Responsible Compliance

Bringing new energy to compliance programs through innovation.

By Rebecca K. Wojcik, PT, EdD, GCS

I would hypothesize that most physical therapists think of compliance programs as a burden existing primarily for the concern of practice administrators. We assume that no one starts out wanting to cut corners or risk noncompliance with the many laws, regulations, and policies inherent in contemporary practice. But often the demands of clinical practice can tempt even the most “compliant” physical therapist to skip a portion of documentation, defer an audit, or selectively audit only cases that comply with regulations. There is huge psychological pressure, probably rooted in childhood experiences, not to be a whistleblower or watchdog over one’s peers, much less over one’s own behavior and everyday practices to comply with regulations. In addition, the normalization of deviation or “getting away with” noncompliant actions many times without “getting caught” is a powerful reinforcer of lapses and infractions.

So, given that requirements to comply with laws, regulations, and policies won’t be decreasing or going away anytime soon, it is prudent to look for innovative ways to shape behaviors and encourage self-motivation to comply. This approach is consistent with the shift in the Office of Inspector General’s (OIG) philosophy of compliance to approaches that rely more on self-correction and coaching than on enforcement and punishment. The growth of negotiated Corporate Integrity Agreements by the OIG and increased use of remediation are examples. The self-motivated approach also meshes well with the inherent doctoring nature of physical therapy practice and the Code of Ethics for the Physical Therapist.¹

Physical therapists can also benefit from applying innovative approaches to compliance with laws, regulations, and policies. Innovation is often viewed as the application of better solutions that meet new requirements.² Expanding your thinking to generate original and innovative ideas takes effort, but physical therapists can benefit from advancing skill in innovative thinking to bring new energy to compliance programs. Dr. Roberta Ness demonstrates strategies for learning to become a better innovator in her book, Innovation Generation: How to Produce Creative and Useful Scientific Ideas.³

Reframing compliance as an issue of an organization’s culture may inspire leaders and others to keep compliance on the “front burner” for all staff rather than in a binder on the shelf in an administrative office. Acknowledging individual or organizational growth in self-identifying compliance opportunities, incubating ideas, and implementing creative solutions/redesigns may be more helpful than repeatedly issuing the “naughty” list and hiding mistakes, errors, and lapses. The heavy reliance on internal controls and training in many corporate compliance programs can be seen as an opportunity to infuse innovation and creativity into organization-specific culture.

The airline industry and space exploration programs have very low tolerance for error or noncompliance, because they know that mistakes can cause significant harm. So, too, in many sectors of health care. Lessons from these industries can also expand the frames physical therapists use in compliance programs.

To approach compliance with innovation, consider the following:

• How is the expectation for compliance reflected in descriptions of competencies, program evaluations, and performance appraisals?
• Are self-reflection, self-identification of errors, and self-correction expected of all staff?
• How supportive is the organization of training for compliance? Are a variety of training opportunities available and delivered in styles that match the clinicians’ learning preferences? Is time devoted to compliance issues in staff meetings, in services, and continued education? Are compliance issues addressed through team-based discussion, brainstorming, collaborative, interdisciplinary problem solving, creativity activities/gaming, or case-based approaches in addition to the traditional lecture-based or written, self-study approach?

Responsible compliance takes extensive and ongoing work, not just by leaders assigned the responsibility or boards of directors. The behavior of each clinician and staff member contributes to the ethos of compliance that ultimately enhances the quality of care and best use of precious resources for the provision of physical therapy. Igniting new approaches to compliance through innovation can contribute to enhanced accountability.

References

1. Code of Ethics for the Physical Therapist, American Physical Therapy Association.

2. Maryville S. Entrepreneurship in the business curriculum. Journal of Education for Business. 1992;68(1):27–31.

3. Ness RB. Innovation Generation: How to Produce Creative and Useful Scientific Ideas. New York, NY: Oxford University Press; 2012.

Rebecca K. Wojcik, PT, EdD, GCS, is a member of the APTA and six sections. She is associate professor and chair of the Department of Physical Therapy at Governors State University in University Park, Illinois, and practices in acute care and subacute rehabilitation in a community hospital. She has served in a variety of leadership positions in the Illinois Physical Therapy Association. Dr. Wojcik teaches ethics, leadership, policy, advocacy, management, and administration principles and concepts to entry-level and transitional doctor of physical therapy students. She can be reached at rwojcik@govst.edu.