Client Orientated Scale of Improvement, The COSI and its uses In Your Hearing Health Consultation

Increasing Patient Engagement In Your Consultation

I wrote some time ago about the COSI and its possible uses in your Hearing Health Practice. I would like to ponder it again and flesh out why I think it can really help you in your consultation. The COSI is an integral part of best practice in the Hearing Profession. The COSI is simply a very well designed piece of A4 paper or a form in one of the many Audiological Software systems. The COSI is a place to record a Patient’s problem situations or lifestyle needs and then trace their ongoing success with a prescribed hearing system. This simple record can be used to bolster and increase Patient engagement in any Practice. Many Dispensers shy away from the COSI because they are not sure where it will fit either in their consultation or follow up nor do they understand how it may be the most powerful tool that they have ever used on several differing and important levels.
At it’s most simple level the COSI is used to record the difficulties that a Patient has in their day to day life. The crux is how you as a professional achieve this and if you use the golden opportunity that this record gives you to emotionally connect and engage deeply with the Patient. The COSI can allow you to connect with a Patient, gain their acknowledgement of lifestyle impact, manage a Patients expectations and gain agreement on a set strategy for dealing with the core issues.
So, how is this simple form going to achieve all this? Simply put, you use it to ask pertinent questions and record the answers. I hear you say I ask the problem areas already, you may, but do you ask in the right way, do you ask enough of the right questions and most importantly do you listen? All questions you ask need to be open questions, questions that generate information instead of yes/no responses.
Ask, “where are the areas that you have problems, the areas I would like to talk to you about are the areas that you feel cause you most problems in your daily lives and relationships. We can record five areas, but really we will concentrate mostly on three of them”. When they give you the areas, dig deeper, “so you say at the family table, who are you seated with and what type of conversation are we talking about, animated, quiet? What exactly are the problems you suffer?!
Dig deep, keep asking those questions When you have found out all of the information and led the Patient on a journey through that situation, ask them, How does that make you feel, how does that impact on you? If you have done your job properly they will tell you. It might be emotional, it might even be hard to listen to, but it generally will be the truth, unvarnished and direct. There may be tears, if so it may be awkward for you, I generally put my hand on their arm for a moment in order to show acknowledgement of the pain.
Go through each situation they have recorded and do the same thing, generally you will not have to ask the loaded question again, they will tell you without prompting. At the end ask them which three problems would they most like to try to fix. When you have identified these areas, grade their current ability, ask them their expected ability and then most importantly agree a realistic final ability. Tell them directly what you feel you can do well and more importantly what you may not be able to do so well.
Why should you do this, there are several reasons, Practice efficacy, human capacity, commercial sense, but most importantly, it is the right thing to do for the Patient. You will make a strong emotional connection to your Patient, they will believe that you are interested in their problems and more importantly that you are interested in dealing with their problems. They will believe that you are an honest, compassionate and caring practitioner, if for some reason they can not do business with you, they will ensure that they will tell their friends to do business with you.
You will help them to truly recognize their difficulties and acknowledge the impact on their lifestyle. You will also manage their expectations openly and usually without Patient rancor. You will gain agreement for a course of action and in fact plan that action out. The Patient begins to talk about when’s instead of ifs. You help your Patient acknowledge trauma and then lead them through it to solution, you allow them to openly express their feelings perhaps for the very first time. All of this from a well designed piece of paper.
So for every type of dispenser, from the most hardened of commercial to the most Patient centered, there is a pay off from the COSI. More importantly, there is a real and valid pay off for their Patients.

About Geoffrey Cooling

Geoffrey Cooling is an Irish hearing care blogger and the author of The Little Book of Hearing Aids and Audiology Marketing in a Digital World. He has been involved in the Hearing Healthcare Profession since 2007 when he qualified as a hearing aid audiologist. He has worked in private practice and for a major hearing aid manufacturer. He has become recognised as an authority within the field of hearing care and hearing aids.


  1. I agree. The COSI should be an integral part of every protocol. We use it in my university program and it does a great job giving the patient some concrete evidence that the HA is providing benefit. Or it can show that we still have some work to improve the patient’s outcomes and give us specific areas in which to focus.

  2. As a tool to assess efficacy, there is simply no better. The beauty of the tool is that it allows people who are not necessarily practised in engagement to do so without any contrived sales rubbish. It is a win win for both Dispenser and Patient.

  3. Oh and thanks Caleb, lots of people read but for some reason few give feedback.

  4. Actually, the COSI is simply the extension of a well-honed sales pitch for first-time users, as carefully crafted questions will lead the client towards realizing his/her problem is, in fact, impacting their life more than they realize, leading them to an “Aha!” moment.

    For example, my favorite question is “Do you hear better when the lights are on?” which leads them to realize they are subconsciously lipreading. Then, I follow with the explanation that, in fact, as hearing declines, the brain will adapt to the loss of communications through the audio channel and will switch to the visual channel.

    Dan Schwartz,
    Editor, The Hearing Blog

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  5. As a folllowup to your blog article is this excellent article by Professor Gail Whitelaw at Ohio State University on CAPD titled,
    Auditory Processing in Adults: Beyond the Audiogram

    “Audiologists are faced daily with patients who report communication issues that they may attribute to hearing loss. These types of communication issues may include difficulty hearing in less than optimal listening situations, reliance on visual information to augment auditory information, a reduced appreciation of listening to music, and difficulty understanding speech when the speaker is unfamiliar. Patients report that these communication issues impact the quality of their lives — often the reason for seeking audiology services… However, some patients who present with concerns will demonstrate normal peripheral hearing acuity based on the results of standard audiometric testing. The assumption is often made that because the results of the audiogram are consistent with normal peripheral hearing acuity, the persons’ reported concerns are not validated.”

    Dan Schwartz,
    Editor, The Hearing Blog

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