$300$

ratended Cases

$7\mathrm{.}4$ Merging and outsourcing transcription services

Competency V$\mathrm{.}1$

Competency VI:$2$

Maria is the new director of HIM as Beochwood Ciny Hospital. This is her first director position Epoe her hire, she was directed to initiate a consolidation of transcription saff to include the radioblogy. pathology, and HIM transcriptionists. A consullam had determined that eross$-$training staff. implementing industry leading productivity standards for line count, and offering an incentive for stieving goals beyond the productivity standard would save the hospital mer $$150,000\mathrm{.}00$ per year$-$

Currently, each of the transcription groups, HIM, radislogy, and pathology, have their oxar lead ranscriptionist and different dictation system. Consoldating the services will resuit in just one lead position and create subslantial savings. Additionally, the consultant found that based on the lines of dictation in all the departments and using the industry leading productivity standands. there were more transcriptionists than necessary in the organization. Merging the transcription services into one central service and increasing productivity would mean termination for it minimum of four full$-$time transcriptoonsis, again creating a cost savings. Finally, consolidating aill transcription under one system will net an annual savings of $$250,000$ in software licenses. and maintenance.

Maria is reluctant to inform the transcription staff about the impending job losses for fear that many of the transeriptionists may be nervous enough io look for positions elsewhere leaving the hospital in a bind. She begins the process by informing all the transcriptiomists of the merger and puts Glocia, her HIM lead transcriptionist, in charge of the combined team. Without sharing any of the rationale for her changes, Maria has the other two Iranscriptionists who were leads begin cross training of the staff to their specialties. She makes no change to their job status since they are performing the cross training. so no cost saving is realized. Gioria is put in charge of training radiologisis and pathologists on the HIM dictation system.

Staff are slow to adapt to the differences in transcribing reports for radiology and pathology. so productivity decreases. Physicians are complaining about the lack of report availability in a timely manner. Meanwhile, the training of the radiologisis and pathologists on the HIM system is also slow. Those physicians do not understand why there has to be a change and Gloria cannot answer their questions. Many of them continue to use the legacy sysiem to dictate.

When Maria tries to implement the new productivity standards, the transcriptionists complain that the line count hasn't taken into consideration the hospital requirements that they must abide by$.$ Work slows down even more

At this point, backlog has grown and now Mara must sutsource some of the transcription work: She finds a vendor who promises great lurnaround time, excellent quality, and competitive pricing. After engaging with the vendor, it is clear that the vendor is uble to handle this morkload at a cost that is much lower than the in$-$house staft. Quatity and turnaround time are being met as well. The chief financial officer $($CFO$)$ met with Maria and indicated that a decision had been made to outsource all transcription services beginning in one month.