Welcome to How to Increase Patient Satisfaction Presenter: Mary - - PowerPoint PPT Presentation

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Ted Annis Senior Marketing Specialist Carrie Pedersen Member Services Supervisor

Welcome to How to Increase Patient Satisfaction

Presenter:

Mary Leisses, MS

Director of Network Education and Training Starkey Hearing Technologies Starkey.com

Housekeeping

• This presentation is being recorded
• CE credit is available! Visit ihsinfo.org for

details

• Note taking handouts are available at

ihsinfo.org on the webinar page. Feel free to download now!

Agenda

• Satisfaction is a process, not an outcome
• Pre-fitting Tools
• Fitting Tools
• Post-fitting Tools
• Q&A (enter your questions in the

Question Box any time)

SATISFACTION IS A PROCESS, NOT AN OUTCOME

Why isn’t “They are happy” good enough?

• Research has shown that a comprehensive

protocol has a major impact on:

• Hearing aid brand loyalty;
• Utility of hearing aids;
• Positive-word-of mouth advertising;
• Satisfaction with benefit achieved;
• Hearing handicap reduction; and
• Hearing aid usage and reduction of hearing aids in

the drawer

Why isn’t “They are happy” good enough?

Kochkin, et al, Hearing Review 2010

Why isn’t “They are happy” good enough?

Kochkin, et al, Hearing Review 2010

PRE FITTING

Pre Fitting

Hearing Loss Simulator COSI Demo Care Plan

Hearing Loss Simulator

• Explanation of Test

Results

– Hearing Loss Simulator – Impactful visual depiction of patient’s hearing loss

Client Orientated Scale of Improvement

• COSI
• An open scale designed for the patient to select

which environments are most important for them

• This is a great tool because it truly validates what

is most important to the patient

• A version of this can be found on the Hearing

Healthcare Report form

• It is also found in the NOAH software

Client Orientated Scale of Improvement

• A paper version can be

printed out

• It is designed to be

interactive between clinician and patient

• Much of the

information would be

• btained via the

discovery process

Client Orientated Scale of Improvement

Client Orientated Scale of Improvement

• As a validation tool, it helps to keep patient

and clinician focused on areas that are most important

• Going forward, it allows continued validation

and to potential demonstrate improvement in quality of life as new situations gain importance

Demonstration

• “As midlife approaches,

people increasingly draw

• n right-brain functions.

They begin relying less on left brain sequential reasoning and more on emotions, aka “gut feeling” or intuition.”

• To arouse the strongest

attention, messages should be rich in sensory stimuli

Jim Gilmartin, Coming of Age, Inc.

Demonstration

• 1 Need = 1 Solution = 1 Demo

– Demonstrate benefit for the patient’s ONE most important need

• Audibility
• Distance
• Hearing in Noise
• Wireless Accessories

– TV – Cell phone – Remote microphone

Demonstration

• Transition into recommendation with confirmation of Demo…

“Isn’t it great to be able to hear the TV like this Mr. …?” “Mrs. …, what would it mean to you if your husband could hear the television like this?”

Audiologist

Care Plan

FITTING

Fitting

• Speech Mapping
• Speech In Noise Testing
• Homework
• IFF-it
• Reading Out Loud
• Auditory Training/Brain Games

Why Speech Mapping?

• I know what you are thinking….
• One more thing you want us to do….
• I don’t have any extra time for this stuff
• Equipment is soooo very expensive!

Why Speech Mapping

• Allows patient and 3rd party to “see” what is

being “heard”

• Allows the clinician to see what the patient

may not be able to describe

• New wireless technology allows more

flexibility and comfort and speed in completing the protocol

Moore, 2008

Why Speech Mapping

Decrease follow visits by 50%

W/O SM W/ SM Patients 13 12 Follow Up Visits 70 35 FU per Pt 5.39 2.92

More successful/satisfied patient

• 76% of patients with above

average success were fit in 1

• r 2 visits
• 47% of patients with below-

average success required 4 to 6 visits

• 64% of practices do NOT do

this

50% Reduction 45% Reduction

Cunningham, 2002 Kochkin, 2011

Speech Mapping Verification

• Goal: quick verification of HA

response to average inputs

• Displays Moderate Fitting

target by default (for 65 dB SPL or operator’s preferred level)

• Optionally, you can display

soft and/or loud targets

• This example also shows

patient’s thresholds in dB SPL.

Speech Mapping Verification

• The thin green line is the

target

• The thicker green band is

the mapped speech signal

• Goal is to have green band

centered on green line

• What do you see here?

Speech Mapping Counseling

• Set-up

– Input+Gain – Soft and Loud curves

Speech Mapping Counseling

• Explanation

– Soft vs Loud is ideal audible range for hearing – 90% of signal should fall within this range

Patient speak

• What are we looking at?

– The blue and purple mark the range for soft to loud speech – If sound falls below the blue line, you would struggle to hear it – The gold bars is what you hear without the hearing aids – Our goal is to get at least 90% of all speech between the blue and purple – The blue/red bars show what you can hear now with the hearing aids

Realistic Expectations

Why not say “All”? Why not say “All”?

Why measure SNR Loss?

• It’s the #1 complaint of hearing-impaired

patients

• It can’t be reliably predicted from the pure

tone audiogram or other standard audiometric tests

An Example

• PTA = 53/55
• WRS = 80%/84%
• PTA = 52/53
• WRS = 76%/80%

SNR Loss = 3 dB, 1 dB SNR Loss = 9 dB, 9 dB

QuickSIN

QuickSIN

• Equipment you need
• QuickSIN CD
• Headphones/ear inserts
• Set up
• CD in the audiometer
• Patient in Sound Booth

• 1. The dusty bench stood by the stone wall
• 2. We dressed to suit the weather of most days
• 3. The water in this well is a source of good health
• 4. That guy is a writer of a few banned books
• 5. The door was barred, locked and bolted
• 6. A big wet stain covered the floor

+25 dB +20 dB +15 dB +10 dB + 5 dB + 0 dB ___ ___ ___ ___ ___ ___ 25.5 - ______ SNR deficit

QuickSIN

• One-minute method for estimating number of

hair cells that are missing

SNR Loss Assists with Technology Selection

SNR Loss Category Technology 0-2 dB Normal Omnidirectional 2-7 dB Mild Fixed or Dynamic Directional 7-15 dB Moderate Dynamic or Adaptive Directional >15 dB Severe FM or Remote Microphones

So you are going to fit a hearing aid

• We need to realize
• Our patients think it will work perfectly everywhere
• Family thinks a hearing aid gives super human hearing
• They are only going to hear what they want to hear…
• What is our reality?
• None of the above happens…

What does a hearing aid do?

• Amplifies soft sounds in environment
• Reduces loud sounds in environment
• Shouldn’t that be enough?
• Does a hearing aid know what to amplify and

what to reduce?

• NO!

So how do we handle this?

• Words you will never use
• “Always”
• ”Removes”
• Words you can use
• “Comfort”
• “Focus”

Examples

• Never say

– “Removes all background noise” – “Will only amplify your wife’s voice”

• Ok to say

– “Provides comfort in busier environments” – “Will help you focus on speech”

How are these statements different?

Learning to hear again

• We need to counsel on
• They are going to hear things they haven’t heard

for awhile

• IFF’it process
• Identify the “new” sound
• Find the “new” sound
• Decide if they need to pay attention or can forget it
• Have them keep a “sound” journal
• Write down “new” sounds they discovered
• Promote positive stories

Learning to hear again

• Stay away from negative statements
• “Things are going to be really loud.”
• “Restaurants are really noisy.”
• “Write down what you don’t like and we will make

changes.”

• Focus on the positive
• “How much fun was it playing games w/the

grandkids?”

• “What sounds of life have you been missing?”
• “How great is it not to fight over the TV?”

Learning to hear again

• If you have a “Nervous Nellie”
• Give them a wearing schedule
• Give them permission to take aid out for a couple of

hours

• Limit first few days to wearing at home only
• Limit places they can wear it in the “outside” world

Learning to hear again

• Why do they need to wear it at home?
• Our homes make a lot of sounds.
• It teaches them to ignore non-important

sounds.

Learning to hear again

• Focus on what they want to improve in their

life

• This isn’t the time to take up bowling…
• Word your verbiage specific to their

world…aka…Discovery…

The family…

• We are not giving super human hearing…
• Unaided/aided testing will reinforce this
• Maximum range of gain “strength” is 6 ft.
• If she is doing dishes in kitchen, he is not going to

hear her perfectly in living room while watching TV

• They need to say patient’s name first to get their

attention

The family

• Have family keep journal in regards to

different environments

• What did they think?
• Was it a busy environment?
• Where were they sitting?

Other things to think about

• Introduce them to Brain Games
• Assign a couple of levels as Homework
• This is our version of Aural Rehab
• Helps with hearing in busier situations
• Involves family
• There is some ownership involved…

Brain Games

• Read My Quips -

http://www.sensesynergy.com/

• BrainHQ – http://www.brainhq.com/
• Angel Sound -

http://angelsound.tigerspeech.com

• LACE (Listening and Communication

Enhancement): Therapy for the Brain www.neurotone.com/lace-interactive- listening-program

Bottom line?

• Get them excited about hearing their life

again!

• They came in looking for help
• Our job is to get them ready for a great

journey

• However…
• It does “rain”
• “Rain” is good
• We will counsel to using an “umbrella”

POST FITTING

Post Fitting

• IOI-HA
• Long Term Care Plan

IOI:HA

• 8 Questions
• 7 questions cover outcome domains
• 8th question quantifies perceived impact

(handicap) of hearing loss

• This question is used to determine which Norm Data

Set should be uses

• Let’s start at the end…..

IOI:HA

• The norms are divided into two groups

– Mild-Moderate – Mod-Severe +

• Dependent upon how the patient answers this question,

the scores for the other questions are graphed on a different plot

IOI:HA

IOI:HA

• The other 7 questions
• Use (Use)
• Benefit (Ben)
• Residual Limitations (RAL)
• Satisfaction (Sat)
• Participation Restrictions (RPR)
• Impact on Others (Ioth)
• Quality of Life (QoL)

IOI:HA

• The first question looks at, overall, how much is the

device used

IOI:HA

• Next we look at benefit in a situation the patient was

seeking help

• This is the crossover between Direct and Indirect

– We may not know what the exact situation is – We know it is of value to the patient

IOI:HA

• The rest of the

questions look at other aspects

• Most are not covered in
• ther scales

IOI:HA

• If our patient had rated their hearing loss moderately

severe, we can see how they do compared to the norms

IOI:HA

IOI:HA

IOI:HA

Quality of result varies with norms and therefore perceived impact of hearing loss

Long Term Care Plan

• Every 3 to 4 Months

– Doesn’t have to be long – Clean and check – Quick conversation on how it is going

• Annual Follow Up

– Repeat Verification/Validation – Test Hearing – Discuss what is plan for next year

Questions

Enter your question in the Question Box on your webinar dashboard

THANK YOU FOR ATTENDING!

Contact Mary Leisses: Mary_Leisses@Starkey.com Visit www.Starkey.com For more info on obtaining a CE credit for this webinar, visit www.ihsinfo.org