Welcome everyone to the webinar, How to Increase Patient Satisfaction. We're so glad you could be here today to learn more about developing a care plan that encourages patient confidence and loyalty. Your moderators for today are me, Keri Peterson, Member Services Supervisor. And Ted Annis, Senior Marketing Specialist. Our expert presenter today is Mary Lysis. Mary joined Starkey Hearing Technologies as Director of Customer Service and Education for Audible in June of 2006. Mary has more than 25 years of experience in the hearing health care and biomedical field. She has worked in clinical practice for major hearing aid manufacturers and for biotech firms. Her personal areas of interest focus on oral rehabilitation and a successful coupling of technology with human lives. She obtained her BS from the University of Wisconsin-Whitewater and her MS from the University of Wisconsin-Stevens Point. We're so very excited to have Mary as our presenter today, but before we get started, just a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on demand through the IHS website in the future. This webinar is available for one continuing education credit through the International Hearing Society and the Association of Hearing Instrument Practitioners of Ontario. We've uploaded the CE quiz to the handout section of the webinar dashboard and you may download it at any time. You can also find out more about receiving continuing education credit at our website, IHSinfo.org. Click on the webinar banner on the homepage or choose webinars from the navigation menu. You will find the CE quiz along with information on how to submit your quiz to IHS for credit. If you'd like a copy of the slideshow from today's presentation, you can download it from the handout section of the webinar dashboard or you can access it from the webinar page on the IHS website. Feel free to download the slides now. Tomorrow you will receive an email with a link to a survey on this webinar. It is brief, but your feedback will help us create valuable content for you moving forward. Today we will be covering the following topics. Three questions that can be used pre- and post-fitting. Define the term auditory training. Understanding three ways speech mapping can be used to increase patient satisfaction. At the end we'll move on to a Q&A session. You can send us a question for Mary at any time by entering your question in the question box on your webinar dashboard, usually located to the right or top of your webinar screen. We'll take as many questions as we can in the time we have available. Now I'm going to turn it over to Mary who will guide you through today's presentation. Take it away, Mary. Thanks, Carrie. I'm excited to be here with you guys today. I want to talk about satisfaction. You can see the agenda of the topics we're going to cover are up on the screen for you. The first thing I want to talk about is that satisfaction is a process. It's an ongoing thing that we work at throughout the life of our patient. We're going to divide it into three areas. Pre-fitting tools, fitting tools, and post-fitting tools. Then at the end I look forward to answering any questions that you can have. Let's jump right in and let's talk about satisfaction as a process, not an outcome. What I mean by that is that satisfaction isn't an end point. It's something that we work at and strive for for the whole time that we work with our patients. One of the questions I get asked is, why isn't their happy just good enough? Research has shown that the most comprehensive protocol that we can offer our patients has major impacts on the hearing aid brand loyalty. Brand loyalty here I don't mean to a manufacturer, but to you. Most people associate the hearing aids from the clinician who worked with them in their fitting, not the people who manufactured it. It also increases how much they use their hearing aids. Taking a patient from being happy to being truly satisfied and delighted increases positive word of mouth, they have more satisfaction with their benefit, and ultimately more usage of their hearing aid, which means we end up with fewer hearing aids in the drawer. We can look at this in the data, and this is from the market track data. If we look at a mean level or a goal level of a five on the success score for our patients, we can see that as you add more steps to your protocol, you increase the level of satisfaction. Don't worry, I already know what you're saying. We already do a lot. What am I doing asking you to do more? What I'm hoping is as we go through the talk today, you might find one or two things you could simply add in or that you're already doing that you may be able to expand that could have a significant impact on your patient. What I really want to focus on here is this need or desire to recommend hearing aids. If you look at it, for those people who use just the minimum protocol, only 46% of patients would recommend the use of hearing aids. For people who use a more comprehensive protocol, 95% of those patients would recommend hearing instruments. That can increase significantly our word of mouth. Let's move on and let's talk about at pre-fitting. What exactly would we want to do at pre-fitting? There's four things that I would like to talk about as part of the pre-fit. The first is the use of a hearing loss simulator. Next is a paper and pencil survey called the COSI. Yes, I'm going to talk about demos. Then the creation of a care plan. This is one thing that I think most of us are all doing. It just becomes a way that we can expand on it, highlight for the patients that we're doing it, so that they've got a better idea of exactly what to expect. Let's start with the hearing loss simulator. I love the hearing loss simulator. The hearing loss simulator is primarily for the third party. I'm just showing you one. There's several different ones that are available. What the hearing loss simulator allows the third party is to understand the impact of the hearing loss on their significant other. They can actually hear how they sound or how the environment sounds to the patient. This increases a level of empathy and gets them more motivated to be involved. The other aspect of a hearing loss simulator, particularly one like this that's PC-based, is it can become a visual counseling tool. We can actually highlight the sounds that the patient isn't hearing over the sounds that they are. Then we can talk about how we want to take and bring sounds up. We can hit multiple modes of the patient to further engage them so that they understand how the hearing loss is impacting them. The next tool I want to talk about is the COSI. The COSI is the Client-Orientated Scale of Improvement. It's an open scale. What we mean by that is that it doesn't have set fixed questions that get asked. It's really a great tool that we can use to find out what's most important to the patient. There's paper and pencil versions of it. We use a hearing health care report form that's got a version on it. One of the things I really like about it is that it is found within the NOAA software. What that means is it can actually be saved in the patient file. You can look at it over time and see how things change for the patient. Within the NOAA software, it is found up under the form section. You can, from this, print out a paper version of it. It's designed to be interactive between the clinician and the patient. It's not something that the patient just fills out. We all do a discovery process. We all ask our patients, why are you here today? What situations are you most concerned about? All of those types of things. Those situations, that information that we get from the patient, that's what we put into the COSI. For this patient, for example, they struggled at a Lions Club luncheon. That was actually the ultimate reason that they came in. They couldn't follow the speaker at a luncheon. From there, we found other situations where they wanted help. From there, the patient actually rakes the level of priority. This is something that I like the patient, whether I'm doing it on the computer or paper and pencil, to actually physically do themselves. Which is the most important situation for them? Ultimately, what the COSI can do going forward is it works to keep the patient and the clinician focused on the areas that are most important. Have you ever had that patient where you're working on those situations that you think are most important to them and at their third follow-up, within their acclimatization or trial period, they show up and they throw an environment at you that's completely different? You can now take that and, using the COSI, go, that's a great situation. First, let's focus on these four that you said were most important, and then we can discuss whether or not we can add that in. Oftentimes, when we can do it that way with our patient, and we've got it documented somewhere, they realize how satisfied they are already in those four key situations, and this is a brand new one. Again, satisfaction is a process. We need to keep in mind where they're looking for the satisfaction, and this is a great tool to help keep us focused. Going forward at follow-ups, we can use the same thing again. We can have that patient who comes in after six months and goes, I don't think I'm doing as well as I think I should be. When we can use this tool, we can actually look at it and go, well, let's go back to these situations where we were focusing on. Often the lack of satisfaction is centered around a brand new situation, and this can help us document that and acknowledge it for the patient and that we're going to handle it differently. The next thing is a demo. I like to say that while seeing is believing, hearing is buying. There's actually research now that's showing us why demonstrations are important. We all know that people's brains work differently, but did you realize that as midlife approaches, we tend to focus more and more on our right brain, on our gut, on our emotion? The left brain is more of our logic and our reasoning. In order to get the strongest message, we want to engage both parts of the brain. But a demonstration can allow us to tap into that emotional side of the brain, and then we can help build the story on the left side that's going to help make it easier for them to make this decision. The reason that most people tell me they don't like to do demos is that they're concerned that it's not going to really help. What happens if I get in the middle of a demo and my patient says they can't hear the difference? Or what happens if I get in the middle of the demo and they don't see the benefit? What we focus on when we do our demos is one need, one solution, one demo. Going back to the cozy, you have that one environment that's most important to them. That is what we're going to demo. Whether it's the audibility of being able to hear their wife, or being able to hear somebody across the room, or hearing a noise, or being able to listen to music, being directly to their hearing aids. We're going to pick one thing, that most important thing, and that's what we're going to demo. The demos that are often unsuccessful are the ones that we call a harbor cruise, in which you put the hearing aids on, you talk to the patient, and then you ask them how that sounds. They don't know what they're listening for, they don't know what to expect, they don't know why it's being done. A demo should be focused and on point. When we're doing a demo for a patient, I will tell them right up front, I'm going to put these hearing aids on you, I want you to listen, and I'm going to see if the advantages or the features of this hearing aid are going to help you do better in noise. We'll start with the features off, and then I'll turn them on, and you tell me if you can hear a difference. They know exactly what they're listening for. Then I don't get the things of, I don't like how my voice sounds, or I'm not sure that I like how the fan on the computer sounds, because I've told them exactly what I want them to listen for. When I get the positive response, and by the way, a little hint, did you know that when people hear something they like, they raise their eyebrows? So whether or not they smile, whether or not they nod, whether or not they get all excited about it, if their eyebrows go up, they liked something that they heard. Then we can use this demo to transition into how we're going to do our recommendation. Isn't it great to hear the TV like this? Mrs. Jones, wouldn't it be wonderful to not be blasted out while your husband's listening to TV? Or wouldn't it be great to be able to follow the card game bids? So we're going to take that primary need that we've documented on the COSI, we're going to demo it, and that becomes the core and base of our recommendation for our patient. This is how we can guide our patient through the decision-making process and for them to understand the potential benefit of amplification and where they're going to see the most satisfaction. The last thing that I want to talk about in pre-fitting is a care plan. A care plan is something that we all do. We all know that we're going to see our patient multiple times throughout their trial period. We're going to do our best. There's going to be transitions. There's going to be adjustments. But I think if we can do a better job of outlining that care plan for the patients, it will be perceived as being a benefit of what we do for them. It gives them an idea of what to expect, and it's been documented that knowing the expectations of the care plan, particularly for analytical and driver patients, increases their level of satisfaction. If you have an analytical or a driver patient, they want to know what's going to happen. Outlining that care plan can make them feel better. I have just a simple form like this, and I write the dates on it. I fit you today, or we did our demo today. You're going to be fit on this date. We're going to do our checkups on these dates. It's all laid out, and then we can check it off as we do it. What I'm setting my patient up is to realize that four visits over the course of an introduction to amplification is not unusual. Then if they're doing really well, maybe we'll skip appointment three. I'll ask them, you seem to be doing well. Do you want to try and go two weeks without seeing me this time? And some of them will say yes, and some of them will say no. But it's much better to set up that expectation, and then if I do need to see them every week, nobody feels like they're failing, nobody feels like something isn't working. But it gives them a structure around what to expect and that they know that they're on track. Setting up the care plan brings us right in to tools that we can utilize during the fitting itself. There's a couple of tools that I want to talk about. The first is speech mapping. The second is speech and noise testing. And then the third is good old-fashioned homework. And there are three things within homework that I sort of want to talk in depth about. One is called IFIT, the old-school reading out loud to yourself, and then the auditory training or brain games, which I think are underutilized and have been documented and proven to increase patient satisfaction and utility with amplification. But let's start with speech mapping. And I know, I know what you're already thinking. It's one more thing I'm asking you to do and you do so much already. And you feel like you don't have time for any extra stuff and the equipment can be expensive. But there is actually a great rationale and even a business case for why you would want to do speech mapping. So speech mapping allows both the patient and the third party to see what is being heard. More than just the patient hearing and responding, for a third party, particularly if they're a visual person, to actually be able to see you getting within a target range, providing amplification, that as you're making changes in your software, it's being shown on the screen, are great tools to engage that third party. And as we're going through this, satisfaction isn't just about the patient. It's about their family members. Have you ever had a patient come back and say, I think I'm doing better and the third party going, I still don't think it's worth it? We have to have everybody engaged and everybody satisfied with the product. What I like about it for me is it allows me to see what the patient may not be able to describe. I had a patient once who told me her hearing aid sounded chunky. I had no idea what that was. I could do speech mapping on it and I could see exactly where that sort of chunky sound came from. As I talked and I said different words, she could say, that's it, that was the word, and I could see exactly how the hearing aid was responding. And it helped me to better fine tune and understand. The other thing is with our new wireless technology, it's not like they've got to be hooked up to 20 cables anymore. They just have to have the real ear equipment on them and the hearing aids can be adjusted and programmed wirelessly. It adds a level of technology to the fittings that we're doing. Still not sold? Well, let's talk about the business case. Did you know that doing speech mapping can decrease follow-up visits by 50%? Yes, we have our care plan. Yes, we're planning on four visits. But by doing speech mapping, we can, quote, unquote, skip some of those appointments without sacrificing patient satisfaction. So this research was published back in 2002, and what they did was they had patients with, they did not do speech mapping and they did do speech mapping. So 13 without, 12 with. Follow-up visits total for the 13 patients without speech mapping were 70 follow-up visits. That's over five visits on average per patient. For the 12 with speech mapping, it was only 35. That was just a little under three visits per patient. So what we're looking at is a 50% reduction from 70 down to 35, and a 45% reduction in follow-up visits per patient. So that's more time in the clinic that you can be seeing new patients working with other patients instead of just doing, working with the one. Here's the other thing. 76% of patients with above-average success were fit in one or two visits. 47% of the patients with below-average success required four to six patient visits. So a couple of things. More visits doesn't always equal more success. I would also venture to guess that the people with the four to six visits didn't have an outlined care plan and that four visits was expected. But more visits can often be perceived as more problems, more trouble, more adjustments, and the speech mapping lets us see what the patient is hearing so the adjustments we make can be more on point and less sort of like shooting in the dark. The other thing I want you to think about is that 64% of practices do not do this, and that's based on Kochkin's data in 2011. So 64% of practices. The big thing everyone's talking about these days is differentiation. How do I make myself different? How do I make myself stand out? Speech mapping is a tool that can do that. And the speech mapping can be a tool that can be used as a verification. So here what we're doing is we're using speech mapping to verify the hearing aids. We're using a standardized signal, the International Speech Test Signal, and we're gonna display a 65 dB target. And you can display loud, soft, whatever ones you want. You can do multiple targets on it. And this one we're also gonna show the patient's threshold is this thin line down here. And just with this equipment, we can quickly see are we providing the audibility that we want to provide? So that thin green line is the target. The thicker is what we're actually providing. And what we want is for the goal to have them overlaid. So I can see right here, I can look at it and I can say, you know what? I'm gonna bump you up in the highs a little bit. I'd like you a little bit closer to that. And it allows me to do it effectively and efficiently. So I told you what you saw there. The other thing is that speech mapping is an excellent counseling tool. When I'm using it as a counseling tool, I do not use that average target. I don't use the full size. I'll use an input plus gain so that we can see what they would be hearing without and then as well with the hearing aids. And then I'm going to put up a range from soft speech to loud speech. And what I can explain to my patient, and different equipment's gonna show it differently, but the concept is the same. The soft versus loud is the ideal range for patients. And I want 90% of their speech signal to fall within that range. So how I explain it to the patient so that it's not going to be complicated is that the blue and the purple are my ranges. If the sound falls below the blue, it's too soft. So the gold bars show what they would hear without the hearing aid. The blue and the red bars on top show what they were providing with the hearing aid, and I want 90% in between. If I can get 90% in, then I know I'm going to have good audibility. So why don't I say all? Why don't I do a bullseye target? Because it's realistic expectations. Depending upon the severity of the loss, so this is an extreme high frequency loss, I may not be able to get 100% in. And I want the patient to understand too, this is a hearing aid, not a cure. So our goal is to aid them in hearing better and understanding better, but we still are not going to allow them to hear absolutely every sound again. So think about speech mapping if you're not doing it. It's an incredible tool for increasing patient satisfaction as well as a counseling tool for realistic expectations. So the next thing I want to talk about is a signal to noise ratio loss, or speech and noise testing. It's the number one complaint of hearing impaired people, and it cannot be predicted from the audiogram. So let's look at the data of two real patients. Their hearing losses are very similar, their pure tone average, their word recognition scores are all within test-retest of each other. So looking at this, you would expect them both to do equally as well. But as soon as we get into a noisy environment, we notice that that SNR loss, or how much separation they need between speech and noise to understand, is very different. This one, it's one to three dB, which is pretty much within normal. This one is nine dB. They need speech nine dB louder than a normal hearing person in order to understand a noise. There's no way to predict that off of the audiogram. And so just another way to look at it, is here we have a pure tone average of 50 dB. And the SNR loss ranges from four dB to as severe as right around 15 to 16 dB. That's a huge range. And it's not linked to the severity of the hearing loss. So the QuickSIN is a quick and easy way to do it. It's the one that I utilize, but there are other speech and noise tests out there as well. But it's a quick, easy one, and it's standardized, and it's easily calibrated, and it takes less than five minutes to do. So with the QuickSIN, all you need is the CD. You can do it under headphones, or you can do it in a sound booth. And when we're talking about in the fitting, I would do it in a sound booth. And I would do it unaided and aided, and let them see how the hearing aid is actually helping them do better in noise. So it's a one-minute method. So what it does is there are six sentences that the patient's asked to repeat back. The words in the sentences that are underlined are the target words. And we're gonna score how many of those they got right. So the first sentence, the speech is 25 dB louder than the noise. And as we go down, we end up at a zero dB signal-to-noise ratio, which means speech and noise are at the same level. And we write down the number of words that they got right. We add those all up, and we subtract it from 25.5, and that gives us our signal-to-noise ratio loss. And it's compared to a normal performance. And there's a couple of things with this. It can really help us validate the technology that we're fitting them with, and help them demonstrate the improvement in noise. So if I've got someone who's in that zero to two dB, just a good, well-fit hearing aid is gonna work great for them. They're getting into that two to seven, particularly if they're at five to seven, I wanna start thinking about directional microphones for that person. If their SNR loss is greater than seven, then I'm for sure gonna want a directional microphone. That's gonna guide me towards what technology I'm going to use. And if they are greater than a 15 dB, then they may need some type of FM system or remote microphone. But if we've got all of this information, then we can fit them. And we can show them that at the time of fitting, we did the test, and you were a seven dB signal to noise ratio loss, and we put the hearing aids on you, and you went down to a three, that's a great improvement. That's getting you almost as good as a normal hearing person. So it's a way for them to understand. It's also a way for them to get realistic expectations. And a lot of what we do within the fitting that's going to increase patient satisfaction is realistic expectations and counseling. It's a hearing aid, it's not a cure. And so we need them to realize it, that they're not gonna have super human hearing, they're not gonna be able to hear from a different room with walls and things in the way, and that they're not going to only be able to hear what they want to hear. One of my favorite stories is that of a individual who they had turned, at the time we had a pediatric noise management program, and they turned on the pediatric noise management program, the patient complained that she could still hear children fighting, because they didn't understand that it wasn't going to take away children's voices. So realistic expectations are critical. Our goal is to amplify soft sounds, reduce loud sounds. The problem is, is the hearing aid doesn't always know what to amplify and what to reduce. So we have to teach the patients, and that's kind of where our homework's going to come in. But before I jump into that, I want to touch real quickly on the language that we use. I've worked very hard, and I've taken the word removes. It's gonna remove noise. It's never gonna remove noise. We have to be careful of the words that we choose and the words that we use, because they can set up unrealistic expectations for our patients. I'll use words instead of removes noise. It helps you focus on the voices you want to hear. It's gonna provide more comfort for you. And I'm finding an increased level in my patient's satisfaction with the hearing aids because their expectations are more realistic. So instead of removes all background noise, it's gonna provide comfort in busier environments. We'll only amplify your wife's voice, which I don't know if that would be a good thing or bad thing for some of our patients, but we'll help you focus on speech. And we can see how those are different and how they can really help the patient understand what to do and how to do it and what the hearing aid can and can't do. And this then leads into our homework. I love giving homework. It may be because I was raised by rabid nuns in Wisconsin, but I think that homework helps to reinforce the realistic expectations of the patient. It helps to make them more actively involved in their oral rehabilitation. And it sets up the expectation that the world is going to be different. So my first and favorite thing is having them keep a sound journal and then playing the IFIT game with the sound journal. And IFIT stands for identify, find, and forget. So I want them to write down every new sound that they hear. I want them to find out where it's coming from. If it's a fan, if it's a bird outside the window, if it's the creak of their shoes when they walk, they need to find where that sound is coming from and then they need to forget it. They have to decide if it's an important sound to pay attention on or if it's one that they can forget. This is something that the normal hearing brain does all the time. A lot of times we will take and we will have sound in our environment and we'll just choose to ignore it. And we forget that it's even there. When I grew up, I grew up about a block and a half from a train track. And the train went by three times a day. I don't even remember hearing the train because my brain knew to forget it. And that's what the IFIT journal can do for them is help them figure out which sounds to forget. The other thing that I do with the journal is I actually put a copy of it in their file folder. That way when they come back for follow-up visits, and again, I get the thing, I don't feel like I'm doing as well as I thought I should, I can go back to that journal of new sounds and go, well, let's go through here. Are you still hearing all of these sounds? We get so easily acclimated to what we hear, what we expect, that we can forget how well we're truly doing for them. And having that list in their file can help us do that. When I'm setting them up for the journal, I'm gonna stay away from things like it's gonna be really loud and restaurants are gonna be noisy, and I never ever say, write down what you don't like and we'll make changes. Did you know that our brains are tuned to focus in on negative statements? So instead of saying things are gonna be really loud, I'll ask my patients, have you ever wanted to go to Niagara Falls? And they'll look at me and I'll say, the first time you go in the bathroom and you flush the toilet, that's gonna sound just like you're at Niagara Falls. And it becomes a joke instead of a negative. I don't use the word noisy. We use the word busy because noisy has a negative connotation. I'll tell them you didn't realize how busy a restaurant you'd like to go to is. It's a really popular one. It changes the connotation. We wanna focus on the positive things. How much fun it is gonna be to play with the grandkids. What sounds have you been missing? How great it's gonna be not to fight over the volume of the TV. One of the things that I've changed is when I go and I get my patients for their first follow-up and I bring them back, instead of asking them, I used to say, tell me what you like, what you don't like, instead I say, tell me the coolest new sound you heard this week. And their face lights up. It completely changes the tone for them. And now they're focusing on the positive. So think about the language that we use. For the most part, I like my patients to start wearing their hearing aids as much as possible. But if you do have more of a nervous Nelly, someone who's more apprehensive or a little bit more sensitive, I will give them a wearing schedule. I'll limit the places that they can wear it outside and build them up slowly to it because I don't want them to be overwhelmed. I was just working with a patient who came back to me after two days and said, I've been wearing them nonstop for two days. And yep, she was wearing them about 12 hours a day. And she said, by four o'clock in the afternoon, I have a headache and I'm tired. Well, that's a good symptom that she's being overstimmed. Her brain needs a break. So I would let her take them out, but not for any longer than two hours. And just that little break is important for them. For sometimes their brain just to process what it's got. It is important for them to wear it at home. So I have a patient, Grandma Lucille, I love her to death. And she was only wearing her hearing aids about three hours a day. It was when she went to Hardee's for coffee with the rest of the farmer's wives. And she wouldn't wear them at home because it was just her. And she wasn't doing well in noise and she wasn't satisfied with her hearing aids, but she was only wearing them in those difficult situations. The brain needs to be stimulated in quiet environments as well as in busy environments in order to learn what to do with the different signals. And one of the best things our brain learns when we're at home and we're listening is what sounds to forget. The refrigerator kicking on, the furnace turning on. All of those little sounds teach our brain how to start classifying important versus unimportant sounds. And so now we wanna make sure that we have that so that we can move focus. So we wanna focus on what they wanna improve in life. The day they get hearing aids is not the day to take up bowling. And we wanna go back to their verbiage. We wanna go back to that discovery, that cozy. Remember, satisfaction is a process and it's gonna carry through everything that we do. Again, with the satisfaction of the family, we want them to be aware that we're not giving them superhero hearing. I almost couldn't get that out. And the aided versus unaided testing will help with that. But yes, it is better. It's still not perfect. The other thing is that this is a hearing aid is a personal amplification device. I stress with my patients that it's designed to work within a three to six foot radius, not 20 feet away. And that if you're in the kitchen and the water's running and you're faced the wrong direction, they may not be able to hear you. If my patient and their significant other do a lot together, then I'll ask the significant other to keep a journal as well. So when the patient comes in and complains or talks about struggling in a certain noisy environment where they were with their wife or their husband, I'll have them open up their journal. And many times, the normal hearing person will have struggled in that environment as well. It becomes sort of a leveling of the playing field for them. The other thing that I wanna talk about is brain games. And think of this as oral rehab is our version of physical therapy. It helps the hearing aid wearer in those busier situations. It can involve the family and there's some ownership involved. So I don't know how many of you are using these, but here are just a couple of ones that I really like. So Read My Quips, Angel Sound, and LACE are all focused and designed specifically for hearing and hearing impaired. Read My Quips is a really cool one because it combines visual and auditory. So it gets the eyes, the ears, and the brain all working together. Angel Sound was actually originally developed for children with cochlear implants, but they've got a lot of different things that they can do. They do have specifically speech and noise training. They've got some work that you can do specifically on the telephone. They've also got some stuff with music, which is really cool because research is now showing that music can help to remap the brain and improve understanding. LACE has been around for the longest time. It's again focused specifically for amplification and hearing aids and hearing and noise. So the Read My Quips and LACE have both been proven in clinical trials to improve understanding and noise, usability of hearing instruments and amplification, and increase patient satisfaction. Brain HQ is a different one. The BrainHQ is actually kind of an app that you would have on your iPad, and they've got all different types of things. So they'll do games for memory, long-term, short-term, speed, all of those types of things, but they also have auditory processing and speech and noise games on there. AngelSound is a free, you can play it off of the PC or you can get a CD from them. The other ones all have a fee that's associated with them. But if you can offer this or encourage your patient to do it in the office, then you can actually hold them accountable for it. And we know that if they do these types of things while they're wearing their hearing aids, they'll adapt to their hearing aids more rapidly. So the bottom line is we want to get them excited. They came looking for help. We want to get them ready for it. And we want to give them an umbrella to help them even when those environments that it isn't perfect. And the tools that we teach them, the way we can help train their brains can be that umbrella that can help them do better. So all of these are things that I work with my patients as part of the fitting process. But when I get to that post-fitting, I'm not done. That's actually where we can really kick it into gear and start doing even more for our patients. And in post-fitting, there's two things I want to talk about. The first is the IOI, which is the International Outcome Inventory for Hearing Aids, and then a long-term care plan. The IOI is a really cool tool that's underutilized. It's an eight question paper and pencil survey. The patient can do it by themselves or you guys can have a conversation while they do it. It's standardized, it's normed. It only is designed to be done post-fitting, so you don't have to have remembered it at the front end. But it's going to let you see how your patient does compared to other hearing impaired patients and see whether or not their satisfaction is on par. So there's seven questions that cover different outcomes and the eighth question quantifies the severity of the hearing loss. So let's start with that eighth question first. So when we're looking at it, it will ask them, when you're not wearing hearing aids, how bad is the impact of your hearing? How much hearing difficulty do you have? And severe and moderately severe get grouped together in the survey, and moderate to mild also get grouped together. So dependent upon how the patient answers this, we're going to graph it on a different plot. Literally, guys, this takes about five minutes for the survey and about three minutes to transfer the scores and figure out how they're doing. So this is the survey. So you can see if they've got a mild to moderate, the target regions are the gray versus having a moderate to moderately severe, you're going to have a different norm, a different expected outcome for them. So let's look at the other questions real quickly. The seven other questions talk about how much they use it, their benefit. I love the fact that it's going to give me an idea of their residual limitations. And those residual limitations are going to give me the opportunity where I could actually provide additional benefit. It gives us their overall satisfaction. It's going to talk about how their hearing loss and in the use of hearing aids, how restrictive they're still feeling. The impact on others is a good one. And if you've got the third party there, it's a good one to have a conversation about. And then ultimately the best one is the quality of life. And that's probably the one that I take the most importance of when I'm looking at it. So residual limitations, satisfaction and quality of life are kind of the ones that I really tune in on. So the first one is, how much do you think you use your hearing aids? And that of course is the use. And let's say that for our patient, they're going to use it four to eight hours a day. The next two questions are look at the benefit of a situation where the patient is seeking help. So this should be one of our cozy environments. It should be that number one environment. So if you do it as a conversation with your patient, you can refer back to the cozy. So playing the card game, how much has the hearing aid helped you in your card game? And then this is the residual limitations is are you still having difficulty? How much? So this is a crossover between what they call a direct and an indirect validation tool. But if we do it as a conversation, we know. And let's say that our patient says the hearing aids helped them a lot and they were only having slight difficulty. The other questions that are gonna come in looking at the satisfaction of the patient. And most of these aren't covered on other scales, which is why I like the IOI. So over the two weeks, how much hearing difficulties have affected you? That's looking at sort of our restrictions. How much do you think other people were affected? That's the impact on others. And then number seven is of course the quality of life. So if we look at where our patients are at, and then we go to that severity. So for the first example, let's say that the patient had rated their impairment without hearing aids as moderately severe. Then what we're going to do is we're gonna take that moderately severe norm and we're gonna plot all of their scores. And this is all you have to do, is X marks the spot. And I can see immediately how they're doing. Whoops, there we go. And so here, use is right on target. I could like to see it up at the five, but what you'll see often is use is at the four, satisfaction is at three. So if I could increase satisfaction, I could bring up that five probably, which then ultimately would probably bring up quality of life as well. So I typically do this at the third follow-up, not the last follow-up. And what that allows me to do then is make changes. So why aren't they satisfied? How could we make it better? It gives me a tool to improve their satisfaction before they're done. Now, if they're in a mild to moderate, it changes. Lookit, they're doing really well for the mild to moderate. So that level or severity of perceived hearing loss is gonna do a lot to drive what we're going to do for them. But it's a great and simple tool that we can use to actually compare how they're doing. And we can do it later too in life. We can do it at a six-month follow-up as well. The last thing I wanna talk about is a long-term care plan. At the pre-fitting, we talked about just setting up a care plan for that sort of transition period for them. I wanna set up a long-term care plan for my patients at the end too, which means I wanna see them every three to four months. If my face isn't in front of them, I'm gonna lose them. Most patients purchase their next hearing aid from somebody else, 50% of them. And we'd all be surprised, those patients that we've lost track of, that they've come back to us and they'll have someone else's hearing aid or a hearing aid that you didn't fit. So the more we can keep engaged with them, the more that we have the likelihood that we're gonna be able to continue to help them. And it doesn't have to be a long appointment. A lot of them are 15-minute clean and checks, making sure the hearing aid's working on par, a quick conversation, how it's going. And then every year, I'm gonna do an annual follow-up. We're gonna do a complete hearing test to make sure nothing's changed there. We're gonna repeat the verification, so the speech mapping and the IOI is gonna get repeated every year to make sure the hearing aid's functioning as expected and my patient is getting the benefit and the satisfaction that they want. And then we'll discuss what the plan is for next year. Do we need to start thinking about upgrading technology? Do we need to talk about an extended repair program for them? What are we going to do next? And what are they looking at changing in their life in the next year? And with this type of plan, we can make sure that their satisfaction is extended and as they continue to work with us and we continue to help our patients move forward. And that, Carrie, is what I have. Great, thank you so much, Mary. We're very excited that we had over 200 of your fellow colleagues joining us today on the webinar. We do have some time for questions. If you have a question for Mary, please enter it in the question box on your webinar dashboard. Our first question is from Nick in Florida and he's wondering where he can obtain more information about the auditory training and brain games you have mentioned. Well, on the slide, Nick, I did put the links to where they are. If you go to the Hearing Loss Association of America, they've got quick links right off of their page as well so that you can get access to all of them right there. So I would go either to the Hearing Loss Association of America or if you download the handout, the websites for each of those games is provided on the handout as well so that you can go and research and determine which ones would be the best for you to implement in your practice. Great, thanks. Our next question is from Jim in Arizona. He wants to know, which of the brain games do you think is the best? That's a really good question. It's going to depend upon my patient. I really, really like the Read My Quips. It's a great game. It's done in a sort of a crossword puzzle style and it has levels of progression. It gets more difficult. So it really challenges the person's brain and auditory system to grow and improve. So if my patient's primary need is better understanding in those busier and more complex environments, Read My Quips is kind of my favorite one. The concept of the crossword puzzle is easy for people to understand and I've had a lot of positive feedback from patients that it is not boring. If I have a patient who's struggling more cognitively, they may have some processing, they may have slower decision making skills, then I really like the Brain HQ because even with the free version of that, you can do things above and beyond just the hearing and noise. You can do things to speed the processing, to improve their short and long-term memory and for them to better utilize their working memory. Angel Sound is a great one if they wanna play games with the grandkids. So I had a patient who was living with his daughter and son-in-law and their two kids and we set them up with the Angel Sound because then he would play against his grandkids who were five and nine. So some of the games on those can be a little bit more simple or a little bit more childish but it really got him out of his bedroom onto the computer with the family and interacting. LACE is a great one as well. My only concern about that one is I get some feedback that it's a little on the boring side for some patients but it is the one that's been most strongly validated. So I hope that helped. Great, thanks Mary. Our next question is from Christine and she wants to know, if the patient does not like the way the hearing aid sounds and speech mapping looks good, do you leave it at the settings that match your speech mapping goals or do you consider patient concern? That is the ongoing debate, isn't it? Speech mapping targets, I use them as a starting point. Ultimately, my patient's preferences are going to weigh out because what the patient wants to hear is more important. Now that being said, it depends. Are they complaining about sharp and tinny because they're not used to hearing the highs? I may turn on an auto-acclimization or I may turn down the highs to begin with and then slowly ramp them back up so that the patient can get used to it because that's why they bought the hearing aids. So it's gonna depend exactly what it is but the bottom line is, I don't know what their brain wants to hear so I have to take feedback from the patient into consideration. Perfect, thanks Mary. Our next question is from Ralph and he wants to know, do you do speech and noise testing for everyone? If it were a perfect world, I would do speech and noise testing on every single patient and I just heard the collective groan of you all out there. The reality is, is it's not a perfect world and we all have time limitations and even though it just takes a couple minutes, you have to be concerned about the fatigue for patients. So kind of the rule of thumb that I use is if their primary complaints and the primary reasons that they're seeking help are complex or busy environments, that's gonna lean me towards doing speech and noise testing so I know what I'm doing, what I'm working with, what my baseline is for them. I always do it. We all have those patients who are the big influencers. They're well known in the community, it's a high potential for referral. I'm gonna do it on them to begin with just so that again, I know what I'm working with and I want them to have the best possible experience. Another sort of trigger for me to do the speech and noise testing is a patient who's been wearing a well-fit hearing aid and still struggles in noise. They most likely have an SNR loss that requires some additional technology and I wanna be able to counsel them on why they weren't having the success or satisfaction to begin with. I tend not to do speech and noise testing on patients who are cognitively challenged. Those who may have early onset dementia or other issues such as that because it can be a frustrating test for them and I'm also concerned about fatigue when I'm working with those patients. So I hope that kind of cleared it up, maybe just as much as mud, but I do have some sort of internal guidelines that I use and unfortunately, I don't have the opportunity to test it on everybody. Perfect. Our next question is from Jennifer and she wants to know what happens if the IOI score is bad? If the IOI score is bad, it's kind of a wake up call for me that I'm not providing the satisfaction for the patient that I want. And that's why I like to do it before the end of the trial period. So if I have a low satisfaction, low use rate and then we can go back and we can talk about that situation that they rated it low on and we can figure out what we can do to make it better. It may be realistic expectations. It may be that if I've got more of an amiable personality, they're not telling me what they wish could be different or better in it. They're just expecting it for it to magically happen. So it becomes a great tool for me to dive in and start doing another discovery on how I can improve those scores. The great thing about the IOI is that we can come back in another couple of weeks and we can do it again and see if we are getting an improvement in it. So it's really a great guide to be able to look at what we can do differently and better for that patient. Thanks, Mary. Our next question is from Michael. He wants to know if you always do speech mapping on the first visit. You know, that's a good question. I do it probably 99% of the time on the first visit. Mostly, and the speech mapping that I do is that sort of that realistic counseling expectations one where I show them sort of the target range and that I want 90% in. 99% of that I do on the first fit because I want them to see that we are measuring, we are looking at it. As far as doing the verification version with the standardized speech signal and things like that, I may do it on the first fit, but then if I do adjustments for it, I need to do it again. And so that one I tend to do closer to the end when we're getting closer to that final fit to see if we're where we want to be and we're truly providing the audibility that they want. I've worked with some practices where they match everything to target, they do their speech mapping, they run it, they print it out, they put it in the file, and then they adjust the hearing aid and they go from there. To me, that's just saying that's no different than running the hearing aid in a test box. It's not truly telling us that we're verifying that the hearing aid's doing for the patient what we want it to do. So that sort of verification one, I'm more likely to do towards the end of the fit. I hope that makes sense. Thanks, Mary. Our final question comes from Frank. He wants to know what if you cannot get speech mapping to hit the target? Well, and that's why I use it just as a target. It's not, it's a starting point. And particularly, it's gonna depend first on the fitting formula that you're using. So right off the bat, I know that DSL-IO, I'm not gonna hit the target on because it's got more high frequencies in there than any hearing aid can actually apply. And then the second is, it's just a starting point. So if I can't get it to hit target exactly right on, kind of like to the other question, I'm not gonna ditch the hearing aid. I'm gonna look then at what I'm providing for my patient. And I'm gonna go back and I'm gonna start to look at more of that 90% between the soft and the loud speech to make sure I'm providing audibility. If I am nowhere near target, that's what I'm gonna look at. Do I need to change out a model? Do I need to change out a product? Something like that. But if I'm getting close and just missing at a few frequencies, I'm gonna sort of take it with a grain of salt because I know that probably 60% of people move one way or another away from target or away from their speech mapping perfect match to reach the patient's ideal sound quality. Great. Thank you, Mary, for an excellent presentation. And thank you everyone for joining us today on the IHS webinar, How to Increase Patient Satisfaction. If you'd like to get in contact with Mary, you may email her at mary__lysis at Starkey.com. For more information about receiving a continuing education credit for this webinar through IHS or AHIP, visit the IHS website at ihsinfo.org. Click on the webinar banner or find more information on the webinar tab on the navigation menu. IHS members receive a substantial discount on CE credits. So if you're not already an IHS member, you will find more information at ihsinfo.org. Please keep an eye out for the feedback survey you'll receive tomorrow via email. We ask that you take just a few moments to answer some questions about the quality of today's presentation. Thank you again for being with us today and we'll see you at the next IHS webinar.

patient satisfaction

audiology

care plan

hearing loss simulator

speech mapping

audibility

speech and noise testing

auditory training

long-term care plan