Regulatory compliance: A lesson learned

Dear Medical Staff Leader:

People say only two things in life are inevitable: death and taxes. But for those in medical leadership, there is a third--regulatory compliance. Healthcare is certainly one of society's most heavily regulated industries. While many people working in healthcare want to focus solely on providing quality care, the responsibility for meeting an extraordinary array of regulatory requirements demands attention. Many of these requirements appear arcane and picky beyond practicality to practitioners' clinical minds.

Let me give you an example. A number of years ago, a young physician was appointed as medical director of a hospital-affiliated family practice clinic just three months before a JCAHO survey. He spent much of the next three months drafting and editing policies developed to comply with a JCAHO standard. This task was particularly frustrating because the physician was very proud of the high quality of care practiced by the dedicated physicians and nurses in the clinic, and all the time and effort spent writing policies seemed to just drain resources.

The date of the survey arrived, and the first request from the nurse surveyor was for the clinic's scope of service. The physician gave that "deer in the headlights" look and asked, "What do you mean by scope of service?" The nurse surveyor explained that the 10-step process for ensuring high-quality care began with defining each department's scope of service--identifying all clinical activities practiced at the clinic. The request frustrated the physician, but he dutifully drafted a scope of service that the surveyor eventually approved. However, the physician's problems weren't yet over. 

The next day, he was invited to lunch with other physician leaders and the surveyors. He waited for a lull in the conversation, leaned forward, and asked the surveyors why the JCAHO "wastes physicians' time with ridiculous requirements that have nothing to do with good care for patients?" The physician harangued the surveyors in louder and angrier terms until ushered away by the hospital's chief operating officer.

I felt much better when finished my little tirade. Yes, I was that young medical director. The good news is that both the JCAHO and I have changed. The JCAHO modified its standards and survey methods to focus on processes of care rather than policy language. And I have developed a bias. My bias is that they are not paying us enough in healthcare to do anything just for the sake of regulatory compliance. We should take good care of patients and manage hospitals effectively. Regulatory compliance can and should be a byproduct of doing these activities well.

So what does this mean to you as a physician leader? This line of thinking is not a justification for being ignorant of regulatory standards. However, when you are told you must do something because it is required by JCAHO, the Centers for Medicare & Medicaid, or other regulator, ask to see the specific standard, associated intent statements, and the scoring guideline. Then think creatively about how you can do the right thing for patients and the hospital while still fulfilling the standard. You'll be surprised at how much flexibility you can find when you think outside the box.

That's all for this week.

Rick Sheff, MD