Changing Times Require Bold Experimentation

Author: Brian Taylor, Au.D.

Joseph Schumpeter, one of the most influential economists of the 20th century said, “All established businesses are standing on ground that is crumbling beneath their feet.” His quote laconically summarizes an important concept for any business: As the world changes and new technology emerges, someone waiting in the wings will use that technology to build a more successful business that will eventually replace yours. There is no shortage of articles and books in the popular press that carry forth this “change or die” mantra. The questions for me are these: Who is going to lead the change in our profession and how are they doing to do it?

If the profession of audiology is to thrive over the next generation, it is up to the independent, entrepreneurial audiologist to lead the charge through bold experimentation of new ideas and emerging technologies. When you look around there is no other group within the industry equipped to do this. Universities are too burdened by fossilized bureaucracy to lead. Big box retailers and chains are all too happy to enjoy the fruits of their incredible operational efficiency under their currently very successful business model. Hearing aid manufacturers and national buying groups with their large margins lack the incentives to keep pace with looming disruptions in the marketplace. Thus, it is the independent, entrepreneurial ADA member left to take the reins of change. Here are four ways ADA audiologists can boldly conduct small experiments that can be scaled to meet the needs of other independent audiologists around the world. The ground beneath our feet may be crumbling, but it can be replace be fertile soil tilled by us.
  1. Attract Younger Patients into the Fold
    As Figure 1 clearly suggests, many individuals notice hearing loss at a young age, but very few seek the advice of an audiologist until much later in life. Entrepreneurs must find ways to get patients between the ages of 40 and 60 engaged in the process of self-monitoring their hearing and equating good hearing with a vibrant and healthy lifestyle.
    Figure 1. This chart shows the age at which hearing loss begins, based on subjects' report of any permanent hearing loss, with percentage distribution by sex (gender) and age. Source: National Health Interview Survey, 2007. Chart created by the NIDCD Epidemiology and Statistics Program. Updated in November 2012.

    The importance of individuals to self-monitor their hearing using smartphone apps. Spread the word in your practice that self-monitoring of hearing is a positive behavior that leads to a higher level of awareness.

    Messages that don’t remind non-users that they are old and impaired, but does inform them that “mishearing” is a strain-on-the-brain, and you help them sort out their options. Actively seek out advertising agencies that are willing to offer you a fresh, daring images consistent with this message.

    Images that equate good hearing with full participation in meaningful activities and leading an active lifestyle. “Early intervention = earlier restoration of hearing.”

    Messages that convey your practice offers comprehensive care from womb to tomb. Examples of the comprehensive care include hearing screenings, community-based aural rehabilitation and personalized counseling services.

    Although most of us think of hearing loss as a disorder of the aged, the data in Figure 1 strongly suggests that hearing loss is a condition of all ages. Notice that the majority of individuals who suffer from hearing loss first notice the condition well before the age of 50.

  2. Build bridges to the primary care physician community According to a recent AARP survey of their members, 65% of adults are likely to talk with their family physician about their hearing. This represents a huge opportunity to connect with physicians and educate them about all of the consequences of untreated hearing loss and the co-morbidities associated with it.. Given the fact that 88% of individuals over the age of 50 have received a vision test in the past five years, and only 43% have received a hearing test in that same time frame, there is incredible opportunity to capture more leads for your customers through fresh messaging and physician referrals. Figure 2 is an example of consistent communication message of hearing loss as a public health concern that can be shared with this important group of stakeholders. Boldly experiment with social media, face-to-face communication, newsletters and e-mail in your practice to see how PCPs can become more effectively engaged in the Better Hearing is Better Living movement.
    Figure 2. Better Hearing is Better Living newsletter

  3. Embrace the shared decision making model of patient-provider interaction Healthcare providers of all stripes, including audiologists, recognize that patients have access to an abundance of information via the web and social media. This means that hearing impaired patients are fairly well informed about their choices before they see a provider. Because of these changes healthcare providers must change from their top-down, paternalistic approach to one in which the patient and provider collaborate and share in the decision making. Oftentimes audiologists in private practice are so busy trying to help their patients that they fail to see opportunities for change.

    • Administration of Dr. Linda Thibodaux’s TELEGRAM (or similar) needs assessment tool allowing patients to self-rate their hearing ability in more than a dozen listening situations. This is a far more collaborative and comprehensive approach to the needs assessment process compared to traditional procedures.

    • Use of solution-based interviewing questions that put the focus on the necessary behavior change of the patient, rather than the disorder itself. Independent audiologists are encouraged to learn more about solution-based interviewing, in the meantime, however, you can get started by simply asking one scaling question: “On a scale of 1 to 10, 1 being great difficulty and 10 being no difficulty, how would you rate your hearing ability?” The answer to this question allows you to segment your patients based on their perception of the problem and deliver a more customizable solution.
    • For those patients who answer the scaling questions somewhere between 5 and 8, consider sending them home with a real-world demonstration of amplification. Currently, there are devices on the market allowing you to conduct at-home trials of various levels of technology are assessable through a single device. For patients answering the scaling question with a 9 or 10 response, experiment with smartphone apps that provide situational application, as this may hasten their journey to more conventional treatments.

    • Experiment with patient journaling as a way to heighten the patient/provider relationship. Journaling can be used to engage the patient in a more interactive means of assessing outcomes.

    • Boldly experiment with hearing test apps that allow the patient to self-monitor their hearing. For example, there is an app called uHear that enables patients to measure their acceptable noise level, thus saving you time in the clinic. This ANL score can be used to guide the hearing aid counseling and selection processes.

  4. Sell service packages, not devices As hearing aids becomes more and more commoditized, it is imperative for audiologists to recognize the value of their service offerings and charging for these professional services accordingly. Over the past few years, a minority of judicious audiologists have begun to decouple the fees for services from the device itself. Audiologists are encouraged to experiment with various types of itemized service packages in their practice, like the one shown in Figure 3.
    Figure 3. An example of service package using itemized bundling.

    Pick One
    The private practice owner and ADA member is the best equipped individual within the profession to provide the fresh ideas and bold experimentation required to ensure that when the ground beneath our feet crumbles, the entire audiology profession doesn’t crumble with it. Furthermore, entrepreneurial audiologists are encouraged to share the outcomes of their bold experiments with new technology and ideas in Audiology Practices. Let the experiments begin!