MAKE IT HAPPEN How to Implement Tele-Audiology in Your Audiology Practice Frances Lockhart

LEARNING OBJECTIVES Goal: To develop a pathway for implementing person-centered tele-audiology services in your clinic, using the Ida Change Guide Take out your tele-audiology investigation guide developed in Part 5 of this course. 2.12.2018

IDA CHANGE GUIDE Enhancing your current audiology services with tele-audiology requires a plan This plan can be developed using the Ida Change Guide Enhancing your current audiology services with tele-audiology requires a plan. This plan can be developed using the appreciative enquiry approach discussed in other Ida courses. Don’t worry if you haven’t seen this, we will do a quick review of relevant sections now. Incorporating person-centered tele-audiology services to enhance your current audiology services involves change, and so this is an approach to change that will help that transition. Lets do a quick review of what appreciative change is. 2.12.2018

APPRECIATIVE INQUIRY The Ida Change guide is based on Appreciative Inquiry The study of what gives life to human systems when they function at their best Questions and dialogue about strengths, successes, values, hopes, and dreams are transformational The Ida Change Guide is based upon Appreciative Inquiry. Appreciative Inquiry is the study and exploration of what gives life to human systems when they function at their best. In a way it focuses on what makes us thrive, or organizations thrive. It is an approach to change that is based on the assumption that questions and dialogue about strengths, successes, values, hopes, and dreams are themselves transformational. So, from this perspective, how we talk about change is crucially important. Borrowing from this approach, the Change Guide helps you reflect on what works well now and how you can do more of that in the future, rather than focusing on problems to change. For more information on Appreciative Inquiry, see The Power of Appreciative Inquiry by Diana Whitney and Amanda Trosten-Bloom and the following Ida resources: https://idainstitute.com/tools/change_guide/resources/ 2.12.2018

THE APPRECIATIVE APPROACH Change happens continuously Focuses on strengths Creates change through shared understanding and collaboration Helps develop personal motivation Creates change through conversation Takes a bottom-up approach involving all participants in the change process Change happens continuously Focuses on strengths Creates change through shared understanding and collaboration Helps develop personal motivation Creates change through conversation Takes a bottom-up approach involving all participants in the change process Change consists of separate challenges to be overcome Focuses on weaknesses Creates change through a linear process: identify the problem, find a solution, implement the change Human aspects are often neglected Takes a top-down approach Change consists of separate challenges to be overcome Focuses on weaknesses Creates change through a linear process: identify the problem, find a solution, implement the change Human aspects are often neglected Takes a top-down approach This way of creating change is fundamentally different from more traditional approaches to change and helps create ownership of the process and ensures more sustainable results. The appreciative approach recognizes that change happens continuously, over time. It focuses on strengths rather than weaknesses. It asks the questions like: “What are we doing right?” rather than “What are we doing wrong?” It is collaborative, and accepts that systemic change can only come from understanding all perspectives. Thus it focuses on shared understanding and collaboration, rather than on a more typical unilateral approach. In this regard, when people have a chance to contribute, their motivation improves. The bottom-up approach also helps motivation and takes into consideration all perspectives. It is inclusionary as opposed to the Top Down approach, in which a few make decisions for the majority, without taking perspectives into account. It is exclusionary. 2.12.2018

CHANGE GUIDE OVERVIEW Session 1: Determine what your tele-audiology goals are Session 2: Identify factors that can help or hinder Session 3: Identify which stages of the client journey you want to focus on, and create concrete action steps Session 4: Conduct short-term evaluations of your change process Session 5: Evaluate your long-term progress We are going to use the Ida Change Guide and the Investigation Guide you developed in part 5 to implement tele-audiology services. Session 1:  Determine what Goals you have for your Tele-Audiology service Session 2: Identify factors that can help or hinder you from integrating a Tele-Audiology service. Session 3: Identify which stages of the client journey that you want to enhance with Tele-Audiology and create concrete action steps that will help achieve your goals Session 4: Conduct short-evaluations of your change process to keep the enthusiasm going, on a weekly or daily basis Session 5:  Evaluate your long-term process *See the Change Guide in its original form: https://idainstitute.com/tools/change_guide/ 2.12.2018

STEP 1: WHAT ARE MY GOALS? Answer the question: What stages of the Ida circle would I be able to make more person-centered by providing tele-audiology services? Draw a mind map of your current services along the patient journey and where your goals of a tele-audiology service would fit in to ensure the patient is at the center of the care. Imagine your tele-audiology service. What would your practice be like if you incorporated this service most of the time? STEP 1: What are my goals for my tele-audiology service? The process begins by considering how tele-audiology would enhance person centered care and your current audiology services, and imagining what your practice would be like if you included these services as part of your everyday business. 1. First answer the question: At each stage of the Ida circle what could I do to make my services more person-centered by providing tele-audiology services? 2. Draw a mind map of your current services along the patient journey and where your goals of a tele-audiology service would fit in to ensure the patient is at the center of the care. 3. Imagine your tele-audiology service. What would your practice be like if you incorporated this service most of the time? You might consider: “Do I want to help with knowledge building and self awareness before they come in to see me in order to help with readiness for the appointment? Or do I want to incorporate that as part of the consultation itself? Do I want to make tele-audiology available for the hearing aid fitting or fine tuning part of the appointment? What about aftercare and consultation/consolidation, etc.? The goals you developed in Part 5 of this course may change slightly once you have completed this exercise. 2.12.2018

STEP 2: HELPS & HINDRANCES What factors may help or hinder my Tele-Audiology service? It’s helpful that I have located a grant… Write down the factors: Helps: Hindrances: …. …. In this step, use your Investigation Guide developed in part 5 and reflect on each of the category factors that may help or hinder with implementing a tele-audiology service in your clinic. Create a list with two columns— “helps” and “hindrances.” List what things will help you implement tele-audiology, and then list what will hinder. For example, your staff may be reluctant to see patients via video link, which would be a hindrance, whereas your patients’ desire to have appointments closer to their home may be a help. YOU CHANGE GUIDE 2.12.2018

STEP 2: TURN HINDRANCES INTO HELPS How can the hindrances be overcome? Example Hindrance: Current staff aren’t confident using web-conferencing. Help: Set up training or mentoring scheme with colleagues to practice web conferencing. In this step you should think about how each of the hindrances can be overcome. Consider what initiatives, skills, and resources can help overcome the hindrances. List these together with the other “helps.” CHANGE GUIDE 2.12.2018

STEP 3: RATE YOUR CHANGE Locate the Spiderweb tool. Add your 5-8 focus points to the Spiderweb. The next step is to consider your focus points for creating change. Select five to eight focus points from the list of helps that you find the most important and work on these selected points. In this step you will use the Spiderweb Tool. The Spiderweb is an online, interactive tool that can be used individually or as a group. Locate it on Ida’s website: https://idainstitute.com/spiderweb First, you enter the 5-8 top focus points (helps) into the Spiderweb. Then use the following question in your Spiderweb exercise: On a scale from 1-5, how easy would this focus point be to create change on? You may need to do some research, or ask clients and/or your staff and colleagues to get an accurate feel for each of these answers. Rate each focus point on a scale from 1-5, based on how easy it would be to create change. 1 = not easy at all – 5 = very easy CHANGE GUIDE 2.12.2018

THE SPIDERWEB In this example you can see that the current website is the easiest thing to implement, and government regulations are the most challenging. 2.12.2018

STEP 3: PRIORITIZE YOUR CHANGE Reflect on your Spiderweb. Write a list of action steps you can begin to take right away. After filling in the Spiderweb survey, you can reflect on the result and think about what is most important for you to focus on to create the change you wish to see. You may also consider if some things are more easy or quick to change than others – are there any low-hanging fruits? Then write a list of concrete action steps you can begin to take right away. For example, if your current website can be adapted to be more person-centered and easily adapted to provide additional resources for different stages of the Circle, then that would be the low hanging fruit/ a quick win. If government regulations are limiting, then explore what you can do and whether there are exemptions etc. CHANGE GUIDE 2.12.2018

STEP 3: ENVISION YOUR CHANGE Think about what your daily practice will be like once you have implemented your action steps. How does that compare with your mind map? At the end, think about what your daily practice will be like once you have implemented the action steps. How does that compare to the mind map you created? The purpose of this exercise is to keep your focus on the positive vision of how things will improve with these actions. CHANGE GUIDE 2.12.2018

STEP 4: EVALUATE YOUR CHANGE To keep up the momentum and enthusiasm for your change process, and to make any necessary adjustments along the way, you should conduct short evaluation sessions at regular intervals. The Ida Change Guide contains two different tools that can help you do this: https://idainstitute.com/tools/change_guide/get_started/personal_change/#page3 https://idainstitute.com/tools/change_guide/get_started/personal_change/#page4 The first one is the Triangle Tool which will help you assess your short-term progress as you seek to implement your tele-audiology service into your daily practice. You may want to use the Triangle tool every other week or so to monitor day-to-day progress. The Triangle tool helps you reflect on how well it is going, and what helps or hinders you as you implement tele-audiology. This will help you decide on concrete actions to take between assessments, to help you improve your service in incremental steps. The other tool is the online Spiderweb tool that was used earlier to prioritize the changes you wish to make. We recommend that you re-do the Spiderweb exercise with the same focus points every six months or so to assess how your overall change process is progressing. This can be seen through a visual comparison of the two sets of results as shown on the slide. Short-term change evaluation: Triangle Tool Long-term change evaluation: Spiderweb tool 2.12.2018

ENJOY THE CHANGE Enjoy your new tele-audiology services and share your stories with others to show how effective this style of service can be in providing person-centered care. Tele-audiology can be a great experience for everyone and an opportunity to reach further than you ever have before. 2.12.2018