Service Innovations Start in the Clinic

Hearing Health & Technology Matters
July 23, 2014

Editor’s Note: Today we continue with the third and final post of Brian Taylor’s discussion on unbundling service delivery in the audiology clinic.

Brian Taylor, AuD

Brian Taylor, AuD

When most of us hear the word “innovation” our minds immediately conjure up thoughts of computers, robotic manufacturing processes, new advances in automated medical devices or some other technology designed to make our lives easier or our businesses more efficient.

The problem with this myopic, gadget-driven  view of technological innovation is that we might be missing out on some real possibilities that center on service innovation. Service innovation, which is the ugly step-child of technological innovation,  can be defined as a change in your clinical offerings that adds practical value for the patient. In other words, a new service or delivery mechanism that has real “value for money” for patients. For obvious reasons, outlined in Part 1 of this series, now is a great time for audiologists to innovate around service.

In his recent benchmarking article, Ron Gleitman wrote, “Practices need to stop focusing solely on how they’re going to compete on price and instead compete on value and service.” In Part 3, I’d like to elaborate on Ron’s astute assessment and suggest some specific approaches hearing care professionals can take to innovating with respect to service delivery.


Matrix Thinking

An “all-hands-on-deck” approach is necessary if we want to unlock service innovation in our practices that might appeal to a broader market.  We can start to crack the service innovation code by examining the work of Leonard Berry and colleagues at MIT. Dr. Berry, who is currently on the faculty at Texas A & M University, characterizes service innovation along two dimensions (shown in Figure 1):  1. Whether a service innovation offers a new core benefit or a new way of delivering a core benefit. And, 2. whether a service innovation must be consumed where and when it is delivered, or can be delivered separately from its creation.

We can use Berry’s approach to finding new service innovations in our practices by first defining our current service delivery model and the core benefit we provide patients.

This might be a little tricky, but I think most of us agree that our current service delivery model revolves around the selection, fitting and follow-up of a pair of hearing aids, largely delivered in a face-to-face manner during a traditional, quasi-medical appointment. As for the core benefit we provide patients, that is likely to include some mix of optimizing a pair of modern hearing aids to the auditory requirements of the patient’s damaged ears, along with some amount of personal adjustment counseling.

Figure 1. Four Types of Service Innovations. Source: Berry, et al 2006

Figure 1. Four Types of Service Innovations. Source: Berry, et al 2006

Once we have defined the customary manner in which we deliver services in our practices and the core benefits we deliver to our current patients, we can begin to explore some service innovation possibilities using the information in Figure 1. Here are a couple of ideas using Berry’s matrix:

Cell 2: Breaking free from the constraints of time and place, you can decide to innovate by delivering services remotely, such as directly to patients at home, like the growing numbers of physicians now practicing concierge medicine.

Cell 3: You can engage the patient on a more emotional level by enhancing the physical comforts of your office. This article might get you thinking about how to implement this approach to service innovation.

The good news is that you don’t need to have business management experience to use the power of matrix thinking. Believe it or not, there are two questions you can ask patients during their initial appointment in your practice that will help uncover opportunities for new service delivery approaches. Both questions are rooted in the technique of motivational interviewing. They are called scaling questions and I have found them to be invaluable when attempting to individualize patient care. From one audiologist to another, I would encourage you to ask these two questions at some point during the initial discussion when it feels safe for the patient to answer them and natural for you to ask them.

Q1. On a scale of 1 to 10 (1 being no problem at all and 10 being all kinds of problems), how would you rate your overall ability to communicate?

Q2. On a scale of 1 to 10 (1 being not ready at all and 10 being ready today), how ready are you to move ahead today with help for your hearing?

Thinking Inside the (4-Quadrant) Box

The really interesting part, for me at least, is how you use the patient’s responses to those two questions to make decisions in your clinic. Rather than tell some patients that they need to see you in a year for an annual hearing screening, possibly also bombarding them with letters and phone calls to motivate them to return to your practice, matrix thinking around those two questions may uncover some revenue-generating opportunities that are not predicated on selling devices. You can uncover some useful service delivery opportunities – dare I say innovative –  by simply charting each patient’s answers into a 4-quadrant matrix.

For those of you unfamiliar with a matrix approach to solving problems, this requires two variables that can be scaled or rated. Charting responses on a 4-box matrix is an effective tool for making business and clinical decisions.

In Figure 2  a patient’s responses to the two questions above are charted into one of four quadrants. Here are the four possible decision pathways  based on the patient’s self-rating of readiness to receive help and perception of a hearing problem.

  1. Low Perception of Problem/Low Readiness for Help (lower left box) Since both are low, this patient likely needs more time to contemplate making a change in their behavior and accepting your recommendation. Maybe not a revenue-generating opportunity at the moment, but a chance to form a relationship centered on education and trust.
  2. Low Perception of Problem/High Readiness for Help.  (upper left box) The patient may be likely to accept your recommendation, but since their perception of the problem is low their investment in time and money to solve the problem is probably going to be minimal. A low-cost, off-the-shelf product might be a viable alternative for patients who fall into this quadrant.
  1. High Perception of Problem/Low Readiness for Help. (lower right box) Patients who fall into this quadrant  notice significant problems with communication, but for whatever reason they are still reluctant to take action to solve their problems. Support groups and a hearing management group that allow patients to “share their stories” with others and to learn practical skills without the pressure of making a large investment in hearing aids might be right for this cohort of patients, at least until they are ready to take actions to use traditional hearing aids.
  2. High Perception of Problem/High Readiness for Help. (upper right box) Chances are good that these are the patients you are already taking great care of. The challenge, of course, is that today, for innumerable reasons, many of the patients you do see in your practice do not naturally fall into this quadrant. Using some matrix thinking might help uncover revenue-generating opportunities for those not firmly in this box.


Figure 2. Service Innovation Matrix


Innovation is not confined to hearing aid technology. It is the responsibility of the clinician to uncover opportunities outside the traditional service-delivery mechanism that will add value for more patients and generate more revenue for the practice. This process begins with matrix thinking centered on two open-ended questions.

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