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Quality Tools Can Be Used to Improve Compliance Processes

Examples of Tools that May Prove Benecial for Compliance Professionals

John Falcetano, CHC, CIA, is the chief audit & compliance ofcer at University Health System of Eastern Carolina.

n todays day and age, when someone talks about quality in a health care setting, most people think of the quality of care a patient has received from a provider. The general public may not realize all the processes that must be performed correctly in order for a patient to have a good outcome. The same is true for compliance. When we think about compliance, the general public may only think about if an individual or organization complied with a particular law or regulation. They may not be aware of the many processes that have to be performed correctly to meet the regulatory requirement. As you can see, both quality and compliance deal with process management. On the quality side, there has been signicant work to improve the quality of services provided. Individuals like Deming and Juran1 have helped guide the quality improvement revolution in the health care industry. Numerous quality assessment methodologies were used to achieve a successful outcome. Organizations implement quality programs to provide the best care to their patients, to meet professional standards, and to enhance the image and perceptions within the organization and the public. Quality management staff uses many quality improvement tools in order to improve the care and services they provide to patients. Because quality management focuses on process improvements, compliance professionals can learn much from their quality management counterparts. Many of the quality tools can be used to improve compliance processes. I will spend the rest of this article just touching on a few of the ones that may be of value to compliance professionals. Lets start with a ow chart. A ow chart provides a picture of the steps in a process. It is an excellent tool to look

Journal of Health Care Compliance November December 2006



at a complex compliance process by using symbols to understand each step in a process. It can help a compliance professional identify problems in the process, analyze the actual steps in a process to the ideal steps in order to identify variation, and identify unnecessary steps in a compliance process. A second tool that can benet compliance professionals is a cause-and-effect diagram. The compliance professional can use this tool to identify possible causes of noncompliance. The cause-and-effect diagram helps to identify possible causes of variation in the process and identies positive and negative relationships. The toll can be used to determine why sometimes an organization may comply with a particular regulation while other times it may not. A third tool that may help a compliance professional identify patterns of noncompliance is a check sheet. The check sheet is used when the compliance professional wants to count the symptoms of noncompliance. The data is gathered based on sample observations. It is important that the check sheet be designed to determine symptoms you want to observe and the time period for observation. The nal tool I will mention today is one that can be of great benet to the compliance professional. That tool is a Combination Interrelationship Digraph Matrix. This tool is used to identify the cause and inuence relationships and strength of inuence among items. The tool helps the compliance professional determine if there is a relationship be-

tween processes. It helps identify critical processes by determining what processes affect other processes and what processes other processes affect. This is important because by identifying critical processes the compliance professional can identify what process an organization needs to focus its improvement efforts on in order to improve compliance. A critical process will have the most effect on other processes. If the compliance professional can focus organizational improvement efforts on the one critical compliance process and improve it, all the other processes that are affected by that critical process are also improved. Compliance does not just happen. An organization creates a culture of compliance by performing many compliance processes correctly. Compliance professionals have a lot of tools at their disposal that they can use to identify and improve critical compliance processes to improve the overall compliance of their organizations. Learning how to construct and use these tools improves the compliance professionals skill sets and increases their value to their organization.
1. William Edwards Deming lived from October 14, 1900 to December 20, 1993. He was a college professor, author, lecturer, and consultant and was well known in the areas of improving design and product quality, among other things. Joseph Moses Juran was born on December 24, 1904 and is well known for his work in the area of business and industrial quality.


Journal of Health Care Compliance November December 2006