Podcast: Easy Ways to Build a Relationship with your Compliance Committee

I’m really excited about my most recent episode of Compliance Conversations because I got to chat with Judith Marber-Fox, a friend, and brilliant healthcare attorney turned compliance professional. Fox spoke at this year’s HCCA about the compliance committee, and it was excellent. So I picked her brain about how she came up with the topic, and the many ways that compliance officers can influence their compliance committee.

“….I really believe that as a compliance officer, your compliance committee can be your best friend,” said Fox. “Really, if you’ve got a good functioning engaged committee and members that show up and participate, and are educated, you can really kind of move mountains in a way that as a compliance officer within your team you can’t really do operationally.”

Fox had a lot of brilliant things to say about the ROI of the compliance officer/committee partnership, and great ideas on how to engage Sr. leadership to actively support a committee’s role and responsibility.

“You need to have patience and a lot of guidance,” said Fox, "if you want to influence senior leadership. Seriously, a lot of education and guidance. I don’t think it’s something that can happen overnight. I’ve been in short term positions, as interim as a consultant, and I’ve been in long term positions, and I think, how do I say, I think being very genuine and upfront is critical. Being authentic, and not coming in as the compliance police.”

"And second, you’ve got to really show up for people." Fox gave examples of how to be genuine and to get involved. “You need to create the opportunities where you have a seat at the table. What I’ve done in the past, I’ve tried to get myself on agendas, be it a directors meeting, or operational or committees, and be a face that people know. This goes back to the authenticity, and genuineness, and just really have them understand who you are, and if you don’t understand something operationally go out to lunch with somebody and learn what it is that keeps them up at night.”

Turns out, empathy and authenticity can move mountains in compliance.

Tune in to my most recent episode of Compliance Conversations, How to Build a Mutually Beneficial Relationship with Your Compliance Committee, with special guest, Judith Marber-Fox, to learn how to build a mutually beneficial relationship with your compliance committee, engage sr. leadership to actively support the committee, and create opportunities that give you a seat at the table.

Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations, my name is CJ Wolfe, I'm Healthicity's Sr. compliance executive. Today I have a fabulous guest, Judith Fox, welcome Judith.

Judith: Hi, how are you?

CJ: Doing great.

Judith: It's good to be here.

CJ: Thank you for joining us. Judith and I connected again at the HCCA compliance conference, as the compliance nerds that we are. We had some good conversations, you presented there, I presented there, and we thought hey, let's talk about some of the things that we spoke about there, and so that's what we're going to talk a little bit about today. Before we get to that conversation Judith, would you mind sharing with our audience a little bit about yourself professionally, maybe a little about your background, and what you're doing today in compliance.

Judith: Oh sure, I'd love to. I've been in compliance since about 1998, prior to that I was strictly a healthcare attorney. I went to law school, knowing I wanted to be in healthcare law. Like many other compliance officers, I just found myself, all the sudden, in the role of a compliance officer without really knowing much about it.

CJ: Right, who grows up wanting to be a compliance officer, right?

Judith: Well I guess there are people now that do, but back in 1998 there were not a whole lot. I had been recruited by Integrated Healthcare System that had a board that was heavily involved with the defense industry, so they were very familiar with compliance programs. When I was brought on as an attorney, in those days it was okay to have a dual role, and I was to implement program. It was a fully integrated system with three hospitals and all the other services and all the accoutrements that go along with that. I was there for about 10 years and developed a system from scratch. From there I had various other positions, but at one point I was contacted by a consulting firm where I was a client for them and did some work for them for a few years on a consulting basis.

CJ: Okay.

Judith: I decided more recently, my last employed position was with a very large system, a national system, that has 11 campuses in Florida, and was responsible for their compliance program. I decided to go out on my own and am currently doing some consulting and loving it.

CJ: Great, and how long have you been doing consulting?

Judith: I've been doing JF Compliance Solutions, let's see, it's two years now, I think I'm just celebrating my two-year anniversary. I've served as interim compliance officer for a number of organizations, and I've performed effectiveness reviews, and gap analyses.

CJ: Excellent, and with a legal background that's a great area to come from compliance. You spoke recently at HCCA about the compliance committee, what a great topic. How did you guys come up with that topic, what was on your mind that drove you to talk about that?

Judith: Okay, I'm smiling, because that's a subject that is really close to my heart, I really believe that as a compliance officer, that your compliance committee can be your best friend.

CJ: Absolutely.

Judith: Really, if you've got a good functioning engaged committee and members that show up and participate, are educated, you can really kind of move mountains in a way that as a compliance officer within your team you can't really do operationally.

CJ: That is so true. Some of us, and I don't know if this was your experience, but I've been in organizations where I've had a really strong compliance committee and other organizations where I didn't, and it is just night and day, like you said. A lot of that drive and culture can be driven by the committee, and you're really, as a compliance office, to manage the day to day operations of the program, but compliance owned by leadership.

Judith: Exactly. As a compliance officer you can really influence the committee. I always, and I spoke about this at the conference, where I think that they need to understand as committee members, and Sr. leadership all across the board, has to understand, in my opinion, that compliance adds value to the organization.

CJ: Yeah.

Judith: That there really is a return on investment, and the ways to do that really is to show, what are the areas that they are concerned about. No matter what conditions they are in. They are concerned about quality of care, efficiencies, revenue, as well as lowering risks, or regulatory risks.

CJ: Absolutely. How do you engage Sr. leadership to actively support that committee's role and responsibility?

Judith: Patience, and a lot of guidance. Seriously, a lot of education and guidance. I don't think it's something that can happen overnight. I've been in short term positions, as interim as a consultant, and I've been in long term positions, and I think, how do I say, I think being very genuine and upfront is critical. Being authentic, and not coming in as the compliance police.

CJ: Yes.

Judith: Really having information that is ongoing, that is meaningful, and that is relevant to what they care about. I think to be engaged Sr. leadership needs to know  "why do I care?",  "why is it important that I'm involved?", so if it hits home to them why is it important to them.

CJ: Yeah. That implies that the compliance officer knows more than just compliance, meaning they know what Sr. Leadership is worried about, right? So maybe if you have chief operations officer, if you have a chief nursing officer, or, you know, you learn a little bit about what runs the organization, and not just compliance. Do you think that's a big component of how a compliance officer can help engage Sr. Leadership is by better understand what makes their clock tick, so to speak?

Judith: Yeah, absolutely, and sometimes it's a challenge, because not all compliance officers, if you're in a system that has not truly operationalized compliance, they might not understand that. The compliance officer may not have a seat at the table.

CJ: That's a good point.

Judith: You need to create the opportunities where you have a seat at the table. What I've done in the past, I've tried to get myself on agenda's, be it a directors meeting, or operational or committees, and be a face that people know. This goes back to the authenticity, and genuineness, and just really have them understand who you are, and if you don't understand something operationally go out to lunch with somebody and learn what it is that maybe keeps them up at night.

CJ: That's right.

Judith: Be able to collaborate what's important to them operationally and how that impacts compliance and vice versa.

CJ: Yeah, because if you can understand what they are doing there are subtle opportunities where you can use what motivates their day to day work and piggyback compliance initiatives on that, but you need to understand what they do. I really like what you said about getting on agendas, I've written about before that compliance doesn't happen in a corner, meaning you need to get out of your office. You need to be on those agenda's, you need to be on those meetings, like you mentioned one can observe your authenticity and your genuine concern, but also that you can learn what is going on in the organization.

Judith: Yeah.

CJ: You mentioned a lot of education.

Judith: I was just going to say, I was going to add if I can, you don't want to be shy about that either, but you don't want to be aggressive.

CJ: That's right.

Judith: It's a really fine line about getting yourself on those agendas.

CJ: It's kind of like an art, if you push yourself to hard people might clam up and then you'll never get on there, that's a great point. You mentioned a lot of education is a great way to engage Sr. leadership, I've always taken the approach, I'd be interested if you found success in this way, I would rather have an opportunity to be on an agenda for education like four times year, for fifteen minutes each, than once a year for an hour. Now obviously I'd like to have even more time than that, but the point being, I think it is frequent education that's not overwhelming, and I wonder if that, when you mentioned that one of the ways to engage Sr. Leadership is a lot of education, do you find that to be true, or do you have other strategies or thoughts on how to go about educating.

Judith: No, we're on the same page there. I was saying earlier that the information that you give, if it's education or if it's guidance, it needs to be relevant and meaningful and ongoing, so if you wait a year to give education about a special project that came out eight months ago, how relevant is that?

CJ: Right.

Judith: I think frequent, short education is critical. I've always, in my life as a compliance officer, I've always included a standing agenda for compliance committees, whether it be a five- or ten-minute topic.

CJ: Absolutely, what a great idea. That kind of segues into my next question a little bit about best practices regarding compliance committee materials, you mentioned the agenda, but could you mention some other important materials, like maybe a charter, a lot of new compliance professionals are not aware of the importance of a compliance committee charter. You mentioned the agenda, minutes, other communications, can you talk a little bit about those materials that go with the compliance committee.

Judith: Yeah, sure. The charter, I agree with you, it's so important. It's sort of the constitution for the compliance committee. It really lays out; I think there is a handful of pertinent pieces that need to go into a charter. You want to be able to lay out by position at a minimum, who, not by name but by position, who needs to be on the committee.

CJ: Yeah.

Judith: People move into different roles all the time; you don't want to be updating your charter all the time.

CJ: Any examples?

Judith: Yeah, I was just going to say you want to get a cross section of operation layers, because that's your sort of captive audience. That's where you have, instead of having silo meetings with different operation layers you've got everybody there. I normally, I always include somebody from Sr. Management, IT, HR, medical staff, nursing, clinical reimbursement. If you have a legal, in house legal representative. What am I forgetting...?

CJ: Yeah those are all great ones, you mentioned reimbursement, I always remember having a CFO, and there are different levels of committees depending on the size of your organization. I was in one organization that had almost twenty thousand employees, and our budget was over a billion dollars a year for the organization, so it was huge. We had a Sr. compliance committee, then they had sub committees, like a privacy committee, a reimbursement committee, a research committee, and so I think depending on the level of the committee, might also affect the level of the people you involve, right?

Judith: Right, and that goes to the charter as well because you want to have the charter authorize the committee to create sub committees and task forces. Even if an issue comes up, it could be some sort of crisis, well I don't want to say crisis, let's say the government comes in and performs an audit, and you need a team to report up to that committee, they can at least authorize so that you are not getting into the weeds at the committee level.

CJ: Gotcha.

Judith: Especially if it's a larger organization.

CJ: Yeah.

Judith: Another example, you may want to have a sub committee that reviews the audits, and monitoring those all, so they can look at things like the details of sample size, and follow up on corrective action, and just report up at a higher level at the committee.

CJ: Right.

Judith: I think the committee members really appreciate that. That they are not getting inundated with lots of details that they really don't need to know.

CJ: Right. One thing I've seen in charters sometimes is some sort of scope authority, so that it will say the compliance committee has authority to review any document in the organization, or it sets out things like that so that, you know, if the compliance committee feels like you need to do an audit or an investigation it has the authority to go where it needs to go. Is that something that you've seen in charters as well?

Judith: I am thinking, I don't know that I've actually put that in a charter.

CJ: Okay.

Judith: That's an interesting one because I think that there are some items that you may not, maybe under attorney client privilege that you may not want to provide to the committee.

CJ: Yeah.

Judith: I think that it could be worded in a way that would take care of that issue as well.

CJ: Good point. If you're working on an investigation and you've deemed that you need to get privileged and you don't want that privilege be in jeopardy for sure. Tell me a little bit about agenda's and minutes, what are some recommendations there? I know on minutes they say the shorter the better, but isn't that a delicate balance between demonstrating that the committee is making important decisions but also, I don't know, do you not want to have it too in depth? Tell me what your thoughts are on that.

Judith: Yeah, I actually take my own notes during meetings, I usually do have a staff member taking notes as well but there might be little nuances that I catch, but to your specific question I think it's really important to not get too long winded with minutes. You don't want anything in the minutes that can come back and hurt the organization, you want to be able to just portray the intent and the flavor of the discussion, and then most importantly the results.

CJ: Okay.

Judith: If there is a long conversation, you don't need to reflect who said what, and I would suggest not to, but to at least get the flavor, and give the result of what the outcome of that discussion was.

CJ: Great.

Judith: The other piece there, is that you as a chairperson in the meeting itself, you want to move people on. A lot of times conversations...you know. Get a little, I don't know, I don't want to say heated, but people have opinions, and you need to move that along. A delicate balance of not being too aggressive, but controlling, at least controlling the agenda, because you want to end on time.

CJ: That was my next question. In your experience, what have you seen as generally effective times, is it an hour, if you're going over an hour do you say you need to reevaluate this, or are you up for a marathon meeting? What are your thoughts on general timeframe?

Judith: What I've done in the past, is I like to incentivize people to want to come. Especially in our busy world a lot of people are maybe skipping lunch or whatever, so often what I'll do is create the meeting for an hour and half, but I'll serve lunch. People like to come to meetings where there is food.

CJ: I was going to say, I'll come to your next meeting.

Judith: I've found an hour and half to be a good amount of time to get what you need to go.

CJ: Do you recommend that these committees meet once a quarter, once a month, I've seen ones as frequent as once a month, but what are your thoughts and kind of the frequency of the compliance committee.

Judith: Really depends on what stage you are in your compliance program. What I've normally done, going back to the charter, is include the minimum frequency in which the committee is to meet, I recommend quarterly.

CJ: Okay.

Judith: If you need to have meetings more often, especially if you're rolling out a new initiative, or if you have reconstituted your committee, you may want to meet, or if you're getting ready for, oh, I don't know, corporate integrity, you certainly want to have, that's a sore situation, but you want to have meetings more often, but the carter will at least sort of mandate that it will be no less frequently than quarterly.

CJ: Okay, that makes a lot of sense. Any other thoughts on this general topic, kind of the materials, we've talked about charter, agenda, minutes. Anything else in that area that you want to mention?

Judith: Yeah, I think with the committee it's really important to ask for resolution as the chairperson. I was saying earlier, discussions will go on and on, and you want to have some kind of decisive end result to that discussion if there needs to be forward movement. Somebody will give an opinion, I think we need to do x, y, and z, somebody else agrees, I'll specifically say, is there a resolution? Then that is documented in the minutes, then you know there is going to be follow up.

CJ: Gotcha.

Judith: I think the worst thing is to have this conversation, come up with great ideas, not follow up, because you want to follow up on the next meeting too, and then report back to the committee what the resolution was.

CJ: That's right, yeah, good point. To point of effectiveness, those types of things will then demonstrate the effectiveness of that committee, if you're ever, heaven forbid, you're being investigated or something, and you need to demonstrate that your compliance program is generally effective, those types of things you just mentioned, I think, tell the story over a period of time that the committee is engaged, and it's not just some sort of window dressing.

Judith: Absolutely, yeah.

CJ: Let me ask, kind of another question, switching gears slightly, can you think of any scenarios, or hypothetical situations that demonstrate the effective use of committee members to operationalize solutions to tough compliance issues? The black and white things we get, those are easy answers, right? You can't do this, you can do that, but what about some tougher scenarios? Are there any scenarios that come to mind that you think that the committee can help operationalize?

Judith: Yeah. That's a good question, a few things come into mind, but one that is sort of out of the box. I was involved with an organization that had a large corporate compliance headquarters, and there was a contract management system that just wasn't working for the local entity, which was a very large portion of the corporate entity, and it had been a topic on sufficient contact management. As compliance we, myself, my team, I mean we were monitoring through audits, internal audits, we were auditing compliance with the contact management protocols, anyway fast forward, the statistics were not that good, and we were finding too, that in actually reviewing contracts that there were a lot of inefficiencies, there were too many people involved across the organization, it was not working as a process for that particular location.

CJ: Okay.

Judith: I brought the issue to the committee, but rather than focusing on the compliance piece of it, I talked a lot, I interviewed a number of people before hand that had a piece of that pie, so to speak, from the time that a contract was being submitted to legal, what the administrative assistance were involved with, how long it was taking, and I had a very good picture to present to all the different committee members about the operational inefficiencies. Some of the results, how we compare to other organizations within the big corporation, and our numbers were not good.

CJ: Gotcha, okay.

Judith: Yeah, and they didn't like that. It's a great example, and the end result was that they really took ownership, the compliance committee took ownership and gave us authority to bring in a performance improvement team, and really look at the details of the system and then get involved at the corporate level. It took, it was about a six to eight-month project, but I actually wound up presenting to the executive finance committee and getting authorization for a separate department, with two new full-time employees, I mean it was needed. It was something that was absolutely needed, but nobody really knew to the extent how inefficient it was working at the time.

CJ: Yes.

Judith: That would be the best example I could think of.

CJ: That's a great example, kind of going back to what we were talking about at the very beginning, about who to put on the committee. If you have the right players on that committee, then they already have the background, they already know what needs to be done because they've been in the meetings, and they have been listening, and they can at least give, what I always called the halo effect, they are the leaders and they can tell their subornments this is an initiative we are going to do. You get this operational support as opposed to the compliance officer trying to go around and convert people.

Judith: Exactly.

CJ: That makes a compliance officers life so much easier, doesn't it?

Judith: It does, and you can see, I love that expression, the halo effect, because you can see it happening to members.

CJ: Yes.

Judith: When issues come up that really involve their areas, that 'ding', the lights go on.

CJ: Yeah, I always think of, in particular one committee I served on, we had the head of the revenue cycle there, and so, obviously revenue cycle and billing and coding concerns and those types of things with compliance were top of mind at most hospitals and providers. I just remember, we worked together so well that most of the time we figured out a solution before we got to the committee, we just got to the committee and they just needed to approve it because the key players were already there, and when it worked, it worked so beautifully.

Judith: You bring up another point, what I try to do, if I think there is a situation that there may be some disagreement about amongst the leaders, I try to have, I give the people a heads up before hand about what the discussions will be so there are no surprises.

CJ: Yeah, and you get to know the personalities of the people, and some people like data up front, some people like to digest that data after the meeting. You start to get to know people, and know what their leadership styles are, and then you can, like you said, kind of cater to those people so there are not surprises, and the committee decision making process runs smoothly based off of preferences. We're getting a little bit low on time, but I wanted to ask you another question. Let's say you've been in an organization and you've had a pretty good compliance committee, it's the same players though and they have been on it, and you are kind of in a rut. Any thoughts on how you can re-energize an existing compliance committee, you've done a lot of the heavy lifting, but it's been years, and you need some energy, any thoughts?

Judith: Yeah, actually. I just had a client where I did that. I went to a committee meeting, they were sort of not energized, but I looked at the composition, I looked at the charter, and I recognized that they really needed to have an infusion of new blood.

CJ: Okay.

Judith: I met with the CEO, and we looked at the org chart and we talked about different people, different roles, what perhaps we could change within the committee to re-energize it. We deleted some people that were not in the appropriate roles on the committee, and vise versa, we added other people, but what I was able to do was have the invitation to this sort of re-energized, newly formed committee, come from the CEO.

CJ: Nice.

Judith: So, it showed that the CEO was engaged basically.

CJ: Absolutely.

Judith: That he had support for the committee, and had a whole new orientation, we advised the charter, got input from all the new members after the orientation on the charter, and had them provide the input and improve it. It just changed around the whole formatting and the style to do basically all the things we just talked about.

CJ: Right.

Judith: Moving items along, giving education, making it relevant. Within a few months there was a significant change in their engagement.

CJ: That's great, I think sometimes just that fresh set of eyes. If you've looked at compliance the same way for five or six years, it's nice to have an extra set of eyes that have seen solutions from a fresh perspective. Sometimes you can get great solutions just because you have a new set of eyes looking at it.

Judith: Oh yeah, absolutely.

CJ: And that brings that energy. Well this has been great Judith. I want to give you a few minutes for any last-minute thoughts where we could maybe wrap up this whole concept, but obviously we could talk for hours. I think you guys did talk for hours, you had an extended session at HCAA if I remember right, any last-minute thoughts or feelings on the compliance committee?

Judith: Yeah. I'll sort of end up as I started, I really believe they can be your best friend, and they are a source, not a source, a resource, for moving operations more actively. I think that one committee in an organization may totally vary from another committee in an organization depending on size and culture. In some committees you want the CEO to be there as the Sr. leader representative, right?

CJ: Yes.

Judith: In other organizations...

CJ: You don't.

Judith: Like the one that you described earlier, the really large one, the CEO is not going to attend, and you're going to have maybe more middle management folks at those committees and have different types of committees. I think as compliance officers we need to be flexible to the culture and to the organizational needs.

CJ: Yeah.

Judith: You can not just dictate this is the way it is and have a bright line.

CJ: That's a great point, and I work with clients who are on the very small side as well, and they might not have enough people for a large committee too, so you have to take, like you said, the size of the organization into account, the culture, and what they are trying to accomplish. Great advice Judith, thank you so much for your time today. Really appreciate you.

Judith: Oh, this has been great.

CJ: Yeah, we appreciate your expertise in this area.

Judith: I enjoyed this very much.

CJ: Good, thank you. We wish you a good day, and I wish all our listeners a good day, and happy compliance, until next time everyone, bye bye.