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When something isn’t working, the instinct is to move quickly. Fix it. Address it. Make sure it doesn’t happen again. And often, that means training. I saw this play out in a small—but telling—way. A nurse wasn’t consistently updating the care plan before team conferences. It happened more than once. And it mattered—because the conference depended on having accurate, current information. So the response was immediate. Training modules were assigned on creating and upd

There’s a belief that meaningful change has to be visible. A new system. A major rollout. A full redesign. Something that signals: This is different now. But most of the change I’ve seen actually work didn’t look like that. It started smaller. In leadership roles, one of the things I tried to do consistently was encourage early reporting. Not polished reporting. Not fully formed concerns. Just… the moment when something felt off. A question. A hesitation. A gut feeling that s

Some of the most persistent risk doesn’t come from what’s broken. It comes from what’s familiar. This is one I’ve seen play out more than once.

On paper, it makes sense. If something goes wrong, you add a rule. If risk increases, you add more detail. If clarity is needed, you expand the guidance. From a leadership perspective, more structure should mean more control. Less ambiguity. Less variation. Less risk. But in practice, the opposite can happen. I once worked with a hospital that had a 27-page Conflict of Interest document. It was thorough. Comprehensive. Carefully constructed to cover every possible scenario. A

On paper, most processes look clean. Steps are defined. The sequence is clear. Everything moves in a straight line—from start to finish. From a leadership perspective, that’s what makes a process safe. Standardized. Predictable. Controlled. But that’s not how care is delivered. Medication administration is a good example. From a design standpoint, it’s precise: Orders are placed. Medications are scheduled. Barcode scanning verifies the right patient, the right drug, the right

Most people won’t say this out loud—but you can feel it: you’re supposed to already know. Once you start seeing compliance as culture, you also start noticing the stories we’ve been telling ourselves—quietly, for years—that make it harder than it needs to be. This isn’t about blame. It’s about naming the myths we inherited—and deciding whether they still serve us. One of the quieter myths we inherit is this: If you don’t already know the answer, you shouldn’t be in the room.

Once you start seeing compliance as culture, you also start noticing the stories we’ve been telling ourselves—quietly, for years—that make it harder than it needs to be. (This isn’t about blame. It’s about naming the myths we inherited—and deciding whether they still serve us.) One of the first—and most persistent—stories is this: Compliance is here to catch you. You feel it almost immediately stepping into the role. As a new compliance officer, you walk into rooms where the

Medication reconciliation is often treated like a compliance task. A form to finish. A box to check. Something that has to be done as soon as possible at the time of admission. But anyone who has worked in patient care knows it isn’t that simple. Medication reconciliation is clinical thinking. It means understanding where a patient started, what changed in acute care, what’s available now, what is redundant or no longer needed, and what still needs to make sense when that pat

One thing my career has taught me is that distance is rarely intentional. I’ve seen it from the bedside. From leadership meetings. From roles responsible for policy, education, and oversight. When compliance feels “separate,” it’s usually because it’s been positioned that way over time — through structure, reporting lines, or simple habit — not because anyone wanted it to be disconnected. But the impact is the same. When compliance sits at a distance, people fill in the gaps

Last week, while attending Health Care Compliance Association (HCCA) 30th Compliance Institute, I had a conversation that stayed with me. A former colleague is in a new role at a medical center. Her compliance department sits structurally apart from much of the organization — with consequences no one likely set out to create. And she’s doing the hard work of closing that distance (brilliantly, by the way). Not by rewriting policies. Not by increasing oversight. But by buildin

Something I keep thinking about after my last post about my son’s class: From the teacher’s perspective, there probably isn’t a problem. The rules are clear. The intent is good. Everyone is being treated “the same.” But from the student’s perspective, the experience tells a different story. That gap doesn’t usually come from bad intentions. It comes from the language we use to describe what’s happening. At the bedside, this shows up all the time. A policy says the process is

Lately, my 10‑year‑old has been frustrated with one of his classes. Not the material — he’s engaged and still putting in effort. It’s the experience of the class itself. From his perspective, the rules feel inconsistent. Situations are interpreted differently depending on who’s involved. Outcomes feel… negotiable — but not in his favor. A small example, but a telling one: At Easter, the girls received beaded bracelets. The boys received rocks with “Jesus loves you” painted on

One of the hidden costs of treating compliance like a visitor is the time spent reacquainting. Because apparently, in healthcare, we have plenty of time for that. Time to remember where the policy lives. Time to re‑interpret language we haven’t seen since last year’s training. Time to figure out how this process was meant to work — not how it actually does. All of this happens, of course, during an already full day. Short staffing. High census. Competing priorities. But sure

My clinical background taught me this early: If a policy can't survive a busy shift, it won't sustain compliance. At the bedside, culture carries systems under pressure - not binders, not reminders, not after-the-fact corrections. That's why compliance works best when it's embedded as culture: familiar, integrated, and grounded in real workflows. This is what I mean by Compliance as Family - where policy quietly supports practice long before anyone calls it "compliance." Wher

No conference. No webinar. Just me, the open road, and watching the back end of a grain truck for 10+ hours. For context: my husband needed a new grain truck, found a used one 8 hours away, and—logistics being what they are—we had to get it home. That grain truck represents a part of farming that’s easy to overlook if you don’t live and breathe it. I know, because before I married a farmer, I overlooked it too. The same thing happens in the compliance world. In fact, many of

Ah—springtime in Iowa. One of my favorite smells is the scent of a freshly cultivated field. (In other words, I love the smell of new dirt in the spring.) To get that fresh‑dirt smell, the tractors must move from field to field using the roads. Moving s-l-o-w-l-y. Often with a line of cars patiently (or not-so-patiently) waiting to pass. On a two‑lane highway. With a double‑yellow line and very short passing zones. If you know, you know. ... That slow, steady pace is exactly

My husband has one of those red buttons in his office — you push it and it proudly announces “that was easy.” A great reminder that some parts of our work are simple. The Anti‑Kickback Statute (AKS) is not one of them. Every time I teach or review compliance programs, AKS comes up. Not because people are trying to be sneaky, but because it’s one of those regulations that looks clean on paper and gets messy fast in real life. Take one SNF–hospital situation I saw years a

🧠 The Habit of Systems Most people think systems slow them down. You and I know the truth: a well‑built system gives time back. I’ve always been a creature of habit. And yes, I’m one of those people who will write a task down just to cross it off. (Go ahead and roll your eyes — I’ll be over here happily checking boxes.) Before EMRs, my “brain sheet” was my lifeline. Neat boxes. Clean lines. Everything in its place. · Patient name, age, diagnosis in the top left ·

Because “that’s how we’ve always done it” isn’t a justification. It’s a warning sign. That phrase grates for a reason. Not because change is easy—it rarely is—but because unexamined routines in healthcare can quietly turn into risks. I get teased by my husband and son for rearranging systems just to see if they work better, but in care settings, regular evaluation isn’t tinkering. It’s responsibility. For years, psychotropic, antipsychotic, and anticonvulsant medications have