January Newsletter

Greetings and Happy New Year. We hope that upon reflection through this past holiday season, that 2023 provided you with seized opportunities for continued growth in health, happiness, and prosperity. We hope this new year brings new opportunities for sustaining changes made in the past, and creating new solutions to challenges for growth manifesting both the present and future. This month, we’ll feature two installments of our newsletter. Later this month, we’ll share our final observations and reflections from 2023 and our 2024 forecast.

Today, close out one theme from last year. We’ll pick up on our topic of trust and expand on this foundational issue to help clarify a significant misconception in behavioral health and point to a foundational source for solutions of so many challenges top of mind for so many today. In this issue, we’ll examine the topic of compliance and its influence in organizational health, business impact, and participant outcomes.

Continuing where we left off in our last edition, trust is the foundation of all things in behavioral health. Measurement-Based Care is showing your work which, is a demonstrable way of showing how trust is built and earned. Measurement Based Care is also a demonstrable way to evidence our integrity of service, in both production and participant impact. Measurement Based Careis also a demonstrable way using compliance practices to ensure integrity in our relationships.

Many find compliance a dry, boring topic…a necessary function driven by external forces as required by (fill in the blank). Most discussions on compliance, especially in behavioral health, cause autonomic nervous system responses evidenced by a tighten of the jaw, stiffening of muscles, narrowing of the shoulders, and a fear of being called out for not tending to some detail (usually documentation of some sort or a task that needs timely documentation). Hopefully before the end of this article, if you experience such autonomic nervous system responses, your perspective can shift. Through considering whatever your past experience or current discomfort can shift to experiencing compliance in a foundational way to inform your approach to behavioral health that provides a clear pathway to building and growing trust, more dedication to the detail of showing your work, and growing sufficient and evolving practices to ensure integrity in your relationships.

Compliance is the process of following rules, regulations, and laws that relate to behavioral healthcare practices. Compliance exists to create consistency in standards & practice from which the best care is delivered. Most behavioral healthcare compliance issues relate to participant safety, the privacy of participant information, and billing practices. Compliance is intended to ensure we follow a series of interrelated processes to achieve a desired result.

Compliance is more than adherence and execution of policies, procedures, & protocols. Compliance is more than meeting the minimum standards of practice according to various stakeholder bodies (e.g., Regulatory, Accreditation, and Trade Organization Membership) and/or contractual obligation (e.g., participants, vendors, payers, staffs, and organizational)

Most often, compliance practices and standards in behavioral health include a system process for consistently and routinely examining how to inform refining and improving the production, quality of services, as demonstrated through Measurement Based Outcomes.

In behavioral health provider terms, compliance is the set of treatment plans for the organization to deliver its mission, vision, values, and services as intended and expected. Compliance contains the goals, methods, and objectives for each part of the organization, complete with ways in which the organization should document the progress and response to these plans.

In function, compliance is the foundation for operational sufficiency and ensures everyone follows proper procedures and understands expectations.

Having challenges with admissions? Look at your policies, procedures, and protocols to determine if staff are following the plans, to include utilizing the resources available within the organization, then measure against what is actually happening. Chances are someone ids deviating from the process, or minimally, taking liberty with interpreting the process to secure an admission (which often leads to greater challenges in clinical care when a complex case enters the equation, or someone promises something to a participant or family member in the admission process that doesn’t get communicated to everyone else, or worse, isn’t something that can be delivered).

Having challenges engaging employee recruitment and retention, examine your human capital management systems and processes, and you likely find either gaps in your approach, or missteps in execution of your compliance measures to ensure the people providing the service are supported in the best way possible to ensure their success in their work.

Having challenges with behavioral health revenue cycle management? Chances are there is a breakdown between several components of the process, including billing, coding, and claim management concerns, documentation insufficiency, service utilization ethical puzzles, and most commonly, a lack of communication with the teams responsible for management each complex and detailed portion of the revenue process.

Concerned about regulatory inspections, upcoming accreditation recertification, or payer audits? How prepared for these routine experiences (and be assured, these activities are routine in the agreements we enter with various governing, accrediting, and payer relationships) depends upon how your organization views and practices compliance. Organized and consistent compliance invested in thoroughly prevents these experiences from needing to be anxiety provoking, uncomfortable, and costly.

Far too often, compliance isn’t taught to be a good thing, but rather something that “Must Be Done”. In fact, which is quite strange given the values driven goals of most behavioral health providers, many folks learn to view compliance in a highly pejorative context. For too many, compliance as seen as a frustrating requirement. Even that word, “requirement” influences peoples experience of compliance. Compliance viewed in this framework is “risk management”, ripe with of fear, guilt, shame, dread, danger, threat, wrought with insinuations of questions about competence and execution insecurities. As one colleague termed it, people often learn “oppositional compliance”. We’ll complete the required documentation and processes, but under internal emotional protest and rebellion. In this view, compliance is “I’ll do what is necessary to avoid any trouble”. We’ll do what is necessary to “follow the rules, but I won’t like or enjoy the process.”

This is an unfortunate consequence of misunderstanding the purpose and value of compliance. Having defined systems and processes that are clear, precise, well communicated and well documented allow for the simplest and most practical way to show your work, evidence trustworthiness, and thus build increasingly attuned relationships for persons served, providers and staffs, and the entire behavioral health community at large. Compliance often is viewed as additional work that takes away from “the real work” being done. Rather seeing compliance as an opportunity to show their work and improve their impact and provide the highest integrity services possible. for so many, they work in a culture that generationally begrudgingly applies compliance measures,

Many years ago, I worked with a clinician, who happened to have practiced law for many years before retiring his legal career to join the behavioral health profession who a simple observation during a staff meeting introducing a new compliance measure being integrated to our treatment milieu. As more systems of checks and balances were handed to our clinical team from management based on new and frankly innovative ways our participants were finding to “navigate” the various rules and guidelines of the treatment facility, and as more experiences drove the organization to create clarified guidelines to inform and refine our treatment process and service, the more compliance measures were integrated into our work.

This seasoned clinician observed that as each new scenario challenged us to respond to the evolving needs of maintaining safety and fostering the healthiest process we could deliver, why not keep things simple with one maxim? Why so many compliance measures, additional protocols, and so many new policies and procedures? Why not a simple rule to inform our work:

Do No Harm!

As one might imagine, the management team responded saying that extracted portion of the Hippocratic Oath is a starting point that leaves too much room for interpretation, much the rules violation leading to the appropriate response of a new policy being reviewed for integration.

If only we all shared the same meaning of harm in all circumstances, and all shared the same integrity in all of our responses. My colleague’s point was taken well and helped foster a rousing discussion on two key points.

First, compliance is built from experience, and it evolves. Especially in the field behavioral health, which drives individualized treatment balanced through delivery of systematic and systematized care for the sake of quality care and economic stewardship, serving peoples evolving and complex needs through a wide variety of responsive approaches, compliance must evolve in response. Compliance must grow, and well executed compliance includes periodic review to improve everything, all of the time. Doing no harm is a beginning, not and end for compliance. Seeking to consistently measure, grow, and improve is a fundamental in any healthy approach to compliance. We must evaluate our treatment plans to ensure they are being achieved or evaluate a different plan to produce the desired and intended outcome.

Second, building a culture of compliance is key.My colleague’s point about shared values and communicating shared values around doing no harm admittedly did presume we all meant the same thing and were committed, and more importantly, prepared to collaborate within our work group towards the same meaning and value. Our discussion in the clinical team meeting quickly led us to discussing the culture of our team, the cultures of our collaborative teams, our treatment center, and the culture of the larger organization (a premier and nationally renowned teaching hospital). Our discussion of culture and perspectives on compliance led our group to find new avenues to refine our integrity of service through a myriad of ways, most importantly taking time regularly assess and consider growth of the culture of our work groups and system as a whole. We found new ways to share our beliefs, practices, experiences that informed some of the most impactful care I’ve been privileged to participate in.

Through this process, our team grew more trust in each other, our collaborate work groups and with no coincidence, the measured outcomes for persons served and their families was evidenced through, you guessed it, our measurement-based care compliance protocols. We not only were able to show our work but were able to clearly communicate what was impactful at each point in the treatment process, and as the results were shared, motivated us to continuously invest in our culture of compliance to improve our care. The return on investment in compliance was measurable in all aspects of care, and we could show how the investment was paying compound dividends in human capital, financial sufficiency, and quality of care. As consistency grew in pressive aspects of work, we narrowed our focus honing in on detailed nuances of our process, seeing corresponding changes in our work and the impact of those we served. As the expression goes, “aim small, miss small”.

Through this example of transforming a clinical team’s and ultimately the entire treatment organization’s experience of compliance within our culture, we identified ways to leverage various software, systems, and tools. So many of our contemporary documentation systems contain valuable resources for aiding and automating compliance practices. Almost all worthwhile Electronic health Record systems, Customer Relation Management systems, and Revenue Cycle Management tools, have an integrated a “golden thread” for documentation consistency, validation, and verification for aiding with compliance management.

Furthermore, collaborative partners of ours such as Simplifyance provide tailored solutions to ensure compliance management integrations aren’t the daunting task of a teams of specialized compliance specialists, but accessible to all to help build and grow cultures of compliance with efficiency, security, safety, and ensure mutual responsibility isn’t just a catch phrase. Picking the right tool for the job makes sure that you don’t fall into the trap of only having a hammer and treating everything as a nail.

Compliance grows within a culture of clearly defined, clearly articulated, and clearly actionable mutual responsibility to promote standards and practices for care to ensure the desired outcomes are sustainably experienced. Maintaining and growing compliance is a requirement and an evolving practice. When compliance is integrated sufficiently, an organization is prepared to respond to evolving needs of the entire ecosystem (economics, all stakeholders — staffs, participants, families, referents, and community needs). Through a healthy culture of organized and attuned compliance, building trust, showing your work, and remaining invested in consistently improving all aspects of care and service ensures that the missions, vision and values of your organization and the lives of those you serve through that process can experience the reality of what is written in your policies, procedures, and protocols, and likely a whole to more.

If you are interested in learning more about how investing compliance evidence’s true results, then reach out to connect with us, as discussions about compliance are always welcome. In addition, tune into a discussion on compliance with one of our collaborative partners, Simplifyance, available here. Improving compliance means investing in greater consistency. Improving compliance means investing in greater consistency. Consistency equals integrity of service, and integrity for our behavioral health consulting firm, C4 Consulting, is first, last, and always.”