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10 Lessons From Our First 10 Years

Smith, Joanna T. MS; Wolfe, Jace PhD

doi: 10.1097/01.HJ.0000515655.50235.9e
Tot 10

Dr. Wolfe, left, is the director of audiology at Hearts for Hearing in Oklahoma City and an adjunct assistant professor at the University of Oklahoma Health Sciences Center and Salus University. Ms. Smith, right, is a founder and the executive director of Hearts for Hearing.



Ten years ago, a team of 20 professionals left the security of a tertiary hospital and took a leap of faith to establish Hearts for Hearing in Oklahoma City, with the goal to create life-changing opportunities for children and adults with hearing loss. With the help from many supportive donors, charitable foundations, manufacturers, and a committed team of professionals with a passion to succeed, Hearts for Hearing was launched in January 2007. No sooner did we realize that we had a lot to learn if we were going to build an organization that would stand the test of time and influence the lives of people with hearing loss.



Ten years later, in November 2016, we moved into a new $10 million state-of-the-art facility that now reflects the quality of the care provided, as well as the research being conducted by our capable and committed employees. The original team of 20 has grown to a staff of 38, and we continue to learn and serve patients and their families who make us better every day. In celebration of our 10 years of service, we share some key takeaways from our experience. A special note of thanks to Teresa Caraway, PhD, co-founder of Hearts for Hearing, for her vision and leadership, as well as R. Stanley Baker, MD, and Mark Wood, MD, who recognized and continue to validate the value of our work.



1. “Why” trumps “what.” None of the 20 professionals who joined Hearts for Hearing in 2007 had degrees in business, leadership, or finance. Instead, we all spent many years and dollars to obtain graduate degrees in speech-language pathology and/or audiology. We became students of leadership by seeking counsel from wise and successful business leaders both locally and nationally. Simon Sinek was one of those leaders who significantly influenced our work. In his TED talk, “How Great Leaders Inspire Action,” he uses his “Golden Circle” model to explain how great leaders inspire action by focusing on why instead of what or how we do our work. We are convinced that our patients and their families don't care so much about what or even how we operate. At Hearts for Hearing, the “why” drives our work. The meaning and power of what we do inspire us to continue to use every available tool to create life-changing opportunities for children and adults with hearing loss to listen for a lifetime. When we focus on this heartfelt and constantly motivating purpose, all the equipment, products, processes, and services we provide either make sense or not. Our “why” is the foundation of our decision-making process. Our actions and investments—whether financial or emotional—are all geared toward the goal of helping our patients with hearing loss.



2. Work ON and IN the business. Another important takeaway is the importance of intentionally “working on the business” rather than just “in the business.” During our first few years of operation, many of us needed to be in the clinic to do the things we were trained to do. There is always work to be done, and we were always busy doing it. Later on, we were challenged to discipline ourselves to “work on the business,” specifically on the areas of teamwork, finance, processing systems, and patient management. We sought to answer the question, “What does success look like five years or even 10 years from now?” Working on the business means our employees function as a team to build “future facts,” which are word pictures of how things should work at the clinic. This simple tool helps us make choices about how to spend our valuable and limited resources to accomplish meaningful tasks. Future facts serve as a compass to keep us on course. For example, if an opportunity arises but it does not help us meet the future facts we've established, then we would graciously decline. The future facts developed by each team member also help each one know if he or she is doing something that could be done by someone else, and if the future fact can perhaps work for another team member.

3. The rules of the game: BAM. Most of us are familiar with Maslow's Hierarchy of Needs, which lists the first level of need (physical) such as air, water, and food, and the second level of safety and security. In the work setting, physical needs are most often satisfied through a paycheck, while safety needs are usually addressed by having a safe working environment with benefits like health insurance. Beyond these needs, however, Maslow said that people work for Belongingness, Affirmation, and Meaning, or BAM. At Hearts for Hearing, this meant that as we were establishing the rules of the game, we needed to make sure that the staff, patients, and their families felt part of something bigger than themselves (belongingness), individual contributions were recognized (affirmation), and the work we do has greater significance (meaning). For stakeholders, whether a donor, employee, or patient, to be engaged, they must feel that they are a part of something significant, receive affirmation for their contribution, and produce something of value.

We utilize BAM stories to affirm stakeholders in our bi-weekly Huddle meetings, weekly therapy appointments, and parent group activities. Our outcomes are better when employees want to belong, when there are many opportunities for affirmation, and when our work is drenched in life-changing purpose.

Salary is important, but the power of BAM has been powerful in our efforts to engage the staff in serving our patients better. Some examples of BAM at work is affirming the receptionist for the way she greets the clients and helping an audiologist who lost everything in a horrific tornado.

4. Develop home grown professionals. Our professionals are our most valuable resources. Considering there is a shortage of pediatric audiologists and Listening and Spoken Language (LSL) professionals, one of the most effective ways we have learned to build a “cream of the crop” staff is to offer fourth-year externships for audiology students and practicum experiences for speech-language pathology graduate students. We were able to attract some of the strongest young professionals in the field by “dating” for a year to get to experience the culture and best practices at Hearts for Hearing. Over the past five years, we have accepted fourth-year audiology interns from the University of Oklahoma, University of Texas at Dallas, University of North Texas, Illinois State University, Texas Tech University, and Vanderbilt University. Although it is a great deal of work for the staff who coordinate these experiences, all our audiology hires have just completed their fourth-year externship, and most of the speech-language pathologists were hired after completing an internship in our program. This gifted cohort of young professionals is positioned to be future leaders in the field.

5. Good is the enemy of great. Jim Collins, in his best-selling book Good to Great, states that “good is the enemy of great, and that is one of the key reasons that we have so little that becomes great.” At Hearts for Hearing, we do not settle for good outcomes. Instead, we seek to maximize our resources to achieve excellent listening and spoken language outcomes. With every patient, task or project, we challenge each other: “Could we have done better or worked harder?” The answer should never be “yes” because if it is, our job is not finished. Success can sometimes bring complacency, so it is important to always strive for improvement. Carol Flexer frequently stated that families seeking information about hearing loss “do not seek our best 2001 opinion; instead, they deserve our best 2017 opinion,” and unless we are willing to do the work to excel, patients may still be getting an opinion from 2001. At Hearts for Hearing, we study and discuss research articles. The director of research shares recent updates with the team so our patients and their families can trust us to provide them with the latest information for the best listening and spoken language outcomes.

6. Better together. One of the most powerful tenets of the work at Hearts for Hearing is the way that we collaborate to support our young patients and their families. Over half of our appointments are scheduled with both a pediatric audiologist and a speech-language pathologist (LSL Cert. AVT). Having both professionals working together gives patients and their families more resources to help them understand the impact of hearing loss on the development of speech-language skills. This model poses financial challenges as insurance reimbursement is complicated when more than one professional is present during an appointment, but the why of our work is so powerful that we have identified partners whose donations allow us to continue with this model of service delivery.

Additionally, when collaborative support is provided, more information can be gathered in less time, thereby offsetting the cost of having two professionals working together. In this set-up, a speech-pathologist who hears changes in speech production can immediately consult with the pediatric audiologist, who may then adjust the hearing aid or cochlear implants. Having an additional set of eyes and perspective has been welcomed by our patients’ families, and it has made us better in our specific roles.

7. Listening is our business. As pediatric audiologists and speech-language pathologists, we teach others to listen and talk. Communication is our sweet spot, yet when problems arise with a growing staff, it is often because of a breakdown in communication. If those who are involved are unwilling to talk about the issue, the problem usually gets worse. In a previous article in The Hearing Journal, we shared that our success is directly proportional to the number of difficult conversations we are willing to have. Unfortunately, people tend to avoid talking to people with whom they have issues.

Realizing that anger and frustration are the result of unfulfilled expectations, we, at Hearts for Hearing, hold each other accountable for communication issues. We acknowledge that we must be better listeners by actively engaging with each other, even in difficult conversations. As Stephen Covey wrote, “We must seek to understand before being understood.” It takes practice and discipline to be fully present, such as keeping cellphones out during staff meetings. But as we learn to actively listen, we get even more opportunities for belongingness, affirmation, and meaning.

8. Embrace difficulties. There have been some hard times in our first 10 years, and there will be more. We have learned as much, or more, from the most difficult days as we have from the best. The downturn of the U.S. economy in 2008-2009 affected the organization financially, changing our trajectory significantly. We were also forced to change key leadership positions and reduce the staff. Yet, during this difficult time, our “why” trumped the “what,” as the team explored creative ways to diversify our revenues, reduce expenses, and invite partners in the community to step up in new ways.

Confronting the brutal facts, whether they be financial or personnel issues, is the only way to generate solutions. Addressing these issues opens an excellent opportunity to identify whether these are truly problems that need to be solved or tensions that need to be managed. Tensions are necessary for a healthy organization, and are often manageable. They can be tensions of quality vs. cost, work-life balance, autonomy vs. teamwork, and of course, income vs. expenses. At Hearts for Hearing, we believe that team members should be familiar with the tension of the organization's finances by offering financial literacy opportunities where everyone can offer solutions. Some of the best solutions for generating additional revenue and cost-cutting have come from those who have just learned about the tension. We seek to maintain a culture of solutions.

9. What gets measured gets done. Without measurement, improvement or failure is just a feeling. Without measurement, we may not know whether we are winning or losing, moving toward a solution, or making a problem worse. In the field of speech and hearing, it seems that we measure just about everything to document progress. It is important to measure the right things to get the right things done. For example, because we depend on charitable donations to provide quality care, it is important for us to properly manage donor dollars. To reduce the number of missed appointments, we track those appointments to determine their impact on our investment of energy, time, passion, and resources. Notably, we need to monitor the items to be measured as people, situations, and technology constantly change.

In Oklahoma, where football is a big deal, the first thing a fan likely does when watching a game late is glance at the scoreboard. In our practice, we recognize the importance of creating a scoreboard for the organization so that each one knows where he or she stands on all the items the team has determined as important to measure. Competitive? Perhaps. Yet, competition is healthy when the scoreboard indicates good performance. Certainly, poorly conceived scoreboards can be discouraging, but creating purposeful and meaningful scoreboards has proven to be important in successfully allocating our resources. The use of scoreboards has also been an invaluable tool for promoting BAM and uniting our team to share their talents and abilities while working toward a common goal.

10. Create a culture of gratitude. Gratitude generates generosity. Andy Stanley, in a leadership podcast, highlights the power of gratitude: “Unexpressed gratitude is the same as ingratitude.” While we recognize the members in our organization who always show gratitude, we have become increasingly focused on taking time to thank those who help us achieve our goal. Expressing gratitude also promotes belongingness, affirmation, and meaning. Our yearly, hand-written thank you notes have resulted in generating almost double the donations we get from a previous year. Gratitude generates generosity. People are motivated by authentic words of gratitude, and the cumulative effect of abundant gratitude in the workplace is transformative. For example, we find that it is important to thank our team and celebrate the organization's achievements in the past year. Although these celebratory days can be expensive, the return on the investment far outweighs the cost.

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