Healthcare organizations are responsible for compliance of an enormous number of regulations and laws. The sheer volume of compliance regulations involves more than any other business sector. While the rules are designed to protect the health, welfare, and data of individuals, creating an effective healthcare compliance program can present a daunting task.
Compliance guidelines are based on both state and federal laws and some experience regular change. Healthcare providers and employers must be proactive in the methodology of approach and follow through in maintaining all existing and new knowledge for compliance.
Seven Key Aspects of an Effective Healthcare Compliance Program
Compliance begins at the top executive level and expands to all employees and staff. Everyone within a healthcare environment needs to be aware of the importance of compliance and the regulations involved. Healthcare organizations should have an understood culture of compliance which involves communication and transparency.
Establishing Procedures, Policies, and Conduct Standards: This information should be documented and written so that they are understood easily for those performing job functions. The procedures and policies should be clear and concise, current, relevant, job-function specific, reviewed on a monthly or quarterly basis, and available for everyone within the healthcare organization environment.
Designation of a Compliance Officer, Committee, and Department: Individuals need to be assigned as part of a compliance committee or department with a Compliance Officer to oversee, monitor, and dictate changes for an organization’s compliance program. The group should review, detect, and correct any conditions of non-compliance, have resources enough to accomplish the duties, support the unique structure of the organization, promote conduct standards, create a clear line of communication for non-compliance reporting, and work with executives within the organization to assure compliance is understood.
Education and Training: Since all staff is responsible for understanding and adhering to compliance, education and training is an important element for compliance. Training should be part of all requirements for employees prior to being hired with additional frequent education and training courses, typically on an annual basis, to assure that everyone is updated on current compliance rules. Education can be in the form of courses, publications, and attending conferences.
Lines of Communication: Good communication within a healthcare environment is an important part of compliance. Effective communication involves making sure there is an established line of communication for compliance issues and that all individuals involved in the reporting process for potential non-compliance are approachable. Staff should feel secure with confidentiality of reporting with methods in place for good-faith reporting/anonymous reporting. A healthcare organization should also keep the lines of communication open for feedback to get suggestions for improvements.
Audits and Monitoring: The compliance department or committee should conduct regular audits of the compliance program to ensure that all areas of concern are being addresses and that the compliance program remains effective. Many healthcare organizations do this on a quarterly or annual basis and follow with changes that are instituted and communicated to all staff.
Guidelines for Discipline: The cost of non-compliance with a healthcare organization can be devastating. Compliance standards not only need to be followed but guidelines for disciplinary actions need to be included in publications supplied to all staff. The information should be clearly stated that everyone, no matter what their title, rank, or position are required to follow compliance standards.
Tracking and Finding Offenses and Corrective Actions: The compliance officer and team should establish a way to track compliance issues and methods to respond. There should be investigative actions combined with efficient documentation for each non-compliance situation. Enforcing corrective actions along with complaint resolutions should be part of the ways to address the offenses and make any changes that are required. Fast action in finding a compliance offense is a requirement for a compliance program to be effective.
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