Lessons from Compliance Communication and Leadership

In the latest episode of Compliance Conversations, CJ Wolf welcomes Jay Anstine back to explore the nuances of effective compliance communication. 

What You’ll Learn: 

• Strategies for delivering tough news to leadership 
• How to avoid creating a culture of false urgency 
• Practical tips for navigating compliance politics 
• The importance of clear communication plans 

Jay draws on years of healthcare compliance experience and shares lessons from his book, Navigating the Politics of Healthcare. Whether you’re dealing with audits, overpayments, or building trust, this episode provides actionable insights you can apply today. 

Episode Transcript

CJ: Welcome everybody to another episode of compliance conversations. My name is CJ Wolf with Healthicity. And today's guest is a return guest, it's such a great job last time we wanted to talk to him some more, Jay Anstine. Welcome, Jay!  

Jay: Hi CJ, thanks so much!  

CJ: Yeah, we're glad you're here. And we got some good topics to talk about. Jay has a lot of great experience with kind of maneuvering, well, obviously he has the technical experience in compliance, but also kind of maneuvering relationships and conversations because a lot of compliance is around that. So, we're going to talk a little bit about that today. But before we get there, Jay would love to hear just kind of maybe a little bit of background about yourself, how you ended up in compliance, or whatever you want to share, what you're doing now, or any of those sorts of things.  

Jay: Sure! Thanks, CJ! So yeah, I think, like you and I know you've talked about this and others that are in our profession. I stumbled on this as that tends to happen. I originally when I was in college was a pre-law major and was going the route of practicing law. Took a few years off after college and started working for a health insurance company, that's where I got into healthcare, and I really liked it. And then when I went back to law school decided; "Okay, I want to marry these two interests!" And so originally started out working legal and then switched over to compliance and have been on that side really the majority of my career; working on both the provider and payer side of the market, and largely have spent time around hospitals, health systems, did spend some time working with some physician practices. And so I think a lot of the things that I've brought up or mentioned either in speaking or in things that have written, have been really from kind of hard lessons learned over the years and communicating with others about compliance issues.  

CJ: Yeah! We get to take advantage of and this is how all of us are, mistakes made, right? And so it's like; "Hey, next-generation or next-person don't make this mistake!"  

Jay: Yes, exactly, exactly!  

CJ: Well, that's awesome and I know you've written a book on some of this. Do you want to tell us a little bit about that?  

Jay: Yeah, I had published a book last year called Navigating the Politics of Healthcare: A Compliance Officer's Guide to Communication, Relationships, and Gaining Buy-in, and really, that came up because of some very political things that I had gotten involved in just from a career several employers ago and just different relationships and things like that, but they were things that I was experiencing at other places I worked at too, and just realized, it's such a political industry, you know, in terms of kind of corporate politics or office politics, not actual politics. But you know, it really is a huge component of the job and it is a part of the job that you've got to just learn through experience. So, part of my goal in writing that book, was to help newer compliance officers just starting out to try and help them avoid some of the mistakes I made and just, you know; "Hey, these are some of the things I learned that didn't work and what did work," and that kind of thing.  

CJ: Yeah! So, appreciate that you have that out there and hope others will take a look at that and take advantage of those lessons. And we're going to talk a little bit about some of those lessons you've learned and some of the ways to maybe deal with that today. And just to kind of tie this off, we want to talk a little bit about, you know, in compliance we're often either the bearers of bad news because we find something or we have to help others make a really tough decision. So, we're going to talk a little bit about that and then we have time we're also kind of talking about making sure we're not creating this false sense of urgency, and how that can affect relationships and future trust.  

So, let's maybe start with that first one, you know, I've had to do it. I'm sure you've had to do it. Where we've had to offer bad news or you're in a meeting, maybe it's before a decision has made, whether the organization is going to move into a new line of work or they think they're going to have a new stream of revenue. And you've got some tough decisions to make. How do you deal with some of that? What have you learned about that kind of context?  

Jay: Yeah, I think, the biggest thing that I had learned when it when it comes to delivering bad news is really developing a communication plan, and really I think that's an approach that you could really take with any type of compliance communication or working on whether it's an audit or investigation or education and training. And I think specific to bad news, a communication plan has always helped me to kind of give thought to really a couple of questions that have really helped me. The first one was, how well I mentally prepare the leaders to hear whatever the news is that I'm going to tell them? And I think that's a good question to run through because it's really aimed at softening the blow of the news that you're about to deliver. You know, I think as human beings, it's no surprise that we have a fight or flight type response when we're confronted with shocking news. You know, if you think about just any type of catastrophic news event. And so just keep that in mind, because that same shock factor can apply to a healthcare leader. You know, when you're confronting them with the news of either a large overpayment or an employee suspected of drug diversion or an employee committing fraud or something like that. 

And so, think about being in that person's shoes; what information, how would you appreciate hearing the information, you know, people are all different and how they process information too, and I think that's something I've learned over the years, and so you might have some people that more drivers and want the information and they want to move forward and you have others that are more processors and thinkers. And so sometimes if you've got the latter, it might be better just to let them have that information, let them digest it, let them process a little bit, and then come back to it later time when they've got a little bit more of a clear head because I think taking that approach it helps make sure that they're more engaged in the discussion and they're not distracted by that shock, and then it also improves your chance of having more of an effective discussion about what the next steps are.  

So, that's sort of the first thing that I would think about as a communication plan specific to delivering bad news.  

And then the second one is, this is some things I've written about too in the past is sort of what is your recommended solution to solve the issue and prevent a future occurrence? And so, the thing I've really tried to emphasize and what I've written about is, think through this as really a package type communication, don't just bring a problem, bring an issue, and or excuse me, don't just bring an issue, but bring a proposed solution as well. And so, think about some of those questions, try to anticipate questions that your leaders might ask you. I know one that I always tend to get whenever I was telling about something was; "Okay, well, Jay, what do you need from me?" And so, I think if you think about that question, as part of your communication plan, again, that helps you get an answer to that, so you kind of know what your response is going to be, and that also I think helps you know as you're delivering that type of community.  

CJ: Yeah, I really like what you said about kind of coming with a solution, I don't know if you're familiar with this, it comes from the nursing background, it's called an SBAR, and we use it just kind of in healthcare professionally as well, you give a really quick, brief situation. What's the situation? What's the background? What's your assessment and what's your recommendation? So, it kind of keeps it organized that really helped me because I tend to be one who just kind of reacts emotionally, I've had to learn over the years to not do that.  

Jay: You're right, right! No, you're exactly right! And I definitely very familiar with the SBAR, with me on the legal side, we had a version of that called IRAQ, which is very similar to; issue, rule, analysis, and conclusion. Sorry, it's been 20 years think about it but a very similar approach and mindset of what you're thinking about is really a comprehensive approach to that issue of thinking about the beginning, the middle, and the end to it.  

CJ: You mentioned kind of preparing leaders, I guess part of that is knowing that person's personality because you mentioned some people are, you know, drivers and they want to just make their decision, move on, others are processors. So, I guess you learn that over time a little bit. As you learn their personality and their communication preferences you kind of prepare for that differently, but one question I wonder if you have thoughts on is, like if it's really going to be bad news, or maybe it's just like a big overpayment, do you tell them like when you're scheduling the meeting? Hey, I want to meet with you. You don't necessarily say it this way; I've got bad news to share, but you might say something, you know, we've completed an audit and I like to share the results. And do you kind of tip your hand a little bit and be like, you know, there may be an over-payment, because when I've done that, sometimes people immediately respond and say; Well, I want to know the details right now! And then I'm like, not in a good position to, like, share that the way I had planned through. So, what are your thoughts on that?  

Jay: Yeah, I think, you know, that's a great question. And yes, that has come up, and a lot of times and this is I think an area too where sometimes compliance folks need to be careful about the language they use and not being so conclusive or concrete if you're not at that particular stage. So, using words like; allegedly or potential repayment, or something like that where you still have work to do, you know, before you come to a resolution and so it, you know, probably typical lawyerly answer if it's going to depend on the facts and circumstances, but I know sometimes in the past when we have been fairly confident we're going to have a repayment, but it's just a matter of how big it's going to be then we might give them a heads up; "Hey, this is a potential repayment we're looking at, you know no conclusions have been made yet, but we want to at least give you this information as early as possible so you're aware of it if you need to factor it in for budgeting reasons or whatever," and that tip that typically tends to kind of help, because you're right, some people do have different levels of, you know, their personality and how they react and some don't do well with not knowing all the information at the time you started to tell them. So, it does take a little bit of finesse sometimes. 

CJ: Yeah! The one other thing that I have found, I'm interested in, if you think this is helpful like if I'm doing an audit and I try to just try to get into this habit of telling the organization or the decision makers look we're going to do an audit in this space and this is our timeline. Here's our audit. Here's when we're going to issue a draft, you know, report so that people can kick it around and be like; "Oh no, you forgot to look at this, or did you know we actually had this." And so, I keep things in draft and then and tell them once after we've had that discussion, then we're going to finalize and then, so I try to like show a timeline even before I get started. And then as people, as leaders work with compliance over and over again, they get used to kind of that flow and so I don't know, do you think that type of strategy helps at all when you have to deliver bad news because then it's just a part of; "Look, this is what we do. Sometimes the results are good, sometimes they're middle of the road, and sometimes they're bad!"  

Jay: Yeah! Yeah! No, I think it is good, and it's funny, a couple of thoughts are coming to my mind because I'm just reading this Brené Brown book right now, and I just came as fast as this statement about “clear is kind,” and that's something I'm right now in the moment trying to continue to keep in mind as I go forward. And I think how I thought about that before was really just sort of expectations, and I think it is always good to over-communicate with leaders if you're doing an audit or something like that where you can tell them sort of the beginning, middle, and end of a process that they may not be familiar with.  

And that's another thing to keep in mind is I think sometimes with compliance officers and this is something I've covered in the book too is we get so close to the rules and the process and how audits are done and things like that, we don't realize that our audience is not that connected to it as we are, so we're kind of glossing over some details that are important to them. And so sometimes you have to take a step back and pause, and fill in some of those gaps as if you're trying to explain this to your son or daughter's 4th-grade class or something like that, job day or something.  

CJ: Yeah, exactly! And you know, there's probably a difference to an approach of if you're doing kind of proactive auditing work and people expect it versus like a reactive situation where you know, you get some sort of urgent thing, right? Like, oh, we just got a subpoena or we just got this or we got that. And then everyone wants to know, what are your initial findings? You know, everyone kind of wants these. So when it's a reactive situation versus a proactive situation, that might change it a little bit, too, do you think?  

Jay: Yeah, absolutely, absolutely! And I think, anytime you can kind of get out in front of it to try and reduce the chances of it being reactive is good.  

CJ:  So, let's say we've kind of worked. We've prepped them a little bit. Now you are at the stage where you are kind of finalized in your thinking, and you're pretty confident this is the final answer. What do you do, or do you have thoughts on what to do if that decision-maker just disagrees and they're like, "OK, fine, you think this is your final answer? But no, I don't think so!" And you get the sense that they might want to change the results a little bit, or maybe they're not going to take the overpayment seriously, or whatever the situation is, those get harder to deal with, right?  

Jay: Oh yeah, definitely and that's another one that it's kind of back to the politics coming. I mean that stuff does come up. Everybody has kind of their own self-interests and performance goals or things that they're doing, you know, within their job role and trying to make decisions. And I think with the compliance role, something to be careful of you know, in the context of this type of situation is not taking ownership over those things that you can't control and just taking ownership over the things that you can control and trying to keep that in mind and you know as the compliance officer, your role obviously is there to you know, help advise them on how to make the best possible decision educating about the regulatory requirements and things like that and so that you can put them in a position to make the best possible decision you know now if they choose to go another direction, then that's on them and that's something that's within their responsibility for the decision that they make. And you just unfortunately can't control that, I think, at least in my experience, you know when it comes to interactions with the government or government investigations or audits or things like that, you know, they recognize regulatory violations are going to occur and everything can't be perfect. And the compliance officer is only responsible for those decisions that are within the scope of, you know, your role. But having said that, the government does expect the organization is going to address an issue once it does come up and you are going to take steps to prevent it. So those are the things that you should keep in mind and focus on and take control or ownership over. And so kind of a shorthand version of this to me is sort of focus on the present. Focus on the future, don't focus on the past and you know, just keep in mind what are the decisions that are within your control and which ones are not and just focus on the ones that are within your control.   

CJ: Yeah! I like that! The other thing, you know as I read new OIG guidance, you know you, as a compliance officer might be reporting you know to management, but you might have a dotted line to the board. Sometimes it's important if the person you're communicating with doesn't already understand that; "Look, I have to report certain things to the board as well, and so, you know, I just need to let you know I'm not, you know, it's just not like I'm telling on anybody. But you know, you know how we've designed our compliance program" and that's why I think it's really important that people design their compliance program in a way so that when these sticky issues do come up, you're not working on processes at that point, you've already figured out. Look, I regularly meet with the board. I regularly do this and so that hard work has already been done. And so now you just have to report the issue potentially.  

Jay: Yeah, right. Absolutely! And you know, CJ, you actually just hit on something I was thinking about, which is it kind of cutting another way too with leaders and especially when you're giving them bad news or something like this and this might be driving some of that anxiety of I need to know everything right now is they also have reporting obligations. If you're talking to a hospital CFO, they might have to report the fact that you've got a six-figure repayment to their divisional CFO or something like that. So that's something to keep in mind as you're developing your communication plan and how you're going to deliver this information because you know just sort of putting yourself in the shoes of your audience and how they're going to react to it  

CJ: Good point!  

Jay: Those are things to anticipate. Just knowing what their perspective is going to be.  

CJ: Yeah! Well, we're going to take a quick break and then when we come back, I'd like to maybe move into this other topic of, you know this false sense of urgency type of thing. So, hang with us, everybody. We'll be right back!  

Welcome back everyone from the break. We've been talking about some of those difficult scenarios that the compliance officer or compliance professional might have to deal with. We've just talked about maybe delivering bad news or how to prepare people for those tough decisions. Jay, if it's okay, let's talk a little bit about also this other concept that we sometimes fall into traps in compliance where we might create a false sense of urgency, and so this concept of making sure we're not doing that. What do you think, you know, I've stepped into compliance or organization compliance culture before, maybe as a consultant reviewing their compliance program where I get the sense from interviewing people in the organization that compliance always says the sky is falling, right? It's like, "Oh, this is going to. I did this yesterday and this, this and this and this," and that can sometimes erode trust. It might lead to a lack of respect. It might be, you know, the boy who calls Wolf all the time. What are your thoughts just in general, about kind of not creating this false sense of urgency?  

Jay: So, a couple of things, because I do think that is a very real thing and it is something that compliance officers do need to be self-aware of with their own communication. And you know how information is going to get received by somebody else and how that can backfire on the reputation of the department, I've certainly seen situations where people have, what I would call overuse the exclamation point and e-mail or whatever, where every e-mail you're getting from them has an exclamation point and they're not always urgent issues. And so that does start to get tuned out. And I've actually heard leaders tell me that in the past. And so that's something I think to be mindful of is not overusing emails or just being judicious about when you're going to, you actually use that feature, for example.  

And then also just keeping kind of a big picture approach to what it whatever it is that you're working on and this is another area where I would kind of borrow a little bit of a mindset from healthcare leaders where a lot of them are driven by mission statements and they've got goals and they're always thinking about a beginning, middle and an end to a service line they're working on or something like that. And I think that's a similar approach that we should take with a compliance investigation or something we're working on is, you know, before you start working on it, what does the end of the investigation look like? So you can kind of keep that big picture mindset, you know, in the back of your mind as you're going forward. And that can help kind of keep you grounded and help you really prioritize; "Okay, what is really a true emergency? What's the process going to look like?" You know, in terms of how we're going to work through this particular issue and that kind of thing.  

Pausing and breathing is always a good first step. I think really no matter whatever you're working on!  

CJ: Exactly right!  

Jay: And then the other thought would be, you know, you're probably as you're pausing and as you're breathing is and thinking about the process and what it's going to look like going forward is just keeping in mind what is at a high level, the risk to the organization, what's the risk to patient care if you work in that type of space? Those types of things cause that can also help you prioritize. Okay, well, this is yes, this is an issue we need to address, but it's not a big deal. I don't say a big deal, but it's not a higher-risk issue versus what is a really high-risk issue that really does need to be addressed and hand-handled appropriately.  

CJ: Yeah, and I think because a lot of in healthcare a lot of people that we're dealing with, if they're on the clinical side, you know, what they think is urgent is this patient is coding and they could die, right? So it's like they're, like usually in healthcare, the mission of the organization is to take care of patients who could die. And that's really what's urgent in the big picture of things.  

Jay: Yeah! 

CJ: But there are, not to minimize compliance emergencies there may be some, but I like what you said, not overusing kind of that everything has to be done today necessarily some people who are drawn to careers in compliance, we tend to be rule followers we tend to and I'm painting with a broad brush here but we tend to be a little nervous, right? Like we want to be cautious. So, our personalities might be such that we want something solved right now because we don't like any untied loose ends. And so, we want things tied off, but that doesn't necessarily mean that's always the threshold for the organization as well.  

Jay: Yeah, that's true. 

CJ: Yeah! So, the other thing I was going to say is, I also think it might help with having like a communication strategy or habits or practices like I've worked with compliance committees before where if I got something into my office, we kind of we put things into buckets, we would say look, this is kind of a tier one type of issue. This is a Tier 2 and this is a Tier 3 because there are occasions when something is more urgent and the committee, the Compliance Committee, and Executive management might want to know about that more quickly, and so having those discussions ahead of time might help reduce creation of this false sense of urgency so that everyone's kind of on the same page and we know, oh, you know, this is.  

I worked in hurricane land, so we had category 5 hurricanes category 4, category 3 they're all they're all concerning, but when we know something gets into category 5, we're, you know, it's going to land tomorrow, we're on a different kind of playing than way of thinking than when it's a category one.  

So with that in mind, are there any examples that you can think of that are legitimate urgent issues like you know I think of look we just got a subpoena, or if government agents show up at the front door with a search warrant, like those are pretty urgent, but any thoughts on where you might place certain topics or issues in urgency level?  

Jay: Yeah, no, I would agree with those that you mentioned. My mind was kind of going to EMTALA or state survey two or something like that as well if you're in the hospital health system type space. But yeah, anything where there is you know response to government agency there's potential for litigation, there's something like that. Those are obviously going to be your higher priority type issues.  

Another category that that tends to come up where there can be some blurring of the lines with their level of urgency is what I would kind of call internally consulting. Which is CEO comes to you and says; "Hey, we want to open a new freestanding emergency department or something like that next year or something. How do we do that or what do we need to do to make sure we're compliant with regulations?" Obviously, that example is a little more of a longer-term type situation, but you could insert a more short-term type we would just want to open a new service line or something like that. But those are where you're obviously providing insight and advice and guidance on how to structure things before they start. And that to me is going to be a little bit lower priority than the surveyors have just showed up in response to EMTALA complaint or we've gotten contacted related to a potential breach or something like that. Those would be your more higher-risk type issues.  

CJ: Yeah, exactly, you know, you got some sort of ransomware going on or, you know, some bad actor is holding your medical record hostage until you pay some sort of ransom.  

Jay: Right! Yeah, absolutely! I mean, there are definitely circumstances that are that are truly emergencies and those definitely need to be responded to accordingly. And then you have the other ones that kind of called sort of manufactured emergencies where it's either an internally imposed requirement or guideline or somebody's fulfilling up a professional goal or something like that. And those ones you just need to adapt and adjust your workload and make sure that you're working together to establish reasonable deadlines.  

CJ: One thing you know, since I worked a lot in revenue cycle and we know of the Medicare overpayment rules that once you've identified and they know you have a time period to identify an overpayment. It's not the moment someone says; "Oh! I think we got overpaid!" You get time to determine if it was a true overpayment, but it is important, I think, to know when the stopwatch has started clicking, you know, when it first starts ticking because if you ignore things and it's months and months, you do start to creep up against certain deadlines that you know you can't just hide your head in the sand, you do have to deal with those and so one thing that I have found useful because compliance deals so much with revenue cycle and potential overpayments is just having a policy written and kind of have deadlines so that, you know, it might not happen overnight, but somebody can see we haven't touched this thing in four months and we're aware of it and we're starting to get into that, orange zone before it turns into the red zone. And so just kind of giving people an idea like a high-level picture of where this particular issue is. That's where I think dashboards can be really helpful if you have like a hotline and you have, you're kind of keeping track of this hotline issue has not moved in four months or this hot light issue hasn't moved, you know. So, any thoughts on that cause those are not necessarily urgent, right when they are identified but if you ignore them, they can become urgent.  

Jay: Yeah, absolutely! I think overall, yeah, definitely need to have some type of system in place to make sure that, you know, the work's not falling off or it's not getting pushed off to the side. So, whether that's a series of calendar reminders or a dashboard, as you had mentioned, or a spreadsheet of pending list items that you're looking at once a week, or you know there are other software capabilities out there that can provide automated e-mail, you know, alerts and things like that you could certainly leverage that. But yeah, just overall having some type of system in place so that things are staying in front of you that need to stay in front of you so it doesn't creep up to the 11th hour.  

CJ: Yeah! Because you know, at one point in my career, I was in charge of the conflict-of-interest program, and no one loves doing those. But we have policies that say; Look it has to be done by this time frame or we start to not follow our own policy, you know, and if you have board members who just, you know, they're busy, they're busy people. They're not doing it on purpose, they just aren't getting to it. And so it's just like you got to think through this and be clear from the get-go and not start late, start early and be like look we're starting this three months before it's due or whatever based off of your how long it takes because you just because ultimately if it fails, someone's going to look at you and be like, well, why did we not meet the deadline, right?  

Jay: Right, right. Yeah, absolutely! And I think that's another one too, where sometimes it can be helpful to keep the audience's perspective in mind or you know, you might have to adapt things a little bit because I've had situations come up where we're rolling out a new process or, you know, had some type of requirement on physicians or leadership, healthcare leaders or something like that and again, come back to what I've seen earlier, this is a new process to them. They're not as close to it as you are. They're not really, you know, may or may not be aware of the ramifications or circumstances. So, always trying to make sure and educate them about that. And then sometimes you even have to, if you're finding that you're sending a series of reminders and it's not working, it might be time to pick up the phone and talk to their admin assistant or somebody and say, okay what is the best way I can get this in front of this person before this date so it happens? Or you can might even be able to develop a process because some people are better at e-mail, some people are better at instant messaging text, whatever. 

CJ: Exactly! There was one time when I was struggling getting a board member to finish their COI and I eventually did exactly what you said. I just like called them or called their assistant said; "Hey, you know the this system might be difficult for some. I learned that the person was having trouble signing in and so I'm like, okay, and they just were not comfortable with technology, they were an older individual. And so I said, okay, let's adjust this, let's do it this way." And so we came up with a different way to do it that met their needs and got it done. But it sometimes just takes that hand-holding and it worked out. But to your point, rather than just be like, well, I sent them 17 e-mail reminders, like, okay, after a few, you know, your return on investment of those emails goes to zero, so do something different! 

Jay: Yeah, exactly! And that's sort of a small example of kind of saying earlier about sort of sort of the self-awareness of your communication and just realizing, okay, maybe this is not working and maybe I need to look at doing this a different way and trying to see if you come up with some other ideas.  

CJ: Yeah, absolutely! Well, Jay, we're kind of coming to the end of our time on these topics. Any last-minute thoughts or kind of you know parting shots or any advice that you might have to people in either of these topics or something else that we might not have talked about?  

Jay: No, I think just, you know, like I said earlier, big picture approach I think is always the best thing to keep in mind as you're working on anything. Communication plans is probably the other one regardless of what it is you're working on, going through that thought process is always helpful because you can try and anticipate the questions you might get asked, and then you've got answers for those ready before you walk into that particular meeting.  

CJ: Yeah, well, I got to tell you, just in talking to you, you have a very calm demeanor, and I'm already calm down. You've been my therapy session for the week. You're very calm and collective when you think about these, I could tell that you're not overly urgent or, you know, the sky is not falling. And I could see where your skills would be very valuable for an organization.  

Jay: Well, thank you! I appreciate it! And like I said earlier at the top of the podcast, it's definitely some lessons learned over the years and identifying what's working and what's not working so, but I appreciate the feedback. Thank you!  

CJ: Yeah, I could tell you're very polished. It may not have been easy when you experienced it, but you've become a polished gem.  

Jay: I appreciate it. Thank you!  

CJ: Well, thank you so much for sharing your time and your thoughts as well. And thanks to all of our listeners for listening to another episode. We always invite you to share ideas with us. If there's a certain topic that you'd like to hear more about, if there's a guest that you would like us to reach out to, or if you know of somebody who might make a good guest, please share that with us. And until next time, everyone, take care!