The COVID-19 pandemic has vividly illustrated the high-stakes complexity of healthcare ethics and compliance. In the face of supply shortages, healthcare organizations have been forced to make life-and-death decisions regarding who can receive complete care and who can’t. But when confronted with these incredibly difficult decisions, a strong culture of ethics and compliance provides guidance.

That culture can help facilitate trust for both staff and patients. “If we’re not transparent about how we make decisions, trust is eroded very quickly,” says Jacob Dahlke, Director of the Office of Healthcare Ethics at Nebraska Medicine. “Sometimes that trust is unrecoverable.”

Compliance in healthcare is anything but simple, yet it remains a critical component of a healthcare organization's operations. Here’s how healthcare organizations and compliance departments can nurture a culture driven by compliance and ethical conduct.

Write Policies That Work for Your People

Compliance policies are not one-size-fits-all. What’s written in the boardroom doesn’t always reflect actual experiences on the frontline. “You don’t write a policy from behind a desk,” says Linda Howard, CEO and healthcare compliance consultant at Alturnative. “Make sure you understand who the policy applies to and how it will be interpreted and implemented.” For example, certified nurse assistants and other frontline workers have a vastly different daily experience from officers in the C-suite. In order to write policies that can be implemented easily and consistently, you need to understand that experience. 

This allows compliance to trickle down to each individual. To cultivate an ethical and compliant culture, every individual needs to be invested with a larger sense of responsibility and purpose. “Compliance is everybody’s business,” Howard says. Compliance leaders need to listen to workers in every department and at every level. When compliance leaders are approachable and available, workers will feel safe asking questions — especially if they have any doubts about whether they’re acting in an ethical and compliant manner. The expansion of telehealth under the CARES Act, for instance, may raise questions regarding HIPAA compliance. Encourage workers to feel comfortable asking questions before they act.

Align Messaging Across the Organization

Compliance officers and executives at the top must deliver a clear compliance message, but the middle managers have a much better understanding of how policies will be interpreted and implemented in actual practice. “The message from the top is filtered through middle management,” Howard says. “Middle management can undermine that message, even if it’s just through body language.” Work with managers to create messaging that is effective across the entire organization.

But if you want your entire organization to be passionate about compliance, you need buy-in at all levels. “The message from the top is important, but you need more than just that,” Howard says. Organizations need to address the official policy but also understand the way middle managers are interpreting it and how it is being implemented by workers on the frontline, she says. You must understand how messages are delivered or diluted along their path across your workforce. 

Plan for Proto-Compliance

Since compliance is rule-based, workers either comply with the policy or they don’t. But the concept of ethics adds a deeper dimension and directs proactive policies. “We always talk about compliance versus non-compliance, but we need to shift to compliant versus proto-compliant,” Dahlke says. Proto-compliance anticipates pitfalls to compliance and addresses them proactively. For example, if there’s a high rate of COVID-19 in your community and you only have a certain number of ventilators, proto-compliance forces you to think potential scenarios through. This directs your actions proactively instead of reactively and helps ensure compliance, even in difficult situations. 

The secret to proto-compliance is building ethics and compliance checks into daily functioning. Channel this through your organizational values, which should tap into workers’ sense of vocation and larger purpose. “Be intentional about asking how what you do aligns with your organizational values,” Dahlke says. “If you find activity that isn’t aligned, that’s an opportunity to make changes.” Frequent values check-ins on both individual and organizational levels will increase your ability to anticipate scenarios that could lead to non-compliance.

Healthcare compliance is complex, and the stakes for non-compliance are high. The best defense against non-compliance is a proactive, ethical culture. When policies support compliant conduct for everyone — and everyone understands how to implement those policies — then workers can live your organizational values every day. And if your people know how to act in accordance with your values, then you’re not just “safe” from non-compliance: You’ve created an ethical culture.