A Broken Business Model
This is the first in a series of explorations into changing our processes in order that we can deliver a more relevant service. Let’s explore how we can change the business model so that we can survive. In my last article, I said that I believe our business model is broken, that it is outdated, was designed around one product, and was designed for a market that barely exists anymore. I think that all of those statements are true and from the reactions to the article I believe that many of you do to. What are we as a profession and an industry to do about that? I invited people to an open forum to analyse and innovate around that idea last year, a few even did! That article can be found here. Unfortunately, we never got the momentum that we needed. Generally, I find apart from a few people who are willing to put their money where their mouth is, the rest like to sit and whine. Yes, that is probably you I am talking about.
Get Off Your Ass
Get off your ass and start thinking about the wider implications that all of this has for our profession. I love Audiology, I believe that we as professionals offer a service that ultimately changes lives and delivers happiness. In order to continue to do so, we need to ensure that we are relevant to the people we are there to help. This isn’t about some philanthropic drive to help the people, I have empathy for people with hearing loss, but I also like to get paid. It keeps me in coffee and cigarettes. I am a strange mix of technical, clinical and commercial, that seems to exist in only a few, although I know some who would say I am a one of a kind. That may be based on other quirky parts of my personality.
In order for us as a profession to innovate around our business model, we need the involvement of all the different types of hearing healthcare professionals out there. Clinically minded, process minded, tech-minded and commercially minded. In this way, we can get a wider view of elements, tools and processes we can incorporate to change the model. Anyway, enough soapbox, let’s talk about pre-qualifying and cutting costs.
Pre-qualifying & Cutting Chair Time Costs
Our profitability is under consistent pressure, so we need to consider how we can cut our costs and make the use of our time more effective. I have watched with sneaking admiration the way one large international retailer has done just this over the last few years. They have a price led business model, so it is imperative for them to keep costs exceptionally tight and to maximise opportunities. A part of that is pre-qualifying every person that ends up sitting on the chair of one of their hearing professionals.
Have a Problem, Ready To Buy
In essence, every person who sits in the consultation room has a problem and is at least in the mindset to buy. In this way, they maximise sales and maximise the time of every hearing healthcare professional that works for them. They go further, they employ people who are qualified as Hear Care Assistants to deal with repair issues, take impressions and even do follow ups if needed. The involvement of a Hear Care Assistant in the business allows them to maximise the time of the hearing health professional.
Conveyor Belt Audiology I hear You Say
Yes, it sure is, however, we can learn from it. I don’t advocate that we follow this model slavishly, what I think we should do is take from it what will benefit us. It makes sense for us that everyone who reaches our chair should actually have a problem. That is the best use of our time, time is precious, I hear many professionals talking about the lack of time particularly Independent business owners. The question I always ask is “Are you using your time effectively?”.
Consider Medical Consultants
Do heart surgeons see people who think they have heart problems? Do brain surgeons see people who think they have brain problems? No, they don’t, so why do we need to see everyone who thinks they have a hearing problem? If we introduce technology or processes to screen people who come to see us, it can only be a good thing for us and for them. It is the best use of our time and theirs. There is technology out there that will allow us to do that easily, it can be based on PTA protocols, but to offer a really good service we should be looking at some sort of speech in noise based screening.
This will allow us to identify everyone who may need our help, everyone who actually has a problem that we may be able to assist with. It will also maximise the profitability of our chair time. That is not a bad thing, it is not an evil thing, yes it is a commercially minded strategy, but so what? I want to deliver the very best service and care to the people I look after, I also want to ensure I get paid for it and have a decent standard of living. These two goals are not averse.
There are many ways we can change our way of Practice to maximise our time and deliver a better service to the people who need us. I plan to look at them all building upon each idea as I go. I picked this particular topic first because I want to speak about some technology in the next article that will allow us to both pre-qualify and maybe increase leads as well. I shouldn’t be a lone voice, I know I am not, I ask all stakeholders to have their say. Hey even if it is only to say you are a gobshite! I am used to that, my skin is thick and my wife reminds me of it every day!
Hi Geoff,
Nice thought provoking article. I agree that anything that stops us from wasting our time is positive. However, just having the opportunity to show a member of the community our excellent business can still be a good thing whether they have a hearing problem or not. All traffic could be considered good in this respect.
I also think that as an independent we have an opportunity to be the antidote to the Specsavers and Boots business model.
Maybe we need to provide a premium service but just make sure that we get paid for it instead of doing it all for free all the time!
Cheers.
I agree that all traffic can raise awareness and the profile of the business. However good front of house staff with the right tech can pre qualify without any loss of impact if it is done properly. Again as I said, adopt what makes sense, don’t slavishly follow.
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The potential for this type of change is fantastic. We have actually been trying to implement this type of a system for over a year now in our practice.
It absolutely makes sense that a new patient should be tested by a (lower cost) technician who is qualified to provide a thorough measurement of the patient’s hearing, following whatever test protocols you design. But there is no reason this person must be your highly paid Doctor of Audiology. This technician, in essence, becomes the gatekeeper.
If the patient does not have aidable loss, then the gatekeeper/technician can redirect that patient in the appropriate way. If the patient has aidable loss, then they are handed over to the (higher cost) Doctor of Audiology or the (higher cost) Hearing Instrument Specialist who has the professional credibility and interpersonal rapport-building skills to get the “yes” for treatment of the hearing loss. Smaller practices may then have that same provider do the actual programming. But larger practices MIGHT then redirect the actual programming to whatever Audiologist or Hearing Instrument Specialist has the strongest programming and troubleshooting skills.
For instance, in our practice we have some older providers who are great at building rapport and getting the “yes”, but have not necessarily been as adept at keeping up with ALL of the different technologies and programming tricks. But we have younger, more technologically savvy providers who are complete prodigies at programming, but have weaker interpersonal skills.
A modular system like this allows you to make the BEST, and MOST EFFICIENT use of your different people.
It is not in any way, shape, or form, a lower grade of service compared to traditional methods. In fact, I would argue that our patients get SUPERIOR care because each member of the team is doing what they are THE BEST at. It is just more efficient, and as a result, more profitable.
I think you are right, in fact, I think that your system makes the best use of the skills of the people who work there. The only fear is that someone may end up pigeon-holed, I think if we can introduce ways to ensure that skills are passed on and every person has the best possible opportunity to learn, then we are on a winner.
We always have our eye on how each member of the team is performing. If the technicians are showing stronger interpersonal skills, stronger motivational interviewing techniques, and more contribution toward moving each patient down the path to getting help, those are the technicians we cultivate and move into the role of sales counselor (If that is where their interest lies).
On the other hand, we’ve had sales counselors who don’t like the “pressure” of having to “make the sale”, or maybe they just don’t feel ready (One example was a very young intern who asked to be moved back into that technician role, where he was more comfortable). These individuals don’t need to be discounted or reprimanded. They just need to be utilized in their proper role. Just like CNAs who get bored, go back to school and become RNs, who then get bored again and become LPNs, who then sometimes get bored and go back to medical school to become an MD. It happens. I think in any growing practice there has to be an opportunity to grow within the company and take on new responsibilities.
This is probably a big reason so many dispensers/AuDs in small practices get burned out. Because there is nowhere to go. You get stuck in the rut of “Test, sell, fit, test, sell, fit…”
On the flip side, there are challenges for anybody looking to build a system like ours. As we implement these procedures in the offices we’ve assumed, there is always some kick back. Initially, patients will often insist on seeing ONLY a specific dispenser/AuD, or they will hesitate at having a technician do their testing, or they will FEEL like they don’t have as close a relationship with the provider because they didn’t get to chat for an hour about personal issues. But I can assure you, it is just a knee jerk reaction to change. As we have gone through these changes over the last few years, we have never lost a patient in the long term over it. And you can tell by our schedule that our patients are MORE engaged and MORE actively pursuing better hearing than they have before.
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