The Difference a Dozen Years Can Make
The Difference a Dozen Years Can Make | HCA, Alan Yuspeh, corporate ethics

Alan Yuspeh

Yuspeh Helped HCA Change its Ethical Direction

When Alan Yuspeh joined what was then Columbia/HCA Healthcare Corp. in October 1997, the challenge was, well, daunting. The Nashville-based healthcare provider, America's largest, was in a tailspin — beset by government regulatory actions (including hospital raids), shareholder and class-action lawsuits, employee grievances, whistleblower complaints, and … needless to say … devastating media coverage.
At that point, the company's reputation was in the cellar. Into that charged environment stepped Yuspeh, who was hired by new management as the first senior vice president of ethics, compliance and responsibility.
A dozen years later, Yuspeh's title has morphed to senior vice president and chief ethics and compliance officer, yet his primary role to set HCA's moral compass has not changed.
When Nashville Medical News interviewed Yuspeh soon after he took the job, he defined ethics as "articulating values for everyone in the organization, articulating standards of conduct and ensuring that people do the right thing in the broadest sense of the word. A piece of that is compliance — following the law, regulations and company policy, at a minimum. But we have a much more ambitious kind of goal — to instill people with this broader sense of values and ensure that their business decisions reflect those values."
Today, that mission is accomplished, Yuspeh said. "From my standpoint, I've been delighted," he said recently.
Formerly a partner with a Washington, D.C., law firm, much of Yuspeh's practice focused on the development of corporate compliance programs. Prior to taking the HCA job, he served as the coordinator of the Defense Industry Initiative on Business Ethics and Conduct. Named to Ethisphere's "100 Most Influential People in Business Ethics" in 2007, Yuspeh is nationally recognized for his expertise in ethics and corporate responsibility. His influence at HCA has helped result in the corporation's pricing transparency efforts, charity care and uninsured discount policies, and recent environmental sustainability push. In November, Yuspeh spoke with Medical News about 12 years of progress.

NMN: Please contrast the corporate culture of HCA now versus what it was when you arrived in 1997. What's happened in those dozen years?

Yuspeh: It's very hard for me to speak in any kind of authoritative way to what the corporate culture may have been prior to my arriving in October 1997. Yet, whatever it was prior to that, today it's very much patient-focused, and certainly focused on the mission and values statement that we had adopted back in 1997, which focused on the fundamental commitments to various stakeholders …
When I arrived in 1997, we did a lot of things very quickly. We adopted and distributed our code of conduct. We started some training programs in all the hospitals. We adopted a new mission and values statement, which was rolled out in a pretty visible way. People actually signed banners of the statement in every hospital attesting to their agreement with it and their support of it. We appointed local ethics and compliance officers at every hospital. We had an ethics hotline, technically established just before I arrived, but we brought on a professional staff qualified in handling ethics-line matters and worked off the backlog of cases.
My feeling is that in the last months of 1997, we quickly got these messages out there and continued to reinforce those messages. Largely, the fundamental messages have not changed a lot since the management change in late July of 1997. Of course, there is continuous improvement.

Is the ethics hotline still in place?

It is, and remarkably, we get a similar number of calls month after month after month. I think that's a good thing because it suggests to me that people know it's there and that they'll use it. By the same token, the fact that the number has not gone up dramatically suggests that we don't have any dramatic increase in problems. The reality is that most of the calls are matters of personal unhappiness as opposed to reports of some system-wide issue that they've observed. We have a professional team that takes every one of those seriously, and we investigate every one.

Is there an ongoing program of employee ethical training?

It's changed somewhat. What we do now is orientation training for all employees regarding the code of conduct, the basic mission and values, obligations to stakeholders and fundamental policies and procedures. Then we do an hour block of training every year for every employee. That has varied over the years, but the most common approach has been what I would call the 'case method of instruction.' In consultation with a high-quality movie production company, we've developed some scripts of problem situations. They then hire professional actors and directors and act out one of these problems. Then there's a process of leading people through a conversation. Some years we've played TV games like 'Who Wants to be a Compliance Expert?' or 'Wheel of Integrity.' The training that we're developing for 2010 is all based on service to patients.

When did HCA's environmental sustainability initiative get legs, and what steps have been taken so far?

I would say it's really getting legs about now. Technically, we established a committee earlier (in 2009), but now we're getting some focus and energy behind it. … We have established four task forces: energy and water, waste management, environmentally responsible purchasing and new construction, considering the costs and benefits of various kinds of LEED certifications.
The other thing that we've done is join a national movement in healthcare called Practice Greenhealth. That's the primary umbrella organization for healthcare systems interested in these kinds of issues, and Practice Greenhealth has actually asked me to become a member of its board of directors.

Why are sustainability and green issues ethical considerations?

Ensuring that we do our business in a way that preserves the environment and minimizes adverse impacts on the environment is one of those things to me like patient safety. Having this sensitivity to the environment seems, to me at least, to fall right in there with things that are fundamentally the right thing to do. …We're now looking at co-sponsoring an initiative called Greening the OR. The operating room has some opportunities for reusable items rather than disposable items, and that might be environmentally sensitive. There are a whole range of opportunities here, and we're just getting started, but we would hope in time to really show some leadership in this area.

Let's switch gears and talk about HCA's pricing transparency initiative. I believe that would fall under your ethical umbrella, as well.

The work was done by our Shared Services Group, and I'm certainly supportive of that and think it's a positive thing. It is absolutely an ethical, proper and right thing to do. I think one of the concerns about healthcare in general … and it's coming out a lot in this healthcare-reform debate … is the feeling that patients have a hard time being effective consumers and that, in many cases, they may not even feel that they are the consumer because their insurance company may be paying substantially all of the costs. The tenor of some of this conversation about healthcare reform is to make them more efficient consumers of healthcare — and you can't ask people to be good consumers unless they know what the price of something is.

What about charity care and discounts for uninsured patients? Is that an initiative you're involved with?

It is. We're proud of what we've done, and as best we know, we think it's an industry-leading practice. We did two things several years back. One is that we clarified our charity policy to say that we would offer charity care to people who were at 200 percent of federal poverty levels. The other thing is that, for those who don't have insurance, we do offer an uninsured discount that basically reduces the amount of the charges on their bill to something that approximates what would they would be charged if they had insurance.

You've mentioned the code of conduct several times. What part of that code — that one word or that one phrase — really sums up HCA's mindset today?

The one most important word in the code of conduct is integrity. What we are trying to do is to establish a culture of integrity throughout the organization. I think if we succeed in doing that, then it means that a lot of the other things will fall into place.