This is perhaps the most important essay I have written on health care. These are my conclusions after 15 years of trying to create a robust compliance system in our organization. These conclusions represent my own challenges to myself and to our teams and how they have rallied wonderfully over the years to any curveballs I have thrown to them. I confess we have been far from perfect. Nevertheless, in this case, as in so many wonderful things about life, our failures became our success. Every failure turned into a new opportunity, a new possibility. To get better, stronger, more and more conscientious, this has evolved as our culture, our constant effort.
I share, as perhaps the most worthwhile contribution I can make to the world of medicine, the following formulae:
1) Compliance is the core and the soul. The most important function of any health care organization is not quality or evidence-based medicine or making money. The integrity that is required to be compliant is the soul of the organization. Without integrity, the body dies.
2) Compliance is everything as everything is compliance. There is no operational process that can be separated from adherence to the law and regulations. Every action is inextricably connected to the same mindfulness, the 24-hour Zen, of always trying to do the right thing, never hiding mistakes and correcting as they are discovered.
3) Compliance is quality is care management is patient safety and is patient engagement. Without compliance, there can be no quality. If I cannot even believe the authenticity of my data or my systems, how can I improve my quality scores, since validation is the most important aspect of quality? The same goes for care management and safety. We cannot take good care of complex patients or ensure their safety if we have gaping deficiencies in the correctness of our own processes. Moreover, if these are compromised, there is no true engagement or service possible.
4) Compliance is consciousness is force. Compliance is an awareness, a constant background of our environment, our baseline. In the ancient Indian philosophy, consciousness is not passive but a force, a Shakti. The same principle applies here. If compliance be our awareness, that creates its own action and ramifications.
5) Compliance is integrity is existence. Our existence, according to the principles of Vedanta, is based on Truth. This truth holds us together and makes us manifest. In addition, Truth cannot be differentiated from existence or being. The same is true for the nature of our existence as an organization. Truth is our existence. If this truth collapses, our existence disappears.
6) Compliance is security is profit. It is true that compliance is the best protection for any health care organization. That is how we have begun to see the equations of greed, ambition and true fulfilment. We also view it as a necessary and inescapable investment. The only profit is what I like to call ‘good’ profit. An earning that cannot be challenged or taken back if audited or questioned in action or intention. Here too, perfection comes from the willingness to constantly comply.
7) Compliance is culture is brand. Compliance has to become a way of life, that which nurtures and sustains, the frame of reference, the baseline and the final arbiter. When all supervisors are removed, how does an employee behave? Does he or she act in a manner that is authentic and adheres to the vision, the policies and procedures? And if he or she does so, that is the real transformation in behavior and mindset and this is what establishes the feel and sense of the organization. Culture is what culture does and this reflects in the daily functioning of each individual. And this is the final brand value, the unique selling proposition of any organization that aspires to provide the best health care possible.
These are the formulae that I have discovered as the deeper principles of running any organization; keeping it safe, creating excellence while attempting to create a lasting legacy. Errors will occur aplenty but, like any true process of learning, if accompanied with humility and the desire for constant self-improvement, something worthwhile can be created that can be a force multiplier for the good.