Unbundling Service Delivery: Start with the Customer’s Viewpoint

Hearing Health & Technology Matters
July 9, 2014

By Brian Taylor, AuD

Brian Taylor, AuD

Brian Taylor, AuD

If you’ve been keeping up with the professional listservs over the past year or so, you’ve probably heard the chatter about unbundling or itemizing various audiological services. There are many valid economic arguments for unbundling service from the selection and fitting of the device, and it’s ultimately the decision of the owner or manager on how (or if) unbundling gets implemented in a practice.

On the surface unbundling seems fairly straightforward, but once you start digging deeper into actually doing it, things can get a little frantic. The good news is that the Academy of Doctors of Audiology has created a task force that is examining all facets of unbundling and hopes to present some of these best practices with respect to unbundling at its annual convention in November.

A big part of the unbundling equation revolves around service delivery. Specifically, which components of service are customers willing to pay for and which should be bundled with the delivery of the devices? The focus of this essay is not to discuss why or even how to unbundle. My purpose is to examine which components of the service experience are valued by the customer and how we can add more value to them, so that the market is willing to pay for these services. This process starts with a deep dive into the wants and needs of the marketplace. Examining the opinions of the market will serve us well as we fine-tune the unbundling process.

As the management guru Peter Drucker said, “the purpose of any business is to create a customer.” In an elective medical/helping profession like audiology and hearing instrument dispensing where we draw from a relatively narrow segment of the population, the creation of a customer can be extremely challenging. Thus it is imperative that we listen to the “voice-of-customer” before we make any significant decision about our businesses. Sadly, aside from the Kochkin MarkeTrak reports there is little voice-of-customer information available. I did manage to stumble across one published report that shed valuable insight on what our customers think with respect to follow-up service.

Stika and Ross (2011) surveyed 942 hearing aid users drawn primary from individuals associated with the Hearing Loss Association of America (known when the survey was conducted as Self Help for Hard of Hearing People). Their primary objective was to analyze the differences between services delivered by an audiologist and  those provided by a hearing instrument specialist from the customer’s point of view. Their analysis of the survey results, in case you are interested, was that individuals who saw an audiologist, on average, reported a higher level of satisfaction than respondents who were provided services from a hearing instrument specialist. You can read the article to see how big the service gap between the professions was reported.

The most actionable part of their article, however, was not that finding. Rather, it was their assessment of itemized services delivered by both groups of professions. Respondents were asked to recall which particular services they received from either their audiologist or hearing instrument specialist. Table 1 shows a breakdown of the percentage of survey respondents who received specific services. Not surprisingly, services that directly impact the use of the hearing aids themselves are provided more frequently by both groups of professionals.

Note that a much higher percentage of services that are inextricably bound to the hearing aid were reported to have been delivered by both groups of professionals. This provides some clear evidence direct from customers that, indeed, as my colleague and friend Barry Freeman suggests, the device is the center of our universe.

One could argue that most of the services listed in Table 1 were actually conducted by the professional, but the respondents simply did not remember it. After all, the authors did ask a group of  elderly people to recall what happened at a prior appointment, which may have occurred several weeks ago. Granted that could be true, but it still doesn’t explain the much higher percentage of services delivered for device-centric activities. If you ascribe to the poor memory recall argument, also keep in mind that patients are less likely to recall something that was not emotionally compelling and memorable. That is yet another reason to make your routine interactions with patients energetic and even entertaining when you can.


Table 1. Percentage of Respondents Indicating Services Provided by Either an Audiologist or Hearing Instrument Specialist. Source: Stika and Ross, 2011.

    *Part 2 Next Week: How these findings could impact audiology and your business


Brian Taylor, AuD, is the Director of Practice Development & Clinical Affairs for Unitron. He is also the Editor of Audiology Practices for the Academy of Doctors of Audiology. He can be contacted at[email protected]

  1. Until manufacturers think about the effect that the other components have to the pricing, I will never do so. Since 2008 manufacturers have added other items with significant costs such as wireless remotes, power RIC molds, tv devices. These items cause much in the way of headaches in pricing.

    The advice of ALL of the manufacturers? Well with the highest end aids we think people should just include that in the costs…so the audiologist’s takes it in the shorts and not the manufacturer.

    This topic of unbundling gives patients the feeling that they are being nickle and dimed.

  2. Valid point. Ulimately, I don’t think it matters much what clinicians (the profession) or manufactucturers (the industry) think. Customers will decide.

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