Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I am CJ Wolf with Healthicity and we're excited to have all of you listening today. We have another great topic. I always say that we never have a bad topic, do we? And our guest today is Jay Anstine. And we wanted to welcome you, Jay.  

Jay: Yeah! Thank you!  

CJ: And Jay, we always like to give our guests an opportunity to, you know, introduce themselves, tell us a little bit about themselves, how you got into compliance, what you're doing, that kind of thing. We'd love for you to take a moment to do that.  

Jay: Yeah, absolutely! Thanks so much, CJ. I think like a lot probably a lot of other healthcare compliance professions that kind of fell into this. I'm a lawyer by training, but I always tell people don't hold it against me I hate lawyers too. I've been in healthcare for about 25 years. I started working in legal for a health system there, I'm originally from the Upper Midwest and had worked for a health system there. Originally, their managed care department, then I switched over to legal, and then in 2005 I had made the shift over to compliance and I just found the work more interesting and I've just stayed here ever since. And so, I have been on the provider and the payer side of the market. I've worked for some organizations of 200,000 employees and others with 20. So, I feel like I got a pretty good perspective about compliance programs having worked in that larger organization environment and then a smaller organization environment.  

And over the last 15 years or so, I've written a lot of articles and spoken at various HCCA events. And one of the topics that I've been very passionate about has been kind of the soft skills-related type topics, so a lot of things have written or spoken about it's kind of been in that area. And I think kind of like you, I also have a passion for education. And so, I've been teaching a healthcare compliance-related course online with the University of Southern California School of Law.  

CJ: Cool. You are busy.  

Jay: Yes, Busy.  

CJ: But we really appreciate you taking some time to talk to us. I'm glad you kind of introduce kind of this soft skills topic a little bit because Jay has written an amazing book; Navigating the Politics of Healthcare, and we wanted to ask him a little bit about that.  

I think as compliance officers, we've all had to deal with that, right? It's a very political landscape if you will. You know, there's some black-and-white to compliance, right? You know, the line is here and we know yes and no. But then there's a lot of gray and then you have to kind of deal with the gray personalities and or the grayness in personalities, right? And you got some people who are a little bit more comfortable with being a little more aggressive and some people who want to be more conservative and all this kind of stuff. So I think this book is a great opportunity to kind of talk about that. What would you before we kind of get into some specific questions, what would you say in general about the book? I mean what caused you to write it? What's the drive behind it?  

Jay: Oh, sure, yeah. No, that's a great question. So yes, background, I mean, since I've been in college, I always wanted to write a book. It was sort of a bucket list item for me, but I'd struggle with, you know, trying to figure out what types of topics to cover, fiction or non-fiction, that kind of thing. And then I think, you know, but like I said 10-15 years ago, I started writing. articles speaking at HCCA events, I kind of did a string for a few years at the Compliance Institute. And spoke on, you know, building strong relationships with leaders and some communication, professional communication type strategies, and what I was finding was a lot of chief compliance officers coming up to me afterward saying, "Hey, this is great stuff. Our newer folks really need to hear this. I'm so glad that you were here to present on that." And I think a light bulb just kind of went off, you know, on the flight home. "Hey, I might have a book here," that I really had at that point kind of three or four chapters already sort of mapped out and so that's just sort of where the idea came from. And these were topics I always enjoyed talking about just because it almost seemed as if I was having a conversation with somebody. And that's really kind of the approach that I took with the book was it to be sort of a conversation. And it's really targeted at the newer compliance folks just starting out.  

And as I was writing it, the thought that was always sort of ever present in my mind was; "Okay, if I'm just starting out in this profession, what would I want to know?" And I felt like there was a lot of information out there about the seven elements and Stark and EMTALA and HIPPA and all the other regulations and things like that. But some of this kind of gray area or interactions, communication, things like that, that's happening every day, all across the country with compliance officers wasn't really written about much. And so that was sort of what I felt like there might be a need there.  

CJ: Yeah, absolutely. Like, you know, it's one thing to kind of teach people these are the nuts and bolts about these laws and regs but then, you know, now here's how you try to implement it at your organization, right? The approach could be completely different depending on the people, right? And even at the same organization, leadership changes over time.  

Jay: Yeah! 

CJ: Yeah, absolutely! So, when you and I were communicating, I thought, "Man, this is this is a great topic, something that I wish I had been better at 20 years ago!" But you like you learned the hard way, right?  

Jay: Yeah! You're always improving, that's for sure.  

CJ: Yeah! And so, to have somebody write about it in a thoughtful way, you know, to your point of trying to help people like from the beginning, don't make the mistakes that we made. So yeah.  

Jay: Yes, absolutely!  

CJ: Yeah, exactly. So, I kind of want to start by talking about one of the chapters that deals with using diplomacy to influence behavior. And as you mentioned, as I've noticed and a lot of our listeners have probably noticed, you've written a lot for HCCA, social media, and in the book about taking this diplomatic approach to compliance with that in mind, what are some ways you think a compliance officer can diplomatically communicate with others in the organization? 

Jay: Yeah! So, a couple of thoughts. One at sort of the outset is, and I always sort of joke about this with people is we've got perception issues in compliance. I mean just hearing the term compliance officer or if you call somebody or set up a meeting to talk, I mean, before you even have a chance to utter your first word, there's always going to be some type of negative impression of who you are or what you're there to talk about.  

CJ: Right!  

Jay: So, you have to overcome that which I think is where a lot of this diplomacy comes in, is trying to get over that hurdle of the perception that we've got. In my experience, there's been a few things that I've done that has helped over the years, the first is just knowing your audience and how you do that is just make sure that whatever you're talking about, you know, whether it's doing education and training, conducting an audit and connecting investigation or something like that, that when you're communicating compliance concepts that you're doing so that you're tailoring it to that particular audience.  

For example, one you know just with you as a physician, this might resonate, you're talking about HIPAA, for example, you know, one you might cover with a physician is those scenarios where the physician walks into a patient's room to discuss the treatment plan or something like that with the patient and you've got three or four other people in the room that the physician doesn't know. And having to make sure that you're doing that vetting process to make sure that the patient's okay with those people to stay in the room if you're going to have that discussion or take other precautions to safeguard the information. So, like as one example, you know, I would use that if I were talking to physicians about some type of HIPAA-related concept with PHI.  

CJ: Yeah, that's a great example, you know, as you were sharing that I thought "Oh, you know, like when I have to go talk to the CFO, I have to brush up on my CFO language!" I'm more of a clinician by background, so that does that talk doesn't come natural to me. So, I have to refresh my memory; "What does the CFO care about? Does he or she find important and how can I infuse that into my compliance message," and that can vary, right?  

Jay: Yeah, absolutely! And I think you hit on a good point because I think it is helpful and something I've done throughout my career is always just making sure you understand the operations or you understand the world in which that person lives that you're talking to. And so yeah, making sure that you do understand if you're talking to a CFO, some of the financial aspects or what point of view a CFO might have if they're going to go into a discussion about a compliance-related matter and that was going to vary as opposed to maybe a department director that's over the ED or rehab or something like that.  

CJ: Exactly! Well, any other tips that you think are important about that?  

Jay: Yeah, I think one other with the audience is just making sure you're really clear that you've identified who that audience is. And sometimes you've got a primary audience and a secondary audience or, just making sure you've you're clear about who the audience is. And so, for example, I just used the ED earlier, so ED director comes and says; "Hey, we need to have you come and do a refresher training on EMTALA for a clinical staff, would you be able to do that?" And so I might pause at that point and just make sure I'm clear with that director; "OK, well, who exactly are we talking about for clinical staff? is that nursing staff? is that physicians? is that on call physicians? you know what, who exactly is the audience so that I can make sure that I've got examples that are going to be prepared for that particular audience." 

CJ: Yeah, that makes a lot of sense.  

Jay: Yeah! One other one is, you know, just exercising self-control, I think along the diplomacy side. So sometimes you run into a situation, this always comes up where you're sitting in a meeting and somebody blurt, you know, they're discussing or updating the group on some type of initiative within the organization and they blurt something out that raises a potential compliance concern, or it might within the compliance officer's head and so then you kind of have to determine, "OK, do I say something now, or do I say something later?" And when the most appropriate time to do so.  

And so, I always have this sort of checklist in my head of kind of three questions that I run through to determine whether to exercise that self-control and, you know, "Does it need to be said?" is the first question I run through. The second one is, "Does it need to be said by me?" and then the third one is; "Does it need to be said now?" and often times it's that third one is where you kind of get hung up because it might be a situation where you don't have all the facts you need to get more facts and you're not really 100% sure that this is an issue or is an issue. If it is an issue, what type of risk are we talking about. So, it may be best just to take that discussion offline, talk to the right individuals that you need to gather your information and then go from there. And if you have to communicate conclusion back to the group then you can do so whatever manner is.  

CJ: Yeah, That's great advice! You know, I wish I would have known those three questions. I think I learned them as I went along. That last one; "Does it have to be addressed now?" That's a really good one. 

Jay: Yeah! 

CJ: Anything else on that that you want to discuss?  

Jay: One other one, and I actually had just had written something about this not too long ago, just for an article was just about jumping to conclusions. And I was talking about the sort of referencing the Ted Lasso series. And there's an episode in there where somebody had told Ted he needs to find out before he flips out. And I sort of equipped that to jumping to conclusions. And so, you just want to make sure as you're communicating about compliance matters that you're not jumping to conclusions that you do, you have gathered all your facts. You've asked yourself, you know, if you are making an assumption, is this what information is this based off of? Is this based off fact or is this based off opinion, that kind of thing. Because I think it's important, if you jump to conclusions, you know a couple of problems can arise; one is you may create confusion if you now have to go back and circle back to whoever you're communicating with, and then now convey a different conclusion.  

The other is sort of the shouting fire in a crowded theater effect, where if you jump to conclusions erroneously and you're wrong now you potentially unnecessarily alarmed others and so then you have to manage that. So, I think that's where it's key to really work on not jumping to conclusions.  

CJ: That's a great one! And I find it interesting you mentioned Ted Lasso. He might make a good diplomatic compliance officer! What do you think?  

Jay: I think so. There's definitely a lot of life lessons I think to be learned from that show and a lot of carryover to compliance, I agree.  

CJ: Yeah, absolutely. Well, this is awesome. We're going to take a quick break and then we'll be right back.  

Welcome back everybody! I am talking to Jay Anstine about his book and diplomacy. Some of the topics and important things that you've included have to do with diplomacy and how to work with others in that healthcare setting. We you kind of gave us a nice kind of overview, let's get a little bit more specific and talk about maybe those in leadership positions like maybe it's a CEO, a CFO, maybe it's even somebody on the board. Are there any specific approaches you feel a compliance officer should take to diplomatically speak or communicate with them that you know something that we might not have already covered. 

Jay: Yeah, exactly! I think there are some specific approaches for that particular type of group. A couple of things come to mind, the first is, just consider again back to what I was saying earlier, who your audience is and making sure that you really have identified very clearly who that audience is. Any characteristics around that audience. And so, when you're talking about healthcare leaders, at least in my experience, a couple things to keep in mind is, first, they're highly educated. They've been trained to be very analytical with their decision. And when it comes to healthcare leaders, a lot of them function in that sort of group think model where if a CEO is planning to or trying to make a decision as to whether or not to open up a new service line within a hospital, say for example he or she might pull together a group that might include the CFO and the CNO and the CMO of the physician side as well as various department directors and gather all that information, all that input, all that data to help he or she and making a decision.  

And so, I think when you combine those characteristics specific to that group, you really need to pay attention to whoever the particular healthcare leader is and what their specific point of view is. And in the book, I'd include a couple chapters about how to think like a healthcare leader that really sort of draws out and identifies the things that shape a CFO's perspective versus a CEO's perspective versus legal counsel's perspective and things like that.  

CJ: Yeah, that's a really good point. And then I think even within, like the CEO, there's different like leadership styles and you know, there are some CEOs that want to be very authoritative, you know, and make the decision themselves quickly, right? Like, that's how they got where they are, they just like; "Oh, I'm making a decision, we're moving forward!" versus like what you said with the group think and I've seen both, right? And both can be successful and have pluses and minuses, but I think that's important to notice. Like the style for that particular person as well.  

Jay: Yeah, absolutely! And that was somebody had commented on was sort of that mirroring the communication style too. And you know some like to communicate via e-mail, some like to do it in person, some like to do it via phone, that kind of thing. And so, it applies to communication, but then probably other areas too, where you really again want to make sure you know your audience and how they think, how they operate. And I think that's where getting to know your leaders, building good strong relationships with them will help because you start to identify very quickly how they think and how they function. And then you can tailor it to that.  

CJ: Yeah, you know, and I know I think you wrote about this as well, and some leaders really appreciate this, if you going to bring a problem, bring some proposed solutions! So for those that are have a nursing background, you may have heard of an SBAR. It's used now outside of nursing. All sorts of ways to communicate succinctly. That stands for Situation, you give a brief sentence of what the situation is, Background that might be a little longer, but you still try to keep it brief. Your Assessment, and then Recommendations, right?  

It's like, "OK, we could ignore it," that's one extreme. "We could do this other extreme, and then we could do these four or five things in between." And I know you wrote a little bit about that bringing a solution. Any additional thoughts on that? 

Jay: Yeah, because part of the reason I put that in there was because again, it's sort of thinking back to when I started out or folks I've interacted with it about newer compliance officers, you know, and I'll find out their instincts are great. They're great at spotting issues. They're great at bringing problems, but then they'll just stop there and they won't carry it forward to that second step, which is trying to identify a potential solution and I think, depending upon your audience, whether it's a supervisor that you're interacting with your own supervisor, or whether it's a healthcare leader, I think there is some benefits to taking the sort of two step approach.  

And so with the healthcare leader, if you're going to bring a bring a problem and then bring a proposed solution with you, I think what it does is it helps them feel at ease, that there is a path forward to resolving the issue. And I don't know about you, CJ, but I know when it comes to healthcare leaders that they don't like surprises.  

CJ: Yeah, exactly! 

Jay: There's uncertainty, right? And so, I think that helps because at least you can communicate in a package; "OK, here is the problem we've got and this is how we're going to get out of it." And I think that helps very quickly restore them back to a sense of certainty that that helps.  

CJ: No, that's a great point, you know and hopefully you never have to, you know, kind of go over a leader’s head. But there are times when I've observed it's best to, I mean, you're not doing it secretly, you might just have an honest disagreement with the CEO on this compliance issue, but you also might have a reporting relationship to the board. I think just being up front and being like, you know, "Yes, this is how I see it. I feel like I need to report it to the board. I'm going to be reporting it to the board." Yeah, that can be tough as well because...  

Jay: Oh Yeah! And you're right. I mean the transparency is definitely key with that and I think the thing too is that can run the way too where you talk about the reporting relationship is it's something else to keep in mind with your audiences; "OK, well, if I tell this CEO of this particular issue or whatever, or department, mostly department. If I tell this department director some particular type of problem, they're going to have a reporting relationship to their senior leader, whoever that is."  

So, being mindful of that, that once I tell this person, there is an obligation to report that and then kind of having that discussion, is this something you want to tell the senior leader or do you want me to tell this thing or how would you like to approach that? So, I think just overall being very transparent about those reporting relationships definitely helps as you're talking through things.  

CJ: Yeah, absolutely. So, you know, I kind of come from the clinical background and on the first day of medical school, we always joke it's like you can tell, you meet your classmate, you can tell; "Oh, that guy's going to be a surgeon! She's going to be a psychiatrist! That person's going to be an OB!" Because these personalities tend to drive people to these specialties. I hate to be like, so, you know, generalizing, but it's so true in so many cases, it's so physicians are a unique breed.  

Jay: Yes! 

CJ: I wanted to ask you and that's kind of a unique thing in healthcare. I also did a lot of compliance in higher Ed where researchers are kind of unique breed too and you want them to be, right? They're breaking through science and you want them to be little cavalier. You don't want them to be cavalier with compliance, but maybe with, you know, push the boundaries of science. And so, you have some strong personalities. Do you, do you have suggestions what you've learned and from yourself and others about communicating with physicians.  

Jay: Oh, yeah! Yes, definitely! Definitely interacted with a lot of physicians over the years, some discussions went better than others and some that I kind of point out in the book. I mean, there's a lot of sorts of situational examples I bring up and a lot of it was sort of like you said earlier, kind of lessons learned and trying to help people avoid the same mistakes that I made when I started out.  

So back to what I was saying earlier about knowing your audience, that still applies here on the physician side. It's just, you know, making sure you understand that that type of perspective and it's going to vary quite a bit from the healthcare leader side and. I think really overall the biggest difference, at least in my experience when it comes to communicating with physicians versus healthcare leaders, is taking into account that unlike healthcare leaders, you know, largely going to operate on that group think model physicians are trained and help me, CJ, keep me honest here if I'm off on this, but in my experience, they're trained to be autonomous decision makers and they operate very differently. And so, you need to account for that. And I think the best way to do that is to make sure that you get their engagement as you're working through whatever type of solution, you're needing to work through with them.  

CJ: I think that's a good kind of overall statement. You know, again, there's always exceptions, but in general they are kind of trained to be autonomous decision making. I think it may have changed a little bit over the last few years where the younger physicians are kind of seeing, I think there's a little bit more training on kind of this team approach, interdisciplinary approach and things and but yeah, overall, I think you're right.  

And the other thing I've learned tell me if you feel the same way, they're pretty straightforward like they want to know the reason why. So, like for example I would do conflict of interest, type of work and they really were not interested to hear that it's because there's a policy. But I had articles, journal articles in the medical literature that demonstrated, you know, because they're research minded and data data-driven, there are research studies that showed that even physicians who were receiving small tokens like a pen or a coffee mug, it actually changed their prescribing patterns on certain medications. So, I would approach them a little bit differently. Yes, I have to say there's a policy, but I try to dig deeper to the heart of what they are about which is, you know data and "Oh! Yeah, this was published in JAMA! JAMA is a pretty reputable journal," and "Oh, I see. Yeah, OK. I can see why conflict of interest is an important topic." That doesn't work for everybody, but it did work for some that I struggled with.  

Jay: Yeah! Absolutely, I agree. That's been my experience too is the data-driven piece I think is huge anytime you can leverage that and provide that background as to why the answer is whatever the answer is or do that but also try and see if you can find a solution that's going to work for them. And I think that's where getting their input and engagement about; "OK, hey, this is what the regulation says we need to do, how are we going to move forward, to try and make this work for everybody?" And I was kind of joke with people too that it's you really want to make sure you get the input from the person that has to live under the rules, not as the person who's enforcing them, if you want to find a solution that's going to work.  

CJ: Yeah, I always struggled too with, so I was involved in coding and billing and educating physicians quite a bit, and that one was just always such a struggle for them, it still is. And they just don't understand it. They're like, "just let me be the doctor and let me..." But you know, it's the world we live in. And so sometimes I just have to say "I'm sorry I didn't write these rules, I don't stay up on the weekends to see how can I ruin Doctor so and so's life."  

Jay: Right! 

CJ: I'm just trying to help you through this. This is the reality of the risks and this is what the institution has decided. And this is kind of where we're going. There's physician representation on our committee and this and that. And so you try to involve them I think is a good way like you said, but sometimes you just have to say this is life!  

Jay: Yeah. No, exactly, I agree! 

CJ: You also mentioned in the book kind of leveraging physician champions. I have found that really successful. Do you have any thoughts on that? 

Jay: Yeah, definitely. It's it is always been helpful to me and I think you know, maybe that's not available in every healthcare provider setting. But I know at least speaking in the health system, hospital type world, there's often a lot of different types of physician champions that you can leverage, whether it's a medical director or a member of the Medical Executive Committee or another type of physician liaison type role; Chief Medical officer might be another example. But yeah, in my experience, there is some collegiality, for lack of a better term, with physicians and I think the message gets responded to much more positively when you've got a physician behind it trying to convey that message. So, there's it's just when you've got that physician-to-physician communication, the results tend to be a lot better than when you don't.  

CJ: Yeah, I couldn't agree more. You know, it's not always easy to easy to find those physician champions and sometimes they're not in a certain department or but you do your best one. One way that we tried to also address it is to make sure we included physician leadership on committees, compliance committees, research committees so that they could hear the background discussions, especially when we're doing policies. And you know, why are we changing this policy all of a sudden and the more involved they are, the better, I think.  

Jay: Yeah! And they're a great sounding board too, because if you've got an issue that you need to get corrected like you'd use the billing and coding examples or something. It's great to run; "Hey, this is what we need to address with this particular physician," and then you can get that physician champions perspective on it as how this position might react to it, because obviously they're going to have the same concerns about making sure that safe care is being provided to the patient and you're taking the patient's interest into account and things like that. And so, I think they can be a great sounding board too, to help you either revise or tweak, you know, whatever the ultimate resolution is going to be.   

CJ: Yeah! Well, I think that's spot on. And Jay, we're getting it a little bit close to the end of our time. But I want to give you some more time to if you have any last-minute thoughts maybe even, I know we focused kind of on this this one chapter that dealt with diplomacy. But maybe you tell us a little bit more about some other highlights in the book. You know where you can get it? That kind of stuff.  

Jay: Yeah! So, you know, couple of other chapters there's like I said, there's a couple that are that address thinking like a healthcare leader, which is again various different healthcare leaders and their mindsets and how you can position compliance to appeal to those particular types of healthcare leaders. And there's a couple other chapters. And some different communication strategies for professionalism that can. Help and then I've got one on what are called common political battles, which is sort of like one example is staying in your, I'll kind of say is like staying in your lane. I know this comes up a lot where you have compliance officers that you know healthcare leaders get confused between compliance and risk and legal and regulatory...  

CJ: Yeah!  

Jay: And who has responsibility for what type of role? And so, there's some of those political battles that kind of highlight and in some ways that you can overcome those.  

CJ: That is such a great chapter there because, yeah, staying in your lane because you're right, if you're not dealing with this kind of stuff day in and day out as your profession, you know, you're taking care of patients. You just kind of see all of them as administrators, legal, compliance, audit, whatever!  

Jay: Yeah, exactly! And be sensitive to that too, with your audience, this is, I think, another kind of common theme I had in the book too is about. You know, with healthcare leaders and physicians, I mean, they're not as close to the compliance rules and the regulations as you are, so you need to make sure and bridge that, there's a knowledge gap there and just make sure that you're bridging that and that you're sensitive to it and giving a lot of grace there that they're just not going to understand the stuff as well as you do. So, you may there's some areas where you have to hold their hand a little bit.  

CJ: Yeah, well, wonderful. Any last-minute thoughts that you'd like to share? I think you've done a great job summing up the book. Where can people get it?  

Jay: Oh yeah, so it's available at on Amazon and Barnes and Noble and other major book retailers.  

CJ: Cool and I know I think I've seen you, you know, share links and stuff on LinkedIn, and I'm sure you'll be willing to share some links for the show notes that we can put in there as well if people have interest there.  

Jay: Yeah, absolutely!  

CJ: Well, Jay, thank you so much for your time and sharing some of the thoughts that you've written down to share with all of us. Appreciate your time.  

Jay: You bet. Thank you so much. I appreciate it.  

CJ: And thank you to all of our listeners for listening again, as always, we love to hear your feedback. If you have suggestions for speakers or topics, things that we haven't covered, we'd love to hear from you and please share the podcast with your, with your friends and colleagues until next time, have a great day everyone!