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Industrialized world‐based healthcare providers are increasingly off‐shoring low‐end healthcare services such as medical transcription, billing and insurance claims. High‐skill medical jobs such as tele‐imaging and tele‐pathology are also being sub‐contracted to developing countries. Despite its importance, little theory or research exists to explain what factors affect industry growth. The article's goals, therefore, are to examine economic processes associated with developing economies' shift from low‐ to high‐value information technology enabled healthcare services, and to investigate how these differ in terms of legitimacy from regulative, normative and cognitive institutions in the sending country and how healthcare services differ from other services.

This research is conceptual and theory‐building. Broadly, its approach can be described as a positivistic epistemology.

Anti off‐shoring regulative, normative and cognitive pressures in the sending country are likely to be stronger in healthcare than in most business process outsourcing. Moreover, such pressures are likely to be stronger in high‐value rather than in low‐value healthcare off‐shoring. The findings also indicate that off‐shoring low‐value healthcare services and emergent healthcare industries in a developing economy help accumulate implicit and tacit knowledge required for off‐shoring high‐value healthcare services.

The approach lacks primary data and empirical documentation.

The article helps in understanding industry drivers and its possible future direction. The findings help in understanding the lens through which various institutional actors in a sending country view healthcare service off‐shoring.

The article's value stems from its analytical context, mechanisms and processes associated with developing economies' shift to high‐value healthcare off‐shoring services.

The issue of offshore outsourcing of healthcare services is a critical but little‐examined problem in healthcare research. The purpose of this study is to contribute to filling this void.

A library‐based study was carried out of the development of the Indian medical transcription offshoring industry.

Cost‐saving potential and the degree of outsourceability are higher for medical transcription compared with most services. Offshoring experience, typically in a low‐value BPO, helps to enhance productivity and international linkages required for the success of medical transcription.

An important area of future research concerns comparing India's factor endowments in medical transcription outsourcing with other services. Further research is also needed to examine how India differs from its regional competitors in terms of factors endowments associated with these services. Another extension would be to investigate the drivers of offshoring of higher value services such as radiological readings.

ICT infrastructures needed for outsourcing require much less investment compared with leading capital‐intensive industries. The development patterns of the Indian medical and offshoring industries indicate that India may attract higher skilled medical functions in the future. The Indian offshoring industry is shifting its focus from BPO to knowledge process outsourcing (KPO). Developing countries need to shift to greater automation and greater levels of skill training to retain and reinforce their comparative advantages.

This paper's greatest value stems from the fact that it examines the drivers of a new but rapidly growing healthcare industry.

The purpose of the paper is to determine the instance of errors made in physician dictation of medical records.

Purposive sampling method was employed to select medical transcriptionists (MTs) as “experts” to identify the frequency and types of medical errors in dictation files. Seventy-nine MTs examined 2,391 dictation files during one standard work day, and used a common template to record errors.

The results demonstrated that on the average, on the order of 315,000 errors in one million dictations were surfaced. This shows that medical errors occur in dictation, and quality assurance measures are needed in dealing with those errors.

There was no potential for inter-coder reliability and confirming the error codes assigned by individual MTs. This study only examined the presence of errors in the dictation-transcription model. Finally, the project was done with the cooperation of MTSOs and transcription industry organizations.

Anecdotal evidence points to the belief that records created directly by physicians alone will have fewer errors and thus be more accurate. This research demonstrates this is not necessarily the case when it comes to physician dictation. As a result, the place of quality assurance in the medical record production workflow needs to be carefully considered before implementing a “once-and-done” (i.e. physician-based) model of record creation.

No other research has been published on the presence of errors or classification of errors in physician dictation. The paper questions the assumption that direct physician creation of medical records in the absence of secondary QA processes will result in higher quality documentation and fewer medical errors.

The purpose of this paper is to examine the factors that influence training decision making in small and medium enterprises (SMEs) in India's IT‐enabled business process outsourcing industry.

The research strategy employed is a case study. Data from semi‐structured interviews, organizational documents, and non‐participant observation are analysed.

The inclusive theoretical approach uncovers novel explanations through the complex interaction that occurs between various internal and external factors that shape the nature and extent of training provision in SMEs in the context of a developing country. In SMEs, enterprise training can take a variety of forms – formal, informal, and incidental. The final training provision is shaped by high employee turnover, the complexity of the process, client specifications, and the presence of certain organizational capabilities.

Although a multi‐case embedded design was followed, the results and findings cannot be generalized to a wider population. Findings are generalized to the literature on the drivers of training.

The paper's findings allow practitioners to utilize scarce resources effectively, particularly for where SMEs are operating in a dynamic outsourcing environment.

This paper extends the current academic and policy discourses on formal and informal training in SMEs by reporting findings from a new context – India's dynamic outsourcing environment. Novel explanations are offered of how SMEs that outsource business process offshore meet their skill development needs.

Human resource development/management and change management, leadership, entrepreneurial development and indigenous innovation.

The case is suitable for final year undergraduate human resource development/management, change management, indigenous innovation, or specialist HRM Master's program (strategic HRM/HRD) students.

The case study highlights the challenges of managing change and growth in India's dynamic business process outsourcing sector. The choice of a small organisation brings to the fore the impact of the strategic decisions owners of capital place on managers as they address issues of sustained growth to support short-term expectations of shareholders. The case highlights India's indigenous approach to frugal innovation or jugaad (finding a creative and improvised work around); how a group of managers consistently reinvented the business model and human resource management practices to stay afloat and meet shareholder expectations.

Depending on the teaching programme and the emphasis of this case in the class, one or more of the following learning outcomes (LO) can be achieved from this case study. These LO have been developed using Bloom's taxonomy and they progressively move from simple to complex LO. Following the case analysis, students should be able to: discuss the key challenges faced by Transcribe and Tally (T&T); identify and analyse the various influences of internal and external factors on training provision; understand the importance of an external network of service provision and identify the key training and organisational capabilities; analyse the dynamic interactions between the various factors and training provision; analyse the relationship between T&T's competitive strategy and its strategic choices (make versus buy) towards investing in training; evaluate the role of training in developing organisational capabilities; and strategize a way forward for Roy Thakur.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety.

The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored.

The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes.

FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions.

FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type.

The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.

Measurements of the quality of physician‐patient communication are important in assessing patient outcomes, but the quality of communication is difficult to quantify. The aim of this paper is to develop a computer analysis system for the physician‐patient consultation process (CASC), which will use a quantitative method to quantify and analyze communication exchanges between physicians and patients during the consultation process.

CASC is based on the concept of narrative‐based medicine using a computer‐mediated communication (CMC) technique from a cognitive dialog processing system. Effective and ineffective consultation samples from the works of Saito and Kleinman were tested with CASC in order to establish the validity of CASC for use in clinical practice. After validity was confirmed, three researchers compared their assessments of consultation processes in a physician's office with CASCs. Consultations of 56 migraine patients were recorded with permission, and for this study consultations of 29 patients that included more than 50 words were used.

Transcribed data from the 29 consultations input into CASC resulted in two diagrams of concept structure and concept space to assess the quality of consultation. The concordance rate between the assessments by CASC and the researchers was 75 percent.

In this study, a computer‐based communication analysis system was established that efficiently quantifies the quality of the physician‐patient consultation process. The system is promising as an effective tool for evaluating the quality of physician‐patient communication in clinical and educational settings.