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Improving Transcription Operational Efficiencies
By Sanjay Rajpal

The medical transcription industry is dealing with the challenge of ensuring real-time transcription with near-to-zero error rates. Gone are the days of having plenty of turnaround time; the new expectation, in many cases, is less than one hour.

Added to this challenge is the expectation of keeping operating expenses under control because of high competition and the availability of many players who have developed and matured the business models based on time zone and low-cost manpower availability.

Yet another challenge is ensuring throughputs under constraints regarding workload, absenteeism, manpower turnover, and technology.

This article discusses options and solutions derived from the modern management concepts of Six Sigma, TRIZ, and the Theory of Constraints, which may be useful in handling the above challenges. The various solutions and point of views are illustrated by examples of the way we handled these situations at Mediscibes, Inc in the last five years.

Understanding Goals
For ensuring that teams clearly understand their personal, departmental, and company goals, an overall vision should be shared that connects the apparently contradicting objectives of various processes. At Mediscribes, we hold communication workshops every six months to ensure individual and departmental goals are aligned and integrated with the company’s goals.

The Theory of Constraints provides a simple and clear way of expressing company goals, such as “value to client leading to profitability for the company.” We keep working on clarity and alignment in our goal-setting workshops. There are some common goal categories that are provided to all departments in which the teams have to identify goals such as improving throughput (realization of money), reducing inventory (blocked money in the system), and reducing operating expenses (waste of money).

These simple but powerful indicators of business goals brings out thinking, motivation, creativity, and measurements from the staff to ensure that the process of continual improvements happen with harmony, synchronicity, and playfulness. This also creates loyalty, pride of association, and a sense of ownership toward the company’s goals.

Measuring Goals
Once the goals of improving throughput, inventory, and operating expenses are established, we developed a scorecard for ensuring the performance of various parameters related to these goals are measured and compared with the expected performance using simple traffic light color codes. The principle of inherent simplicity is always kept as the basis of developing any tool. The simplicity brings much faster acceptance and understanding of the situation.

Picking Up Improvement Projects
For chronic problems, indicated by a continuous “red” status in the scorecard, the projects used a six sigma approach of define, measure, analyze, improve, and control. The team leaders were trained as Six Sigma experts (green and black belts) and made conversant with statistical understanding, ensuring that after completion of problem-solving projects, the levels of parameters are compared with initial levels and benefits are quantified.

The statistical software was handy, especially considering there are high volumes of data analysis involved in medical transcription operations. Typical tools used during six sigma-based problem-solving projects include process mapping, cause-and-effect diagrams, control charts, process capability studies, analysis of variance, and pareto diagrams. The types of projects included those designed to obtain improvements in connectivity, internal communication, turnaround time, accuracy, new client transition, capacity prediction, and optimization.

While some of the improvements focused on optimization of performance with available resources, bottleneck resources were also steered using innovation concepts and experiences gained from similar situations in other industries that utilize TRIZ methodology.

Establishing Long-Term Controls
To avoid regression, quality teams worked on standardizing workflow. Ensuring most transcriptionists could handle any physician’s dictation was a joint initiative between operations and human resources. Templates of all physicians were managed and controlled by a document management system. The configuration and change management of these templates were managed through the capability maturity model (CMMI).
Standare operating procedures and training manuals were created for new employees while new physicians were taught to be compliant with the stage gate system. To ensure proper performance of IT-based systems and the confidentiality, integrity, and availability of files, ISO 27001 is implemented. For overall standardization and auditing, ISO 9001 is used to ensure improvements are maintained.

Involvement of Customers
To ensure customers are confident that their processes and data are secure, trend and file status reports are shared to avoid panic and loss of harmonious relations. In addition, the customer call center provides up-to-date client support and monitors client concerns.

Benefits
Through these improvement initiatives, Mediscibes tripled its  client base within three years. In addition to those gains, employee surveys indicated work culture improved as did motivation.

— Sanjay Rajpal is director of quality for Mediscribes, Inc.