Value of Integrity

Podcast Transcript

Michelle Lampton :
Wonderful. Okay. So can we start with just an introduction, your name, your title, and all that?

Don Sinko:
Sure. I'm Don Sinko. I'm the chief integrity officer here at the Cleveland Clinic.

Michelle Lampton :
Well, thank you so much for spending some time with us, Don. Can you share a little bit about your role at Cleveland Clinic and how you see your role?

Don Sinko:
Sure. As chief integrity officer, I oversee the internal audit, corporate compliance and business ethics programs, enterprise wide. And what makes our departments different than just about actually all other departments within the Cleveland Clinic is we are independent of all other operations, meaning that I don't report to anybody within the operations of the clinic. My reporting is directly to the board of directors of Cleveland Clinic, which is important when you're overseeing compliance and business ethics and the like.

Don Sinko:
We look at the role of what we try to do is we put together the programs that try to make sure that we're complying with federal state and local laws and regulations, our policies and procedures, and trying to do really two things. One, prevent any problems from happening in the first place. And then if we have them try to detect them early.

Don Sinko:
An analogy I like to use, I like to compare it to the medical operations, and I'll compare noncompliance in doing incorrect things, medically I'll compare it to cancers. So there's all kinds of cancers. Some are much worse than others. And just like you have from a cancer standpoint, the thing that you would like to do is prevent getting it in the first place. By not getting cancer, that's the best thing. Same thing with non-compliance. You'd rather prevent noncompliance in the first place.

Don Sinko:
But if you get it, just like cancer, if you get it, you want to detect it early and you want to get it early enough so that it could be resolved fairly easily. Again, the same with non-compliance. So the reason we have internal audit and our compliance programs is one, things like education and training and doing things like that, we are trying to prevent things from happening, but then we do a lot of auditing and monitoring and making sure people are aware of what they should be doing so that if we do have a problem, we detect it early.

Don Sinko:
And even like another comparison is we're independent of operations. If you look at the law department, the law department is trying to determine is something legal versus illegal, making sure our contracts are good and things along those lines. And then you have ombudsman's department, which is looking at it from a patient standpoint.

Don Sinko:
Corporate compliance is in the middle. We're trying to determine, is it the right thing to do? And I can give you an example of that where we have something that could be legal that we could do, but do we really want to do it? An example is I had somebody come into my office recently and tell me here's an opportunity that they had within the clinic, with a vendor. And they weren't sure whether they should participate in it or not.

Don Sinko:
So they explained what it was to be, and I told the person, I said, "Well, it's perfectly legal to do it. If you want to do it, you can, but let me tell you why it's probably not good to do it." I went through and explained it really from an ethical and how it looks standpoint, and we discussed it. So I said, "If you really want to do it and all that, legally you can, but I wouldn't." And the person got up from my office and standing in my doorway, looked back at me and said, "Yeah, you're right. I'm not going to do that."

Don Sinko:
So there's a lot of things that happen, particularly in medicine and particularly in healthcare where it's not a matter of whether it's legal or not, it's a matter of is it the right thing to do?

Michelle Lampton :
So I'm curious being in the middle there, do you find that there's a lot of push and pull that makes you go one way or another? Or is there any other like challenges that exist in that space?

Don Sinko:
Well, yeah. There's a lot of challenges that we have, because there's a lot of things that are not clear cut. The beauty about our setup, the way we are set up here at the clinic, by being independent, we really can look at it for what's the right thing to do for our caregivers. What's the right thing to do for patients. What's the right thing to do for the Cleveland Clinic as an organization. Having that independence, we can really think about it from that standpoint versus looking at things from an operating standpoint, are we making numbers, and things along those lines.

Don Sinko:
So we have to have kind of that viewpoint where is it right or not? And there's always a difference. People have different perspectives as to what that is. And we provide that kind of that independent... Something you can bounce off of. There's lots of things that happen within the clinic, whether it's medical operations, whether it's billing and coding, it could be in the financial administration area.

Don Sinko:
There's a lot of things that are not clear cut. And we get a lot of questions. I mean, one thing that, again, I think because of our independence, people know they can come to us. They don't have to worry that we're going to go running to management, other senior management saying anything. Last year, we got over 2,000 calls. And if you divide that by 260 work days, that averages about nine calls a day. So people should not be afraid to call us when things happen because they will happen.

Michelle Lampton :
Wonderful. Thank you so much for that. So today we're really talking about our value of inclusion and what it means to live with integrity. I'm sorry. Let me say that again, because this is not inclusion. So today we're... Let me...Don Sinko:
I do a lot in that area too, but you're right.

Michelle Lampton :
Well, you've just nodded your head. I was like, "Yes, let's go."

Don Sinko:
I could have gone with that. But go ahead with integrity, that's a better one.

Michelle Lampton :
There you go. So today we are going to be talking about our value of integrity and really what that means to live with integrity as a caregiver. So I wanted to start with a question of what does our value of integrity mean to you?

Don Sinko:
Well, the value of integrity, I think is our most important value. If you look at the Cleveland Clinic values or for that matter, if you look at the values of any company, integrity is always listed as one of them. And in our case, integrity is listed as one of our six key values. But if you look at all of our values, it's very difficult in my mind to excel at the others and have the others if you don't have integrity. It's difficult. How do you put patients first if you don't have integrity? Because if you don't have integrity, that that means that you're looking either at yourself first or you're looking at things from a money standpoint or personal standpoint.

Don Sinko:
So if you look at whether it's patient care, whether it's leading by example, I mean, what caregiver wants to have a boss who doesn't have integrity, who's doing the wrong thing? Who wants to be developed by those kinds of people? People who are not transparent, do not report properly, no one wants to work for. Nobody who says, "Oh, I hope I work for an organization that lacks integrity and the like."

Don Sinko:
If you take a step back and look at all of our values, think about how you could have the other five, if you don't have integrity. So I think that's a key thing. Then kind of living with integrity, the simple thing that you read a lot, but it's very true, it's integrity is doing what's right when no one's looking. And I always tell people, "You kind of know if most of the time you know when you're doing something that's wrong."

Don Sinko:
Not always, but usually you do. So doing the right thing when nobody knows, that's always the key. But the thing is, like I mentioned earlier, there are situations where you might not know what doing the right thing is. And that's why people need to contact corporate compliance or internal audit. We're here to to bounce things off of. I mean, clearly you should try to get answers within your own department through your boss or through management within your department.

Don Sinko:
But if you don't feel comfortable with that, you should be able to come to us. Another thing I look at is living your life with integrity, what I have always found is important. It's great to be able to look back and never have to worry about something that you did worrying that it might come to light. And you think about when people have done things wrong and then years later things come up and they're like, "Oh my gosh, this is going to happen."

Don Sinko:
If you live your life with integrity and you're trying to do the right thing, you never have to look back and be concerned about something in your past, coming up, because your reputation is so important. It's so hard to fix once you've done something and the like. So I think that's why I think integrity is such a key value that we have.

Michelle Lampton :
That's excellent. And I love thinking about integrity as doing the right thing when no one's looking. But sometimes that's a challenge. We might be in a situation that makes it incredibly difficult. We don't want to speak up and sometimes it's easier just to remain silent. So what's your advice to a caregiver who might find themselves in that type of situation?

Don Sinko:
Well, a couple of things. One is, I think, as caregivers for the organization, we have an obligation to report things. And that's why we have a setup where a caregiver can come to us. You can be anonymous either through our anonymous reporting line, through our anonymous phone calling line, if people come to us directly. And most people, by the way, about 90% of the calls we get are directly to us. They're not anonymous. I think people feel comfortable because we're independent of the operations that we're not here to get anybody in trouble. We want to fix problems or resolve problems, or in many cases, most of the time when people call, we're able to provide additional information that shows there actually isn't a problem. They just don't have the information to do that.

Don Sinko:
I think the key is that they have the ability to talk to somebody about the issues and they'll know that we'll take care of it. We had a situation a number of years ago where somebody called me regarding a concern with somebody in their professional staff. They called me at 9:00 in the morning. They told me what the issue was. It was a very valid concern from this person's standpoint. But we in the integrity office, we don't have an opinion when somebody calls. We don't know, "Oh, that's terrible," because what happens is we have to investigate.

Don Sinko:
Sometimes things sound really, really bad and they turn out to be nothing. Sometimes things sound like they're nothing and they turn out to not be nothing. But in this case, they called me at 9:00. I investigated it. I immediately investigated it, found out that it was an issue. We resolved the issue through the Office of Professional Staff. I called this person back at 3:00 that same day and told them, I said, "Thank you for calling. I investigated. We found out what the situation was. We've taken appropriate action. Thank you so much for letting me know."

Don Sinko:
And I'll never forget this. The person responded to me. The person said, Mr. Sinko," which by the way, they can call me Don, but this person said, "Mr. Sinko, I was told if I called you, you would take care of it, but I never would have guessed it would have happened this fast." What was key about that was the person said, "I was told if I called you, you would take care of it." So it shows you that people talk. And the advice she got is she said, "No, you can count on the integrity office to take it seriously and address it."

Don Sinko:
And then you know that that person is then they're going to tell other people about that experience and how positive it is. And I'll never forget that because it's important for people to know what we do, why we do it and how professional we are and keeping privacy as well as addressing issues. It's one of the things I love about the Cleveland Clinic and being here at the Cleveland Clinic. Our senior management has integrity. They want to do the right thing. They support what we do and it's great to work for an organization that's like that.

Michelle Lampton :
I love that. It becomes almost this feedback loop of integrity where the office itself lives with integrity and will investigate. People talk about it and it comes back around and around and around. So you talked about senior management being able to act with integrity. This part of this podcast is learning to lead. So if you were thinking about our leaders, how can they also show integrity in their day-to-day work? Is it different with them versus our individual contributors or is it a similar style?

Don Sinko:
I think the style should be the same. I think the key with leading with integrity, and we do have presentations on that here within the clinic, but I think the key with leading with integrity is being transparent. Being transparent with your people, making sure that they understand what's going on, why they're doing things. Not saying do it because I say so. Being able to explain why we do what we do or they're being asked to do what they do. Listening to their concerns.

Don Sinko:
It may not be a concern for the leader, but if it's a concern for your staff, then you need to hear about it, and be able to respond appropriately. If you agree with them, we need to act on it. If you disagree with them, then you need to be transparent as to why. Because most caregivers just want to know why things are the way they are. And I think that's why a lot of the calls that we get, some of them, we are able to respond to on the phone call.

Don Sinko:
I got a call last week from a patient on a concern and I responded to the patient. I said, "Well, here's why that is," and went through the details. This was just last week. The patient said, "Oh. Well, that makes sense. Okay. I'm going to tell other people." So sometimes it's just a matter of, they don't have the full picture and when they get the full picture... So that's why from a leading standpoint, from a leadership standpoint, being transparent, explaining why things are, they may not agree with you, but if they know why it is you're doing it and it makes sense, well then... I think that's one of the keys. That's why I think integrity is the key leadership behavior for that reason. Because, again, people will believe you. They'll be able to work with you if you know that you're trying to do the right thing.

Michelle Lampton :
Excellent. That's amazing. So if a caregiver is faced with a challenge, what should they do in that situation? What kind of resources or outlets are available to them if things get hard or if they see something, or if they encounter a difficult situation?

Don Sinko:
Well, what we like to say is that people should try to resolve it within their department. So if there's an issue, you should try to resolve it with your boss or somebody within your department, but that doesn't always work. And that person may be part of the concern, in which case, if you can't resolve it within your department, then they should contact us. And what we'll do is depending upon what the issue is.

Don Sinko:
Now, if it's an HR issue, if it's I don't like my boss or I don't, whatever, that's not us. Ours is compliance. Ours is we're doing the wrong thing. We're not following policies and procedures. We're not following regulations and laws. I mean, those kinds of things. But if they don't feel comfortable within their organization, they should come to us, so that we can help resolve it. So we can address it and then help resolve it either by clarifying it or taking care of it.

Don Sinko:
One of the biggest concerns I have, matter of fact, I'd say this in my presentations, that when we uncover a problem, whether it's a fraud or an illegal item, one of my bigger concerns is the number of people within the department that knew that was going on and didn't say anything. Because it's one thing for somebody to be doing bad things. And keep in mind, we have 70,000 caregivers. It's not human behavior they have 70,000 people and they're all doing the right thing. It's impossible to have.

Don Sinko:
So we know there's going to be things going on that are wrong and that's why, so you have an obligation to report it, if you know it. Because again, trying to detect early. But when we uncover something and we find out other people suspected or knew about it and didn't say anything, by coming to us earlier, we could've minimized the damage or the result of what they were doing.

Don Sinko:
And that's a concern is people who don't report it. Because we do have very safe ways for people to do that. And like I said, we get over 2,000 calls a year. So it's not like that person would be alone or feel like they're doing something that others don't do.

Michelle Lampton :
Wonderful. So as we wrap up today, we always like to ask our subject matter experts, our leaders, if there is something that they would like to leave our listeners with, a final piece of advice, a final piece of lesson that you would like to share, any sort of final thought you would like to leave our listeners with?\

Don Sinko:
Well, I think the important thing is I mentioned earlier, I think integrity is our most important value, whether it's within Cleveland Clinic or it's within your personal life. And you really should do everything you can to protect your reputation, do the right thing. In the short-term it might cause some issues, but in the longterm, I think one of the best things that you can do is be able to look back across your career in some future date, look back and say, "You've always done the right thing." That's a great feeling to be able to have. Again, I think it's just by far the most important value.

Michelle Lampton :
Wonderful. Well, that I think is a great place to stop. So I want to say thank you for spending the time with us. I know it was a busy morning, so carving out that time for us, I really, really appreciate it.

Don Sinko:
Okay. Thank you. Thank you so much for asking.

Michelle Lampton :
Sure thing. All right.

Don Sinko:
... that question about kind of any advice, you know, when you had that thing about advice or whatever, and I just kind of said was top of my head. As soon as I hung up I said, "Oh, why didn't I say what I always say when I do presentations?" And there you go. So, you want me to go ahead and do that then?

Michelle Lampton :
Yeah. Do you want me to set you up? Or you can just go ahead because we already have the question.

Don Sinko:
Yeah. Yeah, and what was your question? Like what advice do you have for people or whatever? I can't remember exactly what you said.

Michelle Lampton :
Yeah. So, at the end of all of our podcasts, we like to ask our guests if there is one piece of advice or one thing that they would like to leave our listeners with. So, what's something that you would leave our listeners with and you want to share with them?

Don Sinko:
Advice I like to give to all caregivers is that while we all make mistakes, and mistakes are different than intentional acts, while we all make mistakes, life is going to present you with many opportunities to knowingly do the wrong thing. And you should never do that, because any short-term benefit you get from knowingly doing the wrong thing is more than offset by the potential long-term costs to your reputation, to a relationship, or to your job.

Michelle Lampton :
Excellent. That's wonderful. Thank you so much. Is there anything else that you would like to add or any other final things you'd like to say?

Don Sinko:
No, no. No, I just thought that was kind of a better thing from an advice standpoint.

Michelle Lampton :
Wonderful. Well, I went ahead and-

Don Sinko:
I was going to say, because I do tell that to everybody, I said, "You will have lots of opportunities to do the wrong thing, and you never want to go down that path." Okay, that's it.

Michelle Lampton :
Well, that's awesome. So we went ahead and captured that, so we're all set.

Don Sinko:
Okay. Thank you so much. Have a good weekend.

Michelle Lampton :
Thank you. You too. Bye-bye.

Don Sinko:
Yes, okay. Bye-bye.