Most clinicians understand the primary reason of implementing best practice guidelines: They improve the probability of successful patient outcomes. EDGE is one such example.
When a practice applies a series of clinical tests and procedures in a consistent manner, it often leads to better patient outcomes and improved efficiency. The challenge in a practice with more than one clinician is that each audiologist tends to practice on an island. That is, they closely follow their own set of guidelines, usually ones they learned in school or acquired early in their career. Once these clinical “habits” get ingrained, they can be tough to change.
On its own, following your own set of clinical guidelines is not necessarily a bad thing. After all, most clinicians place the interests of the patient above the needs of the business. The problem, however, comes to the fore when a practice with several audiologists tries to provide a consistent patient experience and create brand presence in their market. If every audiologist is following different guidelines or performing different tests for various appointment types, it usually leads to inconsistent patient experiences and detracts from building a reliable brand in your community.
Thus, it’s reasonable to think the most effective approach to improving patient outcomes or overall business efficiency is getting all the clinicians within a practice following a core set of guidelines. Please don’t misunderstand me; no one is expecting every clinician in a practice to act like robots and do everything the same way. But a clinic should strive to get their clinicians on the same page with a few core clinical tests and procedures. The list below outlines several reasons it is worth your time to create an evidence-based clinical protocol for any appointment type.
Benefits of implementing a clinic-branded hearing aid consultation protocol:
- Improved patient outcomes
- Improved business productivity and efficiency
- Brand consistency in your community
- Sustainability: teachable to new clinicians
- Set your practice apart from local competitors
- Attract new audiologists
- Professional pride
The objective of this article is not to tell clinicians exactly what these tests or procedures ought to be. Practices can decide what their exact clinical protocol should be on their own. Rather, the core message here will focus on how to get a group of audiologists on the same page with respect to executing a core clinical protocol, like EDGE.
This article will focus on how a practice with several audiologists can execute the hearing aid consultation appointment in a consistent way. The following six-step process can be applied to implementing any new clinical initiative in which all the audiologists need to be providing consistent patient care.
Scenario: A practice with seven audiologists wants to have a consistent hearing aid consultation process that they can brand as “patient centered.” For this initiative to be successful, all seven audiologists must buy in to the process. The first steps address how a clinic defines its standard of care.
I. Gathering Information: The First Three Weeks
Step 1. Ensure that all the clinicians are familiar with the published best practice standards pertaining to hearing aid evaluation and rehabilitation. In the case of adult rehabilitation, probably the best source of independent information is the 2006 AAA guidelines published here: https://www.audiologyonline.com/articles/guideline-for-audiologic-management-adult-966
Step 2. Gather information from colleagues around the country on the tests and procedures they use during their hearing aid evaluation. Your Fuel regional manager is a great resource for getting you connected with other clinics that may have a particularly robust clinical protocol.
Step 3. Get the clinicians in your practice involved in the process by asking them to provide feedback for the staff on the tests and procedures they conduct that are particularly effective or helpful. You can facilitate this process by asking each audiologist some version of this question: “What information do you need to help the patient during the hearing aid consultation?”
After reflecting on this question and reading the AAA Guidelines, each audiologist should be able to provide a detailed list of the information they need to gather from the patient during the hearing aid consultation.
Let’s take a brief sidebar. Invariably, there is always at least one experienced clinician in a group who will resist Step 3. This audiologist will say that their clinical workflow, which they have mastered over several years of arduous work and dedication, cannot be duplicated by others. They will say that what they do is so totally unique, it is impossible for others to learn it. Respectfully, this is bunk. Any process, no matter how complex or unique, can be written down and taught to others.
When you encounter an audiologist with a “secret sauce” mentality, tread cautiously. This person could be an outstanding audiologist that simply needs some time to absorb a new initiative. Often their resistance is a cover for defensiveness or reluctance to change. The manager needs to reassure the resistant audiologist that much of the face-to-face-face interaction with patients is improvisational. That is, even within a regimented clinical protocol, there is plenty of room to remain an individual where unique skills are essential. Implementing a protocol does not mean everyone is doing the same thing. Also, it’s helpful to remind resistant audiologists of all the positive reasons for executing a protocol.
II. Finding a Common Thread: The Staff Meetings
Once each audiologist has formulated a list of necessary clinical procedures, the tough work of gaining a consensus begins. This starts during a 90 to 120-minute, face-to-face staff meeting.
Step 4. Using a meeting facilitator (usually the clinic manager), explain to the group that the purpose of this meeting is to get all clinicians on the same page with a handful of tests or procedures so that a more consistent patient experience results. Be sure to set a few ground rules. For example, clinicians must be able support their preferred clinical tests and tools with a reasonable amount of published evidence supporting its effectiveness. It also helps to remind everyone to have mutual respect. There is likely to be disagreement during this meeting, but everyone needs to be respectful and professional toward each other. Finally, the manager reserves the right to impose their own clinical guidelines (if it is supported by evidence) when the group cannot come to a consensus.
Next, ask each clinician to provide their list of “must have” and “like to have” clinical procedures. It helps to list these under audiological and non-audiologist variables. It’s also helpful to agree on the standard amount of time for the typical hearing aid consultation. Table 2 describes some of the “must have” variables for a one-hour hearing aid consultation that was generated during a recent staff meeting.
Step 5. Gain Agreement on a Core Set of Tests and Procedures
After the group has created a list that looks like Table 2, Step 5 requires that the group agrees on the most critical variables that need to be gathered during the consultation. It is helpful to apply the 80-20 rule here. That is, identify the core variables that everyone needs to gather on 80 percent of the new patients that are seen. Keep in mind, there are always outliers, and you are creating a clinical protocol to better meet the needs of the 80 percent of patients we see for services.
Once you have gained agreement on a group of six to eight core tests and procedures that everyone must gather during the HAE, look for questionnaires that allow clinicians to record patient responses for these variables. This is a critical step because you are codifying the interaction between the patient and the audiologist. This is another place where you are likely to encounter a roadblock. Some audiologists are resistant to using the same form because they erroneously believe using the same form means mechanically doing the same thing with every patient. Managers must remind staff that the intent of the form is to ensure the practice is collecting similar information across patients. There are infinite ways to draw the information out of the patient (you are not asking audiologists to read from a script), but the practice must gain an agreement on where the information is collected – this is the purpose of using one customized intake form.
The intake form used during the consultation is often some customized version of the Characteristics of Amplification Tool (COAT), Hearing Handicap Inventory (HHI-A) or the Client Oriented Scale of Improvement (COSI). (Google these terms to see examples of them.) Many clinics borrow parts of each questionnaire to create their own intake form. Along with creating your own branded version that combines items from these questionnaires, many practices use a visual aid that combines communication lifestyle and technology levels. (Fuel has created the EDGE process and can customize it to your clinic and the questionnaires mentioned above.)
III. Execution: The Next 90 Days
Step 6. After all the forms and other visual tools have been created, the last step is ensuring every audiologist uses them. Managers need to set an expectation that the new clinical protocol with its forms and visual tools will be used consistently within a finite amount of time. Ninety days seems to be a reasonable amount of time to allow all clinicians a chance to weave any new process or new form into their existing workflow.
During these 90 days, it is helpful for managers to maintain an open dialogue with all clinicians, identifying opportunities where additional training is needed to hone a particular skill, or tweak a process that might seem a little off-kilter. Like any essential part of patient care, the needs of patients change. This requires managers to maintain high clinical standards while being flexible enough to make changes to existing protocols with buy-in from staff. In the end, anything worth doing is worth doing right.