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Ask 11 questions during performance reviews to assess employee compliance awareness

Radiology Administrator's Compliance and Reimbursement Insider, May 1, 2005

As you develop and implement your compliance plan, look for every opportunity to generate employee feedback and reinforce your commitment to compliance. Acting on your employees' advice and criticism can help you improve your compliance and violation-reporting programs-and show the Office of Inspector General (OIG) that you take compliance seriously. It's never a bad time to take the pulse of your organization through conversations with staff, but periodic performance reviews (PPR) provide excellent opportunities to find out what's going on.

RACRI spoke with compliance expert F. Lisa Murtha, Esq., to find out how to most effectively incorporate compliance issues into employee performance reviews. Her primary suggestion: Give the managers or supervisors who conduct these reviews a list of compliance-related questions to ask each employee.

The OIG says practices should discipline employees who violate compliance policies and procedures. You need to find out whether your employees follow your policies and procedures and whether those policies and procedures are workable.

For example, do employees have trouble understanding your policies and procedures? Do they mistakenly believe those policies and procedures are unimportant?

"You need to find out as soon as possible if employees are failing to use your compliance resources or not promptly reporting compliance violations," says Murtha. And if your employees don't buy into your program, take immediate action to correct the situation.

Employee PPRs are the most direct route to obtain answers about your compliance program. "You can get some of your most valuable compliance feedback when you sit down face-to-face with employees and discuss their compliance concerns," she says. If you go into each review with a predetermined set of compliance questions, you're more likely to get consistent feedback.

To obtain consistent, usable employee feedback about compliance issues during PPRs, ask the right questions. Draft a list of questions and distribute it in a memo to all employees who conduct performance reviews, suggests Murtha.  A memo will instruct reviewers on how to incorporate the compliance questions into the group of questions they ask during the review. It will provide guidelines that tell reviewers to write down employees' answers and send them to the compliance office for review and further action, if necessary.

Determine whether your employees are fully aware of your compliance resources and what they think about your policies and procedures.

If employees don't know as much as they should about your policies and procedures, or if they think the policies and procedures are too difficult to use, find out why your compliance message isn't getting across and ask them for specific information about how you can improve your policies and procedures. Sample questions include the following:

1. Do you keep a copy of our code of conduct and our compliance policies handy? If your employees don't have compliance materials readily available at their work sites, correct this immediately.

2. Have you ever consulted our code of conduct or our compliance policies when dealing with a question? Find out whether your employees actually use your compliance resources in their work. "The best compliance program in the world isn't worth anything if your employees won't use it," says Murtha.

If they've used your policies and procedures in day-to-day operations, find out how they did so. If they don't consult your policies and procedures when faced with questions, find out why.

3. Are our compliance policies easy to understand? Ask employees whether they're able to easily understand your compliance policies and procedures. If employees think your policies and procedures are complicated, consider revising them to make them easier to follow-thus making employees more likely to follow them. To help your compliance program reevaluation, determine which specific policies and procedures employees find confusing and why.

4. Are our compliance policies easy to follow in the context of your job, or do they complicate your routine? One complaint that compliance officers sometimes hear is that policies and procedures are too difficult to follow or that they unduly complicate an employee's routine.

"If an employee says he has trouble following certain procedures, ask him to identify specific instances and give you a detailed account of how they were difficult to follow and how the employee dealt with the problem," Murtha says. This input can help you reevaluate and perhaps rewrite complex procedures.

Note: Take the same approach for policies and procedures that employees find easy to follow but unrealistic in daily operations. If your policies and procedures unnecessarily complicate your employees' routine, they're less likely to follow them. Ask employees to identify which policies are unrealistic and how they think those policies could be improved. You may obtain some valuable employee feedback that can help you redesign the policy for easier use.

5. Do you think our compliance training is adequate? Employees sometimes feel that they haven't been adequately trained to handle compliance issues or use your compliance materials. Ask them whether they need more training or if your training program needs to be revised. Because employees face real-life compliance issues every day, their input can help you build an education program that meets their needs.

6. Can you think of any additional compliance issues our policies and procedures should address? Give employees a chance to comment on your policies and procedures. If you ask for suggestions about additional topics to address, the opportunity should encourage employees to share their thoughts about any aspect of your compliance program that they find useful or problematic. Once employees answer a few compliance-related questions, they will be more likely to think of additional issues.

Questions asked during the PPR are also useful in determining whether your compliance violation-reporting system works. Ask employees the following questions to measure their comfort level with the system and to see whether your practice inadvertently discourages complete reporting:

7. Are you aware of the systems we have to report compliance problems (e.g., hotlines, e-mail, etc.)? Find out whether employees know about your violation-reporting system and how it works. If they don't, reeducate them. Hold staff meetings or issue written instructions to employees describing in detail the system and how to use it.

8. If you discovered a compliance violation, would you feel comfortable using our system to report the violation? How do your employees generally feel about the system? Are they confident in the system and their ability to access it easily and quickly? If they're reluctant to report violations because they don't trust the system, take steps to create a more supportive atmosphere for reporting violations. And if their reluctance stems from finding the system too difficult to use, you may need to make corrections in your system.

9. Have you ever felt discouraged from reporting a compliance violation? This is a critical question. The best violation-reporting system won't help you if your employees don't use it, even if they know how. Find out whether they're afraid to use the system and why. Take action to change their perceptions.

For example, employees might think that their chances of job advancement will be jeopardized if they report violations or that reporting will make them look bad in the eyes of their superiors. To counter this fear, reeducate employees and remind them that compliance is a priority in your practice and that commitment to compliance actually promotes employees' chances for advancement.

10. Do you think you'll get in trouble for reporting a compliance violation? Employees sometimes fear that a violation report won't be kept confidential and that they'll get in trouble-often with their coworkers-if they report violations.

If that's the case, emphasize that their privacy will be protected as much as is legally possible and that reporting compliance violations is part of their job. If they're confident that you'll take all possible steps to protect their confidentiality, they'll have much more confidence in the system.

11. How do you think we can improve our violation reporting system? Give employees a chance to comment on your violation-reporting system. They may think of something during the PPR that will help you fine-tune the system.

F. Lisa Murtha, Esq., partner in the consulting firm of Parente Randolph, LLC, in Philadelphia.

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