I guess to answer the question for my case alone it's interesting to look at my supervisor history and make analagy's from that. Thinking about it it might shed some light on the managers others have to deal with.

My first supervisor was the CEO. There was the obvious period of "trust building" that took place on both sides but once the CEO understood 2 things about me I was given more or less free reign and my decisions and my input were carefully considered in the "big picture". The two things were quite simple really..... I have a grasp of my subject and a grasp of their impact on the organization and that I always do what is best for the organization.

Then a decision was made to reorganize the structure of the organization to reflect a more corporate environment. In doing so they hired in a CFO and placed my department under him....

My second supervisor was the CFO and this was a mess. His basic lack of competence was reflected in his distrust of everyone. This manifested itself in the fact that no individual could tell him anything about anything. It all had to go to committee where he made copious notes and the committee made the decision. By managing in this fashion he avoided actually making a decision and if a decision were made that went wrong he would go to the file, pull out the notes and show that the decision was not his but rather that of the committee. This "method" also served to "choke" everything making decisions take weeks or months rather than minutes or days. I cannot imagine the process of HIPAA complaince if he had been there to give "input".... We'd still be reading the regs rather than acting upon them.

After 18 months of this gentleman I went to the CEO and, to all intents and purposes, told her it was him or me..... (Remember: He was still in the "trust building" phase that I passed several years previously.... ). After a three way meeting where I demonstrated the harm he had done to the organization in such a way that he could only stare past the CEO's head and say nothing - yes, I can be a formidable opponent if you piss me off and harm my department or organization - he saw the crayon on the wall and resigned.... I believe the resignation wasn't _entirely_ voluntary but that's none of my business.... my job was done.

My third and current supervisor was a director that became the COO in the reorganization. Consequently, I had worked with her for ten years or more so we were familiar with each other, trusted each other and actually have a good personal relationship too.... I call her "Dear", (in the "wifely" sense), when we speak....

I think the key item in my experience is trust. Management has to trust your subject ability, your business ability and your committment to the organization. In many cases you also have to be able to trust the managers too. You won't always get your way, (hell, even I lose a few), but it's the dialogue between intelligent individuals that results in a "sane" resolution.

There's also got to be the feeling from the manager's POV that when you suggest something that it has been well researched, it will do what you say it will and that it is more cost effective than any other possible solution. Cost effective can be a "moving target" - it may cost less in initial outlay but take 50 man hours a week to manage... Obviously that's not good and your managers will always question the cost effectiveness and ask questions you never thought of.... You have to have the answers right there and show that you have considered _their_ potential reservations... Do it enough and they stop asking the questions... Except those that shouldn't be there in the first place.

With some managers you will have to write a 50 frame powerpoint and spend 3 hours selling the "product". With others you will be able to walk in to their office and say "Boss, for <insert regulatory requirement here> we need to do this costing this" and it will pretty much be accepted. Eventually the "50 frame powerpoint" manager will come around.... or not.... If it's "not" then it is time to move on if you have the skill set and business understanding to do so. Frankly, if you don't, then the manager is right when he over-rides your decisions.

So... Having gone waaaay off topic, (in a way), the point of the whole post is that good managers trust their employees ability in their field and when you "suggest" something regarding the compliance issue it will, (at least), be seriously considered. Bad ones don't. If you find yourself with the ability to make informed decisions yourself with regard to regulatory compliance with a manager that doesn't listen/trust and you might find yourself liable somehow then you have only one choice..... Get Out Now...... Before you find yourself prostrated in front of a jury of your "peers" that can barely check their own email.....

Am I living in a "special" environment? Maybe. Am I competent to give the advice I do for the level/size/potential risk to my environment? Absolutely.....