Blog Post

Culture of Compliance Begins with the Tone at the Top

Richard P. Kusserow | November 2022

Key Points:

Tone at the top is critical to building a culture of compliance and maintaining reputation, which if damaged, can be very difficult and costly to recover. Protecting and promoting reputation need to begin at the board and executive leadership levels, cascading down throughout all levels of management. It is about creating and promoting a culture where everyone has ownership and responsibility for following applicable laws, rules and standards. DOJ Guidelines prompt prosecutors to ask, “What evidence is there that there is a high-level commitment by leadership to implement a culture of compliance from the top?”  Answering this question begins with having the mission, vision and values statements as part of promoting a culture of compliance and  providing guiding principles in the Code of Conduct that are reinforced in the policies and procedures. The boards and leadership need to communicate to employees what is expected of them and evidence their own commitment by their actions. Without this, employees may sense that their leaders are only going through the motions of supporting integrity and compliance, which would make them less likely to buy into the compliance program. On the other hand, employees who believe their leaders operate with integrity, respect and in compliance, are more likely to develop attitudes and beliefs that support compliance and ethical behavior.

Tone at the top, coupled with operating an effective Compliance Program needs to focus on prevention, detection, corrective action on identified control weaknesses, and acting on those who are in violation of the compliance program. Keys for a positive compliance tone from the top include:

  • Visible executive support of the compliance program and principles
  • Providing guiding principles of mission, vision, and values supporting a compliance culture
  • Imbedding it in the Code of Conduct and policies as commitment to compliance and integrity
  • Leadership evidencing their following the guiding principles of the compliance program
  • Providing incentives and rewards for compliant behavior
  • Prompt and effective corrective actions to identified control weaknesses
  • Consistent enforcement of compliance rules without consideration of position or standing
  • Gaining and acting upon feedback from employees regarding their buying into the message

The challenge is knowing whether all this is having the desired effect on employee compliance attitudes, perception, and actions. The best method for gaining this incite is to simply ask them through credible, professionally developed and administered surveys.  Both the OIG and DOJ encourage credible administration of surveys and questionnaires such as a Compliance Culture Benchmark Survey. Surveying for compliance program effectiveness was cited and suggested over 60 times in the HCCA/OIG Compliance Effectiveness Roundtable Report.

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About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 3,000 health care organizations and entities in developing, implementing and assessing compliance programs.

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