Feature Article: Why Quality Matters: The Changing Healthcare Delivery Model

Brian Taylor

Why Quality Matters: The Changing Healthcare Delivery Model

By Brian Taylor, AuD

In fits and starts, physicians and other healthcare professionals are beginning to realize that the convergence of wireless sensors, social networking, mobile connectivity and robust data management systems will profoundly impact the future. This transformation of medicine is likely to put a premium on healthcare professionals that place the patient firmly in the center of the clinical experience. These same forces will undoubtedly affect audiologists and their support staffs, and quality is likely to be a key differentiator in a disruptive future.

In this new world, physicians and other healthcare professionals are more likely to be reimbursed for the quality of their results, rather than the sheer number of procedures they order. Hospitals and clinics that demonstrate higher-than-average patient satisfaction scores will enjoy higher rates of reimbursement from federally funded programs. Patients are even joining the quality bandwagon as many are demanding greater transparency when shopping for medical services. In essence, patients are demanding to be treated more like customers. Consumer-centered health care is gradually supplanting the antiquated, paternalistic model in which the practitioner is never questioned and has near omnipotent authority over the uninformed patient. Out of this paradigm shift comes the quality movement. For audiologists this means the use of report cards, key performance indicators, and other quality strategies and tactics, if they want to stay relevant in a highly competitive marketplace. If you are like the typical practitioner, there is a good chance these concepts related to quality sound a little strange to you now. This is why I wrote Quality in Audiology: Design and Implementation of the Patient Experience, to help you prepare for some of these changes.

Interestingly, hearing aid manufacturers are very familiar with many of these concepts. In an effort to rise above their fierce competition, manufacturers have been obligated to standardize quality within their production lines by using tools such as Six Sigma and Total Quality Management. At the heart of these quality tools is a drive to eliminate variance. Eliminating variance is a worthy goal for the optimization of medical devices, but clinicians know all-too-well that each patient has built-in variability. Thus, many of the quality concepts and tools device manufacturers have come to rely on to incrementally improve quality don’t work well with patients. This paradox of quality within healthcare, as the book suggests, can be overcome through the standardization of quality around six patient staging areas.

Taylor_QA

The purpose of this book is to bring a level of practicality to the implementation of quality within an audiology clinic. As the book proposes, quality is improved mainly through your grassroots initiatives: procedures, programs, and behaviors you implement, measure, and manage in your clinic. This grassroots perspective requires audiologists and other professionals associated with hearing heath care to reexamine the concept of quality. According to the International Standards Organization, which acts as a sort of quality police for device manufactures, quality is the totality of characteristics, including people, processes, products environments, standards, and learning, of an entity that bear upon its ability to satisfy stated and implied needs. This definition suggests we improve ourselves and our ability to create quality in the world around us through innovation and the judicious use of best practice standards.

From a workaday, clinical standpoint, quality is meeting the requirements and expectations of patients and stakeholders in the business. In short, quality is probably best defined as the standardization of individual excellence. Rather than rely on academic boards and government agencies, the quest for better quality begins with self-motivated and dedicated audiologists and support staff who can use data to make better decisions about their patients. Quality in Audiology will get you on the path to continuous improvement in your clinic.

Feature Article: Technology helps patients with hearing loss thrive

Seilesh BabuBy Seilesh Babu, M.D., Michigan Ear Institute

Hearing loss is one of the most common conditions affecting otology patients whether as a newborn or aging patient. Hearing loss can significantly impact one’s ability to communicate leading to reduced quality of life, isolation, and even depression. Seeking medical help to assist with this hearing loss can be the biggest obstacle for many patients who do not want to acknowledge a hearing issue. However, if the problem is properly managed with hearing aid assistance or surgical therapy, improvement in the patient’s quality of life including anxiety, depression, frustration, and social isolation will be positively impacted.

In our practice at the Michigan Ear Institute, we see thousands of patients annually with hearing loss concerns in all age groups. Some of unilateral hearing loss and many have bilateral hearing loss, ranging from mild to profound. Unilateral hearing loss can be caused by not having an ear canal form (canal atresia) or, from nerve damage of unknown etiology. These patients have several options to improve their hearing such as using CROS hearing aids, bone anchored devices, dental implanted devices, or surgical repair of the poorly formed ear canal in the case of atresia. Many patients have significant improvement in their hearing in various situations using these technologies and surgeries.

Recently, a patient of ours received a scholarship from Cochlear Americas, the global leader in implantable hearing solutions. This scholarship recognizes bone anchored device and cochlear implant recipients who have shown academic accomplishments as well as a commitment to leadership and humanity. Using the technology of hearing devices, patients are able to complete advanced academic pursuits despite having hearing impairment that may have proven to be an obstacle. We are proud to be a part of this successful path for this patient who is currently enrolled in a Ph.D. program.

Hearing technology continues to improve. Advances in hearing aids have occurred with smaller, more powerful processors and noise canceling technology, as well as masking technology that treats tinnitus or ringing in the ear. Middle ear implants provide a surgical treatment option for patients who do not want to wear conventional hearing aids. Cochlear implantation has revolutionized the ability to treat patients with complete hearing loss either as a newborn or for patients in their 80s.

baby_hearing_aidChildren born with complete deafness are able to be treated with a cochlear implant with near normal function from speech and language development to academic performance. Adults with late onset profound hearing loss are also able to obtain a cochlear implant in order to maintain excellent quality of life, independence, and social interactions. Some elderly patients diagnosed with Alzheimer’s disease may in fact be suffering from severe hearing loss that needs to be diagnosed and managed.

In the future, advances in stem cell development and treatments will improve the quality of life of hearing loss sufferers. In addition to these new technologies, it is the collaborative effort of otologists, audiologists, and speech-language pathologists in treating patients with hearing loss that continues to have a positive impact in the lives of these patients every day.

FIRST LOOK: Sound Auditory Training – a new tool for treating patients with CAPD

By Dr. Gail Chermak

Coming soon: Web-based auditory training exercises—Sound Auditory Training—developed by Gail Chermak, Frank Musiek, and Jeffrey Weihing. Based on a wealth of empirical evidence on the neuroscience, diagnosis and treatment of central auditory processing disorder (CAPD), Sound Auditory Training is designed to train auditory processing skills in children, adults, and older adults with CAPD as well as other clinical populations, such as patients with cochlear implants. Sound Auditory Training (SAT) makes available well controlled stimuli that can be customized to exercise a number of fundamental auditory skills. In addition to training, SAT provides clinicians with a toolset to design one’s own training tasks and evaluate auditory skills, and provides clinical scientists with highly accessible stimuli to design psychoacoustic procedures. While the developers offer general guidelines for selecting specific tasks and setting parameters based on clinical profiles, SAT is not a program nor is it a test. Rather, SAT is toolset that includes adaptable auditory stimuli, a range of auditory tasks, and engaging graphic interfaces to meet the clinical or research needs of the professional.

The prevalence of CAPD is estimated at 5% of school-aged children and up to 70% of adults and older adults experiencing hearing and listening problems. The underlying impairments of individuals with CAPD are varied and not currently reducible to a single deficit.  Auditory processing deficits frequently are seen in a number of other disorders including learning disabilities, dyslexia, language impairment, attention deficit disorder (ADHD), and autism. In order to properly describe and treat basic auditory deficits that can affect listening, communication, and learning, one needs to have a flexible, but easy to use tool that spans temporal, spectral, and binaural processing.  The architecture of Sound Auditory Training incorporates the flexibility necessary to adapt stimuli for training regimens to meet the needs of particular individuals. The software provides the flexibility to train in either a game environment for children or a more standard psychophysical paradigm for adults.

Sound Auditory Training relies on adaptive algorithms (i.e., the program changes in response to the user’s performance), flexible feedback to the user (via animations or counters), and flexible parameter settings for the clinician/clinical scientist, parents, educators, and users. Tasks train intensity, frequency, and temporal detection, discrimination, and identification using a variety of non-verbal (e.g., tones, noise) and minimally loaded verbal stimuli (e.g., consonant-vowel syllables). Immediate feedback (error correction and reinforcement) is provided through animations within the game. Skills are practiced intensively until they become habitual and automatic. The exercises are sequenced to challenge but not overwhelm the participant. The clinician can use the software to obtain a more comprehensive profile of an individual’s skill strengths and skill deficits in order to more efficiently and effectively target and train deficit areas on a variety of auditory tasks.

In addition to its usefulness to clinical professionals, Sound Auditory Training is designed to be accessible to parents and teachers so that the exercises can be administered in a non-clinical environment. It is also designed to meet the needs of researchers to serve as a tool for investigation of auditory psychophysics, especially with children.  The flexibility of the program allows updates based in research and thus promotes evidence-based practice.

Sound Auditory Training provides auditory training exercises that encompass a wide range of auditory processing skills. There is no other product like it! Most important, Sound Auditory Training exercises auditory skills which are most likely to have a meaningful impact on a person’s listening, communication, and learning.

Plural Community – April 2012

The April issue of Plural Community is here! In this issue you can:

- enter to win a copy of Clinical Management of Swallowing, Third Edition

- check out our new releases like Choral Pedagogy and the Older Singer

- read a great article by Linda I. Rosa-Lugo, Forin M. Mihai, and Joyce W. Nutta on language and literacy development for English learners with communication disordess

- see Plural’s upcoming events

- and more!

 

Check it out here: Plural Community – April 2012

 

February Plural Community

We are delighted to send you the February 2012 issue of our free content (and free to circulate) newsletter, Plural Community—featuring an article by Robert Goldfarb on problems of diagnosis in communication disorders.

Our regular features include our free-to-enter prize drawing, new books launched this month, and a listing of conferences where you can meet our people and browse our books. Click here to see the newsletter!

Don’t forget to follow us on Twitter and like us on Facebook!

January’s Plural Community

We are delighted to send you the January 2012 issue of our free content (and free to circulate) newsletter, Plural Community—featuring an article by James E. Peck on the little-understood issue of pseudohypacusis, or false and exaggerated hearing loss. Click here to read it!

Our regular features include our free-to-enter prize drawing, and a listing of conferences where you can meet our people and browse our books.

Thank you for reading on; we wish you and your families all the best for 2012.

December’s Plural Community Newsletter

The December issue of our free content (and free to circulate) newsletter, Plural Community, is now available—featuring articles by Karyn Lewis Searcy on child language development and Nancy J. Minghetti on the work of the American Speech-Language-Hearing Foundation. We also include some photographs from the recent ASHFoundation’s Elegant Oceanside Charity Event, held at the home of Plural owner, Angie Singh, last month. There are no incriminating shots there, we assure you!

Our regular features include our free-to-enter prize drawing and a listing of conferences where you can meet our people and browse our books. Click here to go to the December Plural Community Newsletter!

Thank you for reading on; we wish you all the best for the festive season and for a happy and peaceful new year.

Best wishes from the Plural team.

November’s Plural Community Newsletter

The November issue of Plural Community is here! Click here to read it!

In this issue you can:

- enter to win a copy of The Deaf Child in a Hearing Family

 

- see our new releases, like Janice Chapman’s Singing and Teaching Singing: a Holistic Approach to Classical Voice, Second Edition

- read an article about Uganda’s first Speech-Language Pathologists by Helen Barrett

- and find out about the ASHA Foundation fundraiser held at the home of ASHFoundation board member, and Plural CEO, Angie Singh!

 

 

October’s Plural Community Newsletter

October’s Plural Community Newsletter is here! In this month’s newsletter you can:

- Read an article by head and neck cancer survivor and author, Nancy Leupold

- Check out our new releases such as Meeting the Challenges of Head and Neck Cancer: A Guide for Survivor’s and Caregivers, Second Edition by Nancy Leupold, and Janice Chapman’s Singing and Teaching Singing

- Enter for a chance to win Leupold’s new release!

September’s Plural Community Newsletter

The September issue of Plural Community is now available! You can find it here. Inside this issue you can:

- Enter for a chance to win a copy of Otolaryngology Surgical Instrument Guide, by Drs. Justin Golub and Nicole Schmitt

- Read a great article by Dr. Golub on the creation of his book

- Check out September’s new releases like Speech Audiometry by Drs. Gary Lawson and Mary Peterson