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Interview with Michele Fusco and Dan Quall from Sonus Hearing

Michele Fusco, Dan Quall

December 3, 2007
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Topic: Fine Tuning the Hearing Aid Fitting Process
Paul Dybala: Hi everyone! This is Dr. Paul Dybala with Audiology Online, and today we are visiting with Dan Quall and Michele Fusco from Sonus. We are here having a conversation about some exciting things that Sonus has been doing with patient care.

First, if you would each introduce yourself and give us a little bit of a background on what you do for Sonus. Dan, why don't you take the floor?

Dan Quall: Thanks! I appreciate the time here today. I am Dan Quall. I was in private practice some 18 years out in the Northwest. I joined Sonus in 1998, and at that point headed up the Greenhouse program, which we have been very proud of. It's the cornerstone for Sonus.

My current job today is with the Sonus Network, trying to provide small business services to audiologists all over the country. So that's my primary role, along with some third-party contracting.

Dybala: And Michele?

Michelle Fusco: I'm Michelle Fusco. I've been in the industry for over 20 years. I practiced audiology before coming on board with Sonus in 1997.

I have filled a few roles at Sonus. It's given me quite a bit of opportunity, first as a regional manager, managing clinic practices and seeing patients, and helping with the hiring and the training.

When Dan was promoted, I took over the Greenhouse project. So in 1999 I worked with the Greenhouse, and in 2002 we were purchased by Amplifon, and we all moved to Minnesota. I've been managing the the Human Resources department and Professional Development since that time.

Dybala: You've been very, very busy.

Fusco: Yes, it's the people part of the business, which is kind of exciting to me.

Dybala: Well, we are talking about the Sonus today patient-centered approach. Dan, if you wouldn't mind touching on some background.

Quall: Okay. When I left private practice, I was drawn to Sonus by a group of very committed people that wanted to make a difference in the industry and in the professional medical model. Behind this kind of drive was one thing: patient satisfaction. That was the focus.

We did a lot of looking at evidence-based research saying, "What drives satisfaction with hearing aids?" And, of course, at that point in 1998 we weren't quite into the digital products. They were just coming on the market, but we did have the programmable products.

There was substantial data coming from MarkeTrak that told us where dissatisfaction lived. It was our job in the Greenhouse to take and develop a common operating clinical protocol, something that would allow us to provide a consistent level of patient care from office to office.

At that time, Sonus was acquiring clinics across the country. It was an exciting time, because at that point in the industry we used a lot of the same procedures that we had for years, and we wanted to look at doing things differently. We took a group of people from all over the United States in some of the practices we had, and then also bought some of the best businesses across the country.

We took those audiologists, providers, as well as front office people and brought them in. We really took a cross-section of the personnel involved and asked, "From the time we pick up the telephone to the time the patient is satisfied with the problem, what are all the things, big and small, business-centered and audiologically-centered, that need to take place to drive patient satisfaction?"

Dybala: Wow.

Quall: We had several in-depth discussions with this professional group, and took a good, hard look at the evidence.

Fusco: We did lots of role playing.

Quall: Lots of role playing and a good look at evidence on what type of testing needed to be done, and what procedures were out there. At the time, Harvey Dillon and his group had just come out with the COSI. We picked up on that. We saw that as a great tool in the clinic.

And then from there our protocol was developed. We call it a living document because it's constantly changing, and as we pass the baton from one leader of the Greenhouse project to another the patient-centered approach is one of the things that they take care of and try to advance.

Dybala: So, then, here is my next question. If it is evidence-based, what does the evidence say about how effective the Sonus patient-centered approach is working?

Quall: We looked at three different channels and analyzed patients' satisfaction data between those three different channels. Sonus was head and shoulders above the other channels in terms of patient satisfaction.

We feel like we really are moving in the right direction. Michelle and I were very interested in the work that, AAA started talking about compiling a best-practices protocol.

Dybala: Correct, and this was just released in the Fall of 2006, we had an article on this topic (2006) by Michael Valente

Quall: Exactly. What we found interesting after attending related sessions and reading published documents such as the one that you mentioned was that there is a common thread amongst the community. Many of the things they were suggesting are many of the things that we are already doing.

We felt like, "Hey! We are on the right track!" We call that common thread, this desire to be the best, the Sonus Gold Standard. I think that's a term a lot of people are going to be hearing from us.

We want to be the best in practice management and in helping people to hear better. It is important to us to also be at the top in making practices profitable and in helping people reach their goals. That's the patient-centered part of it.

Dybala: Now, one of the things that you mentioned was how the protocol is a living document. I am familiar with living documents and how this would need to be updated, expanded, and maintained. So, Michele, could you touch on the difficult task, sometimes, of keeping things moving forward once the initial item is launched? How have you been working on that?

Fusco: We've been teaching the patient-centered approach since about 1998, and with that we measure customer satisfaction by where we are and what's satisfying the needs of our consumers and what isn't; that's where we take the growth of it. You know, it started out as a small initiative, and since that time we've added the Quick SIN into it, and we've added more patient intake because we also do customer satisfaction studies of our clinics. We give them comment cards and measure subjective satisfaction.

Based on the evidence, the one question that really relates to customer satisfaction is: would you refer a friend or family member to our practice? So we measure how the audiologist performed, our front office staff, our testing procedures, etc. This is the last question we look into, and we make a direct correlation with that question and the knowledge and the listening abilities of the audiologists. We were really happy about that because we built our patient-centered approach around those types of things- where you're listening and you're matching the fitting with the lifestyle and needs of the patient. But, scientifically, you can do that with some of the tests that we have. And so we continue to add those. We've also added the ANL or Acceptable Noise Level test.

Dybala: I'm familiar with ANL, it is a really great tool Freyaldenhoven, 2007.

Fusco: We've found a good correlation with the ANL and the Quick SIN. And applying the COSI is still a big part of our evaluation, and then taking it on to verification and validation. So, every year, even though sometimes we go out and our audiologists say, "You want to teach us the patient-centered approach again?" We replied, "No, we've taken it to the next level." Now, the next level that we've been working on for the last year is Sonus certification. We're raising the bar.

Now we certify our audiologists and our hearing aid dispensers. Although they may have been practicing for over 20 years, we require them go to webinars. We have standard classes. They have to take tests, and they take a final exam. They have a chart review, and in the chart review we make sure they are following the steps of patient satisfaction. Brian Taylor and I just did a poster session here on that and the correlation of our experienced audiologists. We found that as audiologists fit better products when they're Sonus certified, they have a better response rate on patient satisfaction cards. It's all tied together.

Dybala: So if you control for years of experience, if that's what you're saying, and then you account for whether or not they've been certified, you actually see a higher level of satisfaction.

Fusco: And actually better products dispensed. We notice an increase in the average sales price, and that usually correlates to better technology for the consumer. So that's how we've been evolving.

Dybala: Give me a little bit of background, if you would, on the Greenhouse program, for those that may not be familiar.

Fusco: Well, Dan Quall started the Greenhouse. I think his first one was in 1998. And at that point it was just the name: the Greenhouse. We wanted to grow our providers beyond their degree, expose them to lots of manufacturing training, marketing, test procedures, the patient-centered approach. Our training was six weeks long, in-house.

Dybala: Wow, you took them out of the clinic for six weeks?

Fusco: Yes.

Quall: A lot of them were coming right out of their CFY at that point in time, and we housed them during the summer in a dorm.

Dybala: Why not a fraternity house?

Fusco: It turned into a fraternity house. [laughter]

Quall: It was great. We did a number of those. We started out at the five, six week time frame, and we saw what worked and what didn't. We eventually knocked it down to four weeks. And then after we got some of the younger folks out, we said, "Okay, now it's time to get to our more experienced people," and at that point we could start reducing the time. So now we have the process in place, where, in order to receive the certification, you have to come to our Greenhouse. It's a one week program. There's five days, well actually it's six; we work them on Saturday [laughter], and it's a very regimented program. We take them through everything from patient satisfaction to how to manage a practice. So it's slowly come to that.

Fusco: It's practice management boot camp now! [laughter]

Quall: One of the other things that was interesting for us when we were doing our data search when we started this, was that when we brought everybody together, we didn't just look in audiology. We went outside of audiology and looked at business and asked, "In a service-related industry what drives satisfaction in other businesses, and what drives profitability?" We found a lot of information through Harvard Business Review, and that's when Sonus Solution came out. Sonus Solution was developed as a package to create patient loyalty. It's designed to keep your patients close to you, because the value of service is the repeat customer. It's an improvement on the patient-centered approach.

Dybala: Right. It would be easier to keep a patient as opposed to finding a new one.

One thing I wanted to flip back to: Michele, you were mentioning how you're updating the protocol, how you're having to add in new pieces. But since you have a finite amount of time, are you having to drop other pieces out?

Fusco: There's things we would like to drop, but we can't because of the state licensing laws, like 25-word list speech recognition test.

Here's what we did, Paul. We extended the time of the first evaluation. It used to be an hour. We now say that if you need an hour and a half, fine. But most of the tests are not time-intensive; you know the Quick SIN takes just a minute for each ear, at the most.

Dybala: Yeah, it's pretty fast.

Fusco: It's the same with other tests we are using also. What we generally allow for is at least 30 minutes for the upfront discussion with your patient. This is where the patient comes alive. There is where you hear their needs. And then it makes the testing a very short part of it. It's the counseling that should take the time.

But I will tell you, many of our patients, my parents being some of them now, said, "No one's tested me like that before," or "Wow, you tested me in noise!" That's where patients experience problems. So, it may take more time, but in the end, I think it saves us time. I don't think they come back as much, because they understand that it's related to their hearing.

Dybala: I think you'd be hard-pressed to find any audiologist who hasn't heard the comment from a patient, "I've got a problem with noise. Why don't you test that?" Sonus is hearing that and acknowledging it. That's a great point that you make.

Fusco: And when people stand up and say, "I don't have time for that," my response to them is," You don't have time not to do it." You have to do it.

Quall: Also, when you go across the country from clinic to clinic, usually you see patients booked one or two weeks out. But most of the time, everybody's schedule is not full, eight hours a day. We can expand those unused slots of time. And it makes a lot more sense, if you're taking the time to bring those people out, that you have to make it a positive experience. You've got those first impressions. Why short yourself?

Dybala: I think what's key in all this is that that extra time is working. Someone might say, "Well, we'll do that, but I don't even know if it helps." But you've got data right there that shows and reinforces that the extra time is worth it, which makes it really powerful.

Fusco: I think we are doing what we decided we wanted to do since 1997- make a difference. Let's touch more lives. And I'm still just as excited about the patient-centered approach as I was in 1997. I feel that adds value to the hearing health-care industry.

It's a process. You look at the successful practices, like the Mayo Clinics. They follow a process. That's how they became the best. I think it's proving itself out, by what we thought would happen.

Dybala: What do you all see for the future? Maybe we've already covered this, as far as continuing to look at the evidence and increase your protocols. Is there anything else you would think to add to this?

Quall: I think we're constantly looking for new things, for example, the LACE Program. That's something we've always believed for rehabilitation. So, we're going to do some measurements in some more clinics, try it out and see what kind of impact it has. Those are the kinds of things you're always looking for.

The other thing that's really interesting in our patient data that we collect through our questionnaire cards, is that some of the younger patients under 65 are asking for a little bit different experience than the older people. Some of them are wanting it faster, quicker, and more convenient.

Dybala: That's kind of a baby boomer thing, if I understand correctly.

Quall: So, we're starting to scratch our heads and say, "What does that mean? How are we going to start differentiating our customers and give them the right process for their demands?" We may have to change it slightly, not by cutting parts out, but we're going to have to do something to move them through faster, because they want to experience something different.

We have to provide quality audiology, but at the same time make the patient satisfied with the whole experience.

Fusco: That's so true. We're on the road almost three weeks a month, teaching a different way than most of our hearing aid dispensers or hearing health care providers have experienced in the past.

It's not about the product any more, because all of the products are doing about the same thing now. What we try to do is take away the mystery, and really teach the audiologist that by utilizing the patient-centered approach, we can emphasize features that are going to enhance the patient's life.

And we teach it in a way, evidence-based and very basic, where people realize, "Oh, digital noise reduction. Here's where that helps." It's a really good experience, and it's teaching them how to fit the patient, not with a product, but with a process and a solution. I'm proud of those guys.

Dybala: Well, this has been tremendous. I really appreciate, Dan and Michele, the time you've spent with me today. And I'm sure we'll be seeing more from you all soon. So, thanks again.

Quall: Thank you, Paul.

Fusco: Thank you.

About Sonus

Since its founding in 1993, Sonus has grown into the largest professional hearing-care network in North America. Today Sonus offers private-label and multi-brand products to hearing-impaired consumers at more than 2,000 locations in the United States and Canada, including company-owned clinics and independent providers who are licensed Sonus Network affiliates. As an innovator and leader in hearing health care, Sonus is committed to hearing-loss education, prevention efforts and optimizing customer satisfaction. For more information, please visit www.sonus.com or the Sonus Web Channel on Audiology Online at www.audiologyonline.com/channels/sonus.asp

References

Freyaldenhoven, M., (2007, Feb 2). Acceptable Noise Level (ANL): Research and Current Application. Audiology Online, Article 1756. Retrieved May 10, 2007 from the Article Archives or directly from www.audiologyonline.com/articles/article_detail.asp?article_id=1756

Valente, M., (2006, Oct 10). Guideline for Audiologic Management of the Adult Patient. Audiology Online, Article 1716. Retrieved May 10, 2007 from the Article Archives or directly from www.audiologyonline.com/articles/article_detail.asp?article_id=1716
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Michele Fusco


Dan Quall



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