Thursday, September 27, 2007

Trench Warfare

“Recently, on an employee evaluation, I was told that I had to work more on being a team player. I was shocked! And hurt! For a while, I felt really wounded,” writes a medical transcriptionist who is a faithful reader of this column. “But the more I thought about it, the more I realized that my supervisor and I had nearly opposite ideas of the definition of the term. I thought it meant each person contributing their best strengths (not necessarily everyone doing the exact same thing). I thought that working crummy evening and weekend shifts made me a team player, but my boss thinks that my flexible hours make me someone who just wants to do her own thing. I thought that my excellent analytical and problem-solving skills were valuable assets to our team (I’m often interested in making things work better -- especially when it comes to computer problems). But my supervisor thinks that team players focus on production and don’t get sidetracked just because something isn’t working well. You can tell we are polar opposites by the simple fact that I have almost 2,000 entries in our abbreviation expander and she has five. ‘I can type fast, so Idon’t need to use that,’ she says.”

“I started searching for an objective definition of a team player and couldn’t find much!! It seems to be one of those phrases that everyone is throwing around and yet it means something different to each person that uses it. I would love to read your thoughts on what it means to be a team player in the medical transcription world,” notes our loyal MT. Let me assure you, dear reader, many transcription managers would prefer not to hear my thoughts about what it means to be a team player in the medical transcription world. But thanks to your e-mail, today is their lucky day!

First, let’s examine situations where team work is truly necessary. If you’re a musician in a symphony orchestra, you need to follow the conductor’s baton and keep pace with the music. You need to make sure that the sounds you are creating will blend with the rest of the orchestra to produce the desired effect. Is teamwork required? Definitely. If you choose to play random notes at strange intervals not indicated by the composer you will surely succeed in sabotaging the team effort.

How about people who work in a popular dining establishment? Whether you are a waiter, bus boy, line cook, or host, maintaining the pulse and rhythm of a successful restaurant requires an awareness of the other people in your immediate workplace so that meals arrive hot, plates are cleared from the table in a timely fashion, water glasses are refreshed, and bills delivered on time to ensure that your guests are happy with their dining experience and want to return to your restaurant.

Suppose you are a flight attendant. As part of a team of people responsible for the safety, transportation, and feeding of anywhere from 30 to 400 passengers on a single flight, you must be pleasant, courteous, firm, agile, and able to respond to the unexpected. Whether your work requires you to cope with spilled drinks, airsick passengers, newlyweds trying to join the Mile High Club, or potential terrorists, you and your fellow employees must know each other well enough to respond to any situation as a team. Your training has taught you how to cope with First Aid emergencies, crash landings, cabin fires, and emergency evacuations (not to mention children traveling without adult supervision). To keep peace in the cabin -- and a sense of equilibrium throughout the flight – teamwork is definitely required.

What about medical transcription? With whom must you interact during the course of transcribing a medical report? A foot pedal? A keyboard? A digitized chip telling you the parameters of the next job you will transcribe? The sound of a previously-recorded doctor’s voice? What kind of immediacy is there about your physical involvement with other transcriptionists that could ruin the work flow? Are other transcriptionists in the same room waiting for your final keystroke? Can another transcriptionist come over to your desk and listen to a difficult patch of dictation for you? Not bloody likely. So where does the “team” dynamic come into the play?

Are you truly part of the patient care team? Or is that more a fiction developed by the American Association for Medical Transcription to make transcriptionists feel better about themselves? Here’s the key test. If what you do is taken out of the picture for a short period of time, how does it affect the patient?

In most cases, it doesn’t. Let’s run a test just to check out this hypothesis. Suppose your digital dictation system (or the servers for your ASP) crap out – whether from a technical problem, an electrical blackout, or an unforeseen emergency. Is surgery being postponed until you finish transcribing a report? Will the patient be held in the admitting room and allowed to bleed to death if the doctor’s history and physical hasn’t been printed out to accompany the patient to his room? If, heaven forbid, a discharge summary is late-- and not because some doctor waited six months to dictate the report -- will it be your fault if the patient dies after leaving the hospital? Of course not.

What will really happen is that any delays in delivering transcribed reports will create a delay for coders who need to determine the billing so that the hospital can get reimbursed as quickly as possible. Trust me on this one: It’s all about cash flow. Just follow the money.

What does teamwork have to do with medical transcription? A transcription supervisor can set guidelines for turnaround time and accuracy. But if department heads insist that transcriptionists cover the phones while others are on their lunch break, should the transcriptionists be taken to task for failing to meet their productivity goals? If physicians who procrastinate on dictating reports (or suffer from impaired language skills) routinely sabotage a team’s “productivity goals,” should the transcriptionists be blamed? If a transcription supervisor fails to provide the “team” with electronic add-ons such as medical spell checkers, word expanders, drug databases, and high-speed Internet connections, should the transcriptionists (who usually lack purchasing power in a corporate environment) be blamed for failing to increase productivity by 25%?

“Clearly defined duties are important, although at the same time people must be flexible/adaptable and not say ‘That's not my job.’ But where I work I feel like I can't win,” complains a puzzled MT. “There are many types of work that all must get done and I can't do it all. I try to make good decisions about what to do next, but it seems what I don’t do (as opposed to what I did do) is what always gets noticed.”

The Catch-22 described by this transcriptionist is an indication that management really doesn’t understand her work process, the rhythm of her work, and how each part of her work impacts the department’s productivity. Unfortunately, many managers use the team ethic as a bludgeoning tool for reprimanding workers as “bad team members.” Instead of unifying their team, they do a splendid job of undermining productivity by creating a hostile workplace and filling it with a resentful work force.

A much more insightful way to manage service employees is the theme of a PBS series called Back To The Floor. In these documentaries about the workplace, the camera follows the CEO of a major corporation as he spends time on the assembly line, learning firsthand from the workers how even the slightest improvements in their working conditions could lead to a better outcome for all parties. Because I have a particular fondness for ocean liners and have recently enjoyed cruises aboard Carnival’s Ecstasy and Holland America’s Zuiderdam

During his time at sea, Dickinson learned how hard a cocktail waiter must work in order to hustle drinks and earn tips. He also discovered how to make beds properly – and how your shift can be stretched out if guests stay in their cabins and you don’t get to finish all of your assigned rooms in time. An unexpected side-effect? Some maids don’t finish their duties in time to eat lunch and are forced to continue through a strenuous day without a single meal. After discussing the situation with one of the ship’s maids -- and not just asking for her input, but being able to empathize with her concerns -- the CEO realized that it would cost very little to keep the crew’s cafeteria open a little longer. And yet doing so could help solve a larger problem while improving staff morale.

What might the CEO of a large national transcription company learn by sitting in front of a computer and transcribing for a week? Oh, let’s see.

  • What it’s like to be penalized and humiliated for correcting stupid errors made by a dictating physician?

  • What it’s like to be told there is no work available during your shift and therefore you won’t earn any money that day?

  • What it’s like to sit there, waiting for the servers to come back on line so you can earn some money?

  • What it feels like to have burning pains between your scapulae from the tension of trying to concentrate on lousy dictation that has been made worse by poor acoustics?

  • What it’s like to have to rotate between 300-voice hospital accounts every day, preventing you from getting up to speed on a smaller set of voices?

  • What it’s like to spend an entire shift listening to the ESL doctor from hell?

  • What it’s like to struggle through 40 minutes of dictation from a physician with ants in his pants?

  • What it’s like to be told that, because of all these factors, you’ve missed your quotas and are no longer going to be eligible for healthcare benefits but can apply again in six months?

  • Last, but not least, after wading through all that crap – what it’s like to be told that you’re not a team player and you really need to improve your productivity!

I’m happy to offer this challenge to transcription supervisors as well as the owners, CEOs and Directors of any and all medical transcription services. Before you demand an increase in productivity from your transcriptionists, get down in the trenches with them and do some transcribing. Transcribe reports for three solid days. You’ll return to the Executive Suite with an earful of suggestions and some first-hand knowledge that you -- as their team leader --can implement in order to make your transcriptionists better team players.

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