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Focused Action Forums


Please post respectful, constructive comments with your ideas for achieving improvements in the MTSO industry, focusing on solutions to problems and obstacles.  Comments can be found by clicking on the word "comments" found to the right of each forum title.  Forums are moderated.  Forum etiquette tips are located on the Resources page.

Forum Categories: 

1.  Employer Lobbying & Collective Bargaining.

2.  Forming Transcription Service Cooperatives.

3.  Licensing, Accreditation, Association, Legislative, Legal, or Publicity Actions.

4.  MT Coalition Membership, Organization, and Structure. 

5.  Improving working conditions.

You may also send us your comments in the Contact Us form if you prefer.

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Rock Your Business

Posted by Moderator MT Coalition on January 31, 2018 at 4:20 PM Comments comments (40)

Whether we own our own private, public, or cooperative MTSO, and/or are an employee, independent contractor, or a client, we all have a stake in the success of the MTSO. The better run the company, the better profits, pay, value, and service there are for all stakeholders. To that end, this forum is to identify means and methods by which MTSOs, their workers, and clients can together build or improve their MTSO to achieve maximum success. Content areas can include:

  • Business plans
  • Technology and support
  • Process improvement (rework, silos, bottlenecks, efficiencies).
  • Work flows and assignments
  • Atmosphere
  • Quality assurance
  • Metrics and performance measurement
  • Communication
  • Training and continuing education
  • Management style
  • Employee involvement and morale
  • Customer service
  • Recruitment and retention
  • Compensation and benefits
  • Human Resources
  • Payroll, accounting, finance
  • Marketing and sales
  • Legal:  Contracts, policy, security, confidentiality, privacy
  • Other

Beyond working conditions (discussed in the prior forum), from either a MTSO owner, worker, or client perspective, what best practices, technologies, methods, and/or styles would you recommend to build your ideal, maximally efficient and effective, successful MTSO?

This is a chance to get out the, "if they only would do this," ideas on the table so that we all can succeed. Provide comments and cite any articles, web sites, or other references. From the comments, we will select best practices and build a reference area that other existing or new MTSOs that you start may use.

Please share your thoughts and ideas in the comments above (or via the contact form).

Improving Working Conditions

Posted by Moderator MT Coalition on November 17, 2017 at 1:50 AM Comments comments (6)

Home-based workers in MTSOs have indicated improvement needs in the following areas:

1. Market-based wages comparable to peers in healthcare organizations commensurate with the education, skills, and knowledge required for similar positions (Reference Bureau of Labor Statistics).

Many healthcare facilities employ telecommuting MT/E employees, and pay at the same rate as their inhouse employees.  Traditional, in-office positions do not factor in commuting or office wear into their salaries, and this should not be used as a reason for reduced pay.  Employers realize savings from reduced office space expense, overhead, and in many MTSOs, equipment, furniture, references, and telecommunication costs.

2. Hourly wages that include currently noncompensated time for adding demographics, researching terms and names, training, correspondence, QA review feedback, timekeeping, breaks, etc.

3. Working conditions such as those found in #2, that reduce the negative impact of continuous, repetetive, robotic work such as repetetive strain injury, fatigue, and reduced focus leading to errors and reduced productivity. 

4.  Affordable, customary, market-based benefit packages.

5. Performance incentives, if used, are beyond hourly wages to reward additional and exceptional effort, and are not punitive by wage or benefit reductions. Workers can count on their wages and benefits remaining stable until uncorrected poor performance results in transfer or termination.

6. Performance metrics are reasonable and weighted for the complexity and/or variability of work performed, and the time and effort required. Measurements are transparent, verifiable, and nonmanipulated.  Workers can easily check and self monitor productivity, work volumes, and turnaround, and verify quality reviews and challenge results.

7. Performance metric feedback is given at reasonable intervals so that they become meaningful and productivity enhancing versus micro-managing, reactionary versus self adjusting over time, and productivity sapping due to stress (e.g. monthly or quarterly as opposed to daily to biweekly, particularly for experienced workers versus the novice and/or those in new account training).

8. Individual metrics should not be rigidly applied, rather used as guides and goals to identify overall needs in coaching, training, and performance rewards or improvement.   Metrics should factor in extenuating or changing circumstances, variable conditions, and be balanced with other metric measurements (production, quality, attendance, team effort, etc.) for an overall individual contribution.  

Having the ability to monitor every keystroke, pause, and error doesn't necessarily mean it should be done or is an accurate or effective means of human resource management.  A shift to a focus on overall team performance, company turnaround time results, and quality may be effective.

9. Work assignment changes due to account changes should be weighted as ramp-up time in performance measurement and compensation systems.  Production credit is given for computer-caused retyping and speech recognition jobs that become essentially straight typed.

10. Access to coworkers, managers, technical assistance, and trainers with collaborative input into work processes, performance measurement, feedback, and compensation.  Workers know their processes best and how well technology and systems actually work for them.  They should be involved in systems design and process and performance measurement, rather than persons far removed from the process. 

Training materials and company information should be uniform, current, and easily accessible.  Communications should be efficient and timely including response to questions and notification of stat work via messenging systems.

11. Work relationships based on mutual respect, trust, and collaboration, rather than statistics, authoritarianism, and fear.  Remote location workers, effectively managed, should not require more stringent monitoring and micromanaging, or reduced pay and benefits than in-office workers.  

12.  Annual review of wage rate with cost of living adjustment. 

13.  Protections from employment or contract termination due to account losses with provisions for transfer, job reassignment, severance pay, etc.

14.  Use of ethical outsourcing methods:  Promises to healthcare organizations as to quality and productivity gains should be realistic, verified, and specific to each MTSO, account, platform, and workflows. Organizations should understand that human error occurs, and that excess customization in an outsourcing environment with rotating workers working across multiple healthcare accounts adds to the likelihood of error as opposed to a steady and stable workforce.  Complaints by customers are often factored into MT/E metric performance, which may not necessarily be a worker issue versus a sytemic issue. 

Outsourcing healthcare organizations should be aware that promises as to pay and conditions for their outsourced former employees may not last once employees are absorbed into and reassigned within the MTSO.  Outsourcing organizations should specify in contracts and verify that all workers on their accounts are receiving market pay and fair working conditions.  MTSOs should provide transparent evidence of fair billing and compensation methods to outsourcing organizations and their employees or contractors.  

Offshoring to other countries, which can increase the labor and costs required to train and supervise workers, pose increased risks to quality, security, and privacy, and be more difficult and expensive to enforce HIPAA/PHIPA and other privacy laws, should not be used as a means to avoid market base, living, or minimum-wage wages, and is inconsistent with public interest in supporing local and national economies.

15.  There are existing studies which identify the negative impact on employee morale and performance when they are in a punitive atmosphere, or impoverished and/or underpaid in comparison to equivalent peers for the technical knowledge, skill, and responsibility required (impact on patient care and HIPAA/PHIPA).

From 8 Principles of Collaborative Leaderships: "Treat people like human beings, not human resources. People are not assets. They are human beings. Without them, there is no organization. The health and well-being of your team or organization is dependent on the health and well-being of its members."

"I pity the man who wants a coat so cheap that the man or woman who produces the cloth will starve in the process."   President Benjamin Harrison

Without being company specific here, what would you add or modify to the above identified needs that you want to become the standard in existing or future MTSOs?  

Please share your thoughts and ideas in the comments above (or via the contact form).

Medical Transcription Coalition Membership, Organization, and Structure

Posted by Moderator MT Coalition on October 30, 2017 at 11:30 PM Comments comments (2)

The Medical Transcription Coalition (MTC) formed to organize efforts at improving conditions for home-based and other workers in MTSOs in areas including performance measurement, working conditions, compensation and benefits.  There is difficulty in organizing workers to collectively bargain due to lack of access to each other and/or collective bargaining representation.

While there are other web sites and organizations that offer forums to discuss the above conditions among other varied topics, this site offers a focused means to organize through online networking and conferencing to share ideas and strategies to improve conditions in MTSOs.

Membership in the MT Coalition is free.  We volunteer our time and talents.

In the future, if the members choose to engage in work group regulatory activity, or form bargaining units or cooperatives, fund raising, grants, and/or fees could be determined at that time, separate from MTC membership.

Please review the other topic areas in the focused action forums section below for your input.

If you have suggestions for MT Coalition membership, organization, and structure, and/or wish to volunteer in specific activities, please share your thoughts and ideas in the comments above (or via the contact form).  

Licensing, Accreditation, Association, Legislative, Legal, or Publicity Actions

Posted by Moderator MT Coalition on October 30, 2017 at 10:50 PM Comments comments (2)

There have been efforts made over the years to set best practice standards, appeal to labor agencies, legislators, and lawyers, and to publish articles about the need for improvement in working conditions for home-based workers in MTSOs. 

What ideas do you have to make further efforts in any of the areas above?

Do you have resources to contribute or have an interest in volunteering your time and talents in the areas above?

Please share your thoughts and ideas in the comments above (or via the contact form):  

Forming Transcription Service Cooperatives

Posted by Moderator MT Coalition on October 30, 2017 at 10:25 PM Comments comments (2)

Some people believe that working and pay conditions will not change as long as people continue to work for and patronize companies that have less than optimal conditions.   

Worker cooperatives are gaining popularity in many industries given the history of unsuccessful efforts made in the past in the areas of collective bargaining, standards, and regulation to improve conditions for workers.  

Cooperative capitalism can provide competitive edges through characteristics including but not limited to:

1.  Knowledgeable worker input into process improvement resulting in streamlined, uniform processes, communication, and training.
2.  Shared resources with reduced rework, utilizing a franchise, template, or uniform, standards approach.
3.  Lower overhead.
4.  Flattened levels of management.
5.  Lower ratios of management to worker compensation for higher MT/E wages.
6.  Engaged, empowered workers having a greater investment in company outcomes.
7.  Improved retention of the best workers.

The following links offer information on worker cooperatives in the United States:

1.  US Federation of Worker Cooperatives:  ;

How could this work in our industry?  

Are you a current or former MTSO owner with perspectives and interest in this concept and willing to share your ideas and suggestions?

Do you have further information and resources you can share about forming worker cooperatives?

Please share your thoughts and ideas in the comments above (or via the contact form):  

Employer Lobbying & Collective Bargaining

Posted by Moderator MT Coalition on October 30, 2017 at 10:00 PM Comments comments (9)

Lack of access to collective bargaining poses a difficulty in improving worker conditions in MTSOs.  There are often no means to communicate with coworkers, and finding unions can be difficult.

What are your ideas in forming a collective bargaining unit or mechanism for workers in MTSOs? 

Some suggestions have included:

         1. Finding or forming a collective bargaining unit.

2.  Using the MT Coalition to organize, coordinate with other MT/E groups to conference and strategize ways to lobby their organizations.  This could include drafting letters with requested working condition changes, and launching a scheduled CEO Email or management dialogue conference day, etc. 

3.  Forming a worker cooperative MTSO (as addressed in the forum on cooperatives).

What are your thoughts on the above, or other ideas and suggestions related to employer lobbying and collective bargaining?  

Do you have or know others who have expertise and/or resources in collective bargaining that you would volunteer or recommend?

Please share your thoughts and ideas in the comments above (or via the contact form):