Quality and Compliance: Stronger Together in Healthcare

Aligning Missions for a Stronger Program

Too often, healthcare organizations treat quality and compliance as separate functions—each with their own leadership, metrics, and reporting channels. But when compliance professionals are excluded from quality discussions, or when quality teams are unaware of compliance risks, organizations miss out on meaningful improvements.

It’s not that the two functions don’t overlap. They do—extensively. Both disciplines aim to reduce risk, improve patient safety, and ensure that services are provided according to established standards. But they approach these goals from different vantage points. Quality looks at processes and outcomes; compliance focuses on regulations and enforcement.

Where they intersect is where an organization is at its strongest.

The Role of Compliance in Driving Quality

A well-structured compliance program already includes key activities that support quality:

• Auditing and Monitoring: These activities don't just identify coding errors or privacy violations—they can highlight breakdowns in care coordination, lapses in documentation, and gaps in communication between providers.

  
  

• Policy Management: Effective compliance teams ensure policies reflect current regulations, but they also help translate those policies into day-to-day operations—critical for quality improvement initiatives.

  
  

• Training and Education: Quality goals often require behavioral or process changes. Compliance training already reaches clinical and operational staff regularly; aligning education around both regulatory and quality goals improves uptake.

  
  

When compliance professionals are invited into the quality discussion early, they can help align improvement activities with regulatory expectations. This reduces the risk of implementing changes that inadvertently trigger violations—or fail to meet CMS requirements.

Data as a Shared Language

Both compliance and quality programs rely heavily on data. What differs is how the data is used. Quality teams focus on trends in outcomes and performance measures. Compliance uses data to monitor adherence and identify outliers.

Integrated reporting—where both teams contribute to dashboards and risk assessments—can surface problems faster. A spike in readmissions might prompt a compliance review of discharge documentation. A pattern of late entries in the EMR might indicate training gaps, policy confusion, or even a risk of falsified records.

When teams silo their data, root causes go unnoticed. When they collaborate, solutions are easier to find—and easier to support with leadership.

Case in Point: Value-Based Programs

Federal initiatives such as the Quality Payment Program (QPP) under MACRA, the Home Health Value-Based Purchasing Model, and the Hospital Readmissions Reduction Program all tie reimbursement to quality. At the same time, participation in these programs brings increased scrutiny from regulators and auditors.

A provider can’t succeed under value-based models unless both quality and compliance teams are aligned. Reporting must be timely and accurate. Improvement activities must be sustainable and documented. Patient safety initiatives must account for data integrity and HIPAA compliance. In this environment, collaboration isn’t optional—it’s a risk mitigation strategy.

Creating a Culture of Shared Accountability

When compliance and quality teams work together, the organization benefits from a unified approach to risk and improvement. But making that happen requires structural support:

• Joint Committees: Establish a regular meeting where compliance and quality leaders review shared data, discuss initiatives, and align on reporting to the board.

  
  

• Shared Goals: Identify projects—such as reducing medication errors or improving advance directive documentation—where compliance and quality both have a stake.

  
  

• Integrated Training: Develop cross-functional training programs that highlight how compliance requirements support quality goals.

Ultimately, compliance and quality share the same purpose: delivering safe, effective care while reducing risk to patients and the organization. But alignment doesn’t happen by accident. It requires deliberate planning, shared resources, and a commitment to collaboration.

Need help building bridges between your compliance and quality teams?

Simply Compliance works with healthcare organizations to create unified programs that align risk mitigation with clinical improvement—so you can meet regulatory expectations and deliver high-quality care.

Get in touch with Jessica Zeff @ Simply Compliance.