Your Story (December 2012)

In this edition of Your Story we venture beyond the borders of the US to the land of Israel. For many, Israel has great religious and cultural significance. After reading this, you will also be impressed by the quality of audiology services provided to Israeli patients. I first meet Anat Kochva and members of her audiology team at a meeting in Europe a few months ago. I was immediately struck by her dedication to quality and service. As you read Anat’s story you will realize that quality starts with culture, process, high expectations and a personal dedication to excellence. Through her team’s dedication to the execution of best practice clinical protocol they have taken the enviable position of market leader in their country. Anat’s practice embodies quality in action.

AP: Please describe your clinics (how long have you been in business and how many locations).
AK: First allow me to introduce myself–my name is Anat Kochva. My practices are located throughout Israel. I was certified to practice as a speech and hearing pathologist in 1974. I worked in the public sector, mainly in hospitals and childrens’ special education institutions for 15 years. I opened the first Hedim clinic in 1989, and shortly after, more branches were added. Today we operate 17 clinics throughout Israel, offering high quality services all over the country. In all of our branches we offer the same services: speech therapy, various hearing tests, and hearing aid fittings. Practicing and specializing in hearing aid fittings is our leading activity in our branches. In addition, we operate three business units:
  1. Mobile teams, which provide weekly hearing tests and hearing aid services in over 15 elderly houses and day care centers for seniors.
  2. Mobile units, which conduct screening tests in factories and industrial locations.
  3. A laboratory, in which we build ear molds, ear plugs, assemble ITE hearing aids and fix hearing aids.
The company and all of its branches are directly owned and operated by the Hedim Institute, without any use of franchises. We currently employ about 175 employees, out of which about 110 are certified speech and hearing pathologists.

AP: What motivated you to open a business?
AK: I’ve always loved this profession, and pushed myself to provide the most thorough and highest quality service for my patients. The motivation for opening my own clinic rose from the frustration I felt while working in the public healthcare systems, in which I couldn’t provide my patients with the best fitting treatment, due to the system’s limitations. In my own clinic I set the work environment standards, as well as the equipment and service quality. I became the person directly responsible for both successes and failures in my patients’ treatment.

AP: What makes your operation one of the most respected in Israel?
AK: The Internet has changed the way hearing aids and our profession is perceived. Today’s patients are more astute and have come to understand that good hearing instruments (and service) are expensive. Believe it or not, price and cosmetics are not as much a factor as they were in the past. Of course, the patients have come to expect more as a result of the higher prices, but this is okay, because the quality and the size of the hearing aids is so much better, therefore, we can more adequately meet their expectations.

AP: Describe your training process when you hire a recently graduated audiologist.
AK: Each and every audiologist starting to work at Hedim begins with six months of performing various types of hearing tests under supervision and guidance. The training is on a weekly basis and performed by a senior audiologist at the branch in which the new employee started working. The goal of the training is to bring the young audiologist to a high level of integration ability between the medical information, the patient’s inputs, and the tests results. This will lead to developing the ability to get to the correct conclusions and make the best fitting for the patient. Only an audiologist that passes these base requirements can ask to advance to the next level of his or hers professional career – hearing aid education. It is important to note that audiologists’ academic education in Israel doesn’t incorporate enough knowledge and training to enable fresh graduates to provide professional service to patients with impaired hearing. Over time, and as the Hedim staff grew, I’ve built an internal training program dedicated to the hearing aid field. This program includes 120 hours of classes and practical workshops, in addition to personal clinical training which takes place at the specific branch in which the audiologist-trainee is employed. The personal training, which goes on for one year, is given at a minimum of two weekly training hours and covers all the processes and problem solving challenges an audiologist would face when treating a patient in the hearing aid field. At the end of the training program, the trainee would take a practical fitting process test, in which he would fit hearing aids to a new client. Only if the trainee reached a score higher than 80 (out of 100), is he allowed to practice unsupervised hearing aid fitting and treatment in Hedim. After passing the test and starting to work without direct supervision, the audiologist can always consult with fellow audiologists, either in his branch or at any of the other branches. Hedim’s employees act as each other’s professional and personal base of growth and success.

AP: Describe your clinical protocol. What tests and procedures do you complete on all patients?
AK: Before I describe our clinical protocol, I want to note that all procedures conducted at Hedim are assisted by the use of a management software which was created specifically for Hedim’s needs and with our assistance. Every stage of the clinical protocol is digitally documented, and there are several required steps if we want to place a hearing aid purchase order or issue a price quotation for a client. By using this process we make sure that vital information is present in the system and uniformed processes are used and kept throughout the company. For example, if a client previously treated at the Tel Aviv branch transfers to the Jerusalem branch, his digital medical file will also be available at the new branch, and he will continue to enjoy the same high quality service as before. In addition, the meticulous and detailed information filing creates a profound medical and legal foundation. An added benefit of this system is a large and reachable database, which holds the details and medical history of hundreds of thousands of hearing impaired clients. We’ll start the clinical process by getting to know the patient, his daily environment and activities. The question “Where do you experience hearing challenges?” will be asked at this point. We will make sure that we have gathered all the audiological information needed for the hearing aid fitting – a full clinical audiology test, which also includes speech defined MCL and UCL for speech, a four frequency tonal UCL test for each ear, speech understanding over noise at SNR+5 for each ear separately and for both simultaneously if possible. Additional tests, such as ABR and tympanometry are performed according to need. If the patient had hearing tests taken over previous years, we will ask to see the results in order to determine if this is a progressive hearing impairment.

We will follow this by performing a general evalaution with an emphasis on the patient’s medical history from an ENT physician. We will consider motoric abilities, vision impairments, skin issues, ear canal’s form and function, including ear wax and canal hair conditions (for men). According to the information we gathered, we will first pick the best fitting hearing aid shape, based on long term usage perspective, while considering various possible future changes in the patient ability to use the device. After this, we will pick the best fitting hearing aid technological level. We always aspire to fit both ears with hearing aids. However, if the patient is only interested in purchasing one hearing aid, we will take note of his reason in doing so. During the fitting process we will use every visual tool available to illustrate to the patient the reasoning behind our choices and suggestions.

We always encourage the patient to collect the hearing aids accompanied by a family member or a friend. After programming the hearing aids to a default mode we will always perform in Real Ear Measurements, including Speech Mapping, and will adjust the programming accordingly. We will provide all the needed operational training to the patient, and will schedule a follow-up appointment. We try to hold 2-3 follow-up appointments during the free trial first month, and if there is a need to change the hearing aids to a different model or technology level, we perform this as fast as possible.

AP: What does the term “best practices” mean to you??
AK: For me, the term “best practice” stands for believing in what you do, and to perform in the best and most professional manner possible. You have to be a dedicated professional, who constantly educates himself, keeps himself updated and constantly develops. As a business owner and employer I demand from my employees to constantly expand their professional knowledge, and provide training programs and seminars to all staff members, in order to equip them with the best professional tools, and enable them to provide the most professional service.