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'Transformation' of Compliance Led to Dozens of Changes; Executives Asked How to Help

When Donna Schneider joined Lifespan, an academic health system in Rhode Island, as vice president of compliance and internal audit, she had a lot of questions for its leaders, including what it’s like to work with compliance/internal audit, and what they want that they're not getting. Schneider was surprised when, at one point, the executives turned the questions back on her, asking what they could do to help compliance and internal audit.

“People want to help,” she said. “Collaboration is appreciated.” She also asked the compliance team a series of questions, including their perceptions of the job and suggestions for improvements in the department. The question-and-answer sessions helped pave the way for the transformation of compliance and internal audit at Lifespan that has unfolded over four years.

“Transformation is going through change,” Schneider said. “What does that require? Listening and giving people the opportunity to speak and to hear things and the tone in their voice or their nonverbal communication.”

Although the purpose of transformation is improving the effectiveness of the compliance program and internal audit, it’s larger than that, Schneider said. It involves using data “to understand your current experiences so you can be proactive in what you audit and train for” and being “value-added” in terms of advancing the organization’s goals. “It’s part of building momentum,” Schneider said Sept. 9 at a virtual conference sponsored by the Health Care Compliance Association.[1] For example: “Instead of being considered the compliance police, we strive not to be the department of 'no.' We can’t always say yes, but how can we partner with colleagues and be mutually agreeable about the risk?”

Heidi Trier, a partner at Ernst & Young, noted transformation is necessary because “the way of working now” has changed in the past few years. “There’s so much shifting in the compliance, regulatory and financial environment,” Trier said at the conference. “Everybody is asked to do more with fewer bodies. You don’t have the resources to do what you once did.” That’s partly a function of the COVID-19 body slam and its ripple effects. For example, the Provider Relief Fund has shifting terms and conditions, complicating compliance. These developments have upped the ante for technology and “digital enablement” to identify risks, Trier said. “Instead of doing sample-based testing randomly, we use analytics to identify higher-risk items.” A data-driven approach is increasingly used in risk assessments to identify risks and be agile about them as new data comes in rather than have a rigid list for the year.

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