Even though Debbie Miller left her role as a bedside registered nurse nearly twenty years ago, she still approaches her responsibilities as chief compliance officer at Ensign Services with a clinician’s perspective. It allows her to address compliance issues from a hands-on point of view while supporting the company’s client facilities and service lines, such as in-house therapy, skilled nursing, senior living, and home health and hospice care.
“If you’re not a clinician, the practical applications of how regulations apply can be hard to grasp,” Miller says. “I automatically think of care plans and key factors that need to be covered in staff education to promote compliance. It all adds up to a more comprehensive clinical picture and better insights.”
It also leads to process improvements and protocols and policies that are specific to the business lines and culture of client facilities. Miller says that is one of the most basic tenets of effective compliance: making sure programs fit the size, scope, and function of the organization and the communities it serves.
She makes sure that compliance partners (the company’s term for compliance team members) are matched to the specialties in which they work. Nurses train and audit nurses; rehabilitation therapists train and audit rehabilitation therapists. This supports customized instruction and recommendations.
“For effective results, you have to communicate in terms your audience understands,” Miller says. “You also have to know the practice and demands of the environment where they work. Otherwise, you get ‘check box’ compliance, which is relatively meaningless.”
Aside from state and federal regulations themselves, Ensign’s core values are the most important driving forces behind its compliance efforts and, in fact, its entire operation. Represented by the acronym “CAPLICO,” they include:
If employees are the top priority, they provide better care. This means taking their concerns seriously, resolving issues without fear of retaliation, and ensuring that staff is paid for annual code of conduct and compliance training.
Everyone at every level has a voice and is empowered to speak. They are expected to act responsibly in addressing requirements and areas that need improvement.
Passion For Learning
Educating employees promotes better care for patients and residents who cannot care for themselves.
Love One Another
Miller characterizes this as one of the most important values. It enables staff to approach each other about problems from a caring perspective. “If you don’t believe someone cares, it feels like they’re just trying to tell you what to do,” she explains.
Fully understanding potential consequences and rewards of an action leads to better decisions, improved safety, and increased benefits.
The company highlights large and small victories. A successful outside audit might lead to a compliance team-hosted cookout, for example. Contests are often held to reward the first client facility in a state to complete its annual training.
Everyone should be responsible for making improvements and how they can be actively engaged in implementing them.
The CAPLICO values are very real and personal throughout the company. Miller herself feels a deep connection to the value of Passion for Learning because of her personal experience with it. Her spouse of twenty-three years, Paula Parson, was discharged from the hospital with stage-four cancer. She was told she should find suitable hospice care, but that was an option she wasn’t ready to consider. Instead, the couple selected an Ensign Services’ client rehabilitation facility where Parson was taught how to conserve energy while living with oxygen support. She also worked with therapists to achieve specific goals that would help her go home sooner and stay safe outside the facility.
Two years earlier in collaboration with therapy resources, the compliance team had specifically addressed standardizing and improving how therapists administered the very tests that were measuring Parson’s progress toward those goals. “That was an aha moment for me,” Miller says. “It showed how what we do at Ensign Services has a direct impact on helping improve the quality of life for the patients of the people we serve.”
Since joining the company, Miller has come to believe that she has never worked for an organization that honors its core values as much as Ensign Services, and has seen them put into action in a number of other instances. For example, after Hurricane Harvey, staff from around the country, in collaboration with compliance partners, launched an adopt-a-family program to help support individuals and facilities in the affected areas. Donations included everything from airline miles and hotel points to cash contributions and volunteering to unload shipments of supplies. The same program and an existing employee emergency fund also assisted families and facilities in need after fires in Northern California.
Miller addresses the core values as part of the hiring process for her team. She asks applicants—most of whom are former clinicians—which value is most important to them and why, and what they miss most about being involved in direct care. “If they don’t miss it, they’re not a good fit for the job,” she says. “I still miss it after all these years.”
Without exaggeration, Miller is quick to say that she feels she has never worked with a finer group of people.
“My colleagues aren’t just auditors and investigators—they’re cultural ambassadors who live and breathe Ensign’s core values,” she says. “It’s very important to me that I’m serving in an organization that believes in doing the right thing, which, in many ways, makes this the easiest compliance job I’ve ever had.”
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