Effective Communication: A New Health Care Obligation

Beukelman Effective Communication Image

By: Sarah W. Blackstone, David R. Beukelman, and Kathryn M. Yorkston
Editors of the new Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

Prior to his accident, Frank was a 26-year-old energetic, physically active young adult with a wide range of interests and a full social life. A C3–C4 cervical spine injury left him unable to move his limbs. When medically stabilized, he was transferred to the surgical intensive care unit, where he was ventilator dependent and in halo traction. He was unable to speak and his only intentional gesture was a gaze shift. The hospital communication team helped Frank establish a reliable yes/no response (looking up to indicate “yes” and down for “no”). They encouraged his nurses and family to offer other choices as well (“maybe” or “later” or “I don’t know”). A speech-language pathologist showed him a speech-generating device (SGD), but when initially asked if he wanted to use it to “talk,” he responded by looking down, “No.” Later that same day, the team demonstrated the SGD again, showing him how he could use it to control the TV and a fan. When asked if he would be willing to give it a try, he replied, “Yes!” by looking up. Within 24 hours, Frank was using a template on the SGD to call a nurse, ask for medication, control a fan, and turn the TV off and on, all with a simple serial scan method and a switch. Over time, he became an active participant in his recovery process, asking doctors questions and participating in decisions about his treatment plan.

Effective communication between patients and providers is a core component of patient-centered and value-based health care. According to the Joint Commission (2010, p.1), effective patient provider communication is the successful joint establishment of meaning in which patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood. To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.

The medical encounters that occur across the continuum of health care are usually time constrained and many are stressful, high-stake interactions. When communication breakdowns occur, the impacts can be devastating for patients, family members, providers, and the health care system. Research shows that communication difficulties are among the major causes of sentinel events and can negatively affect patient outcomes, safety, and satisfaction, as well as result in increased readmission rates, length of stay, and additional health care costs. Because of the diversity of patients and families served in our health care systems, successful communication can be very difficult to achieve. In fact, many patients present with multiple communication vulnerabilities.

At age 4 years, 6 months, Guillermo was in the ICU, intubated and awake following a series of surgeries for tracheoesophageal reconstruction. Guillermo and his family were from Honduras and spoke Spanish only. Guillermo was most relaxed when his mother or eldest brother were sitting next to his bed and rubbing his arm. Although hospital policy supported his family remaining at bedside throughout the day and night, there were moments when they needed to step away for personal care, to attend team meetings along with a translator, or for other reasons. The speech-language pathologist provided Guillermo with a simple voice output aid (Ablenet Little Mack) with messages that included, “Where is my family,” recorded in both Spanish and English, so hospital staff could understand him. The speech-language pathologists also made a 20-target Go Talk+ device (Attainment Company) available to him. It featured 15 target photos of family members with messages such as, “I want mom,” “You’re my best friend, Frederico,” “I love you,” and “Hold my hand,” as well as some medical messages. All messages were recorded in both languages.

We define “communication vulnerability” as the diminished capacity of an individual to speak, hear, understand, read, remember, or write due to factors that are inherent to the individual (e.g., disabilities related to receptive and expressive language skills, hearing, vision, speech, cognition, and memory, as well as language spoken, lifestyle, belief system, and limited health literacy), or related to the context or situation (e.g., a noisy environment, being intubated in an intensive care unit after surgery, suffering injury while traveling in a foreign country, having cultural practices, lifestyles, or religious beliefs that are not understood or accepted by providers).

Eleven-year-old Joshua had a bone marrow transplant. He was acutely aware of his suppressed immune system and created and used several communication tools during the time he required the use of a Bi-PAP noninvasive ventilator. Using a simple voice output communication tool, Joshua insisted on having the following message available at all times: “If anything falls on the floor, use the Sani-wipe to clean it before you let it touch me. Also, if your gloves touch the floor when you pick it up, change your gloves before coming near me.”

In the book, Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professions, we describe how health care facilities and the providers who work within them can begin to assume a more active role in supporting patients who are communication vulnerable. Speech-language pathologists, nurses, administrators, and physicians are key to improving the “culture of communication” within their facilities, spearheading interprofessional practices that benefit all patients and ultimately providers and the facility’s bottom line. Currently, the role of communication intermediary is assumed by a few providers or family members with a personal commitment; although a rising number of health care organizations are beginning to specify policies and role assignments regarding the coordination of communication support services, communication facilitation for all patients with communication difficulties (not just those who are deaf or have second language issues), or a legal or medical intermediary designated to ensure that communication vulnerable patients accurately participate in legal and medical decisions.

Examples of promising practices and strategies across health care settings are highlighted in individual chapters that focus on doctor visits, emergency services, Intensive and acute care settings for children and adults, inpatient and outpatient rehabilitation, long-term residential care, and end-of-life care. In this book, we have invited authors who have considerable expertise in patient provider communication services across the range of health care settings to share information about the policies, intervention strategies, communication materials, and technologies that are being implemented within their medical settings to support the needs of communication vulnerable patients.

The wife of a person with ALS described his end-of-life experience: He was having a great deal of difficulty breathing and simply could not get comfortable in his hospital bed or wheelchair. We decided to go with in-hospital hospice since his pain management was not well controlled. In hospice, he regularly used his (eye gaze-accessible) SGD to tell us what he did and did not want. I am so grateful that he was able to use it extensively during the last few days of his life. I do not know what we would have done without it.

The authors recognize that there continues to be a considerable gap between clinical research evidence, what is mandated by health care policy, and what is experienced every day by patients, their families, and providers during medical encounters because of the ways in which many health care organizations currently deliver care. In other words, we recognize that implementation, or the process of putting effective patient-provider communication policies into practice, continues to be a challenge within many health care organizations; however, in the final chapter of Patient-Provider Communication we discuss a number of implementation strategies.

References
The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author.

About the Authors
Sarah W. Blackstone, PhD, CCC-SLP, is president of Augmentative Communication, Inc. She has authored multiple texts in the augmentative and alternative communication field as well as articles in Augmentative Communication News and other publications. David R. Beukelman, PhD, CCC-SLP, is the Barkley Professor of Communication Disorders at the University of Nebraska-Lincoln. He has served as director of research and education for the Communication Disorders Division, Munroe-Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center. Kathryn M. Yorkston, PhD, BC-ANCDS, is a professor of rehabilitation medicine and head of the speech pathology division within the Department of Rehabilitation Medicine at the University of Washington Medical Center.

2015 Plural Publishing Research Award Winners

We are thrilled to announce the winners of the 2015 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and the honorees and their faculty sponsors were acknowledged at the annual CAPCSD meeting, which took place this year in Newport Beach, California, April 15-18.

“We received 82 complete applications for the Research Awards this year. The quality was very high in all of these applications, making for a lively review process. In the end, there was one each at the MS/AuD level and the PhD level that were truly outstanding,” according to Richard C. Folsom, who chaired the award committee this year.

Eric Bostwick, 2015 Research Award Winner

Eric Bostwick, 2015 Plural Research Award Winner

At the MS/AuD level, the award went to Eric Bostwick at the University of Wisconsin-Madison. Eric is an AuD student working with Dr. Bob Lutfi and his research is entitled, “Decision Weights and Stimulus-Frequency Otoacoustic Emissions.”

Bridget Perry, 2015 Research Award Winner

Bridget Perry, 2015 Plural Research Award Winner

At the PhD level, the award went to Bridget Perry at the MGH Institute in Boston. Bridget is a PhD student working with Dr. Jordan Green and her research is entitled “Early Detection of Dysphagia in ALS.”

Writing Tips from Plural Authors

Have you ever thought of writing a book in your field? We know that writing a book is no small undertaking, so as part of our 10 year anniversary celebration we enlisted the help of our knowledgeable authors Celeste Roseberry-McKibbin, PhD, Lynn Adams, PhD, CCC-SLP, and Lise Menn, PhD, to share advice on writing a best-selling book! Here you will gain some insight into the inspiration, motivation and hard work that goes into a best-selling Speech-Language Pathology and/or Audiology textbook and professional book.

1. What insight or tips would you offer to a first-time author who is writing a professional development book or textbook in the Speech-Language Pathology and/or Audiology field?

CRM: It is very important to make sure that your contribution is original—something that meets a need in the field. I never write a book that competes exactly with something currently in print. I always make sure that my book is unique, original, and has a perspective that no other book has. The questions I also ask are: who would want to buy my book? Why would they spend money on it? What value does it bring to them? What problems does my book help them solve?
It is so important to think about meeting the needs of your audience. As authors, we have our passions and enthusiasms. Who shares them?

LA: JUST START WRITING…..that is the hardest part!!

LM: Have a colleague in a related but different field read through your book to make sure it’s understandable to someone who doesn’t already know the subject matter.

Go back to the original published sources – amazing amounts of old material are easy to get on-line, and you’ll find that you get fresh insights from reading the classic papers instead of relying on the usual summaries. What you take away from a paper that you read for yourself might be quite different from what everyone else has said about it.

Create or find new examples instead of re-using the standard ones that everyone else uses. You might discover something in the process, too. Continue reading

Are Your Services Educationally Relevant?

Jean BlosserSchool Programs in Speech-Language Pathology 5th Edition

Jean L. Blosser, EdD, CCC-SLP
President, Creative Strategies for Special Education
Author, School Programs in Speech-Language Pathology: Organization and Service Delivery, Fifth Edition, Plural Publishing, 2012

Educational Relevance—What an Important Concept!
Does a child’s disability impact his or her performance in the classroom? If yes, would services such as speech-language intervention, occupational therapy, or physical therapy make a difference? Should those services be intensive, provided face-to-face or via technology, or integrated into the classroom? The primary question is, if therapy services are offered, will the intervention provided make a difference in the student’s classroom performance, ability to access the curriculum, and/or ability to reach his or her potential?

These are huge questions that administrators, educators, clinicians, and parents ponder every day. When school teams evaluate a student, they seek to determine how the disability may be interfering with the student’s learning. Key educational areas that may be affected are academic, social-emotional, and vocational performance. If everyone agrees there is an adverse effect on educational performance, the student’s eligibility for services is confirmed.

How Do We Guarantee Educational Relevance? Continue reading

Feature Article: Toward a More Effective Collaboration

Toward a More Effective Collaboration by Aaron Fletcher, MD

2doctorsAs a discipline Otolaryngology has long recognized the benefits and virtues of a collaborative model of healthcare delivery. In fact, I believe that few other medical specialties collaborate as frequently and as effectively as Otolaryngologists—it is an integral part of our culture. On a daily basis, we are called to collaborate with specialists of diverse expertise (Audiologists, Speech and Language Pathologists, Neurosurgeons, Radiologists, Radiation Oncologist, Medical Oncologists and so on). In consulting these experts, we recognize the knowledge of these specialists as complimentary to our own and no less valuable. In fact, we frequently congregate in multi-disciplinary conferences where everyone has a say, and everyone’s opinion counts.

As our specialty embarks upon a changing healthcare landscape, we are constantly challenged to evolve our collaborative process in order to keep pace with the expanding application of technology across healthcare.This collaborative spirit is one of the major reasons that I enjoy this specialty. One of the things I appreciate most about Otolaryngology is the opportunity to learn the subtle nuances of a diagnostic finding, condition or technique that are afforded by colleagues and other members of the treatment team.  Throughout my very young career, I’ve found that better collaboration invariably leads to better care and that to be successful; collaboration requires shared vision, values, risks, resources, and rewards regardless of function, occupation or level of training. This is truly what collaborative care is all about.

communicationThe ubiquity of internet access via mobile devices and smartphones, along with the rise of social media has changed the way in which health care information is distributed and consumed. This factor has allowed patients ample access to information about their health conditions and associated treatment options. A recent Pew Internet research study found that one in three adults have turned to online sources to figure out a medical condition that they or someone else they know might have1. Combining these internet resources with expanded mobile network technology means that patients are increasingly capable of seeking answers to their healthcare questions instantaneously. This means that patients are now empowered to become more active participants in their care, and this is certainly a good thing.

On the other hand, these factors also exert pressure upon caregivers to keep pace with these changes in health related information consumption by increasing technological sophistication and improving their own access to medical knowledge. By doing so, we are better suited to meet the demands of a patient population that is better equipped to make important healthcare

As the application of technology across the healthcare landscape has led to a greater sense of empowerment among patients, advancements in health IT, (including electronic health records, cloud computing and health information exchange platforms), also hold great promise for clinicians. The advent of these tools has empowered clinicians to mobilize and share clinical information with members of the treatment team at any time and from any location with internet access. Given the intrinsic collaborative nature of our field, it makes perfect sense that we leverage these technologies to expand our approach to coordinating collaborative care. HIPPA compliant hosting and file sharing networks are now working to mitigate the risk of exchanging protected health information (PHI) via the web and mobile devices. These networks work to encrypt PHI both in storage and in-transit, thereby providing a layer of protection against breaches in security. While these platforms should be used with caution to ensure compliance with HIPPA regulations, as these tools continue to evolve, they will create new opportunities for collaboration and partnership across traditional institutional and geographic boundaries.

Naturally, I believe that Otolaryngologists should be at the forefront of integrating these tools into clinical practice, as we continue to seek new ways of perfecting collaborative care.  I believe ubiquitous data accessibility and sharing (cloud computing) coupled with HIPPA-compliant hosting platforms have the ability not only to facilitate, but to enhance the way we collaborate. Using these tools we can share best practices and treatment protocols, coordinate video conferences with colleagues outside our geographic area, and obtain outside expertise about challenging cases. These tools also allow us to interface with patients about their care, and to provide them a portal to share relevant updates on their condition from the comfort of their home. All of these efforts are critical to the long-term success of our collaborative efforts as a specialty, and familiarity with the tools by which we accomplish these aims is imperative.

So as we embark upon a continually evolving paradigm of healthcare consumption and delivery, we must continue in the spirit of collaboration, and seek out the new tools of our trade.  By doing so, we can continue to demonstrate that better collaboration leads to better care.

References:

1.            Fox, Susannah, Duggan, Maeve: Health Online 2013. Accessed online via http://  pewinternet.org/Reports/2013/Health-online.aspx

 

Dr. Fletcher is the author of the just-published Comprehensive Otolaryngology Review: A Case-Based Approach Fletcher_COR

Feature Article- Preclinical Speech Science: A Cool Stroll through the Forest

Preclinical Speech Science: A Cool Stroll through the Forest
by Gary Weismer & Jeannette Hoit

forest

Every discipline has its “trial by fire” entry-level courses; in the field of speech-language pathology, the speech science course is one of those. Students often see speech science as a walk across the hot coals of anatomy,  physiology, and acoustic output of the speech apparatus.  Our view is that it should be more like a stroll through a beautiful forest, with vegetation and wildlife that is so interesting you can’t help but stop and admire it, ooh and ah over the relationship between structure and function of a plant here, an animal there, and want to remember the details of this new and intricate world because you just know that understanding it will be useful to you in the future.

Preclinical Speech Science, Second EditionThere have been many great speech science textbooks over the years, and almost certainly many more to come.  When we set out to write the first edition of Preclinical Speech Science:  Anatomy, Physiology, Acoustics, Perception, we asked ourselves the question, ‘Why write yet another speech science text?’  Our answer was that we wanted to  1) present the kind of beautiful images, coordinated with easy-to-read, straightforward text, that would make students want to stroll, stopping frequently, through this beautiful forest of knowledge that is the back country of speech-language pathology,  2) expand greatly on the ‘other A&P’ (Acoustics and Perception),  3) update the speech physiology to include contemporary notions about how speech production works, and why it has clear relevance to the speech-language pathologist’s daily practice, 4) include examples of clinical applications of speech science in the forms of clinical scenarios and sidetracks, and 5) integrate the fundamentals of the anatomy and physiology of human swallowing, a knowledge base that has become increasingly important over the years in the training of speech-language pathologists. We also wanted an accompanying workbook that would contain problems ranging from the easy, memorization type to those requiring a fair amount of thought.

But every rose has its missing petals, as did ours, which even those who admired our text were quick to point out. Our missing petal was a chapter on the brain. The National Institutes of Health (NIH), in coordination with other government agencies, had identified the period between 1990 and 2000 as “The Decade of the Brain,” and indeed during those ten years there was an explosion of research on the relationships among neuroanatomy, neurophysiology, brain lesions in a host of diseases, and behavior. brainThis explosion was heard throughout the speech science world as well, and continues to resonate with speech-language professionals to the present day. The brain processes underlying speech and language behavior, both normal and impaired,
are under heavy scientific and clinical scrutiny and speech-language pathologists need to be well-versed in this area.  With an ever-increasing aging population and its associated neurogenic diseases and their potential to affect speech-language behaviors, most training programs are putting added emphasis on a deep understanding of brain structures and mechanisms as they relate to communication. So in our second edition of Preclinical Speech Science, we have tried to enhance the rose with a new petal—a full chapter devoted to neuroanatomy, neurophysiology, and brain processes and models specific to speech production and perception.  In preparing this chapter, we retained our devotion to high quality images and patient, comprehensive text to make those images relevant and highly accessible as a new source of knowledge for the student.  We also showed how contemporary models of brain function in speech production are relevant to the diagnosis and management of disorders such as dysarthria and apraxia of speech.

In our writing of the new edition of Preclinical Speech Science, we have also updated much of the information in the original chapters, fixed mistakes, and prepared a new workbook to accompany it.  We urge you to give it a try, stop to smell the anatomical,  physiological, acoustic and perceptual roses in the forest.  If you allow your eyes to linger for a while on the wonderful images drawn by Maury Aaseng and think about what’s written in the text, we think you’ll find the ground less like a bed of coals and more like a cool stroll.  And your knowledge of all things speech science will make you cool in the eyes of your fellow health care professionals!

Featured Article- Choral Pedagogy, Third Edition


CHORAL PEDAGOGY, 3RD edition

Brenda Smith, DMA and Robert T. Sataloff, MD, DMA

Choral Pedagogy 3rd

Singing is known to every culture around the world.   For most of us, singing skill is learned collaboratively in choirs.  To participate in a choir throughout a lifetime, we must adjust our vocal expectations and maintain a dynamic sense of readiness for the changes that occur from year to year.  The choral conductor must work nimbly to accommodate the vocal needs of each age group, including all singers at all times in assignments appropriate to the contributions they are able to make.  There are many challenges, but choral pedagogy, voice science and medical resources are equipped to assist the choral conductor in the creation of a dynamic rehearsal and performance plan.

Lifelong Singing

For the training of vocal skill, trained and amateur singers of any age benefit from the personal attention of a voice builder or choral conductor.  Each voice presents with a specific complement of unique set of vocal, aural, rhythmic and interpretative gifts.  Because singers perceive their voices differently the way they are perceived by their listeners, singers at any age rely on constructive feedback generated by the trusted ears and eyes of a qualified person.

choirChanges in range are a natural part of the aging process and are due to the loss of muscle bulk and alterations in connective tissue in the vocal fold, as well as to respiratory changes, blood flow and alterations in body muscle nerve condition, and other alterations.  Another factor is the ossification of laryngeal cartilages.  The degree of aging changes varies from singer to singer.  People who love to sing wish to be included in choral activities as long as possible.  Choral singing can be particularly beneficial for the preservation of vocal skill and for delaying the inevitable losses of range, control and agility.

 

Medical Aspects

While choral conductors are not expected to have the medical knowledge of physicians, they should have sufficient familiarity with vocal health problems to recognize at least obvious voice dysfunction and suggest that afflicted singers seek medical attention.  Medical voice care has advanced markedly over the last few decades.  Voice is now an established subspecialty of otolaryngology (ear, nose and throat), and expert care for singers is available much more widely than it used to be.

Good medical diagnosis in all fields often depends on asking the right questions and then listening carefully to the answers. This process is known as “taking a history.” Recently, medical care for voice problems has utilized a markedly expanded, comprehensive history, recognizing that there is more to the voice than simply the vocal folds. Virtually any body system may be responsible for voice complaints. In fact, problems outside the larynx often cause voice dysfunction in people whose vocal folds appear fairly normal and who would have received no effective medical care a few years ago.

Physical examination of a patient with voice complaints involves a complete ear, nose, and throat assessment and examination of other body systems as appropriate. In the last few years, subjective examination has been supplemented by technological aids that improve the ability to “see” the vocal mechanism and allow quantification of aspects of its function. With phonation at middle C, the vocal folds come together and separate approximately 250 times per second. Strobovideolaryngoscopy uses a laryngeal microphone to trigger a stroboscope that illuminates the vocal folds, allowing the examiner to assess them in “slow motion”. This technology allows visualization of small masses, and other abnormalities that are simply missed in vocal folds that looked “normal” under continuous light. The instruments contained in a well-equipped clinical voice laboratory assess six categories of vocal function: vibratory, aerodynamic, phonatory, acoustic, electromyographic, and psychoacoustic. State-of-the-art analysis of vocal function is extremely helpful in the diagnosis, therapy, and evaluation of progress during the treatment of voice disorders.

Following a thorough history, physical examination, and clinical voice laboratory analysis, it is usually possible to arrive at an accurate explanation for voice dysfunction. Of course, treatment depends on the etiology (cause). Fortunately, as technology has improved voice medicine, the need for laryngeal surgery has diminished. When the underlying problem is corrected properly, the voice usually improves, but collaborative treatment by a team of specialists is most desirable to ensure general and vocal health and optimize voice function. The choir director should be part of that team.  Details of medical problems associated with voice disorders may be found in other literature. 1-4

The Basics of Singing

Warm ups and cools downs are necessary for any singer.  Warm up and cool down exercises adjust the vocal instrument from speech to singing and from singing back to speech.  Warm ups and cool downs involve four elements: relaxation, posture, breathing and resonance.  Relaxation before and after singing contributes to vocal health.  The vocal mechanism and the extremities need to be stretched and warmed.  Good posture, both standing and seated, must be established in order to achieve a full breath.  Conductors should be mindful that singing in a seated position is not an easy task.  All singers should maintain an erect posture that allows maximum muscular freedom, flexibility and safety.   A buoyant, flexible approach to breath support during exhalation follows.  The final step to vocal readiness involves uniting the breath with the vocal sound.  Exercises that evoke resonant sounds, such as humming, trilling with the lips or sighing set the stage for a focused vocal tone.  In the process of cool down, singers return the voice to the speaking range by sighing, chanting or humming through the mid and lower registers.

singer

The role singing plays in the daily life of each singer is diverse and unique.  The rhythm and discipline of music learning sharpens mental acumen and memory. For choir members who maintain interests in acting and public speaking, singing can be a means of maintaining vocal strength and stamina.  For many, singing in a choir makes life worth living.  The overall musical results of a choir rehearsal may be of less importance than the good experience of being together for the task of singing.  Singers want to continue singing as long as they can and as well as they can.  Choral pedagogy is advancing to accommodate the special needs of singers of all ages.  By establishing good singing habits, remaining physically fit, setting reasonable goals, and attending to vocal health, choral singers can “stay in the game” for many decades.

References

  1. Sataloff, R.TProfessional Voice: The Science and Art of Clinical Care, Third Edition.  San Diego, CA: Plural Publishing, Inc.; 2005.
  2. Rubin, J., Sataloff, R.T. and Korovin, G Diagnosis and Treatment of Voice Disorders, Fourth Edition.  San Diego, CA: Plural Publishing, Inc.; 2013, in press
  3. Heman-Ackah, Y.D., Sataloff, R.T. and Hawkshaw, M.J.  Protecting the Vocal Instrument.  Narberth, PA: Science and Medicine; 2013.
  4. Smith, B. and Sataloff, R.T.  Choral Pedagogy and the Older Singer.  San Diego, CA: Plural Publishing, Inc.; 2012.

 

 

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.

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!

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