The Alignment of Audiology, Health Care, and Interprofessional Practice Through the National Academies of Practice Audiology Academy

Improving health care has been an important focus for many years. Representing the American Psychological Association in 1976, Nicholas Cummings, PhD, was one of many health care providers who testified on Medicare reform for the U.S. Senate Finance Committee’s Subcommittee on Health. Many professional organizations were involved in the meeting as the government sought guidance to improve health care for the citizens of the United States.

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Continued emphasis on health care reform is reflected in the Institute for Healthcare Improvement’s (IHI) Triple Aim performance improvement initiative. In 2008, Berwick and colleagues ¹ first proposed three aims to optimize health care: enhancing the patient experience of care, improving the health of populations, and reducing health care costs (bit.ly/3KgfjSy). While the Triple Aim model has gained recognition and been adopted by many health care professions and institutions, there has been increasing focus on the negative impact that provider burnout and dissatisfaction have on the care experience, health outcomes, and health care costs—thus jeopardizing our ability to address the Triple Aim. Recognition of the importance of the health and well-being of the care provider has led to growing support for adding a fourth aim that is focused on “improving the work life of healthcare providers,” ultimately renaming the initiative as the Quadruple Aim. ²

One of many strategies considered when striving to improve the work experience of providers is to increase health care collaboration. In the field of business, collaboration reportedly has several benefits, including improved quality of work, boosted productivity, increased efficiency, greater employee engagement, and enhanced client and employee satisfaction. When working collaboratively, team members gain knowledge and broaden their perspectives. Similarly, Bosch and Mansell ³ noted that “improved healthcare collaboration has been cited as a key strategy for healthcare reform” and “Collaboration in healthcare has been shown to improve patient outcomes.” As in business, interprofessional collaboration in health care has been associated with many positive effects, including improvements in patient outcomes, reduction in medical errors, increased efficiencies, decreased duplication of services, enhanced professional relationships, and improved patient and care provider satisfaction.

COORDINATED CARE

There is a continuum for working together in health care, and the emphasis on interprofessional collaboration has evolved. The prevailing approach to health care in the past left providers siloed. Providers practiced in parallel, with each provider individually addressing the specific needs of the patient within their competency. Not only did the health care providers co-treating a patient often not know each other, but they were also often uninformed about care plans being implemented or prioritized by other providers. Unfortunately, this lack of communication and coordination represents many health care paths, is inefficient, and continues to yield fragmented, often duplicated, and sometimes conflicting plans of care.

A step up from a fragmented health care model is partly realized when individual providers develop plans of care for a patient, but each communicates and potentially collaborates only with the gatekeeper, or primary care provider. At the highest level of collaboration, interprofessional teaming occurs in which multiple professionals communicate and participate in shared decision-making to enhance patient experience and outcomes. As noted by the World Health Organization, interprofessional collaboration occurs “when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care.” ⁴

INTERPROFESSIONAL PRACTICE

Successfully engaging in interprofessional practice (IPP) requires the development of relationships with others. According to Agbanyim ⁵, the five principles around which relationships are built include trust, respect, willingness, empowerment, and effective communication. These principles promulgated by Agbanyim are embedded across the four domains in the Interprofessional Education Collaborative’s Core Competencies for Interprofessional Collaborative Practice. ⁶ These include mutual respect and shared values (Competency 1. Values/Ethics for Interprofessional Practice); use of knowledge, including of one’s role and those of other professionals, to promote and advance health (Competency 2. Roles/Responsibilities); responsive and responsible communication that supports the team approach (Competency 3. Interprofessional Communication); and application of relationship-building and team dynamics (Competency 4. Teams and Teamwork). Each major competency has multiple sub-competencies (bit.ly/3G0cYbY).

Adherence to Agbanyim’s five principles and the IPEC Core Competencies for interprofessional collaboration can remove silos and lead to the creation of an interprofessional care environment of trust and respect where the contributions of all are valued.

TRANSFORMING INTERPROFESSIONAL HEALTH CARE

While participating in the 1976 U.S. Senate Finance Committee’s Subcommittee on Health’s Medicare reform meeting, Nicholas Cummings, PhD, was reminded of the importance of interprofessional collaboration. He was struck by the evident lack of cooperation among the health care professional groups who were testifying. Dr. Cummings recognized that interprofessional collaboration would be more effective for guiding health care in the best interests of the American public, which led him to recommend the establishment of an interprofessional organization.

The National Academies of Practice (NAP; napractice.org) was subsequently established in 1981 as a nonprofit interprofessional organization of distinguished professionals who would provide guidance and advice to the government on the health care system to promote general health and well-being in our society. Dr. Cummings served as the first NAP president, and its first academy was the Psychology Academy. The inaugural members were inducted in 1982. Nine other academies rapidly followed, resulting in 10 academies representing dentistry, allopathic medicine, nursing, optometry, osteopathic medicine, pharmacy, podiatric medicine, psychology, social work, and veterinary medicine. In 2014, the NAP leadership voted to expand by adding four more professions: audiology, occupational therapy, physical therapy, and speech-language pathology. In 2020, the allopathic (MD) and osteopathic (DO) physicians merged their two academies into a combined -Allopathic and Osteopathic Medicine Academy. The athletic training academy was added in 2021, and in 2023 respiratory care became the 15th academy in the NAP.

NAP AUDIOLOGY ACADEMY

Audiologists Diantha Morse and Victor Bray collaborated with the NAP New Academies Committee to develop and establish the NAP Audiology Academy. The 2014 inaugural class of the NAP Audiology Academy was comprised of Lucille Beck, PhD, Victor Bray, PhD, Linda Hood, PhD, James McDonald, AuD, ScD, and Diantha Morse, MA. Victor Bray, PhD, was selected as the first acting chair of the newly formed -Audiology Academy, and after his term as chair of the Audiology Academy he transitioned to the NAP Executive Committee for two additional terms. Bettie Borton, AuD, was the second chair and served from 2017 to 2018. The immediate past-chair, Tony Joseph, PhD, has served since 2019, and Angela Shoup, PhD, is the current 2023 Chair. The NAP Audiology Academy has grown to 51 members and is comprised of audiologists from a variety of member organizations and practice settings, including academics, administration, research, business, manufacturing, government, hospital, and private practice. Such diversity allows many important perspectives to be represented at meetings and activities within the Audiology Academy.

Members of the NAP Audiology Academy work to advance interprofessional relationships, contribute to guidance and support of Public Policy with an emphasis on interprofessional collaboration, develop and disseminate Public Health messages to educate patients and providers, and participate in other projects and initiatives. For more information on the Audiology Academy, visit: napractice.org/audiology and bit.ly/3zfeT8Q.

NAP MEMBERSHIP

While committed to interprofessional education (IPE) and IPP as an approach to improve health care, NAP had historically been an honorific organization, particularly regarding the original 10 professions. Those who had been in their profession for 10 years or more, had contributed significantly to their profession, and were recognized as exemplary by their peers would be elected across academies as Distinguished Fellows of the NAP (FNAP) in one of three tracks: Distinguished Practitioner and Fellow; Distinguished Scholar and Fellow; or Distinguished Public Policy and Fellow.

The transition from an honorific society to an interpro-fessional organization began with the addition of the four new academies in 2014. Exemplary service to one’s pro-fession remains a prerequisite to be elected as a Distinguished Fellow, but demonstration of IPE, IPP, or interprofessional research is expected as well.

The Professional membership category was added in 2017 to provide an opportunity to early career professionals with five years or more in their profession who have an interest in IPE and IPP to be nominated for NAP membership. This allows early career professionals or more senior professionals with limited IPE/IPP exposure to gain experience and knowledge in IPE/IPP through involvement in NAP activities. Some Professional members may progress to Distinguished Fellow status over time. For health care professionals who do not identify with an academy, membership in the NAP is offered as an associate member and through the Associate Collaborative Group. The NAP’s commitment to interprofessional collaboration across Academies and opportunities to engage in meaningful collaborative projects continues to increase through interprofessional technical papers and advocacy related to health care policy improvement.

For more information about NAP membership categories, see napractice.org/membership-categories.

WHY JOIN THE NAP?

Health care collaboration and coordination have been shown to improve patient and population outcomes. Communication between health care personnel and the patient or family is vastly improved when members of the interprofessional service delivery team are cooperative. This is even more important in today’s progressively innovative environment of telehealth and virtual medicine. The NAP serves as a beacon and home for clinicians, researchers, educators, and policy writers as the place to learn about IPE/IPP and collaboration dedicated to improving health care for all. The NAP firmly believes that close collaboration and coordination of different health care professions, aligned through a common vision, can successfully advocate for patients and be a model of excellence in interprofessional and preventive care. Members of the NAP are offered a platform to collaborate, coordinate, and communicate in projects and activities across multiple academies, professions, and diverse perspectives.

CORE VALUES

As an interprofessional organization that represents multiple health professions, the NAP is guided by four core values: collaboration, patient-centeredness, inclusivity, and interconnectedness. Regarding collaboration, to fulfill the NAP mission and vision, members should foster a work ethic of interprofessional collaboration that is based on learning with, from, and about NAP members from all academies. From the NAP perspective, optimal health care is patient centered. To foster this ideology, public policy, scholarship, and health care practice must be patient-centric, and reflect the best interest of individuals, families, and communities receiving care. Patients should be invited to participate in their care plan.

The NAP supports its members in developing and disseminating best practice models, public policies, and scholarship that enhance interprofessional collaborative care for all individuals. Regarding inclusivity, NAP embraces social justice, equity, diversity, and inclusion and strives to support the implementation of models that ensure equitable health care for all. Interconnectedness refers to fostering connections within and between academies and among members of all groups. The NAP targets initiatives that are designed to maximize these interprofessional interconnections to advance patient-centered public policies, scholarship, and interprofessional collaboration.

HEARING HEALTH COLLABORATION

Hearing health care should be delivered in an interprofessional collaborative and coordinated fashion to maximize the scope of audiology care. The scope of practice of an audiologist encompasses the evaluation and management of hearing and balance-related disorders, but these conditions are often markers for health problems that require care from other clinicians. For example, there are numerous coexisting morbidities regarding hearing loss (e.g., diabetes, cardiovascular disorders, kidney dysfunction, cognitive decline) and vestibular disorders, which produce the opportunity to advance our collaboration and partnership with several health care professionals. Collaboration for individuals who receive audiologic evaluation, management, and rehabilitation often includes the following specialties and subspecialties: primary care and family medicine, pediatrics, otolaryngology, neuro-otology, neurology, occupational health and preventive medicine, pharmacology, nursing, speech-language pathology, physical therapy, social work, psychology, dentistry, neonatal intensive care teams, and educational and medical multidisciplinary care teams. ⁷

A sampling of 12,495 family members who were 65 years of age and older indicated that 29% reported hearing difficulty, 12% tinnitus, 40% poor eyesight, 26% back problems, 44% hypertension, 12% cognition or memory issues, 15% falls or balance problems, 12% depression, and 18% diabetes. ⁸ Those reporting hearing difficulty were almost four times more likely to have tinnitus than individuals with no hearing problems, 3.5 times more likely to have cognitive problems, and five times more likely to have issues with balance and falling. ⁸ Untreated hearing loss in adults can be the root cause of unemployment, relationship problems, safety issues, and decreased quality of life. Hearing loss and tinnitus may lead to problems with the development of communication skills in children, which can produce educational, behavioral, social, and emotional problems. In adults, hearing loss may be a consequence of acute or chronic medical problems. Through NAP, there is an opportunity to initiate training for several health care disciplines about child and adult early identification of hearing loss. ⁷

The importance of interprofessional collaboration is emphasized by the overarching goals for Healthy People 2030 launched by The Centers for Disease Control in August 2020 (bit.ly/3KpsJMl). Specific objectives under sensory or communication disorders include improving follow-up in diagnostic evaluation and intervention for infants who do not pass the hearing screening, increasing the proportion of adults who have had a hearing examination within the last five years, increasing the use of hearing protective devices and decreasing noise-induced hearing loss, increasing the proportion of people experiencing tinnitus and balance dysfunction who have been seen by a specialist, and increasing hearing aid use in adults with hearing loss. Further, in other categories such as increasing the quality of life of cancer survivors or reducing the proportion of preventable hospitalizations in adults with dementia, the need for audiologic expertise in the interprofessional approach is evident.

ABANDON HEARING-HEALTH SILOS

Audiologists must be involved with not only the care process for those with comorbidities affecting hearing and balance, but also with national and international discussions around policies and recommendations for assessment and intervention to enhance quality of life, maintain and improve outcomes, increase independence, derail developmental emergencies, and allow more individuals to safely age in the place of their choice. Interprofessional collaboration has been integral in advancing policies to support telehealth and COVID-19 legislation. Through interprofessional endeavors, audiologists can contribute substantially to the Institute of Healthcare Improvement’s Triple Aim, the Quadruple Aim, and the overarching goals of the Centers for Disease -Control’s Healthy People 2030. As stated in the NAP Value Proposition:

“Members have unique opportunities to work collaboratively, thereby learning with, from, and among all health professions (interprofessional) as well as engaging with members of their respective professions (intraprofessional). The National Academies of Practice is committed to advancing interprofessional healthcare by fostering collaboration and advocating policies in the best interest of individuals and communities. The organization’s vision is to lead and exemplify interprofessional healthcare that promotes and preserves health and well-being. Put succinctly, the National Academies of Practice is transforming interprofessional healthcare!”

Interprofessional collaboration can improve hearing health and increase patient and provider satisfaction. Through IPE, IPP, and interprofessional collaborative approaches, audiologists can improve individual and population health outcomes and reduce health care costs. Many patients with hearing and balance needs have complex, sometimes chronic, comorbidities, requiring an interprofessional health care approach. As such, to improve health care in the US, it is essential that audiologists abandon silos and wholeheartedly promote interprofessional collaboration.

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