Take Note: Silent Type

Twenty-five years ago, registered nurse Marilyn Grebin started a business in the relatively new field of medical transcription services. With extensive knowledge of medical records and charts, several business management courses under her belt, and a typewriter, Grebin landed her first big client — Memorial Sloan Kettering Cancer Center.

The center gave her a boxful of tapes to transcribe and a week in which to do it. "In those days we had typewriters, so we had to type on one side of the page, then we had to flip the page over and type the reverse side of the page, and we weren't allowed to use any whiteout — no mistakes." Grebin built up her account roster and was soon able to hire employees to do the transcribing for her. Today Grebin's company, the Englewood, N.J.-based Silent Type, has 125 home-based employees across the country who have a setup similar to Jet Blue's remote reservation agents. The company has approximately 50 major accounts, including several New York City hospitals and Long Island's North Shore- LIJ Health System.

Silent Type may have started with the clickety-clack of a classic typewriter, but the company has been completely paperless for approximately 17 years. Doctors can record their notes into a handheld device or call into a voice mail–type service instead of sending tapes, and the digital file is automatically uploaded to a server. Grebin's employees access the server, transcribe the notes and post them to secure Web channels for the hospitals. While they used to have days to transcribe tapes, many jobs now require a 24-hour, or even 10-hour, turnaround time. Despite the 21st-century pace and cutting-edge technology, Grebin still relies on some tried-and-true techniques for managing her staff successfully.

"A lot of companies in my industry have sent things offshore to India, Pakistan, Trinidad and other countries, but we don't," says Grebin. "I'm kind of a patriot and I believe as long as we can find people that can do the work here in the United States, I don't want to send work offshore." The company is able to stay competitive with offshore resources by maintaining costs and making sure that each employee is efficient. Transcribers who work for Silent Type work out of their homes and get paid by production instead of by salary or hourly. Each employee has a minimum amount he or she must type in order for the company to maintain its promised turnaround times. "The scale goes higher the more they type, so it begs [employees] to be more efficient because they can make more money," says Grebin. "If people in this business tell you that they're not making any money, they're just lazy." In order to give employees the opportunity to earn as much as possible, the company avoids overhiring. "In my industry, because it's a cottage industry where people work at home, companies will hire 10 people to do the job of six people," says Grebin. "What happens in that case is, the good employees log on in the morning and there's no work — they're fighting over work. Then [employees] can't meet their bills and they can't make their wage. And when they're not meeting their wage, they leave."

Efficiency is based on quality as well as quantity, and Silent Type's error rate is 0.3%, whereas the industry standard is 2%. The company has a quality assurance department to review all documents. Employee performance is reviewed monthly and biannually and bonuses are given based on quality. "We do everything based on production, and it behooves the employees to keep their quality level [high] because their bonus is tied to it," says Grebin.