Into the jaws of the beast
This is a continuation of Parts I and II of “An Audiologist in the Wilderness” by James Curran.
James Curran, M.S.
Because of my lobbying activities, I became noticed and watched by the hearing aid manufacturers in Minneapolis, unbeknown to me. Eventually I received employment offers from two local companies. They came at a propitious time. The truth of the matter was I was becoming bored with the routine daily grind of the retail office. During my last year in the practice, I had become active in speaking to local and national audiology groups, writing articles and generally trying to convince audiologists that they should consider dispensing. I enjoyed that a lot more than the repetitive nature of dispensing, and had enough hubris to feel I had more to offer.
The office had finally turned the corner and was profitable, but I became engaged in a nasty dispute with Don Schaefer over our agreement. He got an offer for the practice from someone else at an outrageous price. I could not match the amount and didn’t think it was fair anyway, for I had built the practice from scratch. So I walked away from it, and seriously considered the offer from Dahlberg. Bob Winslow, President, and Al Schwab, Vice President, at Dahlberg had been the most persistent about me joining them. They were enthusiastic, and painted a rosy picture for me, pointing out that I would have much more impact on improving the quality of hearing aid dispensing if I joined them than I could have as a lone dispenser.
I joined Dahlberg in 1970, had no idea what to expect, and immediately had some misgivings. Along with Beltone, Dalhberg enjoyed the lowest of all reputations among audiologists. Both were committed to the “manpower” model of hearing aid sales. In short, they recruited dealers who had a background in specialty sales and encouraged building large sales organizations. Sales were made in the home, rarely in the office. By contrast, audiologists are trained in a model where hearing loss is considered a medical/rehabilitative problem, and remediation requires expert professional help within a medical or rehabilitative setting. Following leads and engaging in door to door selling obviates this entirely, and potentially can lend itself to any number of abuses. I was very uncomfortable with the specialty selling model, and spent the first few months questioning my judgment.
Specialty selling is a branch of sales that follows a tried and true set of steps to make sales. First, it requires leads to identify prospective customers. Second, it requires demonstrating to the customer he/she has a need for the product. Third, it requires showing the customer that the sales person has the competence to provide it. Fourth, it requires a commitment from the customer that it will be purchased, effected by any number of well-known “closes,” leading to a signed contract and often up-front payment. This is the protocol used by aluminum siding salesmen, vibrating chair salesmen, vacuum cleaner sales people, in short, any product that can be sold door to door, and it makes no difference what the product might be.
Hearing aid selling fitted this structure beautifully: most of the hearing aid companies of the time had an active program for generating leads, but the two most successful were Beltone and Dahlberg. Giving an audiometric hearing test was a demonstration of the dealer’s expertise and lent an aura of high tech competency to the presentation. The salesmen used it to demonstrate to the customer the degree of hearing loss and the need for amplification. Any number of methods, legitimate and otherwise, were used to show that the sales person and the product could resolve the hearing problem, and any number of persuasive arguments were employed to overcome any hesitation to purchase.
I already knew of the Dahlberg modus operandi but was quite unprepared for its ramifications. Hearing aid companies then were more interested in building sales than concentrating on improving the product. Resources devoted to research and beefing up engineering and production were essentially non-existent and by comparison to sales, engineering was starved. This was something I never grew to understand in the early years, for it seemed to me that product quality was the essential ingredient for success, while management almost to a man focused on improving sales. Both are equally important, but product was always given the short end of the stick. Being somewhat impatient, I managed to get crosswise with management from time to time as I lobbied for improved product quality.
After being hired, I strolled back to the section where the final inspection prior to shipping was done. To my chagrin I found that the each hearing aid’s acoustical calibration consisted solely of a 1000 Hz signal input at 60 dB, and the aid was okayed if the full-on output was within + or – 5 dB of the target. No check of the response, no indication of harmonic distortion, no check of the output (SSPL90) level or any other performance measurement.
I found that the production line assemblers relied solely on a few electrical checks of circuit connections and had no idea of the performance of the transducers. The assumption was made that in the end, the response of the completely assembled aid would be as predicted. Transducers and other components were inspected upon arrival at the factory by sampling each lot. A certain number of items of each incoming lot were checked. The higher the number sampled, the higher degree of certainty that the entire lot was OK if all these samples passed. This method of quality control was in effect throughout the manufacturing world after having been developed during WWII. But the downside was that an unknown number of components or sub-assemblies might be defective in the rest of the lot, so that the manufacturer never really knew whether it was building defects or not into the product. The alternative was to inspect every single one of the components that were used, both humanly impossible and outrageously expensive.
So essentially, the manufacturer relied on the word of the component suppliers that their product would perform as specified. I was under the illusion that in hearing aid companies a rigorous research protocol was followed both in evaluating components and designs, and especially, in evaluating the final product before it was sent to market. The truth was quite the reverse. At more than one company I saw circuits designed for a new instrument where the development consisted of discrete components assembled on a breadboard, tested electrically and acoustically in this condition until it approximated desired specs. Then after two to five prototypes were built, the aid was released to production for manufacture. Remember, I am describing things that I saw then, not today. Subsequently, the production floor would encounter all types of difficulties but the assemblers working on the production line were really quite skilled and experienced, and they would feed back information to the engineers that eventually resulted in fixes for the problems. So it was engineering by feel, by trial and error, and coupled with the quality control techniques of the day, the result was products of intermittent quality and reliability.
Over the next few years I realized this state of affairs was not unique to Dahlberg. Hearing aid manufacturing was essentially a garage shop operation in the day. Any person with a desire to enter the industry could start his own company by ordering parts from a number of sub-assembly/component suppliers and be open for business. The four companies I eventually worked for (and the only ones I am reporting on) usually had about five to six, maybe seven, people in the engineering department when I joined, and three or four of those were techs. Highly skilled techs to be sure, but both they and the engineers were often as not non-degreed. The engineers were extremely bright and crafty, highly self- taught out of necessity, and understood electrical engineering issues to a much greater degree than acoustics. They were responsible for every improvement in the industry for they constantly put pressure on the transducer manufacturers for smaller mics and receivers, demanded ever smaller controls and switches, and designed improved amplifier assemblies that provided very high output levels despite impossible size limitations. They routinely designed and remodeled hearing aid cases, minimizing mechanical feedback problems by developing clever isolation techniques. As battery sizes became smaller, they figured out how to still provide adequate battery life in the face of demands for greater and greater output levels and increasingly complex circuit performance.
In retrospect, I have the greatest respect for those early engineers. They were laboring under very difficult conditions, establishing almost from scratch a niche industry that had little glamour and inadequate financial underpinnings. They took advantage of even the smallest breakthroughs in components and materials and adapted them to their needs. They were the first to use the transistor in a commercially successful product (at Dalhberg, if I am not mistaken); the transducers that were developed for head-worn amplification led the way to the proliferation of today’s miniaturized audio and similar acoustic devices. I remember interviewing electrical engineering graduates that we were trying to recruit, and all would go well until they found that they would be dealing with two or three transistor circuits and 1.5v power sources. During their education, for power, they had been used to plugging into the wall, and our limitations just scared them away, for they wanted a career in designing big, complicated stuff, not our penny ante devices. A few bright ones caught on to what we were trying to do, understood the challenges and those that hired on and stayed experienced extremely rewarding careers.
At Dahlberg we manufactured a small portable audiometer that combined pure-tone testing capabilities with a master hearing aid. All of the salesmen in the field were expected to do their “demos” with these machines. Instead of standard TDH-39 earphones, large insert body-aid type receivers and stock earmolds were used. It was evident to me there was a high probability for serious calibration issues. I talked to Dick Martin, one of the pioneer engineers in the industry, whom I admired greatly, and who fabricated the first commercially successful modular ITE aid (the Dahlberg Miracle Ear), and asked him how the audiometers were calibrated. It turned out that they were tested on a 2cc coupler. He had tested the hearing of his engineering crew and other workers, and somehow calculated an approximation of zero on the dial at 1000 Hz based on the hearing of about 15 people. Using a 2cc coupler, he checked each of the earphones at 1000 Hz to determine if they fell within +/- 5 dB. The effect of the stock earmolds on the output was an unknown. He was aware of ASA standards for audiometric calibration, and when I gave a copy to him hoping to influence him to improve our calibration methods, he remarked, “Well, after all, threshold values are all relative anyway.” Which was true, but ours were the most relative of all. Eventually we worked together in designing a totally new audiometer using appropriate transducers for use in the field.
One might think that I became discouraged by what I saw. But I came to realize that most of the key people who made the day-to-day decisions whether in management, in engineering, or in production were mostly properly motivated. With exceptions I will recount later, I saw few decisions made that were consciously or purposefully corrupt, venal or criminal. Our managers were motivated, as most humans are, to do a good job, to earn a decent living, and maintain their integrity. Most of the abuses I saw could be laid at the feet of ignorance, company politics and a certain lack of vision and courage.
Many of the Dahlberg dealer’s offices I began to visit usually had a large room for sales meetings with the number of aids each person had sold in the month prominently displayed, but no hearing aid test box on site, very little ability to effect anything but the most minor repairs, and audiometers in every state of disrepair, calibration and condition. There was usually just a counter to display batteries, etc., and maybe a side office where the occasional hearing test could be done. I was dismayed by this, but also was excited. For I realized that I could make a substantial impact on the Dalhlberg dealers and their salesmen, on their customers especially, and hopefully on the industry, by teaching, writing and speaking about the proper way to conduct evaluations, deal with customers’ problems and learn and perform bench skills. So this became my motivation and my mission, which dovetailed nicely with the intent of those who hired me. They were acutely aware of the technical and audiometric shortcomings of their dealers, and foresaw some of the changes that state licensing would bring if something was not done to upgrade the quality of their dealerships. They supported my endeavors, and the discomfort I might have felt about the Dahlberg marketing and selling operation I was able to overlook.
“Into The Jaws of the Beast” will continue in the next blog featuring James Curran.