The term “best practices” is something I see being used as a marketing phrase and tool in many audiology practices, specifically surrounding the evaluation and treatment of adult hearing loss, which many consider to be the sole “breadwinner” of audiology practice. I see it labeled on everything from letterhead to networks. My question is what does the term “best practices” mean or represent, especially in the practice of audiology?
Merriam-Webster defines “best practice” as “a procedure that has been shown by research and experience to produce optimal results and that is established or proposed as a standard suitable for widespread adoption”. The Oxford Languages definition, which is cited by Google, defines “best practices” as “commercial or professional procedures that are accepted or prescribed as being correct or most effective”. Even these definitions are slightly inconsistent and extremely broad.
So, again, what is best practice in audiology? Typically, professions can turn to professional guidelines or standards. Sadly though, in audiology, many of our professional guidelines for the evaluation and management of adult hearing loss are either grossly out of date (10 plus years old), rarely followed or missing altogether. So, in our case, I think we need to lean on 1) the needs and desires of those we profess to serve in order to help them “hear more and fall less” (kind of in line with the Oxford definition) and 2) the research evidence that may or may not have found its way into guidelines or practice.
Consumers have been asking, and now demanding, for well over a decade, access to accessible and affordable hearing healthcare. They have requested more accessible care options, price transparency, unbundling, and value based solutions. The majority of hearing healthcare providers, including audiologists, have continually refused, fought against, and derided any attempt to make hearing healthcare more accessible and affordable to the consumer, despite mounting evidence of the safety, efficacy and value of this type of care and treatment. Many say that they are against it because it does not meet the standards of “best practice” or that it is “unsafe”. The problem with this approach is striking: 1) The vast majority of audiologists do not consistently provide care consistent with the research evidence within their own practices, 2) we have not followed standards or guidelines on the delivery of this care or pushed to create new standards or guidelines, 3) our current delivery model is leaving 70-80% of those who need treatment without treatment, and 4) is it really “best practices” if our care model makes hearing care inaccessible, unapproachable (“my way or the highway”) and unaffordable? In my estimation, we are not providing “best practices” if that care is unattainable for the vast majority of consumers. I would describe the care we are giving as “OUR PRACTICES” rather than “best practices”.
Let’s provide a few examples. Costco is a retail based care model, which focuses on cost and accessibility. The company has determined that their “best practices” approach to care includes case history, a hearing handicap inventory, a comprehensive hearing test, value based and premium hearing aid solutions, and verification, via real-ear measurement, where they may or may not ever fit to real-ear targets. They practice within a limited scope, regardless of state law, and refer patients for cerumen and tinnitus management and implantable devices, offer provider driven care, and provide care that many believe firmly meets the definition of “best practices”. Yet, despite all of this, their care is continually derided in professional circles as “inferior”. What I do not understand is “inferior to what”? Their care meets the typical definition of “best practices”. Why are their “best practices” not enough?
Conversely, a consumer sees an audiologist in a typical audiology practice. The practice performs a case history, a comprehensive hearing test, premium only hearing solutions, and real-ear measurement, where they may or may not ever fit to target. THIS practice markets itself as providing “best practices”. Is this “best practices”? There was no inventories provided, no speech in noise, no screenings, no comprehensive care plan (everything is about the device), no value based solutions offered, no accessible care options available, and no auditory rehabilitation available, which research has shown for over 50 years that it is the one thing that can always improve patient satisfaction and performance.
My final example is an entity that has created an algorithm that allows for the self-assessment and self-fitting of adult hearing loss. This algorithm has significant research evidence and, when combined with case histories, questionnaires, and inventories, shows both safety and efficacy in evaluating and treating the vast majority of age related hearing loss. The delivery refers people to professionals when their responses do not coincide with an appropriate delivery. It allows for truly accessible and affordable care. Do audiologists embrace these new technologies and see this as an opportunity to reach more hard of hearing individuals and increase access to audition? Nope. Again, they stand behind the term “best practices” and deride it as unsafe and inappropriate, despite the fact that many of them do not provide care that is significantly different than that being provided in remote, patient driven delivery.
I became an audiologist to help people “hear more and fall less”. My true success, as a professional, is the attainment of that goal. I love and support audiologists and the practice of audiology and the provision of research evidence based, patient driven and patient centered care. I though now see, based upon indisputable evidence, that the risks of non-treatment are markedly greater than the risks of less than “ideal” evaluation and treatment, especially when the ideal is so very rarely provided. The path for audiology is bright if we embrace change and evolve what the provision of audiologic care and "best practices" truly means.
For me, “best practice” in audiology involves:
1. Audiologists focusing on haring loss prevention and mitigation.
2. Consumer access to research evidence based, self-assessment and self-fitting systems, coupled with case histories, questionnaires, inventories and pure-tone, air conduction testing.
3. Audiologists providing communication and functional needs assessments and medically necessary audiologic testing and basic health screenings.
4. Audiologists creating a comprehensive care plan that may or may not include a traditional hearing aid (as we are SO MUCH MORE THAN THIS WIDGET).
5. Audiologists offering accessible care (telehealth, evening and weekend hours, home visits, e-commerce sites).
6. Audiologists offering a wide range of treatment options, including but not limited to traditionally delivered hearing aids and value based solutions.
7. Audiologists verifying the patient satisfaction, outcomes and performance post-treatment.
8. Audiologists offering and providing auditory rehabilitation either face to face or via telehealth.
9. Audiologists providing all of the care unavailable at big box retailers and through over the counter, mail order, or internet delivery channels.
10. And, finally, we provide ALL of the above while listening to those we say we serve, collaborating and compromising on regulatory and legislative changes, and unapologetically charging for the care we provide.
THIS is not just best practice, this is, to quote the IDA Institute, truly “patient centered care”. And, I do not know about you, but I will take Patient Centered Care over Best Practices every time!