Question

It is expected that all Compliance plans incorporate seven elements in order to be effective.  Out of the seven elements, which do you believe would be the most difficult to implement and why?  How would you overcome this obstacle?

Answer 1

Compliance programs in health care is the continuous process of abiding legal ethical and professional standards in health care and medical practice.

Purpose of compliance programs

• Promote organisational adherence to applicable federal and state laws,
• An effective compliance programs help to prevent fraud, abuse, waste and potential liabilities.
• The compliance programs show the organizational commitment to adherence of the laws and ethical practices
• It articulates an organizational structure to the health care practice.

7 elements of compliance programs

1. Implement written policies and procedures to indicate the organisational adherence to the ethical and legal practices
2. Designate a compliance officer and compliance committee
3. Conduct effective training and education
4. Establish effective and open lines of communication
5. Conduct internal monitoring and audit
6. Enforce standards through well publicised disciplinary guidelines
7. Response to detected offences and take corrective action promptly.

According to me, conducting internal monitoring and audit is a difficult task.

Because, audit can only be done after the events occur, sometimes it cannot be prevented even it cannot identify the fraud happened associated with it. Monitoring and auditing is tiresome process and have loopholes. Fraud or unethical practices are difficult to identify in the health care practice. It is just like a post mortem analysis and not having a preventive component. Also, if an unethical or illegal activities were happened, in most of the situation, the health care team itself hide the event from the public domain to preserve the reputation of the institution. This may weaken the compliance programs. Sometimes it can be surpassed the audit machinery.

To overcome the obstacle

• Effective and Unbiased audit machinery should be ensured
• Inculcate practice of ethical standards in the roles and responsibilities. This require behavioral modifications among the whole health care membership
• Creation of Ombudsman, to assess the practice and standards in health care unbiased, and seek complaints from the patients and health care members itself notifying the unethical or illegal activities happening in the work settings.
• Empowe health care members to follow effective documentation of events for each patient should be done clearly and legibly.
• Ensure advanced audit machinery to overcome the defects of traditional auditing process
• Important to set up patient complaints cell and patient satisfaction survey after each hospital visit. It will give much more Unbiased realities of the situation and events.