Mary Bennett

Mary Ann Bowman Beil

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…Impacted Your Ability to

Reach Peak Program

Effectiveness2

1. Downsized workforce with low morale

2. Increased chance of mistakes

3. Increased chance of ethical or legal violations

4. Increased government enforcement

5. Doing the same or more on a smaller organizational budget

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� Times are hard -- but starting to get better

� The government needs money, so stepped-up enforcement is likely

� Particular enforcement focus on fraud, waste and abuse in health care

� Stakeholder expectations are changing, rapidly

� Employees, fearing job losses, may do “whatever it takes” to meet objectives

� Risk profile changed in economic downturn4

� December 29, 2009, Department of Justice Colorado-based Spectranetics Corporation to Pay $5 Million to Resolve Allegations Relating to Its Medical Devices

� December 22, 2009, Department of Justice Oklahoma Hospital Group Pays U.S. $13 Million to Settle False Claims Act Allegations False Claims Allegations

� December 1, 2009, U.S. Attorney, Central District of California Kerlan-Jobe Orthopaedic Clinic Agrees to Pay $3 Million to Settle Kickback Allegations

http://oig.hhs.gov/fraud/enforcement/criminal/2009/1209.asp5

�You are the Chief Compliance Officer for your healthcare organization. The CEO, facing a difficult economic forecast, has ordered a 20% budget cut across all “non-essential functions.” You must revise your budget for 2010 by identifying what is “essential” and what is “nonessential” and make a business case for your budget request.

�The latest investigations summary shows that there has been a 25% increase in reports of harassment and accounting fraud investigations over the past two years. Most recently, a finance manager admitted to manipulating the financial figures, stating that he “felt pressure to meet the numbers because the vice president said everyone had to hit their targets this quarter, no matter what.”

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1. Oh $!$%&*! - I’d better update my resume if compliance in health care is “non-essential”!

2. Cut 20% across the board3. Delay hiring plans, cut training, skip conferences,

cancel audits, and fire the consultants4. Conduct cost/benefit analysis of the program5. Provide an updated risk analysis to the boss with a

suggested mitigation plan that is sensitive to resource constraints

6. Something else…

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1. Knowing what is most critical to emphasize2. Thinking outside of the usual box3. Prioritizing the list of things I need to accomplish4. Staff shortages in my department5. Less employee time to focus on ethics and

compliance6. Something else

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� Ascent Planning� Determine essential v. non-essential program activities

� Expedition Underwriting � Identify ways to continue essential activities with less

cost

� Effective Climbing Techniques� Incorporate proven methods to manage risks and increase

effectiveness

� View from the Peak� Know what effectiveness looks like on a budget

� Keep the long –term perspective12

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Prevent Detect Correct

Risk identification and management

Helpline and other reporting systems fully operational

Consistent discipline for issues found; Discipline for failure to act

Leadership support with identified champions

Auditing and monitoring including issue trending / tracking

Communications and training as needed for remediation

Periodic communication of key messages

Strong HR processes in goal setting, hiring, promotions, and exit interviews

Fill gaps in policies, processes, or programs identified by issues or investigations

Training including targeted high-risk training

Active oversight by leadership and governing authority

Periodic evaluation of effectiveness

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� Annual Code update or printed copies of the Code

� Excessive spending on print materials

� “Like to have” training – either extra content or expensive approach

� External resources

� New headcount

� Conference attendance versus webinars

� Continued silo culture

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1. Yes2. No3. I’m not sure

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� Leverage existing resources:

� Marketing person is probable expert on surveys

� Audit person knows about problems not being addressed

� Interns can scroll the web for best practices

� Greater use of the intranet to disseminate information, save printing costs, get it there faster

� Make the most of association memberships – call a peer

� Borrow from peers, don’t reinvent what is working elsewhere

� Declare a truce on turf battles20

� In tough times, even more important to do risk assessment� Go out and talk to people in your company to get a feel for

risks� Ask peers and leadership to participate in process

� In a recession, some risk exposures have to be more of a priority – i.e. people cutting corners� Enlist your auditors – get them involved in reviews –– ask

people in your company where problems are

� What happens when budgets are cut?� Morale decline� Revenue recognition concerns� Use and misuse of company resources� Sales pressures

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1. Downsized workforce with low morale2. Increased chance of mistakes3. Increased ethical or legal violations4. Increased government enforcement5. Doing the same or more on a smaller

organizational budget6. Something else

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� Continue internal efforts versus training provided by outside resources, if you can

� Keep essentials and step up the role of line management� Ten minutes from direct manager is often better than 1 hour from

trainer� Focus on risk and role based content

� Break up blocks of training into smaller time frames

� Cut back on company-wide communications. Focus on target audiences.

� Build and renew relationships with peer functions. Share resources

� Mix the messages into existing channels

� Find low-cost, high impact ways to promote the messages

� (e.g. HIPAA sticky notes)

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� Work closely with HR, Audit, Security, and Legal to identify and track trends.

� Conduct thorough investigations

� Broaden your questions – ask what else is going on

� Wrongdoing tends to cluster with systemic problem

� Follow-up on related issues

� Coordinate corrective and disciplinary actions

� Survey employees

� Make special inquiry of departing employees. Interview those who voluntarily terminate

� Work your helpline data to identify correlations and trends

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� High percentage of anonymous calls

� Numerous audit findings and failures

� Excessive litigation

� High percentage of HR complaints

� High number of third party complainants

� High attrition rate/excessive management turnover

� Increased allegations of nepotism or favoritism

� Increased allegations of harassment, retribution, and retaliation

� Claims that reports of misconduct are ignored

� Management condescends to Ethics Office/disregards advice

� Ethics awareness training not conducted in a timely/reverent way25

� It’s more important to travel smart than to travel rich

� Allow your colleagues to invest in your expedition � Share the vision

� Ask for their participation and budget support

� Invest in the most important equipment, the essential elements that matter

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� Map the best route to the summit

� Have a base camp

� Select the optimum expedition companions

� Learn to rest step

� Prepare to breathe in thin air

� Be prepared for the unexpected crevasse

� Set lines to guide

� Know the skill of balanced climbing

� Know how to clean climb

� Never underestimate the weather

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� Examples from Memorial Health designed to :

� Incorporate proven methods to manage risks

� Save costs

� Increase effectiveness

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� Keep it simple

� Clear agendas

� Matrix over minutes

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� Building a portal

� Proof of Plan

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1. Identify and stop all non-essential activities2. Work with peer departments3. Consolidate program documentation4. Create a way to collect “proof of plan”5. Increase monitoring and auditing efforts6. Something else

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� In spite of time and resource constraints, think “efficiency”� Staff shortages

� Build and renew relationships with co-stakeholders – are there resources you can share?

� Consider what you can do well, and what should be outsourced to other experts (internal or external)

� Allow the staff to focus on the few true priorities

� Defer the truly nonessential tasks to a future date

� When there is less time for employees to focus exclusively on compliance and ethics

� Mix the messages into existing channels

� Break up blocks of training into smaller time frames

� Find low-cost, high impact ways to promote the messages

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� Cost-effectiveness� Focus on the critical issues of today and tomorrow

� Find new ways to accomplish the tasks

� Can you combine efforts for certain essential aspects of your program with other stakeholders?� Human Resources

� Legal

� Corporate Security

� Audit

� Regulatory compliance

� Business leaders with specific compliance requirements(e.g., CFO)

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� Program effectiveness� Continue doing all of the “essentials”

� Effectively identify and manage your E&C risks

� Set goals for your training and communications and measure their achievement

� Engage the Board with more than a report of helpline numbers

� Formally measure program effectiveness including cultural impact� Internally conducted every 1-2 years – enlist Audit,

Marketing

� Externally conducted every 4-5 years – this is when you need a consultant

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� Turbulent times give the ethics and compliance officer a chance to step up to a leadership role.

� The business problems that lead to turbulence often are culture-based. This provides an opportunity to exercise leadership in a way often not possible in “normal” times.

� Make yourself and your program part of the business solution. Think of yourself as a business person who happens to be running the ethics program.

� Emphasize the role of cultural change in reducing effects of turbulence

� Act as a facilitator (the cultural glue) to make sure the various interests in the organization pursue similar cultural goals and send out consistent “messages”

� Remain sensitive to key business objectives37

� An effective ethics program does not send mixed signals. Whether you expand, maintain, or shrink your program in response to turbulence, avoid at all cost the notion that you are changing (or retrenching from) underlying business ethics, ethical principles or basic values.

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