Kimberly Johnson, RHIA, CPC, CHC - Health Care Compliance ...

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Sparking an epidemic of compliance
By Stephen Kelly, JD, LLM, CHC, CHRC
July 2010
20
Editor’s note: Stephen Kelly is the Chief Compliance & Privacy Officer for
the Carle Foundation Hospital and Health System, located in Urbana,
Illinois. He may be contacted by telephone at 217/383-3927 or by e-mail
at mcshane66@gmail.com.
It’s axiomatic that an organization cannot have a culture of compliance
without executive leadership and the board members
setting the right “tone at the top.” The conventional wisdom
is that if the leaders of the organization talk the talk and walk the
walk, somehow a compliance ethos will permeate all layers of the
organization. Undoubtedly, having leaders who pay more than lip
service to compliance and ethics is a huge step in the right direction.
Without their support, the compliance program doesn’t get the staff
and resources it needs, it doesn’t get included in significant decisions
affecting the structure and operation of the organization, and it
doesn’t get the muscle to mete out discipline or to make significant
overpayment refunds to payers and the government. After reading
Malcolm Gladwell’s, The Tipping Point, 1 however, I began to question
the assumptions that once an organization’s leadership has bought in
to the compliance program, the rest of the organization will surely
follow, or that creating a “tone at the top” is the only way to create a
culture of compliance.
If you have not read it, The Tipping Point, is a compelling study of
how the rules governing viral epidemics can also be used to explain
dramatic changes in social behaviors, cultural trends, and the broad
acceptance of new ideas. According to Gladwell, there is a tendency to
think that, in order to affect major change, one has to put out major
effort in order to have the desired impact. For example, I once thought
developing a culture of compliance in my organization could be
accomplished through a series of over-the-top gestures, such as getting
in a dunk tank during Compliance & Ethics Week, or by showing
up on the clinical floors in the middle of the night to demonstrate
the organization’s commitment to compliance. To the contrary, the
key message of The Tipping Point is that dramatic changes in societal
or organizational behavior are not necessarily achieved through such
grandiose efforts. Instead, they are normally achieved through a series
of much smaller adjustments: adjustments to the message being
communicated, to the type of people to whom the message is delivered
and, finally, to the environment in which the message is delivered. By
making such small-scale adjustments, one can accelerate the contagiousness
of an idea, trend, or behavior to the tipping point, which is
the point where it becomes a cultural or social epidemic. This article
examines Gladwell’s thesis and ponders whether the ideas presented
in The Tipping Point can be applied to the chief aim of compliance
programs (i.e., to prevent fraud, waste, and abuse and to develop a
culture of compliance throughout an organization). In other words,
can one create an “epidemic” of compliance?
The three rules of epidemics
In his study of social epidemics, Gladwell identified three unifying
principles that all of them have in common. By altering a message
to exploit these rules, Gladwell suggests that we have the power to
control what ideas transform into epidemics both in society and in our
organizations.
Rule number one: The Law of the Few
Gladwell’s first rule of epidemics is The Law of the Few, which holds
that the spread of a social epidemic heavily depends on a very small
number of people who become the primary agents of change. These
are people who are blessed with certain social gifts and who most
effectively carry the message, new trend, or idea (i.e., the contagion) to
the broader population we are trying to reach. Gladwell refers to these
people as Connectors, Mavens, and Salesmen.
A Connector is the type of person who seems to know everyone and
is a natural at networking. If you go to lunch with a Connector, he
or she will probably run into somebody they know. Not only do
Connectors know a lot of people, they know a lot of different types
of people. For example, in high school, a Connector was the kid who
could easily circulate amongst the jocks, the nerds, and the artsy crowd
with little difficulty. In our context, Connectors are important because
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