Creating a Code of Conduct
Author: Cynthia M. Roehr, CPA, CMPE
There were a number of sessions at the ASA Practice Management conference in January that spoke to the value of a “code of conduct” for practices. But what is a Code of Conduct? And how do you create one? And what is its value? And more importantly, how do you get your group’s buy-in?
So what is a Code of Conduct? According to the International Federation of Accountants, it is “Principles, values, standards, or rules of behavior that guide the decisions, procedures and systems of an organization in a way that (a) contributes to the welfare of its key stakeholders, and (b) respects the rights of all constituents affected by its operations.” I’m a little less formal – I see it as your definition of what you expect of your colleagues. Theoretically it could be only 4 words “do the right thing;” but we all know that a more thorough listing will have more impact and be more valuable.
Creating a code of conduct is pretty simple – it is akin to making a listing of all the morally correct behaviors – timeliness, honesty, compliance, compassion, professionalism, etc. fused with applicability to your practice.
So how do you create your own? I would recommend starting by having members create a listing of the most frequent and/or harmful behaviors that impact your group or group functionality; then convert these into ideals. Having members anonymously submit a listing of misbehaviors (not the instigators, just the behaviors) they would like to see eliminated keeps the president/administrator/leader(s) from being viewed as a prig and helps to starts the buy-in process.
For example, if you have an issue with tardiness or absenteeism, your bullet might be “Timeliness, Reliability and Responsiveness." This should be followed with some specifics, such as "To be timely and arrive for cases so as to not delay surgical start times. To avoid unplanned absences and accurately know and abide by your work and call schedule. To provide prompt notification of any changes to your availability or case durations. To respond to pages promptly.” I’ve seen groups actually put parameters on these standards, such as expecting arrival 20 minutes ahead of the scheduled case start-time or respond to pages within 5 minutes. Those standards can be within your Code or simply listed in other documents (such as Handbooks) within your practice.
If your issue is someone being unprofessional during meetings or monopolizing discussion during those meetings, your Code might include “Meeting Participation" with sub-bullets of "Attend all meetings. Display civility and professionalism. Welcome dissenting opinions. Assist in meeting time-management by self-limiting duration of comments.”
A Code of Conduct is a tool for managing your personnel and it will only have value if you publish/publicize and utilize it; it will be worthless if simply tucked into an employee handbook or website. In my experience, once adopted, buy-in happens rather quickly, especially if well publicized. Members were already aware the behaviors were problematic; but now they have an authoritative document that allows them to put a spotlight on the issue, and violators are now on notice that there will be no tolerance.
Your mission is then to keep this Code in front of your group and consistently enforced, so that all members know what is expected of them. Members also need to know that being non-compliant could result in being called-out or punished – or even terminated. Here are a few of my suggestions:
- Read it aloud at the start of each group meeting. I know some of you will think this is superfluous and a waste of time, but these standards need to be indoctrinated into your culture. Everyone needs to be reminded of the standards their peers are expecting.
- Use it as a touchstone for evaluating your providers and employees. I would suggest performing provider evaluations by surveying the nursing staff on questions directly correlated to the ideals in the code of conduct.
- Promptly hold members accountable. Have a defined process established for reporting and addressing incidents or concerns. And identify individual(s) that are beholden to the group to assure non-compliance is not tolerated. (And hold those individuals accountable for active enforcement.)
- Provide the Code to all recruits during their visits to your practice. It sets the tone of what will be expected and what they can expect from day-one.
My experience is that one or two individuals in each group cause 80-90% of the behavioral issues and thus they devour immense quantities of time and effort of the leadership team. A Code of Conduct puts renegades on notice as to the expectations that are in place. When misbehavior occurs, the disciplinary meeting/notice should directly reference the area of the Code that was violated and the correction needed to bring return to compliance. And if that doesn’t sink in, the Code of Conduct will be “Exhibit A” in the termination proceedings.
Cindy Roehr is a CPA with over a quarter-century of anesthesia and practice management experience. She has been a frequent speaker at ASA and MGMA conferences and consults with groups on provider performance evaluations, hospital contracting, governance, financial modeling and RCM issues. Additional information about Ms. Roehr and additional articles pertaining to practice management may be found at www.roehrconsultingllc.com