Patient Care | May 2022 Hearing Review
This is Part 2 of a two-part series looking at why audiologists should consider transitioning to a person-centered approach —especially in light of developments around over-the-counter devices — and how they can make the mindset, practice, and business changes required.
By Judith Vonberg
In Part 1 of this series in the April 2022 Hearing Review, we looked at the case for person-centered care (PCC): the empirical and anecdotal evidence that this approach can improve patient outcomes and adherence rates, lead to higher levels of client and employee satisfaction, and increase rates of hearing aid purchase and success. We also used case studies of possible future clients to show how this model of care—which focuses more on partnership with the client and less on fitting and selling hearing aids—can enable hearing care professionals (HCPs) to future-proof their businesses, even (and perhaps especially) when facing competition from online and over-the-counter (OTC) devices.
That’s all very well, you might say, but what does person-centered care look like in practice and how can clinics make the transition?
The Ida Institute’s Change Guide (https://idainstitute.com/tools/change_guide) was designed with precisely this process in mind. This article shows how clinics can use this free resource to make the necessary mindset and practice changes, and it provides practical tips and examples from hearing care professionals who have experienced success through the process. We start by looking at how to cultivate what’s known as the “appreciative approach,” which is key to success and sustainability in any change process.
1) Create a “Pull Towards the Future”
Change can be emotional and difficult. Human beings have the tendency to view the process negatively: to focus on the problems in our way, to resist. But it doesn’t have to be like this. Cultivating an appreciative approach to change allows us to embrace the process, focus on the future, and—most importantly—create change that lasts.
“While change can be driven by negative emotions, they’re not sustainable over the long run,” says Sarah Lewis, organizational change expert and founder of evidence-based psychological consultancy, Appreciating Change. “Positive emotions, like passion and joy, anticipation and excitement, are much more sustainable for building change.”
For HCPs considering a transition from a biomedical to a biopsychosocial model of care in light of developments in OTC devices, this is especially pertinent. This transition should not be driven by fear—of being undercut or becoming obsolete, for example—or by seeing OTC developments as a threat or a challenge. Instead, audiologists and hearing aid specialists should view these developments as an opportunity to make a positive change and focus on cultivating a hopeful vision of what their business could look like in the future.
“We encourage people to create rich pictures of how the organization could be, to create a pull towards the future, rather than a push away from the present,” explains Lewis. “And by building a sense of hope and optimism about how the future can be, people start to become more willing to be motivated, more willing to take a chance, be innovative, and so forth.”
HCPs could start by identifying their clinic’s successes—satisfied clients and a strong bottom line, for instance—and then generating a tangible picture of how these will grow as a result of the change process. For example, creating protocols for ensuring shared decision-making at every appointment could result in increased client satisfaction. This may in turn lead to more clients due to word-of-mouth recommendations and an even stronger bottom line.
And this future needn’t be months or years away. Carol Clifford, AuD, founder and owner of Albuquerque Hearing and Balance, saw rapid changes at her clinic after initiating the change process. “Person-centered care changes everything for the better and you don’t have to spend hours learning it,” she says. “Try doing it one week in the clinic and you will immediately see how much better you feel and how much more receptive your patients are.”
2) Make Mindset Changes
Once that tangible, positive picture of the future is in place, it’s time for mindset change. The goal is to reach a shared understanding among all clinic staff of what PCC is and why this specific team considers it important.
It’s vital that this phase is an active and collaborative one, but it doesn’t need to be time-consuming. In just one 60-minute session, staff can work together to deconstruct the concept of PCC, identify the most important elements for them, and select a counseling tool to try out with clients in the following weeks.
The specific outcomes of this session will be unique to every clinic. Some may identify active listening and shared decision-making as the most important elements in the person-centered approach, while others may value finding a personalized solution for each client or enabling clients to better prepare for appointments. What’s important is to identify tangible elements that all staff can agree to work towards and create a shared vision of what the new future looks like.
Even if the PCC approach is not brand new to the team, this process of discussing and aligning is an important one. One audiologist from Hörakustik Hahm, a chain of five hearing clinics in Germany that has gone through this change process, reflected during the mindset change session: “Though we were aware subconsciously, it was helpful to become conscious of all the factors involved [in PCC].”
Preparation is key to the success of this session. This could mean gathering information about the proven benefits of the biopsychosocial approach and finding the best way to communicate the “pull towards the future” for this particular business. The aim is to focus on ways to generate positive emotions and an appreciative approach in the entire team.
3) Make Practice Changes
Start using person-centered tools. The practice change phase starts as soon as the mindset change session has finished, with staff preparing and starting to test a person-centered counseling tool. For those using Ida’s tools for the first time, this could be the Motivation Tools: the Line or the Box, for example (https://idainstitute.com/tools/motivation_tools). The audiologists at Hörakustik Hahm found their skills and confidence in using these tools grew quickly, once they were able to trial them with different clients and, crucially, with each other in role-play scenarios.
Once all clinicians have used the tool a few times, it’s important for the whole team to come together for a second session. This is where staff can share specific experiences with the tool, discuss what helped or hindered its implementation, and identify how to overcome any hindrances.
Plan and implement small changes. Using the information from this discussion and the shared vision of PCC from the mindset change session, the team is ready to identify the key focus areas for their clinic’s change process and plan tangible next steps.
These steps should be small and easily achievable. For the team in Germany, these included removing some brochures in the appointment room to minimize distractions, sitting next to the client rather than behind a desk during appointments to encourage information sharing, and adding plants around the clinic to create a more pleasant environment.
Staff members soon noticed a positive impact. Clients began talking more freely and recommending the clinic to others, while staff also felt more comfortable and less stressed.
A small but vital change for Dr Clifford in Albuquerque involved nothing more than some basic stationery items: “As a long-time audiologist, I found I didn’t always have the right language for the person-centered approach, so I made sure to always have a clipboard with me, with open-ended questions and Ida tools such as the Line and the Box.”
Embed and monitor change for the long term. Longer term, Dr Clifford has introduced PCC protocols and training for new employees, and updated the language relating to company values and ethics in the clinic’s Office Policy and Procedure Manual.
Regular team discussions have also been key to the ongoing change process in her clinic: “At our weekly clinical staff meetings, the audiologists discuss patients who were successful in moving forward and others who weren’t, and we discuss as a team why these were the outcomes. For example, by asking how well we connected with the patient and their communication partner. Then every other month or so, we have broader discussions around empathy and connecting with patients.”
Other possible steps could include unbundling your fees, placing information and brochures from local hearing loss support groups in the waiting room, introducing annual client satisfaction surveys with open-ended questions, or making PCC training (such as the Ida Institute’s online courses) mandatory for staff.
It’s vital to regularly monitor the progress of all these steps, both to draw motivation from aspects that are going well and to identify where strategies and processes could improve.
Communicate the changes with clients. For both Dr Clifford and the Hörakustik Hahm team, the level of client willingness to engage with a PCC approach has been a key determiner of success. When first testing out the Ida counseling tools, the German audiologists found that some clients were surprised to be offered anything beyond a hearing test and a hearing aid, and struggled to respond to the clinician’s open questions. In response, the clinic introduced a policy of informing clients about what to expect in the appointment and explaining why it’s beneficial for them if the clinician has a detailed understanding of their lifestyle and communication needs.
Once the change process is underway, each clinic will need to decide the best way to communicate the approach to their current and future clients. The strategy could include posting information on the clinic website, setting expectations with clients when booking a first appointment, becoming an “Inspired by Ida” clinic and displaying these credentials, or a combination of these and other elements.
4) Be patient
As previously noted, change is difficult and emotional. It also doesn’t happen overnight. But by following the process outlined here, clinics can experience a smooth, efficient, and sustainable transition to the biopsychosocial model of care. Key to success is maintaining an appreciative approach and ensuring that mindset and practice changes go hand in hand. Without commitment to the person-centered approach from all team members, the implementation of it will likely fail. Equally, without an achievable and monitorable action plan, good intentions are worth little.
The specifics of the future vision, the process, and the results will look different for every clinic, but the benefits will resonate through them all: better outcomes, happier clients, more satisfied staff, and a strong and sustainable bottom line. Visit the Ida Institute website (https://idainstitute.com) to access all the resources mentioned above for free, including the Change Guide.
Correspondence can be addressed to Judith Vonberg at: [email protected].
Citation for this article: Vonberg J. How to transition your practice to person-centered care. Part 2. Hearing Review. 2022;29(5):20-22.