Turnaround is not a single number
Vendors love a headline: twelve-hour turnaround, next-morning delivery, STAT in four. A clinic lives in exceptions. A file sent at 5:02 p.m., a file sent at 11 p.m., a STAT that was not labeled STAT, a letter that is three pages, a progress note that is forty seconds. If your SLA is one number for all of that, you do not have an SLA. You have a brochure. Split turnaround by document type and by clock. Overnight progress notes are not the same promise as a same-day operative report.
Name what happens when the promise is missed. A credit, a callback, a re-priority, or nothing. Clinics that skip the nothing option discover it during a Monday of unsigned visits. You do not need punitive theater. You need a defined response so your staff are not improvising. Medical audio transcription is a production line. Production lines have queues. Queues overflow. The SLA should describe overflow, not pretend it cannot occur. If a salesperson cannot explain a bad night, they cannot staff one.
Clock start, clock stop, and overnight reality
Agree when the clock starts: completed upload with identifiers, or first byte of audio, or when a human assigns the file. Agree when it stops: available in the portal, filed in the EHR, or sitting in an inbox nobody watches. Overnight work is especially slippery because 'morning' means 6 a.m. to one administrator and 10 a.m. to a vendor in another time zone. Put the time zone in the SLA. Put business days in the SLA. Put holidays in the SLA. Ambiguity is how a 7 a.m. clinic starts with empty charts.
Incomplete files should pause the clock or travel a separate path. Inaudible audio, missing patient identifiers, and clipped endings are not the vendor's creative-writing assignment. They should bounce to a named clinic contact with a time stamp. If they sit silently until the turnaround expires, both sides will argue about a file that was never transcribable. Build that bounce into the overnight process. Someone at the clinic must be reachable or must accept that bounced files wait until morning. Choose that. Do not assume a transcriber will guess the missing name correctly at 2 a.m.
Accuracy clauses that mean something
Speed with wrong laterality is not a win. If you bother to write an SLA, include an accuracy definition and a correction path. Sunrise states a 99.8% accuracy standard for human-reviewed transcription. Whatever number you accept, define how it is counted, on which documents, and how disputes are sampled. A percentage with no method is marketing. Require that corrections are acknowledged and that repeated errors update a glossary. An overnight team that never hears about Monday's misses will give you the same miss on Tuesday, faster.
STAT should mean a human is interrupted, not that a label is applied. Limit who in your clinic can mark STAT or you will have no overnight capacity, only a queue of fake emergencies. Procedure notes that unlock the next day's OR may deserve it. A routine follow-up dictated at 10 p.m. because the clinician was tired may not. Put examples in the SLA. Then price STAT honestly. If everything is STAT, you are buying panic. Per-line pricing plus a STAT surcharge is easier to audit than a flat seat that hides the panic.
Coverage when volume spikes
Flu weeks, snowbird seasons, and a partner who returns from vacation with a recorder full of files will break a roster sized for an average Tuesday. Ask how the vendor adds reviewers overnight without dumping your cardiology files on a stranger. A trained float pool is an answer. A public marketplace is a different answer. You are allowed to prefer the first. You are allowed to require U.S.-based processing during spikes, not only during calm. Spikes are when people cut corners. The contract should not permit a geographic surprise because the queue got long.
Give the vendor a heads-up when you can. A clinic that knows locums start Monday can send templates on Thursday. A clinic that dumps three times normal volume into the portal at 6 p.m. with no warning will get what a surprised night shift can do. Reciprocity belongs in the SLA: you will forecast known spikes, they will maintain surge capacity, and both of you will talk if a surprise storm hits. This is operations, not sentiment. Physician transcription quality on a bad night is the actual product. Anyone can look accurate on a light Wednesday.
How to write an SLA a clinic can actually use
Keep it to a few measurable promises: turnaround matrix, clock definitions, accuracy and correction path, STAT rules, spike coverage, and where PHI is processed. Add the BAA as a condition of sending files, not as a footnote. Assign an owner in the clinic who reads the monthly exception report. If nobody reads it, you do not have governance. You have a PDF. Review the SLA when a specialty is added or when you change capture methods. A phone-dictation SLA and an app-upload SLA may need different clock starts. Write that down once.
Then test it before you need it. Send a labeled STAT. Send a file with a missing identifier. Ask what the portal shows at 6:05 a.m. after a 7 p.m. upload. Keep the emails. A vendor who performs in that drill will usually perform in January. A vendor who resents the drill will resent your flu week too. Overnight transcription is a trust exercise with time stamps. Make the stamps explicit. The rest of the relationship is secondary to whether the right note is on the right chart before the first patient.