Assess the Effectiveness of a Healthcare Compliance Program

Dave Clifton

Compliance programs play a pivotal role in ensuring top-notch healthcare delivery. When a healthcare organization and its staff adhere to standards, practices, and protocols, it establishes a foundation for accountability and excellence. However, the healthcare landscape is in constant flux, prompting the crucial question: how does a healthcare organization assess the effectiveness of a compliance program?

Managing a healthcare compliance program is no small feat, especially when it comes to regular and routine assessments. It often requires a collective effort or a helping hand from cutting-edge compliance software.

What Exactly Is a Healthcare Compliance Program?

A healthcare compliance program is a systematic set of protocols designed to ensure that healthcare organizations comply with legal and ethical standards in their service delivery. These programs serve the dual purpose of preventing and detecting violations of healthcare laws and regulations, while also promoting patient privacy and data security. Additionally, they uphold the highest standards of patient care.

Typically, healthcare compliance programs encompass a combination of policies, training, auditing, monitoring, and reporting mechanisms. Together, these elements mitigate risks, nurture a culture of compliance, and safeguard both the organization and its patients from potential legal and ethical breaches.

How Frequently Should You Assess a Healthcare Compliance Program?

Assessing healthcare compliance programs is essential to ensure their effectiveness in maintaining legal and ethical standards. These assessments can be either external or internal in nature.

External Assessment: These are carried out by independent third-party experts and can be scheduled or impromptu. They involve a comprehensive review of policies, procedures, and practices to identify any weaknesses, gaps, or potential compliance violations. Importantly, external assessments hold healthcare organizations accountable, providing a powerful incentive to stay up-to-date with evolving regulations and best practices and avoid negative publicity due to violations.

Internal Assessment: These are conducted internally by the healthcare organization’s own compliance team, officer, or contracted firm. These assessments entail continuous monitoring, auditing, and evaluation of program components to pinpoint areas that may require improvement or adjustment. The frequency of internal assessments should be regular throughout the year, with a focus on specific areas determined by risk assessments and regulatory changes.


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The 7 Key Elements of an Effective Compliance Program

Effective healthcare compliance programs incorporate various elements to ensure adherence to legal and ethical standards. While specific requirements may vary by industry, here are seven fundamental elements from the Office of Inspector General often deemed essential:

  1. Written Policies and Procedures: Clearly documented guidelines that outline compliance expectations and regulatory requirements.
  2. Leadership and Governance: Strong senior management support and dedicated compliance oversight.
  3. Training and Education: Ongoing programs to educate employees about compliance standards and their roles.
  4. Risk Assessment and Mitigation: Regular identification of compliance risks and the implementation of control measures.
  5. Monitoring and Auditing: Continuous evaluation and assessment processes to detect and address compliance issues.
  6. Reporting and Response: Mechanisms for reporting concerns and a structured process for investigation and resolution.
  7. Enforcement and Discipline: Consistent approaches to enforcing standards and addressing violations.

These elements form the bedrock of an effective compliance program, helping organizations prevent, detect, and respond to compliance violations while fostering a culture of ethics and integrity.

Ongoing Assessment of Compliance Programs

Given the need for regular compliance program assessments, a manual approach may not be the most efficient. Sustaining a robust healthcare compliance program requires ongoing commitment. Fortunately, compliance management software is revolutionizing oversight by simplifying the work of compliance management professionals, allowing them to focus on continual improvement.

Here are some valuable ways technology can help keep compliance programs current:

  • Version and Approval Tracking: Digital tools efficiently manage and document changes in policies and procedures, tracking revisions and providing a clear audit trail to ensure compliance documentation remains up-to-date with evolving regulations and internal standards. Every policy has a requirement of when it needs to be updated – for example emergency preparedness and HIPAA must be updated every two years. 
  • Track Employee Training: Healthcare-specific learning management systems (LMS) regularly update training modules and track policy changes to ensure all courses are relevant and compliant. They offer real-time tracking and reporting of employee progress and performance.
  • Survey Employees: Gathering feedback from employees is crucial for assessing and enhancing compliance standards. Digital surveying tools accurately capture employee engagement and understanding, emphasizing the relevance of asking relevant questions.
  • Incident Reporting and Tracking: Incidents reports are a great indicator of the effectiveness of a compliance program. Electronic systems make it easy to see trends, so when you see there are numerous incidents in a certain location or related to a certain procedure, then you can offer updated training or new policies to help curb the issue before something major happens. You can then watch to see if your solution is effective.

MedTrainer: Your All-in-One Compliance Software Solution

MedTrainer offers comprehensive tools for monitoring, tracking, and evaluating various compliance elements within healthcare organizations. Our platform centralizes data and documentation, simplifying the assessment process for policy adherence, employee training, and incident reporting. With a user-friendly interface and automated features, MedTrainer empowers healthcare compliance teams to keep their programs current, efficient, and well-documented.