Why Effective Lines of Communication in Healthcare Compliance are So Important

Effective lines of communication are a foundational element of an effective healthcare compliance program. Over decades of advising healthcare organizations, we have seen how communication failures can increase risk and undermine compliance efforts. Strong communication practices help employees understand expectations and raise concerns before small issues become larger problems.

Why are Effective Communication Practices Important in Healthcare?

Effective internal communication is important to healthcare organizations. It is important for many of the same reasons that communication matters in other business organizations where large numbers of employees interact with the public.

• Effective communication is essential to employee morale, which in turn affects customer or patient satisfaction.
• Effective communication can enhance operational efficiency and teamwork.
• Open lines of communication can encourage buy-in and help employees understand business goals and priorities.

Effective communication procedures can be an important component of an effective compliance program. This is particularly true for healthcare organizations that bill federal and state healthcare programs for their services. This is one of the seven elements of an effective compliance program, per the Office of the Inspector General (OIG) Guidance on compliance programs for healthcare organizations. 

Moreover, all healthcare organizations that utilize electronic health records systems or otherwise maintain electronic records of patient-protected health information (ePHI) are subject to the HIPAA Security Rule.

The Administrative Safeguards of the Security Rule require covered entities to provide security awareness training, including periodic security awareness reminders.

What are Effective Lines of Communication in a Healthcare Compliance Program?

The OIG Guidance lists several effective communication practices for healthcare management to consider. They include:

• Hotlines 
• A website portal;
• An email address dedicated to compliance;
• An internal mailbox.

At least one method should enable staff members to report compliance concerns anonymously. This can be accomplished with an internal hotline or a hotline maintained by a third-party vendor. Staff members should not be required to bring concerns to a supervisor or manager before reporting them to the Compliance Department.

The organization’s commitment to confidentiality and non-retaliation should be known and documented in its compliance policies and procedures.

Healthcare leaders should not underestimate the impact direct supervisors can have on effective communications. Healthcare leaders rely heavily on managers and supervisors to communicate with employees. They often convey information on a wide range of topics during staff meetings and other gatherings.

Detailed information about the elements of the compliance program may not roll off the tongues of managers and supervisors. But emphasizing the availability of ways to communicate to the Compliance Officer or Compliance Committee should not be extraordinarily challenging for most managers or supervisors.

And of course, the venerable open-door policy can always help, too.

Why do Healthcare Workers bypass Internal Reporting Mechanisms?

There are numerous reasons why employees may bypass internal reporting mechanisms or even decline to report compliance concerns at all.

• Employees may fear retribution from supervisors, managers, or even executives for reporting compliance concerns. We all know the bearer of bad news is not necessarily feted at the next all-hands meeting.
• The concerns may be related to an employee’s direct supervisor or someone else in the chain of command.
• Employees who reported in the past were disciplined or even terminated.
• Reporting mechanisms may be unclear or difficult to use, or there may be no procedures for anonymous reporting.
• Employees may worry about retaliation for reporting or may have engaged in misconduct themselves.
• Staff members may not recognize the issue as a compliance issue or think it is too small or an isolated incident.
• Some may even fear the organization’s reputation may be damaged by a revelation of compliance matters.

What Happens when Employees Turn to Outside Organizations?

These days, staff members have numerous alternatives to turn to. This is especially true if, for whatever reason, they do not or cannot report compliance issues to a supervisor or to the Compliance Officer. There is a seemingly endless list of attorneys who are offering their services to whistleblowers across all types of individual, corporate, and government activities.

Healthcare organizations in particular may become involved in investigations related to false claims to government health insurance programs, or to activities such as kickbacks or even Stark Law violations. 

Healthcare organizations employ or contract with numerous professionals such as physicians, nurses, laboratory scientists, imaging technologists, therapists, and many others. These people are typically devoted to taking care of patients and have professional codes of ethical behavior. They can be outraged by misconduct or even mistakes such as medical errors. And of course, the professionals managing the medical coding, billing, and financial activities also know the difference between right and wrong.

For the most part, people only become whistleblowers after trying to report questionable actions or activities internally.

Judgments against healthcare providers can be influenced by institutional indifference to ignored reports. This is particularly true when internal concerns were raised but not addressed. 

How do Your Lines of Communication Stack Up?

Here is a practical checklist you can use to evaluate the effectiveness of open communication lines in your organization. A downloadable PDF version is also available below.

Conclusion

If there is one thing that our forty years of consulting services have taught us, it is that communication is a never-ending challenge.

There will always be staff members who say they never got the word about a compliance program. Others may not know how to report erroneous practices or ask questions when issues arise. Still others may never have heard the term HIPAA or understood that it was at-risk conduct to discuss patient information with friends and neighbors.

Developing and keeping open lines of communication are part of those never-ending challenges. So always have it on the agenda, and don’t ever think you have done enough!

Healthcare Compliance Communication FAQs