The popular management book Fish! by Lundin, Paul, and Christensen1 describes how to harness your staff’s enthusiasm to attract customers and deliver superior service. The book is good, but the following article comes from a different experience. The authors operate an audiology practice in Australia, rather than a fish-shop in Seattle. While driving home with the fish we bought at the second-closest fish shop, we discussed how the closest shop was totally unattractive. The owner/operator obviously doesn’t love his product and doesn’t love his customers. Both his product and his service stink, to put it bluntly.

Maybe the second-closest fish-shop owner had read the book by Lundin et al. Every purchase there is handed over with “That’s a great choice, mate” (“mate” because we are in Australia). We found that the fish was always fresh, and we felt good about our purchasing experience.

The above experience reminded us of our own hearing aid dispensing practice, as well as some of the current problems in the hearing industry, in general, where we have a product that is not utilized by 80% of hearing-impaired people. Many consumers believe our product “stinks,” with complaints that include inadequate/excessive volume, whistling, uncomfortable, too expensive, etc.

If not properly dispensed or cared for, everyone would agree that hearing instruments certainly can have all these faults. This led us to a discussion about how our dispensing clinic is the “second-closest shop” for the majority of our consumers; some drive past five alternative dispensing offices to get to us. Some of our consumers have access to free services, but still come to us. How did we become their supplier of choice?

We think we know why.

Years ago, we started surveying our hearing aid clients to find out what devices were delivering good performance, where the clients thought our service was doing well, and where we were going wrong. We didn’t have any benchmarks to compare these results to, but we could at least work out that our clients were happier with Model A than Model B, or whether they thought we gave them enough explanations, service, time for counseling, etc. Another benefit was that our clients really appreciated being asked.

In 1996, we revamped the survey, using questions based on MarkeTrak, to give us a much more detailed view of our clients’ experiences. When we presented our results to colleagues, a few asked if they could use the same survey. “Of course,” we said, since it made no sense for them to replicate the work we’d already done.

However, the in-house work involved in mailing, tabulating, and analyzing this survey prevented many of these professionals from using it. One thing led to another, and the survey is now run as an independent business called EARtrak, taking most of the work out of the clinics and standardizing the processing. Although we can provide a fairly long list of benefits (a more technical article on the system will appear in a future edition of HR), EARtrak provides two key benefits:

  1. Clients report back more candidly to an independent consultant than to their service provider—especially on the negative aspects of service. This goes to the heart of a system for Continuous Quality Improvement (CQI). You can’t correct what you don’t detect.
  2. Grouping the results from many clinics creates a benchmark of performance. We can now see where we are relative to other offices and practices—good or bad. Our clients’ satisfaction with “listening in groups” is 52% (compared to the group average of 42%), which is good for us. But, if we scored 81% satisfaction with our “professionalism” (our peers average 93%), that might indicate a need for some assessment.

Detection Leads to Correction

We don’t believe that our industry is composed of people who don’t care about their products or their clients. On the contrary, almost all dispensing professionals do their level best to satisfy their clients. However, we do know that most of us have at least one “blind spot” in our total service offerings, and this blind spot differs from audiologist to audiologist; dispenser to dispenser; and office to office.

For example, we might not spend enough time instructing our patients on the use of the telephone, so our clients note that “Hearing aids don’t work for telephones.” Another practice might use a poor shell laboratory, so their clients note that “Hearing aids are uncomfortable.” An office colleague might be trying to economize on the technology offered (with all good intentions), but his clients note that “Hearing aids don’t work in noise.” Unfortunately, these negative comments summate in the minds of potential hearing aid users, and equate to “All hearing aids are uncomfortable, don’t work in noise, and are incompatible with telephones,” with other problems thrown in, as well. No wonder we convince only 20% of potential users to try our services. As an industry, we must detect and solve these problems.

Kochkin2 has pointed out that consumers who receive any form of postfitting survey generally report higher levels of customer satisfaction. The data also shows that those dispensing professionals who administer surveys have much higher postpurchase service ratings.

Organizational Outcomes

The hearing care field currently has several good methods for validating individual outcomes (albeit administered and tallied directly by the dispensing professional), such as the COSI, APHAB, and GHABP. However, there has been no real method to validate the effectiveness of service delivery—or provide an assessment of overall organizational outcomes.

For the industry, a standardized survey of organizational outcomes could mean significantly better hearing aid fittings and more satisfied users of amplification products. For example, a telephone survey of audiologists using the EARtrak process in Australia found all respondents reported finding at least one “blind spot.” They all had different areas of poor performance that they hadn’t suspected. And they all worked to correct that defect.

As mentioned previously, there are several things that can go wrong in any hearing instrument fitting. MarkeTrak VII3 identified the 10 most cited reasons for hearing aid returns as:

  1. Lack of benefit (cited by 51% of those returning the devices);
  2. Background noise (49%);
  3. Whistling/feedback (38%);
  4. Value (36%);
  5. Comfort (35%);
  6. Sound quality (29%);
  7. Phone utility (19%);
  8. Difficult to handle (18%);
  9. Reliability (16%);
  10. Stigma (6%)3

Without the benefit of a third party asking questions that probe the depths of your customers’ satisfaction, many of these rather simple, but fundamentally important, issues go unanswered. A lack of understanding about where our products and services are falling short is a recipe for continued market underperformance.

Eyes Wide Open

EARtrak represents an independent, client outcomes-based, benchmarked, and systematic process to detect and correct problems in hearing care service offerings. Specifically, the system is designed to:

  • Be a simple, time- and cost-effective client outcomes survey that can be easily implemented in hearing care businesses, large or small.
  • Measure how clients view both their hearing aids and the quality of care they receive.
  • Link demographic data with clients and their hearing aid fittings.
  • Compare your performance with that of other hearing care businesses.
  • Enable you to improve your clinical performance, your client satisfaction, and your bottom line.

We can all gain by improving public perception of our products and services. The potential benefit is huge—a fivefold growth in the number of people benefiting from our profession. This step needs to be taken by each clinic, but that first step will be of enormous benefit to those clinics and to their clients, and ultimately, to our industry.


  1. Lundin SC, Paul H, Christensen J. Fish! A Remarkable Way to Boost Morale and Improve Results. New York: Hyperion; 2000.
  2. Kochkin S. MarkeTrak VI: Factors impacting consumer choice of dispenser and hearing aid brand; use of ALDs and computers. Hearing Review. 2002;9(12):14-23.
  3. Kochkin S. MarkeTrak VII: Obstacles to adult non-user adoption of hearing aids. Hear Jour. 2007;60(4):24-51.

This article was submitted by Neil Clutterbuck and Susan Clutterbuck, who are the founders of EarTrak and operate an audiology practice 100 miles east of Melbourne, Australia. Correspondence can be addressed to , and more information on the EarTrak system can be obtained at