Audiologists have a window of opportunity, before over-the-counter (OTC) hearing aids hit the market, to add value to their patient offering and differentiate their practices. This opportunity comes in the form of patient-centered care, a model employed by top physicians and health plans. In patient-centered care, audiologists configure their offering around the patient's goals. The result: strengthened bonds with patients and more profitable practices.
Goals are a keystone of patient-centered care. These are specific to each patient and mutually set by the provider and patient, indicating a shared understanding. “Health and medical goals are highly individual,” said Jessica Briefer French of the National Committee for Quality Assurance (NCQA). “People's engagement in setting goals improves not only their participation in treatment but also their health outcomes and quality of life.”
Million Hearts®, an NCQA partner initiative, seeks to prevent a million heart attacks and strokes by 2017 by coaching patients on blood pressure and cholesterol management. The best cardiovascular outcomes thus far are for patients whose physicians and health plans have embraced patient-centered care. These practices and plans organized care “around a patient's goals and circumstances” (NCQA, 2014 http://bit.ly/2nhCQ84).
Does this approach apply to audiology? Certainly. Hearing loss, like heart disease, is a complex, chronic condition. Research shows that techniques such as direct questioning and heavy persuasion are not effective in managing patients with chronic conditions. In fact, a lack of understanding of the patients’ needs frustrate patients and clinicians alike (American Diabetes Association, 2006 http://bit.ly/2nhve5s).
“While goal setting in health care is common sense,” said Briefer French, “It is anything but commonplace.” In the face of OTC hearing aids, audiologists have a meaningful opportunity to experiment with goal-setting techniques from patient-centered care.
MEET THE PATIENT CASES
Every patient who walks into an audiology practice has needs, although some patients are better at articulating them than others. Consider the following actual patient cases. (Only names and a few identifying details have been changed.)
Alicia is a marketing executive in a small company, married, with two teenaged sons. At work, she struggles to hear clients on speaker phone. Her hearing loss is moderate. On vacations, she and her family used to ride bikes, until Alicia switched from in-the-canal hearing aids to receiver in the canal (RIC) and was beset with the unbearably loud sound of wind gusting in her hearing aids. “Cycling was the one sport that we all agreed on!” she reminisces. “Biking together was great for family harmony.” During checkups, her audiologist focuses on Alicia's work environment, neglecting to discuss sports. Alicia has incorrectly assumed that cycling is a casualty of her hearing loss.
Steven is a modern art dealer who is 72 but looks 10 years younger. His hearing loss is mild. He has a passion for squash and often hosts clients at his club. He attributes his success in the art world to not only providing exceptional service but also the youth he projects. Although he strains to hear during dinners at the club, he is fearful of trying a hearing aid. “I'd rather lean my ear close to someone and say ‘what’ repeatedly than wear a hearing aid,” he exclaims. “Also,” he adds with a boyish grin, “I'm dating.” Any hearing aid he wears, even on a trial basis, must be invisible.
Both Alicia and Steven have multiple and intertwining needs. To address these, here's a step-by-step process of eliciting patient goals.
STEP 1: UNDERSTAND PATIENTS’ DESIRED LIFESTYLE
The first step occurs during the initial consultation and hearing test. The objective is to understand how the patient's hearing loss interacts with his or her desired lifestyle. Audiologists may initiate the discussion with, “Do you mind if I ask you a few personal questions?” and then proceed to ask a couple of the following:
- “What are some of the biggest challenges you experience from your hearing loss?”
- “If you didn't have hearing loss, how would you live your life differently?”
- “What might you worry that you need to give up if you were to wear hearing aids?”
- “How might hearing aids prevent you from living a full and satisfying lifestyle?”
Audiologists should gently probe for additional details and reflect their understanding of patients’ needs by summarizing what they've heard. They may tactfully steer the conversation if the patient veers off-topic. One indicator that the interaction has been successful is that the patient does a lot of the talking.
This patient-centered discussion, catalyzed by open-ended questions, draws out the patients’ full set of needs. In addition to earning rapport and a foundation of trust with the patient, the audiologist is now equipped to recommend the most suitable hearing aid.
In Alicia's case, her audiologist would realize that Alicia needs to hear well not only at work but also during those treasured bike rides with her family. A program to minimize wind, protective hearing aid sleeves to shield the microphones, or an in-the-canal aid would be options when Alicia is ready to upgrade.
As for Steven, his audiologist must comprehend both his profound hesitation in wearing hearing aids due to stigma and his love of squash. The logical choice would be a water- and sweat-resistant, invisible-in-canal (IIC) aid.
STEP 2: FORMULATE GOALS
The second step occurs when the patient is fitted with new hearing aids. The objective at this point is to transform the patient's stated needs into concrete goals. The audiologist should establish one to three goals for each patient, and if the goals diverge, work with the patient to set priorities.
The empathetic mode of conversing with the patient described in Step One—questioning, asking permission, and summarizing—continues to be useful for this step. In Alicia's case, the audiologist would seek agreement by saying, “With your permission, I'd like to note that wearing the hearing aid while cycling is an important goal for you.”
With the patient's top goals articulated and documented, the audiologist now has an effective point of leverage during the patient's critical transition period to hearing aids, as explained in Step Three.
STEP 3: FOLLOW-UP
The last step takes place during follow-up conversations with patients. Ideally, patients with new hearing aids would receive a call from a care coordinator within 24 hours of leaving the office, then periodically afterwards. These follow-up conversations should center on how well the new hearing aids are helping patients achieve their goals. In Steven's case, for example, the care coordinator might ask the following:
- “We documented that one of your top goals is to wear the hearing aid while playing squash? How is that going?”
- “You also established a goal to wear the hearing aid during dinners at the club. Have you managed to wear the aids in that setting? Are they helping you to hear better?”
Patients will be far more likely to weather the transition when audiologists reinforce to patients the connection between wearing their hearing aids and achieving their most cherished goals.
PRACTICE INVESTMENTS AND CONCLUSION
Audiologists may fear that patient-centered hearing care will consume too much time but “patients typically need only three to four minutes of good active listening to communicate their concerns” (American Diabetes Association, 2006 http://bit.ly/2nhve5s). The bigger investment for audiologists is in training the staff on empathetic patient interview skills and implementing a patient management system that enables recording and follow-up of patient goals. Despite these investments, the payback potential is significant: engaged patients, more satisfied practitioners, and significant value added to a clinic's offerings relative to OTC hearing aids.