordance with the compliance and ethics program;
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Compliance Metrics & Evaluation
Discuss handout documents and next slides
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Human Resources People Goals = hiring and maintaining qualified workforce maintaining a satisfied workforce
Risk area = excluded individuals or criminal history consistent sanctions
Compliance strategy = Monitoring activities
FSG = The organization shall use reasonable efforts not to include within the substantial authority personnel of the organization any individual whom the organization knew, or should have known through the exercise of due diligence, has engaged in illegal activities or other conduct inconsistent with an effective compliance and ethics program.
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Human Resources People Strategy and Goal = Create an ethical (Just) culture and behavior standards
Risk = Inconsistent discipline and unreported issues (fear of retaliation)
Compliance Strategy = Monitor disciplinary actions and exit surveys
FSG = (b) Due diligence and the promotion of an organizational culture that encourages ethical conduct and a commitment to compliance with the law within the meaning of subsection (a) minimally require the following:
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Supporting a Just and Fair Culture(its not just about the data & plan)
● Commit to establish and maintain an environment that is respectful, fair and just for all (patients, families, staff and providers) when looking at outcomes.
● A just and fair culture looks at system opportunities and supports the patients, families, staff and providers through a process to evaluate why an error occurred.
●Resource: Dr. Lucian Leape Professor, Harvard School of Public Health Testimony before Congress on Health Care Quality Improvement http://www.health.ny.gov/professionals/patients/patient_safety/conference/2007/docs/patient_safety_and_the_just_culture.pdf - Also “The Just Culture Organization” link is available on the resource page.
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Quality – Clinical Standards Strategy: Evidence based Medicine= Meet quality standards established through CoP
Risk to achieving the goal= CMS quality outcomes and timely reports, HACs, and other
Compliance strategy = Audit the monitor and report activities of requirements
CPGs & CIAs address quality: FR Compliance Programs Guidance in section A. “Benefits of a Compliance Program” – “The OIG believes a comprehensive compliance program provides a mechanism that brings the public and private sectors together to reach mutual goals of reducing fraud and abuse, enhancing operational functions, improving the quality of health care services….”
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Contracts & Procurement Financial goals = Meet a specific financial outcome, improved process or
efficiencies
Risk to achieving the goal= Stark, Anti-kickback, Exclusions, DRA….
Compliance strategy = Monitor contracts, payments, procurement…
FSG = The organization shall take reasonable steps— (A) to ensure that the organization's compliance and ethics
program is followed, including monitoring and auditing to detect criminal conduct;
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Development and Education People strategy and goal = Maintain a qualified workforce
Risk to achieving the goal = Workforce knowledge to maintain skills and qualifications
Compliance strategy = Monitor and report workforce participation
FSG = The organization shall take reasonable steps to communicate periodically and in a practical manner its standards and procedures, and other aspects of the compliance and ethics program, to the individuals referred to in subparagraph (B) by conducting effective training programs and otherwise disseminating information appropriate to such individuals' respective roles and responsibilities.
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A Seat At The Table
Is to have a voice and opportunity to participate in discussions regarding corporate business strategy and therefore have influence.
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The Challenges We Encounter
Bullying can be an occasional issue we encounter.
Corporate/Institutional bullying is when it is entrenched in an organization and becomes accepted as part of the workplace culture.
Corporate bullying can be blame without factual justification, unfounded criticism, or being treated different than the rest of your peer group.
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The Challenges We Encounter
Competition: Means to compete for something; engage in a contest; measure oneself against others.
Competition: conflict is seen as a contest with a winner and a loser.
Competition often creates conflict a natural “fight or flight” phenomenon.
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Emotional Intelligence?
Pause
Perspective
Prepare
Present
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Self Awareness
Self Management
Social Awareness
Relationship Management
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Communication Is Key Compliance Today’s Exhale by Shawn DeGroot
“In the compliance field we are blessed (or cursed, depending on personal perspective) with delivering messages to a variety of audiences. We listen, educate, investigate, question, ponder and respond. We routinely digest regulatory information in preparation for the next question during and investigation or to provide training to an audience. Our verbal messages can be succinct and clear, yet misinterpreted if incongruence exists with our body language.”
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Communication Strategy Negotiate
Cooperate
Challenge assumptions
Provide accurate and honest information
Develop and use your emotional intelligence skills
Its’ ok to …..
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Cooperation: the conflict is seen as a joint problem to solve.
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Communication
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It Can Feel Like This
Compliance Professionals can help change the perspective.
It’s not just about what is legal but the risk environment and appetite of the organization.
Its not about saying NO, it’s about helping evaluate HOW.
Management is being told (even by regulators) to be innovativebut sometimes the regulationscreate red tape.
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Our Code of Ethics Keep our role in perspective.
We can’t mange people or business operations but we can manage ourselves through the circumstances we encounter.
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Effect : Sustainable Results
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TogetherEveryoneAccomplishes More
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A Few Resources “Leadership: The Power of Emotional Intelligence” by Daniel
Coleman
“Results that Last” by Quint Studer
“Straight A Leadership” by Quint Studer
“Crucial Conversations” by Kerry Patterson
TheJust Culture Organization www.justcutlure.org;
HCCA & SCCE publications and resources: Compliance Professional Manual, Compliance Today, Surveys,
Videos, Books and more
Linked-In Groups and conversations
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