The Difference Between Enforcement and Stewardship

Several years ago, someone in a therapy department approached me with concerns about a therapist's billing practices.

I reviewed the documentation, billing records, and appointment information. The concern was valid, so I brought the concern to hospital leadership.

The information was acknowledged, but no action was taken.

Over the next several years, other members of the department became aware of the issue. Eventually, concerns were raised that the matter would be reported to regulatory agencies if it continued to go unaddressed.

Shortly thereafter, the therapist was terminated.

I thought of the situation as a compliance issue: the therapist was overbilling, the documentation did not support the services being billed, and the standard wasn't being met.

It was straightforward.

The more interesting piece was what happened after leadership became aware of it. Or maybe more accurately, what leadership communicated by choosing not to act.

When we hear a story like this, we usually, understandably, focus on the individual who committed the bad act. The individual's actions created the immediate risk and ultimately led to consequences.

But focusing only on the individual misses a much larger question:

What responsibility do leaders have once they become aware of a problem?

Organizations need enforcement.

Standards, accountability, and consequences all matter.

But enforcement is inherently reactive.

By the time enforcement is required, something has already happened. A standard has been violated. A risk has materialized. A concern has become impossible to ignore.

Stewardship begins the moment leaders become aware of a concern.

Awareness creates responsibility.

The question becomes:

"What responsibility do we have now that we know?"

That question changes the conversation.

People pay attention to what leaders do next. They watch to see whether standards are applied consistently and whether accountability is actually demonstrated.

Whether leaders realize it or not, the response becomes part of the culture.

Every action teaches something.

Inaction teaches, too.

When concerns are addressed, people learn that standards matter. When concerns are ignored, they learn something else.

Culture is often shaped more by what leaders do than by what leaders say.

That's why stewardship is different from enforcement.

Enforcement addresses the issue.

Stewardship considers the culture left behind.

Leaders communicate expectations through what they address, what they tolerate, and what they ignore.

That responsibility requires consistency, courage, and a willingness to act when concerns are first identified.

Rules can be enforced.

Responsibility must be cultivated.

Policies can be written.

Culture must be built.

Enforcers create compliance events.

Stewards create compliance cultures.

Thanks for reading.

I write about compliance, leadership, organizational culture, and the human stories that shape the systems we work within.

Through the Compliance as Culture™ Framework, I help healthcare organizations translate regulations into daily practice.