LM214 - How to Be More Hit Than Miss: High Reliability in Audiology Practice

Abstract:
The airline industry, military, surgical services, and car manufacturers have at least one thing in common. They are all considered examples of high reliability organizations. For each one, mistakes are can have devastating consequences. In audiology, mistakes can lead to consequences such as language delay, social isolation, or refusal to use devices. Creating high reliability processes and cultures within audiology affects patient satisfaction, interactions, and maximizes time, while avoiding errors.

Summary:
“To Err is Human”. It is also the title of a paper from the Institute of Medicine which identified that over 100,000 patients die from medical errors every year in the United States. While audiologists do not often encounter life or death decisions in practice, they do highly affect quality of life outcomes.

Hospitals, airlines, the military, and Amazon have implemented procedures and culture to drastically reduce errors within their organizations. These same principles applied to the practice of audiology have the potential to ensure that patients are diagnosed earlier and appropriately and receive intervention and support effectively.

For example, we know that only 34-53% of audiologists report using probe microphone measurements (Mueller and Picou), despite evidence that verification ensures access to sound and leads to improved outcomes (Jorgensen).

In the above scenario in which a patient did not receive appropriate audibility because real ear measurements were not performed, consequences could result in missing key information at a doctor’s appointment, an argument with a loved one, or refusal to wear devices at all thinking they do not help. In the case of a pediatric patient, consequences have the potential to drastically affect language outcomes.

This attitude exceeds adhering to protocols or guidelines as it also considers the culture of the workplace. In the book, Zero Harm, the authors discuss the importance of a shared responsibility towards patient care. Applied to hearing healthcare, this could be the audiology assistant noting that the audiologist has a fitting on their schedule for the next week without having ordered hearing aids and alerting them before the patient arrives. It could also mean stocking each fitting room with a complete set of tools so that time is not spent hunting for an otoscope with a waiting patient.

Some large corporations, such as Walmart, have started utilizing Centers of Excellence across the country. High volume and specific protocols have led to excellent outcomes in these centers. Walmart believes these clinics to be a cost saver rather than facing increased cost from medical error. What would that look like in an audiology clinic? Might high reliability outcomes lead to not just improved patient outcomes but financial sustainability?

As audiologists, we have a duty to our patients to provide evidenced based care based on high reliability principles.

Clapper, C., Stockmeier, C., & Merlino, J. (2018). Zero Harm: How to achieve patient and workforce safety in healthcare. McGraw-Hill Education.

Jorgensen L E. Verification and validation of hearing aids: opportunity not an obstacle. J Otol. 2016;11(02):57–62.

Mueller H G, Picou E M. Survey examines popularity of real-ear probe-microphone measures. Hear J. 2010;63(05):27–28

Walmart Centers of Excellence. (2024). One Walmart. Retrieved October 4, 2024, from https://one.walmart.com/content/usone/en_us/me/health/health-programs/centers-of-excellence.html

Brief Summary of Clinical Takeaways:
The clinical takeaway in this session is what high-reliability practice in audiology looks like.