Change Management and its Application in Medical Transcription Outsourcing

Change Management and its Application in Medical Transcription Outsourcing

Changing from an in-house transcription solution to an outsourced provider can be a truly daunting decision for CFO's, HIM executives, and physicians. Not only is the decision a major change for the internal dynamics of the hospital, but the hospital must trust a service organization that is in the midst of a rapidly changing industry.

Take a look at the medical transcription industry and you will realize that it is not unlike numerous industries that have faced dramatic change over the past few years. "Change" in its broadest sense is a planned or unplanned response to pressures and forces. Our industry has faced technological, regulatory, global, economic, and social forces that have forced our industry and our customers to change whether we like it or not. Change is such an issue these days because simultaneous, unpredictable, and disruptive forces have become the norm rather than the exception. When these forces are broadened to a global scale, the forces multiply exponentially.

Ultimately, the pressures that provoke change can be considered threats or opportunities. They can elicit despair or mobilize the energy of good managers who are determined to compete. The reactions depend on how an organization interprets the forces surrounding it. Med-Scribe is of the belief that change can be managed and that hospitals and clinics can work toward a competitive solution for their transcription needs by working with a qualified medical transcription service provider ("MTSO").

As a company with a service record of twenty-two-years, Med-Scribe has historically recognized that when an outsourcing project is announced by the leadership at a facility, its meaning will be immediately transposed onto the private maps already existing within the organization and rephrased in terms of the uncodified background knowledge that each member brings to the workplace to answer the question "What's in it for me?"

Simply because organizations have changed, are changing, and will be obligated to change in the future doesn't mean that the process will be pleasant. On the contrary it is usually disheartening and frustrating. Managers complain that change takes too long - or doesn't last long enough. It is too costly – or doesn't save enough. Change is never welcome but is always necessary. The "bottom" of the organization claims that the "top" doesn't practice what it preaches. Meanwhile, the "top" of the organization insists that the "bottom" is dragging its feet. The middle blames both.

Given that making an outsourcing decision to change the transcription process will be met with resistance and "what's in it for me", Med-Scribe offers a few guidelines on managing the change process to ensure a smooth transition to an outside transcription vendor. Can change be managed? Med-Scribe believes it can, by starting with the right questions…

When is the decision made to pull the lever and implement the change? An HIM department can implement a change when things are going well, when results are mixed, or when a full-fledged crisis is upon it. Although waiting for a crisis makes the message of the need to change much easier to disseminate, the decision to outsource should be made in anticipation of difficulties.

Waiting for an insurmountable backlog, a crashed dictation system, irritated physicians and the like only make the outsourcing decision rushed, the implementation hasty, and the initial results poor. Outsourcing arrangements are long term partnerships and should be entered with careful planning with the right partner. Although it is difficult to energize the organization when things are going well, the time to implement an outsourcing arrangement is when the department is running smoothly.

I venture to say that there is not a national outsourcing company in existence that has trained,
qualified, transcriptionists waiting to jump on "PRN" work at a moment's notice. Outsourcing arrangements need to provide a long term benefit to either parties or the relationship will fail. An HIM department needs to commit to a certain department, work-type, or volume so an MTSO can plan for the production and staff accordingly. In most acute care hospitals, a significant amount of interfacing, process flowcharting, and implementation support is required to create a seamless workflow for the doctors. Partial outsourcing projects often prove difficult to ROI because the implementation costs can be the same for part of the hospitals volume as they would be for the entire amount.
It is important to establish that a decision to change is not an indictment of precious decisions or
actions. It is difficult for people to promote change when they have been a part of creating the conditions that cause the need for change. An HIM director who has been working hard at recruiting and training internal staff could understandably be resistant to considering outsourcing. Restricted resources can be an issue these days with all eyes on ICD-10 and other related EHR implementation projects.

Another issue we typically encounter is the common reaction to consider "sunk" costs when making an outsourcing decision. Conventional thoughts such as "but we just bought that system" prevail when considering the change to an outsourced vendor. "Sunk" costs by definition will never be refunded.

The only costs that should be considered when deciding whether or not to outsource are the pending costs.

  • What are the annual support fees on your equipment and software?
  • What are the expected upgrade costs?
  • What are the management costs?
  • Will these costs disappear in an outsourced solution?
  • will they just decrease?
  • possibly increase?

Factoring in sunk costs is holding on to a decision that was made in a different time and situation and allowing it to continue to impact the future of the organization.

Once the decision to change has been determined, choosing the right MTSO is the most important next question to consider. Because transcription outsourcing arrangements are highly interactive and long-term, they require the facility and the transcription provider to share an understanding of expectations, a strategy for problem solving, and a commitment to the success of the program. The ability of the MTSO to be able to deliver consistent, long-term results with a similar scope and size is important and therefore provided references need to be checked thoroughly. Integration is a vital role in today's electronic health record and MTSO's need to demonstrate the ability to support integration requirements of each phase of every project touch point.
A common mistake often made is for the outsourcing facility to believe that they should not tell the
impacted employees until the last possible moment. Before internal change management announcements are made to the employees, the facility's management team needs to be prepared. Specifically, they should be able to answer the questions "what's in it for me". "Will I still have a job?" "If so, how much will I be paid?" "What are the benefits offered by the MTSO?" The Good News - there is not a transcription company in the U.S. who could not immediately use a good hospital transcriptionist. If an MTSO does not want your transcriptionists or offer them a job, the work must be going offshore immediately; otherwise they will be very interested in retaining your people. Some MTSO's that utilize overseas labor will sometimes make short term promises until
the new account can be digested and sent offshore, slowly starving the domestic employee. It may be important for the employees to work with a company that only uses U.S. labor to protect against this problem. Increased emphasis is also placed on the MTSO's production platform and technology. In an industry that is experiencing significant pricing pressure from buyers, MTSO platforms that increase individual production in both traditional transcription and speech recognition editing are extremely important to ensure consistent wage earning potential.

Perhaps the greatest challenge of the entire change process is managing the overall reaction to the change by those people who show up on Monday to learn "we've got a new plan". These people have not been involved in the decision making process and will have a deep psychological reaction to the decision. If these reactions are not anticipated, and managed, we believe it is fair to state that change will be needlessly painful and perhaps even unsuccessful. The effected employees should be offered an opportunity to understand the reason for the change, discuss their options, and be provided with customized "bridge" package to ensure the transition goes smoothly. The details of a "successful" bridge package typically involve customized incentives that are predetermined by both the MTSO and outsourcing facility. Examples include extended COBRA coverage options until the MTSO's insurance takes over (typically 90 days) and/or guaranteed rates of pay during the transition. If the employees elect not to take employment with the new MTSO, any severance should be based on staying with the facility until a certain predetermined date or at least until all backlogged work is cleared from the facility's legacy system.

An MTSO needs a change agent in the organization to effectively implement an off-site solution.

Change agents always need the ability to get all people affected by the project involved, to ensure their support and commitment. This requires a high competency as the basis for acceptance as well as soft skills, which are often summarized as emotional intelligence. This includes the ability to communicate, to understand and to take into account opinions and doubts of others.

Change agents should know the process well and should be able to give the MTSO valuable information regarding the process requirements in the hospital. A change agent has to be provided with the same "what's in it for me?" assurances such as a new position once the change has occurred.

The change agent needs the unconditional support of someone high in the organization, The Champion. The Champion is typically the CFO, CEO, or other executive who has the organization clout to help the Change Agent through the difficult periods. The Change Agent doesn't necessarily need to know the details of the process flow and the timing decisions, but they need to be committed to the change and offer their support when the internal obstacles appear in the organization; obstacles such as commanding the time and attention of the IT Department.

Much of the success of implementation is based upon the MTSO gaining good information prior to the implementation. Information such as volume, work types, templates, routing requirements, and the like are all critical to a successful implementation. Since hospitals can be large, complex, and full of processes that are undocumented and misunderstood, we believe it is always a good idea to pilot certain volumes, departments, or work types prior to a full transition. Piloting and testing are crucial to ensuring that the MTSO has all the correct information and that if important details were overlooked, at least their effect is isolated to a pilot situation rather than a full blown implementation. It is much harder for an MTSO to fix problem "on the run" than it is to learn about requirements in advance and conduct proper testing prior to full scale implementation.

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