Improving Operational Efficiencies of medical transcription: A dive for solutions into the ocean of modern management tools and

concepts
Sanjay Rajpal, Director Quality-Mediscribes, Inc.

Background: Medical Transcription industry is going through challenges of ensuring real time transcription with near to zero error rates. The days of enough turnaround time are over and expectations of less than one hour TAT are common. Added to this is the operating expenses control requirements due to high competition and availability of many players who have developed and matured the business models based on time zone and low cost manpower availability. Another challenge is to ensure through-puts under varying loads/ absenteeism/ manpower turn around and technological constraints. This article brings options and solutions derived out of modern management concepts of Six Sigma, TRIZ and Theory of Constraints which may be useful in handling above challenges. The various solutions and point of views are illustrated by examples/ case study of the way we handled these situations at mediscibes, inc. since last five years. Understanding Goals: For ensuring that the teams of various departments understand their personal, departmental and companys goals clearly, it necessary that overall vision is shared, common thread of connecting the appraently contradicting objectives of various processes owned by identified departments/ functions are ironed out time and again. We made it a culture to ensure communication workshops happen once every six months to ensure the individual and departmental goals are set/ aligned and integrated with the companys goal. The theory of constraints bring out very simple and clear way of expressing company goal such as the one we zeroed down to value to client leading to profitability for the company . We keep brainstorming the goal clarity and alignment in our goal setting workshops. There are some common goals categories which are provided to all departments/ functions in which the teams have to identify goals such as goals of Improvement in Through-put (realization of money), reduction in Inventory (blocked money in the system) and reduction in Operating Expenses (Waste of money). These simple but powerful indicators of business goal, brings out thinking, motivation, creativity and measurements to ensure that the process of continual improvements in these three fronts happen with harmony, synchronicity and playfulness. These shared business facts also brings loyalty, pride of association and sense of ownership towards companys goal.

Measuring Goals: Once the goals of through-put, inventory and operating expenses are established, we developed a score card 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 basis of developing any tool. The simplicity brings out much faster acceptance and understanding of situation. In many situations just measurement and monitoring initiated process of small-small improvements (kaizens) without consciously calling them improvement projects or action points. Picking up Improvement Projects: For the chronic problems, indicated by continuous red status in score card, the projects using six sigma approach of define, measure, analyze, improve and control methodology initiated. The team leaders were trained as Six Sigma experts (green and black belts) to ensure the proven problem solving approach of six sigma methodology is followed. The team leaders were made conversant with statistical understanding of problems and ensuring that after completion of problem solving projects, the levels of parameters which are improved are compared with initial levels and benefits are quantified. The statistical software was very handy considering high volumes of data analysis involved in medical transcription operations. Typical tools used by teams during six sigma based problem solving projects include projects process mapping, cause and effect diagrams, control charts, process capability studies, analysis of variance and pareto diagrams. The problem solving projects taken-up and completed by the team include improvements in connectivity, internal communication, turn-around time performance, accuracy performance, new client transition time improvement, capacity prediction and optimization etc. While some of the improvements were focused on optimization of performance with available resources, some of the bottleneck resources were also steered using innovation concepts and using experience of similar situations of other industries using TRIZ methodology. Establishing long term controls: To avoid slip back tendency for improved situations, the quality teams also worked on standardization of work flow of files and work handling. Multi skilling of transcriptionists for by job rotation to ensure almost all transcriptionists can handle all physicians dictations was one of joint initiative of operations and HR team. The template of all various physicians were ensure to be managed and controlled using Document Management System. The configuration and change management of these templates was taken up to a high maturity level using process areas of capability maturity model (CMMI). The SOP and training manuals created for ensuring initial induction training for new employees. The transition process of new physicians

ensured to be more formal and compliance to stage gate system is put into practice. For ensuring performance management of information technology based systems and ensuring confidentiality, integrity and availability, controls of ISO 27001 are used to avoid risk to client highly sensitive medical records and data. For overall standardization and auditing system, model of ISO 9001 is used to ensure on-going process of maintaining the improved state. Involvement of Customers: To ensure the customers are also having the confidence that their processes and data is in secured and safe hands, trend reports and status of files is also shared with clients to avoid panic and loss of harmonious relations. The customer care cell ensured to constantly anticipate and proactively provide upto-date information for clients support. The cell also ensures to carry out surveys to identify slightest possibility of dissatisfaction to clients staff. Benefits: With these improvement initiatives, within three years, mediscibes, inc increased the client base three times with equivalent increase in profitability. Intangible benefits of improved work culture and motivation is also unmatched as monitored in periodic employee surveys.

About Author: Sanjay Rajpal is working for Mediscribes, inc as Director-Quality. He is an eminent trainer and practitioner of theory of constraints, six sigma, TRIZ and standardization process since last two decades. He can be contacted at sanjay.rajpal@mediscribes.com