The lecture for our AudiologyNOW!® 2017 Indianapolis attendees will take place on Wednesday, April 5, and features Barbara Balik, EdD, MS, RN. Dr. Balik is a nationally recognized expert, speaker, and educator on health-care safety, quality, and adaptive systems design. She is a senior faculty member with the Institute for Healthcare Improvement, the Arizona State University Executive Fellowship in Innovation Health Leadership, and she serves on a variety of boards, including the National Patient Safety Foundation and the American Society of Health System Pharmacists Research and Education Foundation. 

She serves as a committee member of the Presbyterian Healthcare Services System Quality Committee and heads an organization called Common Fire. Common Fire helps to transform health care through partnerships with organizations who are committed to making and keeping promises to patients, families, and communities—promises for care that is safe, that promotes health, that assures value, and that offers experiences that bring joy to both those giving and receiving care. 

Dr. Balik’s work is applicable to the current state of audiology. I had the pleasure of interviewing Dr. Balik about her thoughts on the current state of hearing health care, and how to address disruptive forces and plan for the future. This interview below provides some hints as to her presentation at AudiologyNOW! You will want to be sure to add it to your itinerary.

Therese Walden (TW): Thank you, Dr. Balik, for accepting our invitation to speak at AudiologyNOW!, our annual convention, this April in Indianapolis.

Barbara Balik (BB): Working with other colleagues who are excited about partnering with patients, families, and community members is always a highlight for me. Thank you for the invitation.

With your background in nursing, you have the necessary health-care credentials to know how to care for patients on the front lines. How have you been able to use that skill set in your current role with the Institute for Healthcare Improvement (IHI)?

Deep partnerships with patients, families, and community members can ground all of us in what is real, not what is abstract. It focuses our practice on what my IHI colleagues advise—moving from solely asking “What’s the matter?” to also asking “What matters to you?” My experience as a labor and delivery nurse, as a pediatric nurse practitioner working with both healthy children and children with chronic conditions, and in extensive executive roles helps me bring a clarity of focus on “What matters to you?” I apply this experience in both my work with IHI and in my consulting practice.

The ever-changing health-care arena (decreasing reimbursement, restricted access to care, challenging insurance scenarios, quality reporting systems that change regularly, etcetera) has audiologists and most health-care providers wondering how to care for patients cost-effectively, while providing the highest level of necessary care. How can audiologists navigate this cumbersome system and still be recognized for the care they provide?

Someone once advised me to “never waste a good crisis” as an avenue for transformative changes. As messy as our current health-care world is, it also opens doors now, whereas before the resistance to opening them would have been too great. The time is perfect for audiologists to take rapid action on several fronts—(1) ramp up your planned public awareness campaign to help the public learn about what we do not know about hearing and balance health and the invaluable roles of audiologists; (2) find new partners who share this commitment to hearing and balance health, especially those involved in the care of elders, those helping all of us age in place rather than a reliance on institutionalized care; and (3) partner with consumers to innovate new paths to hearing and balance health since the current models in health care will severely limit the existing path.

A good crisis is right! How might audiologists expand their influence with the extended family of the patient? With community members? Other health-care professionals? What are these groups looking for exactly, i.e., what will appeal to them that will gain their trust that audiologists are their ‘go to’ professional for hearing and balance wellness and care?

Unfortunately, for both community members—who will occasionally be patients—and for other health-care professionals, we don’t know what we don’t know. When you shared with me the link between hearing loss and depression and dementia, I was stunned. I consider myself highly inter-professional and well versed in health care. If I missed that, as close as I am to contemporary trends, I am sure I’m not alone in missing this vital piece of data.  Two approaches, therefore, come to mind:

Take every opportunity to partner with patients, families, and community members to co-design hearing and balance health approaches at every level. Most models of co-design include three levels: (1) care interactions between clinician and patient/community member; (2) care or community sites, where care is designed or improved—clinic, senior center, assisted living community, schools; and (3) organization or policy, where policy is designed or influenced. Seeing the world through the eyes of consumers can illuminate where we can make the best improvements within those three levels and accelerate change.

Give voice to the consumer’s need about hearing and balance health. Providing a platform, a human-centered design, for consumers to help educate others on the needs and solutions, moves the conversation beyond audiology professional domains and into a larger space for other consumers and health professionals to gain needed awareness. Colleagues at Kaiser Permanente, for example, incorporate design thinking into their human-centered design approach to discover innovative ways of meeting pressing needs. 

What would be an example of an innovative outcome for audiologists?

You shared with me a small part of the recent strategic plan summary that was developed by the Academy and its partners. I understand that this “action plan” will help direct the focus of the Academy in the short and long term. This summary identifies several huge problems that demand innovation: people of all ages will have greater need for audiology services, while fewer audiologists are available; cost constraints of covered services; consumers paying more out of pocket for basic health services while the purchase of hearing devices is (currently) likely one of the largest out-of-pocket expenses consumers will have—other than cars. 

All these spell out that the current approach is unsustainable. In design-thinking approaches, several innovation steps would aid in identifying potential paths forward. From colleagues at the Kaiser Garfield Innovation Center and in my own work, the emphasis is first on deeply understanding the current state of issues for both consumers and professionals, then looking at other situations where similar challenges exist—inside and outside health care—to seek new ways of thinking. I also advocate asking disruptive questions such as: what if every practicing audiologist had a caseload double or even triple his or her current size? What would you do differently? Who else has transformed a service that previously required extensive professional time but now does it with a mix of skills (think automation)? What technology could be used to meet growing needs (at home hearing tests?)? What if the price of hearing aids was $200—what would need to change to meet demands? These are tough questions but they have to be addressed by audiologists.

Research is piling up that links untreated hearing loss to incident dementia, increased risk of falling, mild cognitive decline, depression, and a host of other health problems (Lin et al, 2014). How might audiologists use this information with their patients to help them recognize the importance of hearing health care? Conversely, early identification and treatment of hearing loss in infants, as well as older adults, results in better outcomes in terms of language development (in infants and children) and thwarting aging effects in the brain in adults (Campbell and Sharma, 2014; Amieva et al, 2015). Consumers still seem surprised by this information—as though hearing health is an after-thought. How might audiologists go about changing the narrative to engage more people?

Partnerships with patients, families, and community members is a powerful way to learn how to make research findings real to the broader community. Linking with leaders who are expert in developing patient advisors, such as Patient Family Centered Care Partners, is a marvelous source of insight into this type of question. Patient advisors are those who have experienced parts of the health-care system and are committed to helping health care get better. Imagine a group session where you briefly explain the known research and ask how to best convey it to people like them—from all walks of life and backgrounds. I am confident you would find a wealth of ideas.

More and more health care is moving into the “retail” model. Medical care is no longer only available at traditional offices. Retail medicine is here to stay and, of course, the Internet plays a part in some consumers’ health-care plans. Are all health-care providers doomed in a world where price is the key determinant as to where or even why a consumer will get care?

Yes! Cost has been and will continue to be a determinant of who gets care. The current disparities in health-care outcomes are heavily determined by the resources someone has, their race/ethnicity, and where they live (Egede, 2006; CDC, 2011). I would say, and evidence suggests, that access to hearing health is currently determined by the same factors (NIDCD, 2009). I would suggest shifting our thinking from “doomed” to “potential” would make a huge difference if innovative solutions can be found. I know the woman who developed the concept of minute clinics—the early retail medicine development that many of us now use. It was a classic disruptive innovation—not seen as high-quality, criticized as a potential hazard to consumers—yet here we are with a huge retail service that offers low-cost, accessible services. What can happen in hearing and balance health to match that?

Minute clinics were certainly disruptive and considering how audiologists can match that or align with that model is scary. It has always been, however, the case that audiologists are uniquely positioned as cost-effective health-care providers, as compared to more expensive physician models. Can we change how the consumer views us just by saying we are as good (or better)? Is there something more to do that will help set the care provided by audiologists apart from others who may claim to know hearing and balance issues?

My question in response would be: What can audiologists do to make their services more accessible, cost-effective, and trusted than any other health-care provider? Does the retail medicine model work in any part of hearing and balance-care delivery? Does everyone need the same level of hearing and balance care? If the optimum audiology model meets those criteria, then there will be no need to convince consumers since they will see for themselves and tell others. As long as any health-care service is scarce, expensive, and difficult to use, it is ripe for disruption if it is to survive. What a grand time for audiologists to reshape their world!

Thank you, Dr. Balik. That’s a good deal of information to consider and absorb and implement in all audiology workplaces. Everyone is talking about disruption and people like it when it happens to others, not so much when it hits close to home. But, as you say, it’s also about survival and like it or not, audiology, like much of health care, is in survival mode; we just need to find the way forward to own most of hearing and balance care, to include prevention of problems in the first place. We look forward to hearing more from you in Indianapolis in April. Thank you again for agreeing to speak with the attendees!