TWANE DUCKWORTH: Hello, and welcome to another episode of WTW's U of Risk Women in Risk and Education series, our WIRE series, where we take you on a road and travel down a new path with another risk manager in the education field to be able to give you insight about how you might be able to improve, enhance and encourage your organization to enhance their risk management capabilities so that you all can be successful in this field.
I'm so excited to have today with us, Desiree Ramirez from UNT HSC-- a mouthful, and we're going to let her explain all of that in a moment-- as their compliance and chief integrity officer to explain to you how she helps to contribute to the risk management of their organization in the higher education field. Please, Desiree Ramirez, introduce yourself. Talk to us about your title, your school and a little bit about your background and what you do.
DESIREE RAMIREZ: Sure. Well, thank you to Twane for having me today. I'm really excited to be here. So, as you introduce, I am Desiree Ramirez, and I serve as the chief integrity officer for the University of North Texas Health Science Center at Fort Worth. As you said, that's a mouthful, but I have to-- for branding purposes, I have to say all of it. But we go by HSC, so it's just easier to say HSC.
And so I have been with that organization now for seven years. I served as the, first, as the chief compliance officer, and then it's evolved to the chief integrity officer, which we'll talk a little bit about. And so there, I am responsible for not only the compliance program, but compliance risk, as well as our integrity program, which is a little variation, but it is something unique to HSC. And we're really, really excited to start that journey and continue that journey at the organization.
TWANE DUCKWORTH: Wonderful. And just do me a favor because I know we've met not too long ago. Help our listeners understand the dynamics, as far as when you say HSC. What does that stand for?
DESIREE RAMIREZ: So, HSC stands for the Health Science Center. So UNT HSC is actually the Health Science Center campus, so we're the health professions campus of the University of North Texas system. And so there, we have six schools and colleges, as well as five research institutes on the campus. So that's a little bit broad about what we do on the campus, but specifically, people.
We get confused a lot with UNT. We're part of the system UNT. The undergraduate, graduate campus is in Denton. We also have the University of North Texas in Dallas, and then us in the Health Science Center in Fort Worth. And then the system, overall, is the UNT system.
TWANE DUCKWORTH: So, in other words, you have a broad coverage scale there. You have a lot of things that are keeping you busy.
DESIREE RAMIREZ: Lots of things are keeping me busy, particular being the Health Science Center is a little bit more regulated than the other campuses, so we have a lot going on there.
TWANE DUCKWORTH: So, describe for our listeners, how did you arrive at your current position of compliance?
DESIREE RAMIREZ: Thank you for that question. I'm going to date myself a little bit, but happy to share. So back in-- way back in 1995, when there was the evaluation and management, I would say, crisis for billing to Medicare, that is when I got involved in, quote, unquote, "compliance," starting in the Health Science Center field or the health field, which evolved into academic medicine.
So back then, they were looking for-- my first position was at Memorial Sloan-Kettering Cancer Center, and they were looking for a new series of newly graduated students who had just come out of college to really start on their new revenue cycle billing system. And part of that is compliance, because you have to make sure that you're billing Medicare and Medicaid and all the insurance correctly.
And so that is where I started. And then that evolved into staying within health care and hospitals, working in a medical school and then evolving into academic medicine. So, nothing that I suspect that I would be doing when I graduated from Howard University, but here I am.
TWANE DUCKWORTH: And that's kind of true of many of us. I know I have a very interesting path and how I ended up in insurance and risk management, but we'll save that for another episode. I've talked about that a few times, coming from a different background as well. I didn't think that I would be doing insurance and risk management either and ended up in one of my roles, previously, as the risk manager for the city of Jacksonville.
And a lot of ways, I was a de facto compliance officer because I had come from our general counsel's office and then into the risk management position. And many times, I would get inquiries just from across the organization. And they would just ask, Twane, is this something we can do? How do we do this correctly? Are we complying with a number of different things?
So, because of that background, in a lot of ways, I ended up being a lot of compliance mixed with risk management. And a number of the institutions that we represent have academic medical centers. So I'm happy to hear that you have that cross-pollination, where you are dealing with compliance and risk-type issues.
And I know that there are a number of different thought processes, as how to identify your risk and how to be compliant. And when you're in a highly regulated field, such as medicine, there are a number of different things that you utilize, such as integrity frameworks. So, talk to me about compliance integrity frameworks and how you utilize that, those things in your day-to-day activities.
DESIREE RAMIREZ: Sure. So, the integrity framework is something that was not necessarily developed for health care or compliance at all. It was actually developed by the Organization of Economic Cooperation and Development for member countries to fight corruption. But as I've done compliance over the years, I've always felt that there is a different way to do compliance.
Because what you ultimately want is for people to change their behaviors. We'll always have rules and policies that people can utilize. But what the framework does is take the behaviors and the values, along with compliance, to try to move people in a different direction, as far as being compliant, but under their own volition.
So, utilizing their own values and their own ethical behaviors to really move the needle on how we're compliant in the organization. So, what the framework does is set up four foundational components, determining and defining integrity, which is really your values, your policies, your code of conduct, conflict of interest, the tools that you need to really define your organization.
The second component is what we call guiding towards integrity. And what we utilize that part for is, really, for training, communication, transparency, education, and just managing people. And I hate to say managing people, even though that's the term they use, but we use the term an agency. We use people engagement.
So, we want to engage our people to be part of the process, to know that we're available to them. And then the third part, which is where we're going in this conversation, there is monitoring integrity, where you use risk assessment and auditing tools and things, just to keep your program. What are the things you need to do to ensure that your framework is working?
So, all of those things are wonderful that I just mentioned, people engagement, having a code of conduct, but you really have to monitor how is that working. And including that also is your trust line, what we call trust line. People say whistleblower, but I don't really like that term. But we use the trust line because those are the tools that you're going to need to monitor, how is this working?
And then of course, the last part, which is the part that people get scared when I say, but it's the enforcing integrity. And it's not just-- you can't force people to have integrity. What it is just ensuring that the processes and tools that we use are transparent, and that there is an understanding of how we're ensuring that you are being compliant, how ensuring that you are mitigating your risk.
And that's what enforcing integrity means. So that's how we utilize it in the compliance program. And Twane, the great thing about the integrity framework is it does it-- compliance is a department that can use it, but it can be utilized in any department. You can apply those tools in any department, whether you're the school and college itself, whether you're in the medicine field. You can apply all of those concepts, whichever and whatever area that you work in.
TWANE DUCKWORTH: You know what I love about that? The reality is, Desiree, is that as we're dealing a lot with the strategic goals of risk management, a lot of people will toss around terms, like enterprise risk management, strategic risk management, and what that encapsulates for most thought processes that you're talking about, expanding the role and the idea of everyone contributing, everyone participating in the risk management and risk ownership model so that the organization can acknowledge the fact that there is a lot of intersection between what's going on in one department versus another department.
It's not just risk management job. It's not just the compliance officer's job. It's not just the people in the C-suite who are thinking about liabilities and concerns and the overall health of the organization. It's really the entire organization's role and duty. So, I was excited when we met at-- obviously, we met recently at Texas Wesleyan, just having an opportunity to engage with your organization UNT HSC and meeting with the people that were participating in that.
And we connected. And I said, this is interesting, how you all are taking on the compliance aspect and understanding how that intersects with risk management and what our objectives are. And as you're talking about it, when you say, thinking about that integrity framework and having people, on their own volition, comply with the rules, the procedures, and things of that nature, that's what risk managers live for, right?
DESIREE RAMIREZ: Absolutely. No, absolutely. I mean, like I said, one of the biggest components of this is transparency and communication. And I like to say education. I don't like the word training, but there's difference. But I like to use the word education. Because we want people to be a part of what's going on.
Normally, when people hear about risk assessment, or they hear about internal audit, they get afraid. And they don't understand that. Sometimes, they don't understand the impact that they, as individuals, have to mitigating the risks across campus, that they also play a part in this. So, once you use the framework to do education, I think people start to understand that I have a factor to play in this, whether it is as simple as--
And not all parts of the framework does everybody participate in. But there is always a component where they feel as individual that they're contributing to the betterment of the organization, whether that is participating in the risk assessment itself, helping to mitigate the risk in what we call their OKRs, their objectives and key results that they do throughout the year, in their performance, and in their behaviors.
They are all contributing to participating in risk management, whether they see it that way or not. But they really are. What we to do with the education of the framework is for people to understand that you play a part in risk management. It's not just the internal auditor or the compliance person or the risk officer. It is everybody in the organization, playing a part in mitigating the risks.
One of the things I will say is one of the places I've worked-- and they treated that brand like a family member. So, they participated in risk and that, hey, I know that if my behavior could equate to not only my individual concerns, but also the concerns of my team member and the concerns of the organization.
So they make decisions differently, or they think about it differently because I value the organization. I value my team. And of course, I value myself as an individual, about how I contribute to what is in the best interest of the institution.
TWANE DUCKWORTH: And a number of institutions, risk management and compliance will be something that's separate. And that's one of the reasons why I was so interested in bringing you on to this series. Do you have any recommendations for these institutions on how risk management and compliance can work together and intersect seamlessly?
DESIREE RAMIREZ: I think for us, it has been all about the education. About a couple of months ago, we do Integrity and Awareness Week. Some people have Compliance Week. But what we did this year is we did something called Risk-a-Palooza, which is we created a live-- I would say it was a monopoly board, but just a live game board.
And what we did is we integrated risk management methodology and information with compliance policies and information for people to understand that there is some-- there's a concerted effort between the two areas. And understanding that here are the things that can equate to a risk that are maybe a compliance issue, but they can equate to risk and how those two marry.
And so as they walk through the board and roll the little inflated dice, they started to learn about, hey, this is what-- this could be risk. This is what this term is mean. This term means what's technology risk? What is reputational risk? This is how reputational risk can equate to, maybe, a compliance issue.
And one of the best compliments we got after we did the game was from a student who actually said, I didn't win anything, but I learned something. And so that was like one of the best compliments. Because the game was fun. We still have the board. Anybody ever wants to use it, we'll happily rent it out or lend it to you.
But it was really a lot of fun. But I have to tell you, especially coming from a student who-- they're there for a transition period of time, but to know that they participated and they're leaving there or that leaving that day with an understanding of some of the risk terminology and how it correlates to what we do in the compliance and integrity area was just a really great thing to see.
TWANE DUCKWORTH: Now that's actually very interesting. First of all, I need to trademark that. That might be a game for you all. That might be a revenue source for you all. Did you all create this yourself, or did you actually go out and purchase?
DESIREE RAMIREZ: We actually created it ourselves. We had a great-- she was at technology analyst. She's no longer with us. She moved on to something else. She's not passed away. And she created the actual game board, just thinking about how monopoly game board looks. And then as the team, we provided the questions about how can we put these two together.
If you're not in risk management, you're not here all the time. But as you participate in risk, as I talked about earlier, having everyone participating, these are terms that they're going to hear. And so just making them as simple as possible and then correlating them to things that they see every day, like code of conduct or minors on campus and how those things relate to the risk and the organization. So it was just really a unique way and a lot of fun for them. So we're looking forward to doing it again.
TWANE DUCKWORTH: Sounds really cool. You all need to-- you should probably consider doing something with that corporate. And I've discussed this before, Desiree, because, again, it's one of those things where this is not-- generally speaking, it's not something that's popularly advertised. It's not demonstrated a lot in the film industry. You don't hear a lot about risk management.
There's no major films on being a compliance and integrity officer. It's just not something that tends to make it to the silver screen or anything of that nature. So a lot of these areas, people are just completely unfamiliar with, until you become familiar with it, until someone shows it to you, so I think it's quite interesting. The other aspect of it is-- and I think this is something in nature that you specialize in.
Again, a lot of institutions have AMCs or Academic Medical Centers and medical profiles associated, along with their academic institutions. Is there anything that you see on the horizon that specifically relates to the medical orientation of our educational dynamics that are either concerning for you, or you might just want to advise people to be on the lookout for.
DESIREE RAMIREZ: So, what I will say is artificial intelligence, not necessarily concerning for me, but really just looking at the ethical use of AI, particularly with medicine, because as you know, health disparity is in this country, across the world. And really, ensuring that the artificial intelligence, we don't have additional risk when it comes to health disparities or the way that it's utilized in the clinical setting.
Because there are so many risks there with things that can be missed, depending on how it is used. So, what we got to do to mitigate that risk is really provide guidelines for staff, clinical area, research, and students about how to use AI and what that responsibility means to help to mitigate some of those risks. Because you have not only the clinical area, but you have research.
You have a lot of risks for plagiarism. And you just have also some different ways of thinking, I would say, about how artificial intelligence is used. You have some people who think it's the worst thing that ever happened. And you have think of people who rely on it very heavily. And I think what we forget is artificial intelligence is also based on human interaction and human data.
So, we don't want people to utilize it so heavily, that they forget that what they are learning and what they are doing today is what's going to dictate AI 5.0 or whatever iteration coming down the road. So we want to make sure that we put not policy but parameters around the use of it, as well as the personal responsibility and accountability of each individual using it so that we mitigate the risk for the institution.
Because what we don't want is for someone to-- so, for example, someone to publish something, where the heavy use of AI, and then that's a reputational damage for the institution, as well as themselves. So we want to make sure that people understand what the responsibility is, as they use artificial intelligence, again, to just to navigate risk for individual, as well as to institution.
TWANE DUCKWORTH: Yeah, certainly. I know that that's obviously extremely important when you're talking about medicine because a lot of medicine is advanced through research, publication of documentation, and just that whole dynamic is important to the medical field as a whole and many other disciplines as well. But certainly, in medicine, that's a general part of medicine advancement.
So that's certainly something to be considerate of. I've been watching a number of documentaries and doing a lot of investigation, as are many other people, and talking about just being very cautious about how AI is going to affect all of the various things that we do on a daily basis. And it already has been. And just being conscientious of putting guardrails around how we move forward because it is something to take into consideration.
And again, we're already using it in so many different perspectives and just being careful with it. I appreciate that. Now, Desiree, talk to me a little bit about, just like your personal background-- family background, and how, if at all, that's impacted what you do professionally and how you go about things.
DESIREE RAMIREZ: Sure. So, I am born and raised in Brooklyn, New York. I'm very proud of that. But I come from an immigrant family. My parents are from Panama. On my mother's side, they emigrated actually from Barbados to work on the canal. And on my dad's side, we're actually-- we're escaped slaves from Colombia is my father's background. So that's how they were in Panama.
But my grandmother emigrated to the United States in the mid-1950s, a widow, and so left my mom in Panama, was raised with her grandmother and her uncle. And to hear the stories about a widow from another country, coming here and navigating in the 1950s as a woman of color. And then, to then find her way to work in a hospital.
At the time, they called them CMAs now or Certified Medical Assistant. But at the time, she was a nurse's aide. So, to know that she worked in a hospital, and I wanted-- I thought it would be a nurse as well, and then realized that was not for me. But to know that I could serve health care in a capacity that most people of color don't even know exist.
I mean, there are a lot of students right now thinking that medicine is only a doctor or a nurse, radiologist, not knowing that there's so many other aspects of health care where they have impact, whether it's compliance or health policy. So, I think my motivation was my grandmother, again, going through what she went through being very brave and knowing that, I can do something differently.
And quite frankly, just stumbling upon this work. I mean, my aspiration, my undergraduate is in international business. And my aspiration was to join the foreign service and travel the world. And that just didn't happen that way. I came out of college when I think we were on an economic downturn, and there weren't a lot of jobs and just didn't work out.
And my then-boyfriend, husband now, was working in health care. And he said, why don't you try this, and showed me something in the paper. And that's how it started. But never thought in a million years that I would be doing anything like this, but I wouldn't change it for the world.
TWANE DUCKWORTH: Well, I certainly appreciate that in letting us know a little bit about you from a background personally. Because I know, at the end of the day, a lot of times, that influences where we go, how we proceed and how we perceive things professionally, and how we engage. And you obviously come from a very strong and determined background, and that's really interesting to note.
In fact, I would be curious to know, would you have any particular advice, as we wind down here, that you would provide to any other young women that are interested in the field of compliance and risk management? What would you advise them if someone was entering this field today, anything, if at all.
DESIREE RAMIREZ: I would say if you're entering the compliance field, know that it is evolving. And you can-- once you have great support, you can make that program wherever you land, what it needs to be. Because we have to evolve with the world that we are in. And again, what I was doing years ago is not what I am doing today.
But you have to have the mindset of, this is going to change, and what can I do to not just impact the institution or the company that I work in, but how do I change things that are happening, and how can I change the world? How can I leave it a little bit better? So, if any advice I had to leave is, make these programs your own. There was a different way to do it.
Don't think that compliance is just these seven elements that we've learned about throughout the years but make it your own. Look at your organization. Look at the impact that you want to make because compliance is, strange as it seems, can leave an impact not only on the institution, but on the individuals that you encounter day to day. Because I tell people, compliance officers are people, too. And so, yeah.
TWANE DUCKWORTH: Well, that is wonderful. Thank you. Well, first of all, again, absolutely pleasure to have you on our series to speak to our audience, to help them appreciate the intersection between compliance and risk management, particularly as it relates to our health care field and academic medical centers and all of that necessary interaction between the two. So, I'm very proud of having you on our series. And I want to thank you again for showing up and thank you so much.
DESIREE RAMIREZ: Thank you so much. Thank you for having me. And before we leave, I want to give a thank you to Dr. Sylvia Trent Edwards for introducing us. So she's our president of HSC, so thank you to her as well. And thank you so much for having me. This was wonderful. Thank you.
TWANE DUCKWORTH: Thank you. We appreciate it. So, from that standpoint, we are wrapped up. And I want to Thank you for joining us, once again, for another episode of WIRE, Women and Risk and Education, a part of U of Risk series with WTW. Enjoy and have a wonderful day.
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