Vol. 12 •Issue 20 • Page 6
Management Q & A
Medical Transcriptionists Need Director’s Intervention
Q: Carla is the director of health information management (HIM) at a small rural hospital. She hired a medical transcriptionist (MT) to fill the fourth full-time position. One full-time MT works from home while the other two transcriptionists work in-house. Belle, who works in-house, is in charge of training the new employee, Agatha, who has approximately 20 years experience although not in a hospital setting. Agatha has worked in the department five months but has yet to have a one-on-one meeting with Carla.
Agatha has questioned Belle about a number of transcription policies, as well as hospital policy. Belle and her co-worker have answered Agatha’s questions to the best of their ability, but Agatha continues to make derogatory comments about the way things are done or she blatantly refuses to follow procedures. Belle, as Agatha’s trainer, has suggested she go to Carla with these issues. And, without trying to sound like a “tattletale,” Belle has also contacted Carla to let her know that Agatha has had questions of this nature. The MTs have tried to keep the lines of communication open with Agatha and Carla, and they have tried politely to explain the reasoning behind the policies and procedures that Agatha has questioned, yet there seems to be a breakdown of communication between Agatha, the new hire, and Carla, her immediate supervisor.
In addition, Belle continues to review Agatha’s work with her usual high standards but is greeted with angry sighs when Agatha has to make corrections. On more than one occasion, Agatha has questioned Belle’s judgment.
What additional action should Belle take? How should Carla handle this situation? Should there be a meeting between Carla and Agatha and/or a meeting for all transcriptionists with Carla?
A: Carla should meet with Agatha and review the policies and procedures. After completing the review, she should ask her if the policies are clear to her and if she has any questions or issues with the policies. Carla should also emphasize that Belle is instructed to implement these policies according to the strict rules of the hospital.
In addition, emphasis should be placed on attitude. When Belle, who is in charge of training, makes corrections or suggestions, Agatha should be more receptive to her. Belle should also remember to use words like “we do it like this” or “this is how we do it,” rather than “you did it wrong!”
If any of the above does not work out, then a counseling session should be set up with an ultimate probation period, if necessary.
–Gene Plascoff
A: Belle has been given responsibility without authority. This could be one of the possible reasons why Agatha’s attitude is not improving. Agatha’s morale may be adversely impacted because she doesn’t have the opportunity to interact with her supervisor. Additionally, because Belle is not officially the supervisor, it is not clear if her high standards are also the standards of the department or the industry in general. While the value of Belle’s excellence should be acknowledged and encouraged, there is a possibility that Belle is an extraordinary employee and that others may never reach her standards.
Most new employees, regardless of their position, organization, etc. need the opportunity to become integrated with their peers on their work team. This may be very difficult in this situation where a peer is providing training, feedback and guidance without the involvement of the supervisor. They also need to develop a relationship with their immediate supervisor to gain the necessary confidence in the progress of their orientation. New employees also need to obtain an understanding of how their work fits with the overall operation of the department and to feel valued.
Belle should consider approaching Carla with a new plan. Perhaps Belle could submit to Carla a list of the policies and procedures that Agatha has been struggling with, as well as a summary of Agatha’s progress to date. Additionally, she could offer to continue training Agatha with Carla’s involvement in the feedback process. Belle might suggest to Carla that she talk with Agatha to determine if she feels that her training program and experience are adequate. Training requires extreme patience and organizational skills. The timing, approach and delivery of feedback are critical to the success of the training effort and of the trainee. Also, personality types influence our ability and comfort-level in providing feedback to others, especially if we are introverted. Also, the trainee may perceive discussing opportunities for improvement as confrontational.
This is also a good opportunity for Carla to review her expectations with regard to performance (i.e., best practices, productivity standards, quality standards) with the entire team in a group meeting. Also, she could review the policies and procedures because there may be other MTs who have questions. If the MTs with the most tenure are comfortable doing so, they could help Carla with presenting the material for the meeting. Finally, the MT group would have the opportunity to express their opinions, offer suggestions and obtain clarification on any issues they may be thinking about.
–Beth Kost, RHIA
This Week’s Panel:
Gene Plascoff is a business office administrator (former HIM) for the University MRI and Diagnostic Centers in Boca Raton, FL.
Beth Kost, RHIA, is a chief compliance officer and vice president of professional services for Precyse Solutions in King of Prussia, PA.
