Good Company Policies: the road to good healthcare practices or to a 3-ring circus?

Companies that take the time to conceive good policies set the stage for good practices in healthcare. I say conceive because all too often, there’s a long road between the idea of the policy, and even the preparation of the policy, and its translation into practice on the floor. And the closer you get to the bedside, the longer that road becomes.

Michael Rasmussen, president of Corporate Integrity LLC, outlines a very clear process for making sure that policies stay relevant and current. He proposes a “lifecycle” approach to policy management that includes four elements, creation, communication, management and maintenance. Creation is an iterative process of ownership, authorship and approval. Communication involves publication, training, and attestation. Management includes enforcement and exception management. Finally, management includes review and archival.

I find this scheme very useful for its simplicity and easy application. The process itself is challenging, but this framework is a user-friendly road map.

Rasmussen also makes a compelling argument for the importance of well-managed policies in compliance and risk management. Since organizational psychology defines culture as the way work gets done, it’s easy to see the essential role that policies and procedures play by defining the way work gets done and establishing clear expectations for compliance.

The Proverbial 3-Ring Circus....

Why is it then, as vital as good policies are, that so many long-term care companies focus on policy binders rather than on content? 

So why is it, as important as they are, that so many long-term care companies focus on their binders rather than their content, burying themselves under so many policies that it becomes virtually impossible to manage the binders much less the policies effectively?  

Too often, I find that when a monitor or surveyor reviews a policy, they find it outdated or not being followed. In my own work over 30 years, I have universally found policies to be little known and little used tools. Thus, the very policies that should articulate our culture of service, care, and compliance actually work against us. Or maybe we work against them.


I think it is time to rethink the way we create, communicate, manage, and maintain organizational policies and procedures so that they serve the needs of the organization and its customers in real time. I’d like to see policies that make the organization think and learn and grow so that policies grease the wheel of performance improvement, continuously moving the company toward greater and greater achievements. Working with clients to develop tools and policies in tandem so that the principles of performance improvement are built into every practice is a major focus of our work for this very reason.