An expectation-performance gap between money laundering reporting officers and their directors – evidence from Germany

Purpose Money Laundering Reporting Officers (MLROs) carry out day-to-day anti-money laundering (AML) tasks while directors ultimately remain responsible for AML compliance. Therefore, directors’ expectations of what their MLROs do should ideally coincide with what their actual tasks to minimise liability risk. This paper aims to test for gaps between MLROs and their directors in terms of knowledge, expectations and performance of AML tasks. Likewise, it is researched whether MLROs and directors communicate well with regard to MLROs’ tasks. Design/methodology/approach This paper first develops a model for analysing the dyadic relationship between MLROs and their directors, based on the audit expectation-performance gap. Second, a paired electronic survey of MLROs and directors of German companies was conducted in autumn 2020, testing for participants’ knowledge, expectations and performance of possible AML tasks (n = 136 pairs). Findings While there is no knowledge or performance gap among MLROs and directors, expectations among them are partially unreasonable and their communication needs to be improved. Additionally, this study suggests that MLROs of German non-financial businesses are less knowledgeable, perform AML duties more poorly, and communicate less effectively with their directors. Practical implications Training of MLROs and communication with their directors need to be improved. Especially in the non-financial sector, action is urgently required. Originality/value This paper reports the results of the first paired survey of MLROs and their directors, offering unique insights into their relationship and the status of private AML efforts.

What’s the Rush?

This chapter analyzes changes over time in early-term births. Labor induction rates have risen over time and many experts speculate that at least half of inductions are elective. Popular accounts suggest that pregnant women are driving this by requesting inductions. Healthcare providers are also part of the story because they can refuse women’s requests, but hospitals and OB/GYN practices benefit enormously from scheduling births even though they pose medical risks. Analyses of early-term births in low-risk pregnancies reveal that providers are more likely to take unnecessary risks in states with tort reforms that limit their liability risk. This effect was strongest during the period before 2009, when the strength of professional recommendations against early elective induction had eroded.

If in Doubt, Cut It Out

This chapter examines the effects of malpractice on cesarean deliveries in light of historical trends and changes in the standard of care. Nearly one third of births in the US involve a cesarean delivery, and cesareans are usually the first thing that people think about when they think about defensive obstetric medicine. While some popular accounts attribute the rise in cesareans to women’s requests, most maternity care providers and public health experts are skeptical of the idea that “choice” is driving the trend. This chapter highlights the ways that providers respond to three types of risk when they do cesarean deliveries: medical risk, iatrogenic risk, and legal risk. A culture of malpractice fear encourages obstetricians to prioritize legal risk, and they know that patients are more likely to sue them for not doing a cesarean than for doing an unnecessary one. Providers also described expedience, organizational efficiency, and changes in medical training as important causes of medically questionable cesareans. Analyses reveal that the odds of a cesarean are higher in states where providers face more liability risk, but the effect is extremely small. Professional guidelines, which changed over time, also mediate this effect.

The Machine That Goes Ping!

This chapter explores the use of electronic fetal monitoring (EFM) as a prime example of technology fetishism. EFM is not evidence based, but most maternity care providers routinely use it. Obstetricians say that they use EFM to defend themselves against liability, and malpractice attorneys often fetishize the paper strips that the EFM produces as “evidence.” At the same time, an analysis demonstrates that EFM is more common in tort reform states that limit providers’ liability risk, which contradicts the idea that providers use it to reduce legal risk. The chapter then explores institutional motivations for EFM use, including scheduling, workload, and profit benefits. These institutional priorities can undermine patients’ rights, quality of care, and informed consent, which are issues of reproductive justice. This chapter then explores the effects of reproductive rights laws on EFM, finding that more fetus-centered laws encourage more EFM, while EFM is less common in states that protect women’s reproductive rights.

Reproductive Regimes

This chapter argues that defensive medicine is not a significant problem in American obstetrics, despite strong myths about it. Maternity care providers intervene into labor and birth more than is optimal for maternal and infant health, but they do not do so primarily for legal reasons. An analysis of weekend births reveals that births are less likely to occur on the weekend in tort reform states. This suggests the opposite of defensive medicine: providers intervene more in the timing of births when they face less liability risk. Weekend births are also less likely in states with fetus-centered laws, so providers intervene more when women have fewer choices during pregnancy. This chapter then explores two cases as examples of a woman-centered and a fetus-centered regime: Oregon and Mississippi. From a policy perspective, laws that support women’s ability to make decisions for themselves and their fetuses encourage more evidence-based maternity care practices. Reproductive justice would also benefit from universal healthcare that covers all aspects of reproductive health.

Law Matters

This chapter explores theories about how laws and organizations influence each other. First, the chapter explores the purpose of tort laws and the goals of the tort reform movement and uses them to define provider-friendly and patient-friendly tort regimes. An analysis of the effects of tort laws on obstetric malpractice lawsuits illustrates that, contrary to expectations, the rate of lawsuits is higher in states where tort reforms have reduced healthcare providers’ liability risk. The chapter then uses reproductive justice theory to examine reproductive health laws that govern contraception, abortion, midwifery, prenatal substance use, and fetal rights. These laws define fetus-centered and woman-centered reproductive rights regimes.

The Business of Birth

The Business of Birth examines the effects of malpractice and reproductive rights laws on maternity care practices in the US from 1995 to 2015. It is a common public belief that frivolous malpractice claims and women’s choices shape hospital birth practices. This book uses mixed methods to demonstrate that this belief is inaccurate. The Business of Birth carefully documents how there are interconnected systems of laws and policies, or legal “regimes,” that influence birth practices in unexpected ways. When it comes to malpractice, the standard of care that defines malpractice is internal to the medical profession. This means that tort laws do not exert the external pressure that physicians believe they do, although professional associations, liability insurers, risk managers, and hospital legal counsel reinforce a fear of liability risk. This fear can encourage obstetricians to intervene into labor and birth with scientifically unsupported technology or procedures with known risks. But reducing liability risk can encourage risky practices that promote organizational efficiency over patient safety. The Business of Birth also examines the implications of reproductive rights laws for maternity care practices, defining states that protect women’s reproductive rights as woman-centered and those that protect fetuses as fetus-centered. Reproductive justice theory argues that pregnant women’s rights during childbirth are connected to laws governing the full spectrum of reproduction. Woman-centered approaches to pregnancy and abortion promote choice, informed consent, and the right to bodily integrity when women give birth, while fetus-centered regimes limit women’s rights and choices during birth.