Home Health Healthcare Compliance Policies and Procedures

Healthcare Compliance Policies and Procedures


Protecting healthcare data is one of the top priorities for governments all over the world. Through compliance laws, public entities ensure that all citizens feel safe when receiving medical assistance. Among others, these protocols and policies also ensure the highest quality of service.

Besides having a legal obligation, medical professionals also abide by a set of professional and ethical standards. Like in other sensitive sectors, the regulatory bodies’ work doesn’t stop with the creation of modern laws; they also need to ensure that healthcare providers abide by them.

In this article, we’ll explain the importance of healthcare compliance and programs, after which we’ll explain some of the key elements.

What are compliance programs?

Compliance programs are sets of standardized procedures, policies, and other healthcare processes meant to streamline day-to-day medical operations. Through them, governmental organizations can detect and prevent any unwanted behavior and practices that can potentially harm patients.

Breaching these policies leads to various sanctions for healthcare providers, ranging from mild fines to exclusion. Still, it’s worth noting that every medical company has the ability to modify its internal programs. Given that each hospital and clinic works under specific circumstances, these businesses have to create programs that don’t go against the law yet are suitable for their needs.

As you can expect, these policies and procedures change according to the regulatory changes. Each new practitioner is required to learn them by heart so they can implement them in their day-to-day operations. Aside from introducing relevant documentation, a healthcare organization is also responsible for training and audit.

7 Elements of a compliance program

Your ability to execute a compliance program is heavily dependent on the office culture. Healthcare organizations that stay on top of things, streamline their communication, and provide suitable training, usually have no problem adhering to governmental policies.

OIG or Office of Inspector General, there are 7 main elements of an effective compliance program:

1.    Create standards of conduct, procedures, and policies

Before you can enact new policies, it’s recommended that you take a look at the previous practices. Through audit, you can set the basis to build upon and fulfill existing gaps. The initial analysis is especially vital for large medical providers that have offices in numerous cities and states.

Given that most internal documents are turned into digital format nowadays, healthcare organizations use knowledge bases and support files to share their policies. Furthermore, it isn’t unusual for companies to store all their sensitive data within online software, making it easily accessible to everyone.

2.    Establish a committee that will oversee the compliance process

Once you create a program, you need to assign an individual or a team to ensure everyone adheres to it. The person in charge should oversee the entire program across different departments. Among others, the regulatory body should provide training, monitor compliance, and enforce corrective measures.

In most cases, healthcare organizations assign a well-respected individual to this position, usually someone who has been with the company for a while. Besides executing various day-to-day tasks, this person is responsible for setting an appropriate tone for all peers.

3.    Create a system of communication for all participants

The only way for a compliance program to be effective is by ensuring proper communication between different entities. Not only should management provide relevant information to employees, but the employees should also feel free to provide feedback. Most importantly, medical professionals should have a channel through which they can anonymously report infractions to the higher-ups.

The company’s duty goes beyond sharing policy files. The management also needs to educate employees as to why these rules are important and why ethical norms help everyone involved. Furthermore, employees should understand the potential sanction if they were to breach these rules.

4.    Provide continuous training for your employees

Speaking of training, this isn’t a one-and-done process. As laws change all the time, so does your program and, with that, employees’ responsibilities. Through training, medical practitioners can also learn how to implement these procedures at a high level so they won’t inadvertently break the rules.

In an ideal case, you should use real-world examples that would demonstrate to practitioners what kind of potential problems await them. Lastly, make sure to organize courses and seminars that would allow practitioners to hone their skills.

5.    Establish a system for oversight

Even if you can provide the best training in the world, you shouldn’t blindly trust that your employees will remain compliant in every situation. Instead, you should introduce a monitoring system that would oversee their work. Besides ensuring compliance, such a system could assess employees’ performance and associated operative risks.

6.    Enforce discipline on all levels and consistently

Perhaps the hardest thing of them all is enforcing disciplinary measures. Everyone who infringes on the company’s policies should be dealt with as prescribed in the disciplinary manual. The same rules should be applied to everyone, regardless of their role and experience, thus ensuring there’s no favoritism between employees.

While the process of monitoring and enforcing generally lies upon the committee, everyone is responsible for compliance. As mentioned, other employees should report breaches to the person in charge, ensuring that potential infractions are dealt with in-house. That way, medical organizations might be able to circumvent major penalties from governmental organizations.

7.    Take preventative and corrective actions

Healthcare providers should perform a full compliance audit every once in a while. With these audits, companies can ensure data safety, workplace health and safety, acceptable management standards, patient protection policies, and more.

During this step, medical companies face a lot of challenges. Among others, through audits, they’re trying to determine if current policies could harm the company in the long run. That way, they can introduce the necessary tweaks that would ensure better compliance while maximizing profitability.


Healthcare compliance is an extremely sensitive subject. The topic is important for everyone involved, from patients to governmental agencies and even medical providers. Because of that, the companies need to follow the 7 previously mentioned principles to ensure adherence to the current legal frame.

Felicia Wilson


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