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Focused Action Forums

Rock Your Business

Posted by Moderator MT Coalition on January 31, 2018 at 4:20 PM

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).

Categories: Forming Transcription Service Cooperatives

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Reply MTE Activist
5:52 PM on February 5, 2018 
Some ideas...
Quality and production standards: Different MTSOs have different quality standards probably to offer perceived competitive edges, ranging from 98% to 100%. The difficulty run into is that they may not adjust the production standard enough or at all to meet the standard set. It is not an exact science to predict how much more time is needed to achieve a 0.5% or 1% or more added quality standard, so it becomes arbitrary, and can cause performance issues unnecessarily, trying to meet one standard at the expense of another. Similarly production standards can be difficult to achieve with any regular precision due to unweighted variables in work types, changing accounts due to account or staff losses and gains, differences in IT platforms, account specification variables that are not efficiently indexed for reference, bottlenecks in the system, insufficient communication and training, etc.

Overall, metrics need to be reexamined and used as guidelines for performance improvement and rewards versus rigidly applied, with judgment used and flexed in extenuating circumstances, regardless of the size of the MTSO. If a company is too large to use judgment over spreadsheets in human resource management, they are too large/insufficiently staffed. AHDI has some guidelines, and is working on a QA publication, so more efforts in that direction by MT/Es, MTSOs would be helpful.

The client also should be involved, because their expectations need to be managed. They need to know the costs of customizing their specifications, and that many MTSOs have revolving staff working on their accounts, also working on other accounts, where it becomes difficult to keep track of variable specifications and exceptions to them, and which slows production and quality. Also, customer feedback needs to be taken with some amount of judgment, and given as feedback only if there are patterns versus isolated instances, particularly as the MTSO staff already are being audited with feedback, so adding more customer feedback doesn't always add more value, just more stress, defensiveness, fear, hopelessness, resentment, etc. A person with a stellar QA score, may get a feedback from a customer on a single complaint, which may be taken negatively by management, causing the MT to be more cautious, jeopardizing their production standard, even though they are already achieving above quality standards.. It adds no value, takes time from production work, and creates negativity. This is different than if there are repeat patterns or if the complaint was something significant, and that is where some discretion should be used.

MT/Es could also be coached on how they take in and best respond to feedback that is valid, as well as invalid in positive, professional, yet assertive ways. Dictators should be given dictation cue cards for best dictation practices to help with the process, and be given positive feedback for improvement. MT/Es, though it is difficult to deal with poor habits, could cut the dictators some human slack, and help create a more educating/supportive, working-together environment to create a less negative, us-versus-them perception of HIM/MT, when we want to continue providing existing and expanded services to them.

QA and other metrics should add value, not a toxic environment, or excessive work which is hardly productive or quality. Thought should be given whether a seasoned MT/E working on the same accounts really needs to be audited every week or month versus annually. Or whether more value would come from less individual and more team audits for overall company performance.

Importantly, MT/Es who know their work the best should be involved in setting standards and performance measurement rather than somebody in management who is far removed from the process, yet thinks a measurement plan "sounds good." Though there will always be outlier performers, (the more gifted and the less gifted; those with revolving, multiple, difficult accounts and platforms, and those with steady, single, easier accounts and platforms), standards should be comfortably achievable by the majority within individual MTSOs, and our measurement programs should not get in the way of working, and working healthy.
Reply MTE Activist
12:31 AM on February 13, 2018 
Regarding compensation: Speech recognition rates are too low at the typical average of 4 cpl, with some reportedly introducing a new cut to 3 cpl. There is no difference in the technical knowledge and skills required for editing as straight transcription, it only saves wear and tear on the hands, which is a savings to companies in lost time for surgeries. In healthcare organizations who keep their inhouse staff (who make an average 50% to 60% more), they don't lower the rate of pay with their speech editing and EHRs, they just up their production requirements. And here is the key, not by some arbitrary or wishful thinking number, but by the efficiencies and consistencies of their work assignments and flows, difficulty of authors/work types, and the efficiencies of their software, and factoring in other tasks as assigned. In other words by the actual productivity gains they can realize with the SR and other factors that they have. It is set on a company by company basis, not an industry "standard."

This is part of the problem for MTSOs. Inefficiencies, top heavy management, and overhead may be another problem. The other problem may be greed, but that is a subjective possibility. As mentioned in the petition, many MTSOs do not realize a 100% production increase with SR to justify a 50% difference in the rate between SR and TR. They often only realize a 25% to 35% increase in production due to assigning work across multiple changing accounts for TAT or OOW, lost or offshored accounts, They are not weighted for any difficulty factors such as report type, author, or platform; work assignments can be luck of the draw (or manipulation), yet all are held to the same standards. Some workers will do okay, some better, and some will have difficulty meeting standards, not always due to work performance issues, but often systemic issues.

Also, do the math. If a company sets their minimum production standard and then sets their cpl pay rate, figure it out. It is set to be close to minimum wage for speech editing now, and not too much further off for transcription, which is only about 5% of the work for many companies, the other 95% of the work being speech recognition. What is particularly galling and insulting and takes a lot of nerve, is when companies come back to their employees with a performance issue saying they "had to" mark up to minimum wage because their production was not exactly at minimum level for that pay period, often for factors not within their control. Minimum wage is typically for unskilled laborers, not the technical knowledge and skill required for transcription and editing. Even unskilled labor, Mcdonalds or Walmart workers can now make more than an MT/E. "Having" to mark up to minimum wage isn't a performance issue, it's a pay rate issue.

As FDR said. "No business which depends for its existence for paying less than living wages for its workers has any right to continue in this country. By living wages, I mean more than a bare subsistence level, I mean the wages of decent living." Pretty sure he wasn't suggesting offshoring either, which is robbing Peter to pay Paul, has its own added costs, quality, security/privacy problems, is harmful to local economies, and reportedly isn't so lucrative for the offshored workers either.

That is the reality.

Solutions can be: Looking at flattening management layers, streamlining processes, and improve efficiencies. Some may be in reinstating weighting factors to work types and authors, as these are not the same widgets being made on a factory line; each piece can be different in the amount of time needed. Weighting can be complex, which is why some may have abandoned the effort. Really, setting an hourly wage by BLS standards, retaining production goals that can be guides, and then getting off the worker back, is what is more likely to work. Healthcare facilities who do this, retain the best workers and lower their employment costs by the increased gain in efficiencies, and do not need to replace workers who depart. They can lower their staffing needs or add other administrative duties or services to their descriptions.

Another solution is to create a worker cooperative MTSO, or MT/E staffing agency for hire by healthcare facilities, providing the recruitment, staffing, training needs, payroll, benefits, etc, to log into into healthcare facilities systems, not the MTSOs, and bypass the middlperson's cut paid to the MTSO, .
Reply MTE Activist
7:07 PM on February 14, 2018 
Regarding work processes and work assignments: IMO, more time should be spent on process improvement and enhancements and less on performance monitoring. Very few other positions are monitored and reported for metrics as closely as in MT/E work. When discussing this with a nonMT, the feedback was, that would be awful (a more colorful word was used, but will spare you that). If a manager wouldn't want their every movement monitored, they shouldn't expect it of their workers.

Some process improvement ideas:

1. Account specification materials need to have a template so that each hospital account specification is uniform in organization and presentation of the specifications. When an MT/E has 8-10 accounts they are working on, and they have to stop and look up who wants what bolded or roman versus arabic numerals, or how CCs are handled, the information needs to be organized and present so that they can quickly look this information up. Otherwise it is nonkeyboard, wasted time that is noncompensated (which it should be, but that is a different story). This needs to be updated and present upon new account implementation, and is another duty that could be performed by workers on an hourly paid basis to break the monotony and keep up with the needed specification documentation. It would be great to have this information split on the same screen as the document the MT/E is working on at the time for quick access, otherwise in a notepad format that is quickly accessible.

2. Training materials likewise should be uniform, organized, consistent and up to date. MT/Es should have efficient access to a trainer/mentor for questions 24/7. Training and mentoring is also a task that MT/Es could participate in.

3. Staff should have access to teammates for questions, process improvement, TAT completion, and comradery. Teams can be set up for blank checking, other questions.

4. Access to prior reports for samples on individual physician dictation habits and formats. Again, MT/Es could be involved in keeping these up to date.

5. Efficient word expanders, dictionaries, physician and area resource lookups, which will speed up or slow down the process.

6. A good communications system including email, messaging for stat work, and staff meetings. It doesn't have to be fancy or that high tech, it just needs to be present and get the job done.
Reply MTE Activist
1:38 PM on February 16, 2018 
Regarding IT: Variable system efficiencies obviously affect productivity and need to be factored into individual MTSO/account production standards, such as:
1. Processing speed of report downloads and uploads, or wait times to access account specifications, prior report samples, physician name lists, medical references, notes to client/QA.
2. Quality (accuracy or robustness) of the speech recognition engine, spell checking, word expanders, templates, and screen and demographic navigation capability.
3. Accuracy of downloaded facility demographics.
4. System up or down time.
5. IT support response time to errors and down times.
Reply MTE Activist
1:52 PM on February 16, 2018 
Regarding Finance/Payroll:
The MTSO industry has had problems and lawsuits in the past with poor transparency, errors, and fraud in both client billing and employee pay.

Pay methods should be simple to track, follow, and verify. If the performance metric systems and line counting, and weighting conversion systems are too convoluted and complex, they become prone to error and fraud. Pay per hour is the simplest, lowest error and fraud risk method available, which can still retain some standards to make sure people are not sloughing off and positively incenting, but not so intrusive as to create a nonproductive, toxic environment.
Reply lynneallyson
12:58 PM on March 2, 2018 
I hope everyone has had a good week. It has been a little slow for me, so I guess I will be working this weekend to try to catch up. Ah, the life of the IC. It does have its ebbs and flows.
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