quality standards for adult hearing rehabilitation services
TRANSCRIPT
© Crown copyright 2009
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RR Donnelley B60164 04/09
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QualityStandards for Adult HearingRehabilitation Services
Quality Standards for Adult Hearing Rehabilitation Services
Audiology Services Advisory GroupOctober 2008
© Crown copyright 2009
ISBN 978-0-7559-7301-9
Scottish GovernmentSt Andrew’s HouseEdinburghEH1 3DG
Produced for the Scottish Government by RR Donnelley B60164
Published by the Scottish Government, April 2009
Executive Summary
In January 2003, the Public Health Institute of Scotland (PHIS) published a Needs Assessment Report on NHS Audiology Services in Scotland. This report identified a number of areas in which Audiology services were failing to meet the standards expected by service users and other stakeholders. The modernisation of hearing aid services tried to address these areas as well as modernise the patient journey. Scotland began the modernisation of its audiology services in 2003 by investing in new Digital Signal Processing (DSP) hearing aid technology, new infrastructure, information systems and training based around the patient care pathway. However, whilst there was clarity around the patient pathway there was no clarity around appropriate quality standards by which the services could be audited or on which services could base a service improvement plan. One of the recommendations of the PHIS Report was that “NHS QIS would produce an agreed set of standards for audiology services and conduct an assessment of the service’s ability to meet these standards, taking into account established documents from voluntary bodies and professional organisations.” In its response to this recommendation, NHS QIS indicated that it would not be possible to fulfil this within a timescale that all interested parties could agree to.
It was then suggested that the work be undertaken by a sub-group of the Scottish Government’s Audiology Services Advisory Group following the NHS QIS standards development methodology and that NHS QIS would consequently quality assure the development process.
This document has subsequently been developed by a multi-disciplinary project group comprising representatives from the Audiology profession, the voluntary sector, higher education, UK health departments, senior NHS management and others.
An audit of that modernisation process has been carried out by Davis et al 2007, which used a set of draft standards, with support from the late Professor Stuart Gatehouse, against which services could be viewed for this purpose. In taking that task forward the audit group developed a Quality Rating Tool that attempted to directly assess services against those draft standards to establish whether the services
• are responsive to their needs • empower patients to be good partners in meeting those needs • make the best use of staff skills and resources.
The timescale of the audit meant that it had to use draft standards which have been updated in the light of their use, together with the quality rating tool. Comments from stakeholders have been elicited about the standards, rationale and criteria for the adult hearing services quality standards, together with the quality rating tool.
Contents
1. Quality Standards for Adult Hearing Rehabilitation Services 2. Adult Hearing Rehabilitation Services 3. Hearing Aids, Hearing Aid Styles and the Rehabilitative Context for
Hearing Aids 4. Development of the Quality Standards 5. The Quality Standards 6. A Quality Rating Tool for Audiology Services 7. Appendices
1. Quality Standards for Adult Hearing Rehabilitation Services 1.1 Context
In January 2003, the Public Health Institute of Scotland published a Needs Assessment Report on NHS Audiology Services in Scotland. This report identified a number of areas in which Audiology services were failing to meet the standards expected by service users and other stakeholders. These included:
• Inadequate facilities at base hospital, peripheral clinic and community sites. • Shortages in qualified staff and staff skills leading to compromised service access and quality. • Financial pressures compromising service quality, with an undue emphasis on activity at the expense of outcome. • Poor or non-functioning inter-agency links. • Large variations in services across NHS Boards. • Inferior service quality and outcome in comparison to elsewhere in the UK and overseas. • Recommendations and guidance from the NHS (particularly the Good Practice Guidance on Adult Hearing Aid Fittings), professional groups and voluntary organisations regarding service standards have not been implemented, despite the demonstration of their efficacy and effectiveness in other contexts. • Good working practices are often not in place. Developments in Audiology services elsewhere in the UK are largely absent in Scotland.
As a result of these findings a number of recommendations were made by the Audiology Needs Assessment Group. Among these was the recommendation that “NHS Quality Improvement Scotland (QIS) should produce an agreed set of standards for audiology services, and conduct an assessment of the service’s ability to meet these standards, taking into account established documents from voluntary bodies and professional organisations”. In its response to this recommendation, NHS QIS indicated that it would not be possible to undertake the work within a timescale that was acceptable to the Group. It was then suggested that the work be undertaken by a sub-group of the Scottish Government’s Audiology Services Advisory Group following the NHS QIS standards development methodology and that NHS QIS would subsequently quality assure the development process. This document has been developed by a multi-disciplinary project group comprising representatives from the Audiology profession, the voluntary sector, higher education, UK health departments, senior NHS management and the private sector. In developing these standards the project group has adhered to the basic principles and guidelines laid out by NHS Quality Improvement Scotland. As a result it is expected that both the process of developing these standards and these standards will be quality assured by NHS QIS.
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1.2 Background on the Development of the Standards
The development of these standards has been carried out by a multi-disciplinary group under the guidance of a sub-group of the Scottish Audiology Services Advisory Group (ASAG) and following the principles and processes of NHS Quality Improvement Scotland. The Audiology Services Advisory Group’s remit is “to monitor the development of NHS audiology services in Scotland and to provide appropriate advice to NHS Boards, the Health Department and other relevant bodies that will facilitate effective and efficient development.” For more information on QIS please see the following website www.nhshealthquality.org
1.2.1 Basic Principles
Standards developed using the NHS QIS quality assurance process are required to be clear and measurable, based on appropriate evidence, and written to take into account other recognised standards and clinical guidelines. The standards are:
• written in simple language and available in a variety of formats. • focused on clinical issues and include non-clinical factors that impact on the quality of care. • developed by healthcare professionals and members of the public, and consulted on widely. • regularly reviewed and revised to make sure they remain relevant and up to date. • achievable but stretching.
1.2.2 Process
The way in which standards are developed is a key element of the quality assurance process. Project groups working on standards development are expected to: • adopt an open and inclusive process involving members of the public, voluntary organisations and healthcare professionals. • work within NHS QIS policies and procedures. • test the measurability of draft standards by undertaking pilot reviews.
1.2.3 Format of Standards and Definition of Terminology
All standards quality assured using the NHS QIS process follow a similar format: • Each standard has a title, which summarises the area on which that
standard focuses. • This is followed by the standard statement, which explains what level of
performance needs to be achieved. • The rationale section provides the reasons why the standard is
considered to be important.
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• The standard statement is expanded in the section headed criteria, which states exactly what must be achieved for the standard to be reached and how the service will achieve this, in that it is expected that they will be met wherever a service is provided. The criteria are numbered for the sole reason of making the document easier to work with, particularly for the assessment process. The number of the criteria is not a reflection of priority.
1.2.4 Assessment of Performance Against the Standards
Work to develop and define the assessment of performance against the Standards is in progress, based on the attached Quality Rating Tool. The Audiology Services Advisory Group is taking a lead in this work.
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2. Adult Hearing Rehabilitation Services 2.1 Introduction to Adult Hearing Rehabilitation Services
Hearing problems arise from defects in either the middle or the inner ear. The former lead to conductive hearing losses and the latter to sensorineural hearing losses. Almost one in five of Scotland’s adult population suffers from a measurable deficit in hearing which is likely to lead to difficulties in understanding speech, particularly in noisy backgrounds. The population prevalence of hearing impairment increases exponentially with increasing age. Changes in population demographics will, therefore, have important implications for future services. Additionally, population prevalence halves with every 10dB increase in hearing level. This leads to large numbers of people in the population with moderate to severe hearing problems and smaller numbers with severe and profound hearing losses, though the latter do of course have a much more severe impact. While around one in six adults could benefit from current NHS hearing services, only one third of candidates attend for management, leading to substantial un-met need in the population. Audiology departments supply services to manage disability associated with hearing impairment. This includes, in addition to hearing aid provision, support and counseling usually delivered within a team of professionals working in association with other agencies/voluntary sector organisations e.g. in some local teams this may involve care from Hearing Therapists and Speech and Language Therapists. It should also include onward referral for those with significant residual disability to appropriate services such as agencies providing assistive listening devices, courses on non-verbal communication, cochlear implants and bone anchored hearing aids. The services which should be offered by audiology departments with suspected hearing impairment include:
• Appropriate hearing testing, with screening for other causes of hearing
impairment and onward referral as appropriate; • Evaluation of the audiological needs of the service user; • Agreement with the service user on the best aiding device(s) for their
problems, and discussion about the likely effect of such devices on their ability to hear;
• Fitting of aids to provide sufficient and appropriate amplification; • Training service users in the use and maintenance of their aid(s), and
provision of rehabilitative support to ensure that they can use them effectively;
• Providing information on other sources of help, support, equipment and assistive devices, or referral to organisations which can provide these as appropriate;
• Ongoing repair and maintenance of hearing aids (including provision of batteries and replacement tubing).
The scope of this document does not include specialist hearing rehabilitation services but does cover the services provided for the majority of clinical activity. Examples of care pathways are shown in the Do Once and Share care pathways (www.mrchear.man.ac.uk) and those shown in good practice documents such as Transforming Adult Hearing Services (Department of Health, England. Good practice in transforming adult hearing services for patients with hearing difficulty. June 2007).
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3. Hearing Aids, Hearing Aid Styles and the Rehabilitative Context for Hearing Aids
3.1 Hearing Aids
Middle ear problems leading to conductive hearing loss are potentially managed by surgery. At present there are no surgical or medical interventions for sensorineural hearing loss, and the only effective management available is the provision of amplification via hearing aids. Some conductive hearing losses are not suitable for surgery and also require management via hearing aids. Hearing aids require an appropriate rehabilitative context to be effective. Defects in the middle ear lead to a conductive hearing loss which is a simple attenuation (quietening) of sound which often varies only relatively little as a function of frequency. However, the vast majority of hearing losses (particularly in the elderly) are sensorineural in origin and result from damage to the hair cells in the inner ear which convert sound into nerve impulses. Sensorineural hearing losses are usually more severe at high frequencies than at low frequencies. Vowels in speech have predominantly low frequency energy, while consonants are predominantly high frequencies. Thus speech can be audible though not intelligible. In addition to simple attenuation of sounds, sensorineural hearing loss results in a number of other distortions. This results in listeners with sensorineural hearing loss being much more susceptible to the effects of background noise than their normally-hearing counterparts. Simple amplification (making sounds louder) will not necessarily remove all of the difficulties that such a listener experiences. Furthermore, while people with sensorineural hearing loss experience impaired auditory sensitivity (inability to hear quiet sounds), more intense sounds are perceived as just as loud by such individuals as they are by people with normal hearing. In particular thresholds of uncomfortable listening are not elevated in the same way as hearing thresholds. Thus listeners have a reduced range of hearing (dynamic range) between the threshold of hearing and the threshold of uncomfortable listening. A hearing aid is required to take a signal that a listener wishes to hear and to amplify it so that its components are above threshold but not uncomfortably loud. This means that higher frequency sounds have to be amplified by more than lower frequency sounds. Hence a hearing aid has to have the capability to shape the way it amplifies sounds according to the profile of a listener’s hearing loss. Hearing aids which have greater degrees of flexibility in this regard will be more effective. Given that listeners have reduced dynamic ranges, hearing aids are required to amplify low intensity sounds by more than they will be required to amplify high level sounds. This differential amplification as a function of level will vary with frequency, because the dynamic range between thresholds of hearing and threshold of uncomfortable listening varies between low and high frequencies. This form of hearing aid processing is termed “amplitude compression”, because it attempts to squeeze, or compress, the wide range of input signals into the reduced range of hearing. Because listeners with sensorineural hearing loss experience more difficulty in noise than normal hearing listeners, hearing aids attempt to amplify the
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signal by more than any noise. One option is a directional microphone. The hearing aid is more sensitive when it is pointing towards a sound source and is less sensitive to sound sources which are off to the side or behind the listener. This is effective given that people usually orientate themselves so that they are facing a sound source that they want to hear. Thus a microphone with a directional pattern can help to improve the relative levels of the signal and the noise. Any amplifier is prone to whistling or feedback and hearing aids are no exception. If the sound delivered to a hearing impaired listener’s ear is able to leak back to the microphone such feedback can occur, even in the presence of well fitting ear-moulds. Hearing aids can attempt to identify when feedback is likely to occur and to either try and cancel it or to turn down the gain in a particular frequency region so that feedback is avoided. The next section gives a short and simplified list of the sorts of processing and fitting features that are potentially available in hearing aids.
3.2 Hearing Aid Styles and Implementation
Hearing aids can be classified by the physical type and size, as well as the ways in which the processing features are achieved. The majority of hearing aids used in the NHS in Scotland are behind-the-ear (BTE), which is sometimes called postaural. More miniature devices (in-the-ear (ITE) or completely-in-the-canal (CIC)) offer greater cosmetic acceptability to listeners, though sometimes at the expense of their ability to provide the processing that is required. These are often chosen when the option is available. Until the 1990’s all hearing aids achieved their processing by analogue electronics (i.e. amplifiers and filters were employed in exactly the same way, though on a miniaturised scale, as the technology in domestic hi-fi systems). When a control required to be adjusted, this was achieved by a small screwdriver-driven potentiometer, similar to the base or treble control on a domestic music system. These are analogue hearing aids. One development was the ability to control these analogue hearing aids using digital computer systems, leading to digitally programmable hearing aids. In these hearing aids the underlying processing was still achieved by analogue technology, but was now controlled from a computer, removing the need for a series of miniaturised controls on the hearing aid. More recently has been the development of fully digital devices where, in a similar manner to developments in music systems, the electrical signal is represented in digital format and the mathematical and signal processing is achieved using this form of technology. Potential advantages of digital processing are increased ability to shape the frequency response to match a hearing loss, greater flexibility in compression characteristics, and greater capabilities to manage feedback. Hitherto digital hearing aids have only been available at the “top end of the market”, and have been comparable in price to the most expensive analogue devices. However, as manufacturers devote more and more of their research, development and manufacturing capability to digital implementations, the relative cost penalties of digital versus analogue devices have inevitably narrowed and nearly all new hearing aid models brought to market are now digital.
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3.3 The Rehabilitative Context for Hearing Aid Fittings
Digital hearing aids can be programmed so that they are tailored to match the acoustical characteristics of an appropriate target derived from the listener’s hearing loss; the fitting can also be verified using real-ear measures to ensure that a hearing aid is indeed delivering an appropriate acoustical signal. The patient’s listening needs can also be considered whilst programming the aid, particularly in setting up a number of different programmes for use in different situations. There is a need for appropriate patient contact time both in fitting and follow-up to ensure an understanding of the mechanical competence with the hearing aid system (which, if not adequately performed, will undermine hearing aid use and acceptance). Fine tuning of the hearing aid can also be important, especially if based on comments after the patient has tried the aid for several weeks in different listening situations.
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4. Development of the Quality Standards
In July 2006, a project working group was established with a remit to develop a set of national standards to accompany a self-assessment framework for hearing aid services in adults. The group, chaired by Martin Evans, comprises a variety of healthcare professionals involved in the delivery of audiology services, patient representatives and representatives from the voluntary sector, higher education, the UK health departments, senior NHS management and the private sector. The group’s full membership can be found in Appendix 1. The group worked in a number of facilitated sessions to identify key critical areas for clinical standards that were unique to audiology (other areas such as workforce development, efficiency, innovation and patient experience were outside the scope as they are covered by more generic NHS standards). The group identified six standards that followed the service user journey and three areas of infrastructure that were unique to audiology services. These were • Referral pathways • Information Provision and Communication with Individual Patients • Assessment • Developing an individual management plan • Delivering an individual management plan • Outcome • Professional competence • Multi-Agency Working • Service Effectiveness and Improvement The approach taken to develop the standards described in this document involved considering a broad range of service quality issues that share the common feature of ultimately impacting on health outcomes for service users. In an environment where the allocation of health service resources may be driven by access time targets it is particularly important to encourage recognition of other worthy (and ideally measurable) service quality issues. These standards have, therefore, been developed and constructed bearing in mind the need for an associated questionnaire-based tool to assess performance of services against the standards. The approach taken in the more detailed development of the standards was to follow the service user pathway to describe the key service quality themes. Standards 1-6 describe the service user journey and care pathway, whilst 7-9 relate to professional delivery and communication mechanisms that underpin the other standards. Whist Audiology services have benefited from significant technological advances in recent years, achieving beneficial outcomes for service users is also heavily reliant on non-technological, holistic and customized approaches to intervention that are all reflected in the standards. In particular, the development of care tailored to the best needs of the individual is reflected by the adoption of the Individual Management Plan (IMP) as a prominent feature (See Appendix 4).
The group agreed that, following the production of draft standards, there should be a full consultation with service users and their carers/families, referrers and professionals delivering hearing aid services. The information collected during consultation was used to inform the content of the final standards.
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4.1 Context
These standards are designed to improve service quality issues in clinical areas unique to Audiology within the NHS: elements of service quality such as cleanliness of facilities or workforce development are outside of the scope of this work as they are expected to be addressed by local healthcare governance mechanisms and/or more generic NHS standards. Although the standards apply to NHS audiology, the hope is that their implementation will encourage and further develop collaborative working, both with fellow NHS professionals and external agencies.
In addition, awareness of and compliance with statutory requirements, such as the Disability Discrimination Act 2005, is assumed, as is awareness and understanding of consent requirements.
It would be impossible to exhaustively list the many and varied service user groups who access adult hearing rehabilitation services, therefore, it is intended that these standards apply to all service users equally.
4.2 Evidence Base
During the development of the draft quality standards for adult hearing aid services the project group considered a wide range of documents from a variety of sources and these are fully referenced in Appendix 2.
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5. The Quality Standards
Standard 1. Accessing the Service STANDARD STATEMENT
RATIONALE
CRITERIA
Direct referral to audiology services is a more effective and efficient way of meeting patients’ clinical needs where there is no robust evidence of otological pathology. Allocation to the wrong referral pathways (or absence of alternative pathways) means additional inconvenience to the patient and inefficient use of time and resources. Correct information to an Audiology service results in more effective use of available resources.
1a.1. All adult patients with hearing problems and their significant other(s) have access to Audiology via Direct Referral where this is clinically indicated. 1a.2.The information about referrals and the criteria which patients need to meet to be referred is clear so that they are fully understood by referrers. 1a.3.Information about referral criteria and pathways, including any changes, are widely disseminated to all potential referrers on a regular basis.
1a. All patients with hearing problems and their significant other(s), who require referral (for first or subsequent appointments) to audiology services are able to: (i) access the correct audiology service to meet their needs, ii) conveniently access the services they require, (iii) see Audiology or specialist medical professionals as first points of contact, as determined by agreed local clinical criteria, iv) Gain access to audiology service as quickly as any other specialist medical service.
Public Health principles promote delivery of services close to patients for their ultimate healthcare benefit. To provide an equality based service audiology centres must allow for all different types of patients to gain physical access to the service
1a.4 .The proximity of patients to centres delivering audiology services is similar to other adult services in the Board/district. 1a.5.The audiology centres provide ease of physical access to all areas where audiology is delivered.
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Simple equity implies that no patient should be penalised by having to wait longer for a direct referral to Audiology than they would have experienced by referral for a specialist medical service. Simple equity implies that patients who have previously accessed an audiology service must be able to access it again, should the need arise, without prejudice.
1a.6. Waiting times for direct referrals to Audiology are the same as waiting times for patients who are referred to other specialist medical services, such as ENT or Audiovestibular Medicine. 1a.7.The maximum waiting time from referral to treatment1of hearing should meet the national target regardless of the referral route and regardless of whether a patient is re-accessing the service or accessing it for the first time.2
STANDARD STATEMENT
RATIONALE
CRITERIA
1b. Service demand and referral data are accurately monitored, reviewed and reported against available indicators and used to guide service planning.
The number of incorrect referrals to the specialist medical route informs the effectiveness/clarity of the criteria and compliance of referrers to those criteria. Improvements can then be made to ensure that patients are not incorrectly referred to certain services.
1b.1. The number of inappropriate direct referrals is monitored and action plans implemented to address any non-compliance with referral criteria. 1b.2. The number of inappropriate referrals to specialist medical services is also monitored. Action plans are then implemented to address any non-compliance with the referral criteria for specialist medical services.
1 Treatment is defined as fitting of hearing aid. Fitting following re-assessment is assumed. 2 At time of writing, the national target in Scotland is 18 weeks from referral to treatment and work is ongoing on a document called principles and definitions for the 18 weeks referral target, which will help clarify how audiology services help to achieve the 18 week patient target when patients are referred on to other healthcare services.
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Effective allocation of health resources is reliant upon accurate information on the balance between demand for services and available resources. It is important that waiting times for all stages of the patient pathway from referral through to treatment (e.g. hearing aid fitting3) for new and existing patients are collected and monitored in an effective manner. The use of IT systems to compute information such as demographic data and waiting times will inform allocation of services and help prevent an overload of patients accessing the same service and resources being strained.
1b.3. Waiting times are monitored within the department based upon robust data collection.
Effective allocation of resources relies upon information on actual demand and potential/projected demand for specific services.
1b.4. The following data are collected, reviewed and used in annual service review: • the uptake of NHS
hearing aids in the local population compared with the predictive need for services,
• the number and type of referrals to Audiology services,
• demographics of locally served populations, including factors such as ethnic diversity, social deprivation and age. 4
3 Whether direct or via specialist medical service (eg ENT) referral routes. 4 This is to establish a benchmark and to gauge the service trends over time.
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STANDARD STATEMENT
RATIONALE
CRITERIA
To ensure effective initial and ongoing care; agreed multidisciplinary local ear care / wax management procedures should be in place.
1c.1. All patients are advised of and have access to ear care / wax management services that use protocols agreed between Primary Care, Audiology and ENT services and patients.
1c. There is effective ongoing life time maintenance of hearing aid use - including supportive care.
Prompt access for existing hearing aid patients to a basic repair service and replacement batteries (and onward referral as necessary) is required to help maintain long term use and benefit from hearing aid use. Uptake of such services will benefit from promotion of the service to patients.
1c.2. All hearing aid repairs are carried out within 2 days of the repair service receiving the hearing aid. 1c.3. Where Audiology services are delivered away from the main Audiology base; there is at least 1 clinic per month for repair services. 1c.4. Audiology departments will fulfil requests for replacement batteries within 2 days of the request being received. 1c.5. Patients are actively offered information about repair/replacement battery services at each appointment. This will be provided in writing and verbally.
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Standard 2. Information Provision and Communication with Individual Patients STANDARD STATEMENT
RATIONALE
CRITERIA
2a. Timely and relevant information is provided to meet the needs of hearing impaired patients and their significant other(s), in formats that accommodate their communicative abilities.
Good communication before, during and after intervention benefits patients – through reduction in anxieties/concerns and encouraging appropriate uptake of further care.
2a.1. Written information about the service, assessment procedures, types of assessment, possible interventions and clinicians involved is provided by the Audiology service for all new and existing patients and their significant other(s) prior to attending the appointment. This will include a request to contact the department in advance of an appointment if an interpreter is required. 2a.2. Consent is gained from the patient for assessment of their hearing and their significant other(s) being present. 2a.3. Straight after assessment, results are recorded, explained verbally and given to patients and/or their significant other(s) 2a.4. Information is provided, by audiology, regarding services offered by other agencies (including voluntary sector organisations).
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Written information that is clear, up to date and in a format that is accessible to the individual facilitates understanding of the service
2a.5. All written information provided to patients is developed in conjunction with service user groups, has the Crystal Mark plain English approval (or similar) and is reviewed annually. 2a.6. A written individual management plan is provided and updated at subsequent visits (explained in further detail in appendix 4).
To avoid discrimination, services should meet the specific communication and information needs of hearing impaired patients and their significant other(s) accessing the service.
2a.7. All frontline staff with direct patient contact5 receive deaf-awareness and communication training as part of their induction, which is then updated every 3 years. This training is approved by a relevant third party such as a voluntary sector organization. The training will include deaf-blind awareness and also underline key areas of communication.6
Technology should be used to enable audiology staff to communicate effectively with the patient group and to ensure that the information is given in a manner that the patient understands.
2a.8. Prior to their appointment, up-to-date technology is used to support communication between patients and the Audiology service (e.g. email, text phones, sms messaging, department websites). All staff responsible for using the technology are trained on how to use it. The application of such technology reflects the advice of representatives of local user groups.
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2a.9. At clinics, up-to-date technology is used to support communication with patients (e.g. message boards and loop systems in reception areas and waiting rooms). All staff responsible for using the technology are trained on how to use and carry out maintenance checks on it. The application of such technology reflects the advice of representatives of local user groups.
Well lit rooms help aid the ability of hearing impaired patients to lip read and improve communication generally.
2a.10. All areas used for staff and patient communication are well lit
The involvement of significant others (e.g. spouse) in the rehabilitative process can provide improved outcomes.
2a.11. Significant others are routinely encouraged, through formal invitation, to participate in clinical contacts (where consent has been provided). They are also encouraged to engage with the service through patient forums to facilitate planning, satisfaction auditing and information development etc.
5 Including call centre staff if applicable 6 For example, the importance of staff introducing themselves, greeting the patient and showing empathy towards the patient.
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Standard 3. Assessment STANDARD STATEMENT
RATIONALE
CRITERIA
3a. All patients receive an individually-tailored audiological assessment which is carried out to recognised national standards, where available, and includes: • measurement of
hearing impairment, • assessment of activity
limitations related to hearing impairment,
• evaluation of social and environmental communication and listening needs and an evaluation of attitudes, expectation and behaviours as a result of hearing impairment,
• a relevant medical history.
The need for, and content of, any Individual Management Plan requires knowledge of a patient’s hearing status. The quality of assessment is more likely to be assured if undertaken in accordance with nationally recommended procedures Measures are compromised if not gathered using equipment calibrated to national and international standards and if they are not used in a quiet test environment.
3a.1. The following are established for every patient: • hearing thresholds by
air and bone conduction,
• thresholds of uncomfortable loudness levels7,
• additional/further diagnostic procedures as required.
• a relevant medical history.
3a.2. There are written BAA/BSA recommended procedures or protocols available to all staff in the department and these include air and bone conduction testing, thresholds of uncomfortable loudness levels, and tympanometry. 3a.3. Equipment is calibrated annually and documented to international standards, and daily checks are carried out and documented to international standards.
7 Unless clinically contraindicated
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Hearing status is a necessary prerequisite, but is not sufficient information alone to configure an Individual Management Plan (IMP) • The goal of the service is
to alleviate listeners’ activity limitations rather than manage hearing losses.
• Services should select a validated self-report questionnaire to assess activity limitations related to hearing impairment.
• Situation-specific structured questionnaires have been shown to offer significant advantages in clinical settings over more general disability and handicap inventories (e.g. GHABP).
3a.4. Hearing tests, with the exception of domiciliary visits, are always carried out in acoustical conditions conforming to national and international standards8. 3a.5. A self-report questionnaire is a routine part of the assessment protocols9 and is used in conjunction with all information gathered relating to social circumstances, psychological impacts, communication and listening needs and expectations. 3a.6. Information is recorded in a standardised way and is used to develop the content of the IMP. Included in this information should be details of why an assessment or intervention could not be carried out.
8 To enable the accurate testing of normal air and bone conduction hearing threshold levels down to 0 dB HL, ambient sound pressure levels should not exceed any of the levels shown in Tables 2 and 4 respectively from BS EN ISO 8253-1. However, it is reasonable to relax this requirement for BC testing so as to provide for testing down to 10 dB HL by adding 10 dB to the figures in Table 4. 9 Questionnaires will always be used unless recorded as clinically contraindicated.
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Standard 4. Developing an Individual Management Plan STANDARD STATEMENT
RATIONALE
CRITERIA
An IMP is most effective if it takes into account a range of factors in addition to the type and level of hearing loss. An effective IMP also relies on consultation between the Audiology professional, the hearing impaired person and his or her significant other(s). Only when all parties are committed to the joint goals is an optimal outcome received.
4a.1. The IMP is contained within the clinical record. It contains details of: • hearing status, • expectations, • social circumstance, • options for
rehabilitation (including hearing instrument management),
• referral to other agencies and
• specific goals associated with assessment information.
4a.2. The IMP is agreed with the patient and significant other(s) at each appointment and a copy is made available for them.
4a. An Individual Management Plan (IMP)10 is: -
• developed for each patient, initially based on information gathered at the assessment phase,
• determined in conjunction with the patient and/or their significant other(s),
• updated on an ongoing basis and
• accessible to the clinical team.
To be successful, IMPs need to be flexible. Flexibility within the structure of the IMP is beneficial because the content and the goals of the IMP may change over time, reflecting the positive outcomes of interventions.
4a.3. The specific goals of the IMP are recorded in the clinical record. The plan includes details of:
• the decision-making process,
• the implementation plan and
• proposed timescales
10 Examples of an IMP can be found in appendix 5.
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11 For the purposes of this tool, the clinical record is defined as including NOAH data and descriptive text.
An effective IMP will detail specific actions associated with agreed goals that take into account a listener’s social, communication and listening needs, in addition to their hearing impairment and related activity limitations, e.g. living alone vs family setting vs sheltered accommodation. The IMP is flexible so that different goals can be set if the patient’s circumstances/environment changes.
4a.4. Information is recorded in the patient’s clinical record11, which is updated over the period of the journey through the IMP. This consists of information about the individual’s hearing impairments, expectations (goals), psychological impacts, social, communication and listening needs.
4a.5. Recorded updates of patient IMP occur at each appointment to reflect changing patient goals.
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Standard 5. Implementing an Individual Management Plan STANDARD STATEMENT
RATIONALE
CRITERIA
In order for agreed interventions to be effective, referral to another agency/ service for interventions should be prompt so as to be based upon an up-to-date appraisal of need.
5a.1. Where referral to an external agency/service is indicated, referral is made from Audiology within 7 days of appointment in at least 95% of cases.
5a. The Individual Management Plan is implemented over a series of coordinated appointments with the opportunity for revision of outcome goals at each stage.
Planned and coordinated intervention leads to better outcomes. Such an approach requires recording of interventions and their effectiveness to guide on-going development of the IMP.
5a.2. The clinical record and IMP includes the details, justifications and effectiveness of all non-instrumental interventions implemented.12 5a.3. The clinical record and IMP includes the details, justifications and effectiveness of all instrumental (hearing aid) interventions implemented.13
12 This will include referrals to other agencies (e.g. to voluntary sector, social services, advanced rehabilitation; counseling, assertiveness, lip-reading, etc).
13 This will include earmoulds selected, basic settings/acoustical characteristics of the prescribed hearing aids/s and advanced features (such as directional microphones, noise reduction algorithms and multiple programmes).
21
STANDARD STATEMENT
RATIONALE
CRITERIA
Audiologists should be confident that the aid is working to specification before fitting it to a patient so that the aid does not cause harm.
5b.1. Prior to issue; every hearing aid has its technical performance tested to specification.14
Professional bodies and national guidelines should be followed to ensure provision meets the needs of the individual.
5b.2. Local protocols should be in operation concerning selection, fitting and verification of hearing aids. These should comply with the latest professional body and/or national guidance.15
5b. Where provision of hearing aid(s) is required the service ensures: • hearing aids fitted are
functioning correctly, • nationally agreed
procedures and protocols are followed at a local level,
• that patients are offered a hearing aid for each ear where clinically indicated and
• performance of hearing aid(s) is carefully matched to individual requirements and settings are recorded.
Laboratory based evidence suggests that many patients with bilateral hearing impairment gain more benefit from hearing aids fitted bilaterally rather than unilaterally. Emerging evidence, particularly from studies of open canal fittings, indicates more real life self-reported benefit too.
5b.3. At least 95% of patients who need and are clinically suitable for bilateral hearing aid fitting should be offered 2 hearing aids.
14 Electoacoustic performance will be tested directly on a test box or by using REM. The acoustical consequences of any activated feature of the hearing aid(s) ( e.g. directional microphones) are also verified where standard procedures exist. 15 E.g. the BAA, BSA and Scottish national guidelines.
22
16 Explained whenever IMP’s are completed and recorded in patient held records.
Evidence suggests that hearing aids are most effective when their performance is carefully matched to the requirements of the individual.
5b.4. Real Ear Measurement (REM) of hearing aid performance is to be used to verify at least 95% of hearing aid fittings16, unless clinically contraindicated for individual patients.
5b.5. Where REM is performed: the acoustical target is verified at three different input levels (50, 65 and 80 dB) in more than 75% of cases.
5b.6. Where REM is performed: measurements do not deviate from the recommended target at more than one frequency (in 95% of cases) unless clinically indicated 5b.7. The maximum power output of the hearing aid/s is checked (in 95% cases) by REM if performed, or by coupler measurement. Adjustments are made, if required, to ensure that the individual’s uncomfortable loudness level is not exceeded.
23
STANDARD STATEMENT
RATIONALE
CRITERIA
5c. Following implementation of the plan, a process of ongoing support and maintenance continues.
On-going use and benefit from hearing aid use is likely to be increased if the process of support and maintenance includes routine audiological reviews and potential for updating the IMP. Such provision is required to accommodate the changing rehabilitation needs of individuals.
5c.1. Each patient is given a follow-up appointment following hearing aid fitting within a maximum time of 12 weeks. 5c.2. A review appointment is offered to all hearing aid patients every 3 years (in at least 95% of cases). Patients are regularly advised that they can self refer for review or repairs at any time.
24
Standard 6. Outcome STANDARD STATEMENT
RATIONALE
CRITERIA
6a. The outcome and effectiveness of the Individual Management Plan are evaluated and recorded following a post-management assessment of the impact of intervention.
The management of hearing impairment, within a comprehensive management plan, involves more than a simple technical matter of hearing aid fitting. It involves the provision of a systematic approach, supported by evidence, which addresses not only the hearing impairment, but also other related activity limitations and consequent reductions in quality of life (QoL). Subjective outcome measures, in the form of disease-specific questionnaires, can assess the impact of a hearing impairment on the patient’s communication functioning and activity limitation. This can then be used in the evaluation process to measure how effective the IMP has been. IMP’s help to record multiple hearing aid outcomes; such as functional benefit, satisfaction and QOL within a single questionnaire. Measurement of outcome is required to shape further progression of IMP’s.
6a.1. Validated outcome measures e.g. the Glasgow Hearing Aid Benefit Profile (GHABP), IOI-HA and COSI are used to evaluate the outcome of intervention and further develop the IMP in at least 95% of cases (unless clinically contraindicated).
25
Measurement of outcome is required to: -
• obtain feedback (including a progressive evidence base) on the effectiveness and benefit associated with the service delivered to the patient group and
• facilitate further
development of IMP and judge progress on patient outcomes.
6a.2. Clinical records are used to facilitate further development and judge patient progress. The records contain information about the extent to which the interventions helped meet the specified goals (outcomes).
26
Standard 7. Professional Competence STANDARD STATEMENT
RATIONALE
CRITERIA
To help ensure a safe and effective service, clinical audiology staff should work within their agreed Scopes of Practice and have the skills required for their contribution towards the rehabilitation of hearing impaired patients. Health Professions Council ‘Standards of Proficiency’ for practitioners statement details requirements for registered practitioners to remain registered. These are produced for the safe and effective practice of the professions they regulate and are deemed to be the minimum standards which are necessary to protect members of the public.
7a.1. All audiologists and clinical scientists are registered, at least voluntarily, with a registration council.
7a. The Head of Service/Clinical Lead ensures that: • Each service provides,
within a governed team approach, the clinical competencies necessary to safely and effectively support the assessments and interventions undertaken,
• Where tasks are undertaken by non-registered persons (e.g. volunteers) this takes place within an established competency-based framework,
• Links with external agencies are in place to provide complementary service.
Registration bodies and some employers require demonstration of regular CPD activity. Facilities to access CPD close to the point of work and the CPD being received in association with colleagues is advantageous.
7a.2. All clinical staff have evidence of access to an appropriately maintained CPD programme that provides for active participation - normally run internal to the service (or in formal association with another organisation).
27
Peer review provides a useful approach to help ensure clinical competencies are maintained.
7a.3. Competency for all clinical procedures is verified formally by peer review observation, at least every 2 years for all clinical staff undertaking such procedures. Ongoing assessment of all clinical staff’s competency should also be carried out, informally, by local audiology centres.
To ensure safe and effective outcomes for patients it is important that there are safeguards in place governing the employment and deployment of volunteers.
7a.4. Volunteer staff supporting the audiology service should work to clearly defined quality standards17, applicable to all such staff. These include: • working to locally
agreed scopes of practice,
• in-house training using competency-based frameworks,
• recruitment compliant with national and local requirements.
17 http://www.vds.org.uk/tabid/232/Default.aspx
28
Standard 8. Multi-Agency Working STANDARD STATEMENT
RATIONALE
CRITERIA
Multi-agency collaborative working is more likely to result in services that address the needs of those hearing impaired patients who benefit from a more supportive, social environment.
8a.1. Audiology takes a lead role in setting up formal quarterly meetings with collective representatives from social work; voluntary sector organisations; local volunteer schemes and patients. The remit includes the planning, development, delivery and audit of services.
8a. Each audiology service has in place processes and structures to ensure collaborative working with the appropriate agency to meet the needs of patients through the pathway. These include: -
• social, • specialist
audiological and • other health needs.
Having awareness of and appropriate links to specialist audiological services is more likely to result in the hearing and communication needs of patients being met.
8a.2.Written protocols/processes are in place to support referral to the following services/agencies: -
• Social work, • Volunteer
services, • Voluntary
organisations, • Local NHS
mental health services,
• specialist audiological and
• other health needs, for example, speech and language therapy and falls prevention clinics.
29
Awareness of and appropriate links to other health services is more likely to result in additional health needs of hearing impaired patients being met.
8a.3. Audit of multi-professional and multi- agency working should be carried out annually and should include the take up of referral to these agencies. 8a.4. The Audiology Lead should be aware of any concerns that arise from the audit and should discuss these with all agencies involved before developing plans to mitigate areas of concern raised in the audit.
30
Standard 9. Service Effectiveness and Improvement STANDARD STATEMENT
RATIONALE
CRITERIA
9a Each service has processes in place to measure service quality.
Measurement of qualitative and quantitative data helps to inform ongoing service improvement.
9a.1. Patients and significant others are encouraged to complete surveys on, at least, an annual basis to determine satisfaction with different elements of the service received. These include: -
• accessibility, • proximity, • information
provision, • professionalism of
staff, • care and treatment
and • overall service
received. Participation rates in the survey are checked, annually, to ensure an acceptable proportion of patients have participated and a representative sample of the local population is covered (including gender and ethnicity). Sufficient analysis and interpretation of findings from satisfaction surveys are carried out annually by audiology services. The information gathered will also be used to ensure fair and equal access to services in line with Scottish Government Equality Duty requirements. Action plans are implemented, when needed, to address areas of concern arising from surveys.18
18 An example of a survey satisfaction questionnaire used by audiology services is listed in appendix 8.
31
9a.2. Annual quantitative analysis on the quality/effectiveness of the service is undertaken using GHABP.
STANDARD STATEMENT
RATIONALE
CRITERIA
9b Each service has processes in place to regularly consult with patients and stakeholders.
Audiology services that seek, consider and respond to the views of users will be more likely to meet the needs of their patients.
9b.1. The audiology service has a framework in place to ensure regular consultation with patients and stakeholders. 9b.2. Results of satisfaction surveys and service QRT scores are made available and discussed with patients on an annual basis.
32
STANDARD STATEMENT
RATIONALE
CRITERIA
9c Each service has processes in place to keep up to date with and employ key audiological innovations.
Use of up to date hearing instrument technology is integral to effective service delivery and ongoing improvement. New technologies make new models of service delivery possible.
9c.1 There is a named lead in Audiology services with responsibility for coordinating the identification, appraisal of potential benefits, local development and implementation of new technologies. 9c.2. Regular, national meetings are held by audiology services to appraise new national/international technology developments. This should include evidence from pilots/trials where the new technology has been tested. The analysis should include the potential patient benefit and the impact the technology could have on workforce and service delivery. 9c.3 When new technology is implemented, departments should be able to demonstrate tangible benefits to patients and should continually monitor newly- implemented technology.
33
Improving Quality and Outcomes in Adult Audiology Rehabilitation Services through Critical Evaluation
A Quality Rating Tool for Audiology Services19
19 This quality rating tool has been developed for adult audiology service providers and other interested parties to highlight best practice in rehabilitation service provision in order to ensure local audiology services meet population requirements and address health inequalities.
34
Foreword This quality rating tool has been developed to assist providers of adult rehabilitation services in assessing their ability to deliver adult audiology rehabilitation services to meet the needs of their local population against the Quality Standards for Adult Hearing Rehabilitation Services It is envisaged that service providers will find the format of the tool helpful in measuring their progress towards meeting and indeed exceeding the quality standards for adult rehabilitation services. Beyond use by providers for self assessment, the tool could also be employed within an external (independent) assessment process. In this application, all interested parties could regard outcomes of service quality rating as a valid and reliable indicator of the performance of providers, within the context of wider frameworks for healthcare standards set out by the UK health departments. The publication of externally verified service quality ratings could also help potential service users (and their advisers) make more informed decisions on the services that they choose to access. The Quality Rating Tool can be implemented in different ways, depending on the medium used, but on-line self assessment can be readily achieved.
35
Using the quality rating tool This quality rating tool covers the 9 Quality Standards for adult rehabilitation services in audiology. Standards are only part of the cycle within which services are delivered and reviewed/monitored. Assessment against the standards will inform participating stakeholders of areas of good practice and areas in need of development, performance management and consolidation. Assessment should be an ongoing service management function. External quality assurance programmes will reinforce local ratings and contribute additional objectivity and transparency. Each section contains several quality statements relating to different criteria within the quality standards. Providers can rate their current activity against the scale 1-5 where 1 means that no elements of the quality statement are met/implemented and 5 represents full compliance with good to best practice, with graduations in between. Examples of what a score of 1 and 5 might look like have been given so that users of the tool can make better judgements about where on the scale the service corresponds. The 5 positions are:
1. No elements of the quality statement are met (or not evident*) 2. Few elements of the quality statement are met 3. Meets around half of the elements of the quality statement 4. Almost fully meets the quality statement 5. Fully compliant with good to best practice as indicated by quality statement criteria
In judging evidence of performance (assigning an overall score for each standard) those completing assessment should consider the following elements of compliance:
• All examples of best practice (where there is more than one) • The population served, (eg, all geographical areas, and all facilities) • Reflecting practice over the preceding 12 week period as a minimum (prior to the
date of the assessment)
* NB An inability to provide evidence of performance against a standard (sufficient for external scrutiny) cannot be regarded as compliant with good practice. In addition, a separate field provides suggestions of evidence to assist users of the tool in their rating assessment and direct discussion for any external quality assurance visit. On completion of the quality rating tool, an overall position will indicate those areas that require further development and review. Understanding the score The underlying assumption used here is that, when scoring each standard, all quality statements (criteria) are equally important and therefore carry the same score weighting. Some criteria may have more aspects than others but each criteria should only be scored once. For instance when a criteria achieves 2 out of 4 different standards that the service should meet then appropriate approximate score would be 3 out of 5. A reminder of how to score the standards can be found in the rating scale at the top of each standard. For each standard, a percentage quality score can be calculated and an interpretation given of the meaning of these scores (eg needs urgent attention, needs attention, does not need attention). For instance; if a service scores a total of 32 out of 40 then the service is deemed to have 80% compliance with standard 1.
36
Stan
dard
1 –
Acc
essi
ng th
e Se
rvic
e 1a
. A
ll pa
tient
s w
ith h
earin
g pr
oble
ms
and
thei
r sig
nific
ant o
ther
(s),
who
requ
ire re
ferr
al (f
or fi
rst o
r sub
sequ
ent a
ppoi
ntm
ents
) to
audi
olog
y se
rvic
es a
re
able
to:
(i) a
cces
s th
e co
rrec
t aud
iolo
gy s
ervi
ce to
mee
t the
ir ne
eds,
(ii
) con
veni
ently
acc
ess
the
serv
ices
they
requ
ire,
(iii)
see
Aud
iolo
gy o
r spe
cial
ist m
edic
al p
rofe
ssio
nals
as
first
poi
nts
of c
onta
ct, a
s de
term
ined
by
agre
ed lo
cal c
linic
al c
riter
ia,
iv) g
ain
acce
ss to
aud
iolo
gy s
ervi
ce a
s qu
ick
as a
ny o
ther
spe
cial
ist m
edic
al s
ervi
ce.
1b S
ervi
ce d
eman
d an
d re
ferr
al p
atte
rns
are
accu
rate
ly m
onito
red,
revi
ewed
, rep
orte
d ag
ains
t ava
ilabl
e in
dica
tors
and
use
d to
gui
de s
ervi
ce p
lann
ing.
1c
The
re is
effe
ctiv
e on
goin
g lif
e tim
e m
aint
enan
ce o
f hea
ring
aid
use
- inc
ludi
ng s
uppo
rtive
car
e.
Rat
ing
Scal
e 1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
ts a
roun
d ha
lf of
the
elem
ents
of t
he q
ualit
y st
atem
ent c
riter
ia
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
P
leas
e us
e th
e ra
ting
scal
e an
d ex
ampl
es g
iven
in th
e 1
and
5 co
lum
ns a
s an
indi
cato
r to
help
you
sco
re th
e se
lf-as
sess
men
t tab
le b
elow
. Eac
h ta
ble
shou
ld o
nly
ever
hav
e 1
self-
asse
ssm
ent s
core
. Whe
n yo
u pe
rcei
ve th
ere
to b
e m
ore
than
1 a
spec
t of t
he ta
ble
that
you
cou
ld g
ive
a sc
ore
for,
plea
se u
se a
n av
erag
e of
eac
h of
th
e as
pect
s.
37
Crit
eria
1a.1
-a.3
- D
irect
refe
rral
pat
hway
s
Qua
lity
Stat
emen
t rat
iona
le
Dire
ct re
ferr
al to
aud
iolo
gy s
ervi
ces
is a
mor
e ef
fect
ive
and
effic
ient
way
of m
eetin
g pa
tient
s’ c
linic
al n
eeds
whe
re th
ere
is n
o ro
bust
evi
denc
e of
oto
logi
cal p
atho
logy
.
Allo
catio
n to
the
wro
ng re
ferr
al p
athw
ays
(or a
bsen
ce o
f alte
rnat
ive
path
way
s) m
eans
add
ition
al in
conv
enie
nce
to th
e pa
tient
and
inef
ficie
nt u
se o
f tim
e an
d re
sour
ces.
C
orre
ct in
form
atio
n to
an
Aud
iolo
gy s
ervi
ce re
sults
in m
ore
effe
ctiv
e us
e of
ava
ilabl
e re
sour
ces.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ther
e is
no
proc
ess
for
patie
nts
to b
e re
ferr
ed to
or
acc
ess
audi
olog
y di
rect
ly.
All
adul
t pat
ient
s w
ith h
earin
g pr
oble
ms
and
thei
r sig
nific
ant
othe
r(s)
hav
e ac
cess
to A
udio
logy
vi
a D
irect
Ref
erra
l whe
re th
is is
cl
inic
ally
indi
cate
d
The
info
rmat
ion
abou
t ref
erra
ls a
nd
the
crite
ria w
hich
pat
ient
s ne
ed to
m
eet t
o be
refe
rred
is c
lear
so
that
th
ey a
re fu
lly u
nder
stoo
d by
re
ferr
ers.
Info
rmat
ion
abou
t ref
erra
l crit
eria
an
d pa
thw
ays,
incl
udin
g an
y ch
ange
s, is
wid
ely
diss
emin
ated
to
all p
oten
tial r
efer
rers
on
a re
gula
r ba
sis.
Evid
ence
sou
rces
rele
vant
to c
riter
ia
Writ
ten
refe
rral p
athw
ays,
W
ritte
n re
ferra
l crit
eria
, W
ritte
n po
licy
on c
omm
unic
atio
n w
ith re
ferr
ers,
C
opie
s of
com
mun
icat
ions
with
refe
rrers
, R
esul
ts a
nd o
utco
mes
of a
udit.
38
Crit
eria
1a.
4-a.
5 -
Ease
of a
cces
s Q
ualit
y St
atem
ent r
atio
nale
P
ublic
Hea
lth p
rinci
ples
pro
mot
e de
liver
y of
ser
vice
s cl
ose
to p
atie
nts
for t
heir
ultim
ate
heal
thca
re b
enef
it.
To p
rovi
de a
n eq
ualit
y-ba
sed
serv
ice,
aud
iolo
gy c
entre
s m
ust a
llow
for a
ll di
ffere
nt ty
pes
of p
atie
nts
to g
ain
phys
ical
acc
ess
to th
e se
rvic
e.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
The
prox
imity
of p
atie
nts
to
cent
res
that
del
iver
au
diol
ogy
serv
ices
is fa
r w
orse
than
for o
ther
adu
lt se
rvic
es.
The
audi
olog
y ce
ntre
s ar
e im
poss
ible
to g
et in
to a
nd/o
r im
poss
ible
to n
avig
ate
arou
nd o
nce
insi
de.
The
prox
imity
of p
atie
nts
to
cent
res
deliv
erin
g au
diol
ogy
serv
ices
is
sim
ilar t
o ot
her a
dult
serv
ices
in th
e B
oard
/dis
trict
.
The
audi
olog
y ce
ntre
s pr
ovid
e ea
se o
f phy
sica
l ac
cess
to a
ll ar
eas
whe
re
audi
olog
y is
del
iver
ed.
Evid
ence
sou
rces
rele
vant
to c
riter
ia
Map
s of
ser
vice
loca
tions
aga
inst
dem
ogra
phic
info
rmat
ion
of p
atie
nts
rela
tive
to o
ther
adu
lt se
rvic
es,
Aud
it of
ser
vice
s ag
ains
t Dis
abili
ty D
iscr
imin
atio
n A
ct,
Pat
ient
sat
isfa
ctio
n su
rvey
s.
39
Crit
eria
1a.
6–a.
7 - W
aitin
g tim
es
Qua
lity
Stat
emen
t rat
iona
le
Sim
ple
equi
ty im
plie
s th
at n
o pa
tient
sho
uld
be p
enal
ised
by
havi
ng to
wai
t lon
ger f
or a
dire
ct re
ferr
al to
Aud
iolo
gy th
at th
ey w
ould
hav
e ex
perie
nced
by
refe
rral
to a
sp
ecia
list m
edic
al s
ervi
ce.
Sim
ple
equi
ty im
plie
s th
at p
atie
nts
who
hav
e pr
evio
usly
acc
esse
d an
aud
iolo
gy s
ervi
ce m
ust b
e ab
le to
acc
ess
it ag
ain,
sho
uld
the
need
aris
e, w
ithou
t pre
judi
ce.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Wai
ting
times
are
not
equ
al
for d
irect
/indi
rect
refe
rral
s to
A
udio
logy
The
wai
ting
time
targ
et is
not
kn
own
and
wai
ting
times
are
no
t mon
itore
d.
Wai
ting
times
for d
irect
refe
rral
s to
A
udio
logy
are
the
sam
e as
wai
ting
times
for p
atie
nts
who
are
refe
rred
to
oth
er s
peci
alis
t med
ical
ser
vice
s,
such
as
EN
T or
Aud
iove
stib
ular
M
edic
ine.
The
max
imum
wai
ting
time
from
re
ferr
al to
trea
tmen
t20 o
f hea
ring
shou
ld m
eet t
he n
atio
nal t
arge
t re
gard
less
of t
he re
ferr
al ro
ute
and
rega
rdle
ss o
f whe
ther
a p
atie
nt is
re
-acc
essi
ng th
e se
rvic
e or
ac
cess
ing
it fo
r the
firs
t tim
e.21
Evid
ence
D
ata
to h
and
idea
lly o
ver s
ever
al ti
me
poin
ts to
indi
cate
tren
ds a
gain
st n
atio
nal t
arge
ts
20
Tre
atm
ent i
s de
fined
as
fittin
g of
hea
ring
aid.
Fitt
ing
follo
win
g re
-ass
essm
ent i
s as
sum
ed.
21 A
t tim
e of
writ
ing,
the
natio
nal t
arge
t in
Sco
tland
is 1
8 w
eeks
from
refe
rral
to tr
eatm
ent a
nd w
ork
is o
ngoi
ng o
n a
docu
men
t cal
led
prin
cipl
es a
nd d
efin
ition
s fo
r the
18
wee
ks re
ferr
al ta
rget
, whi
ch w
ill h
elp
clar
ify h
ow a
udio
logy
ser
vice
s he
lp to
ach
ieve
the
18 w
eek
patie
nt ta
rget
whe
n pa
tient
s ar
e re
ferr
ed o
n to
oth
er h
ealth
care
ser
vice
s.
40
Crit
eria
1b.
1-b.
2 - M
onito
ring
and
man
agin
g re
ferr
al p
atte
rns
Q
ualit
y St
atem
ent r
atio
nale
Th
e nu
mbe
r of i
ncor
rect
refe
rral
s to
the
spec
ialis
t med
ical
rout
e in
form
s th
e ef
fect
iven
ess/
clar
ity o
f the
crit
eria
and
com
plia
nce
of re
ferr
ers
to th
ose
crite
ria. I
mpr
ovem
ents
ca
n th
en b
e m
ade
to e
nsur
e th
at p
atie
nts
are
not i
ncor
rect
ly re
ferr
ed to
cer
tain
ser
vice
s.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f as
sess
m-
ent s
core
ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ther
e is
no
mon
itorin
g of
co
mpl
ianc
e w
ith re
ferr
al
crite
ria
The
num
ber o
f ina
ppro
pria
te
dire
ct re
ferra
ls is
mon
itore
d.
The
num
ber o
f ina
ppro
pria
te
refe
rral
s to
spe
cial
ist m
edic
al
serv
ices
is m
onito
red.
A
ctio
n pl
ans
are
impl
emen
ted
to a
ddre
ss s
igni
fican
t non
-co
mpl
ianc
e w
ith re
ferr
al
crite
ria.
Evid
ence
A
udit,
D
ata
to h
and
(for d
irect
refe
rral
s), i
deal
ly o
ver s
ever
al ti
me
poin
ts to
indi
cate
tren
ds.
41
Crit
eria
1b.
3 - M
onito
ring
and
revi
ewin
g w
aitin
g tim
es
Qua
lity
Stat
emen
t rat
iona
le
Effe
ctiv
e al
loca
tion
of h
ealth
reso
urce
s is
relia
nt u
pon
accu
rate
info
rmat
ion
on th
e ba
lanc
e be
twee
n de
man
d fo
r ser
vice
s an
d av
aila
ble
reso
urce
s. It
is im
porta
nt th
at
wai
ting
times
for a
ll st
ages
of t
he p
atie
nt p
athw
ay fr
om re
ferr
al th
roug
h to
trea
tmen
t (eg
hea
ring
aid
fittin
g) fo
r new
and
exi
stin
g pa
tient
s ar
e co
llect
ed a
nd m
onito
red
in a
n ef
fect
ive
man
ner.
The
use
of IT
sys
tem
s to
com
pute
info
rmat
ion
such
as
dem
ogra
phic
dat
a an
d w
aitin
g tim
es w
ill in
form
allo
catio
n of
ser
vice
s an
d he
lp p
reve
nt a
n ov
erlo
ad o
f pat
ient
s ac
cess
ing
the
sam
e se
rvic
e an
d re
sour
ces
bein
g st
rain
ed.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Wai
ting
times
are
not
m
onito
red.
Wai
ting
times
are
mon
itore
d w
ithin
the
depa
rtmen
t.
Mon
itorin
g of
wai
ting
times
is
base
d up
on ro
bust
dat
a co
llect
ion.
Evid
ence
M
onth
ly d
ata
to h
and
from
a p
atie
nt m
anag
emen
t sys
tem
, A
udit
of ro
bust
ness
of d
ata
colle
ctio
n,
Pol
icie
s an
d pr
otoc
ols
to s
uppo
rt da
ta c
olle
ctio
n
A ra
ndom
sam
ple
of re
leva
nt p
atie
nts
to c
heck
dat
a co
llect
ion
thro
ugh
to p
rese
ntat
ion
in re
porte
d w
aitin
g tim
es.
42
Crit
eria
1b.
4 - S
ervi
ce P
lann
ing
Qua
lity
Stat
emen
t rat
iona
le
Effe
ctiv
e al
loca
tion
of re
sour
ces
relie
s up
on in
form
atio
n on
act
ual d
eman
d an
d po
tent
ial/p
roje
cted
dem
and
for s
peci
fic s
ervi
ces.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f as
sess
men
t sc
ore
base
d on
ev
iden
ce
sour
ces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
data
is c
olle
cted
re
gard
ing
upta
ke, r
efer
ral
and
dem
ogra
phic
s of
pa
tient
s.
The
follo
win
g da
ta a
re
colle
cted
, rev
iew
ed a
nd
used
in a
nnua
l ser
vice
re
view
: •
the
upta
ke o
f NH
S
hear
ing
aids
in th
e lo
cal
popu
latio
n co
mpa
red
with
the
pred
ictiv
e ne
ed
for s
ervi
ces,
•
the
num
ber a
nd ty
pe o
f re
ferr
als
to A
udio
logy
se
rvic
es,
• de
mog
raph
ics
of lo
cally
se
rved
pop
ulat
ions
, in
clud
ing
fact
ors
such
as
eth
nic
dive
rsity
, so
cial
dep
rivat
ion
and
age.
22
Evid
ence
D
ata
on h
earin
g ai
d up
take
, D
ata
on re
ferr
als
to a
udio
logy
ser
vice
s,
Dat
a on
pat
ient
dem
ogra
phic
, A
nnua
l ser
vice
revi
ew.
22
Thi
s is
to e
stab
lish
a be
nchm
ark
and
to g
auge
the
serv
ice
trend
s ov
er ti
me.
43
Crit
eria
1c.
1 - L
ife lo
ng h
earin
g ai
d us
e - e
ar c
are
and
wax
man
agem
ent
Qua
lity
Stat
emen
t rat
iona
le
To e
nsur
e ef
fect
ive
initi
al a
nd o
ngoi
ng c
are;
agr
eed
mul
tidis
cipl
inar
y lo
cal e
ar c
are
/ wax
man
agem
ent p
roce
dure
s sh
ould
be
in p
lace
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Adv
ice
abou
t ear
car
e an
d w
ax
man
agem
ent i
s no
t sy
stem
atic
ally
giv
en to
all
patie
nts
Ther
e ar
e lim
ited
ear c
are/
wax
m
anag
emen
t ser
vice
s
Ther
e ar
e no
writ
ten
agre
ed
prot
ocol
s fo
r ear
car
e/w
ax
man
agem
ent
All
patie
nts
are
advi
sed
of a
nd h
ave
acce
ss to
ear
car
e / w
ax
man
agem
ent s
ervi
ces
Ther
e ar
e pr
otoc
ols
agre
ed
betw
een
Prim
ary
Car
e, A
udio
logy
an
d E
NT
serv
ices
and
pat
ient
s.
Evid
ence
W
ritte
n in
form
atio
n on
ear
car
e/w
ax m
anag
emen
t ava
ilabl
e to
all
patie
nts,
E
ar c
are/
wax
man
agem
ent s
ervi
ces
avai
labl
e,
Writ
ten
and
agre
ed p
roto
cols
for e
ar c
are
and
wax
man
agem
ent
44
1c.2
–1c.
5 - L
ife lo
ng h
earin
g ai
d us
e - a
cces
s to
hea
ring
aid
repa
irs a
nd b
atte
ry re
plac
emen
t Q
ualit
y St
atem
ent r
atio
nale
P
rom
pt a
cces
s fo
r exi
stin
g he
arin
g ai
d pa
tient
s to
a b
asic
repa
ir se
rvic
e an
d re
plac
emen
t bat
terie
s (a
nd o
nwar
d re
ferr
al a
s ne
cess
ary)
is re
quire
d to
hel
p m
aint
ain
long
te
rm u
se a
nd b
enef
it fro
m h
earin
g ai
d us
e. U
ptak
e of
suc
h se
rvic
es w
ill be
nefit
from
pro
mot
ion
of th
e se
rvic
e to
pat
ient
s.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
hear
ing
aid
repa
irs a
re
carr
ied
out w
ithin
2 d
ays
of th
e re
pair
serv
ice
rece
ivin
g th
e he
arin
g ai
d.
Ther
e ar
e no
repa
ir cl
inic
s w
here
aud
iolo
gy s
ervi
ces
are
deliv
ered
aw
ay fr
om th
eir m
ain
cent
re.
Rep
lace
men
t bat
tery
requ
ests
ar
e no
t ful
fille
d w
ithin
2 d
ays
of
the
requ
est b
eing
rece
ived
.
No
info
rmat
ion
is e
ver o
ffere
d ab
out r
epai
r/rep
lace
men
t ba
ttery
ser
vice
s.
All
hear
ing
aid
repa
irs a
re c
arrie
d ou
t w
ithin
2 d
ays
of th
e re
pair
serv
ice
rece
ivin
g th
e he
arin
g ai
d.
Whe
re A
udio
logy
ser
vice
s ar
e de
liver
ed a
way
from
the
mai
n A
udio
logy
bas
e; th
ere
is a
t lea
st 1
cl
inic
per
mon
th fo
r rep
air s
ervi
ces.
A
udio
logy
dep
artm
ents
will
fulfi
ll re
ques
ts fo
r rep
lace
men
t bat
terie
s w
ithin
2 d
ays
of th
e re
ques
t bei
ng
rece
ived
. P
atie
nts
are
activ
ely
offe
red
info
rmat
ion
abou
t rep
air/r
epla
cem
ent
batte
ry s
ervi
ces
at e
ach
appo
intm
ent.
This
is p
rovi
ded
in
writ
ing
and
verb
ally
.
Evid
ence
C
linic
list
s,
Writ
ten
info
rmat
ion
for s
ervi
ce u
sers
on
how
to a
cces
s re
pair
serv
ices
and
bat
tery
repl
acem
ents
ser
vice
, Lo
g of
ser
vice
rece
ipts
and
issu
es b
y A
TOs
at e
ach
stag
e of
the
proc
ess,
M
onito
ring
of lo
gs to
ens
ure
that
repa
irs a
re c
arrie
d ou
t with
in 2
day
s of
rece
ipt.
45
Stan
dard
2 -
Info
rmat
ion
Prov
isio
n an
d C
omm
unic
atio
n w
ith In
divi
dual
Pat
ient
s 2a
Tim
ely
and
rele
vant
info
rmat
ion
is p
rovi
ded
to m
eet t
he n
eeds
of h
earin
g im
paire
d pa
tient
s an
d th
eir s
igni
fican
t oth
er(s
), in
form
ats
that
acc
omm
odat
e th
eir c
omm
unic
ativ
e ab
ilitie
s.
Rat
ing
Scal
e
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
46
Crit
eria
2a.
1 –
Goo
d in
form
atio
n pr
ior t
o as
sess
men
t Q
ualit
y St
atem
ent r
atio
nale
G
ood
com
mun
icat
ion
befo
re d
urin
g an
d af
ter i
nter
vent
ion
bene
fits
patie
nts
– th
roug
h re
duct
ion
in a
nxie
ties/
conc
erns
and
enc
oura
ging
app
ropr
iate
upt
ake
of fu
rther
car
e.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
writ
ten
info
rmat
ion
is
prov
ided
to p
atie
nts
and
thei
r sig
nific
ant o
ther
(s) p
rior
to a
ppoi
ntm
ent.
No
refe
renc
e is
mad
e to
pa
tient
s an
d/or
sig
nific
ant
othe
r(s)
abo
ut th
e av
aila
bilit
y of
inte
rpre
ting
serv
ices
.
Writ
ten
info
rmat
ion
is p
rovi
ded
for
all n
ew a
nd e
xist
ing
patie
nts
and
thei
r sig
nific
ant o
ther
(s) p
rior t
o ap
poin
tmen
t abo
ut :-
• th
e se
rvic
e,
• as
sess
men
t pro
cedu
res,
•
type
s of
ass
essm
ent,
• po
ssib
le in
terv
entio
ns a
nd
• cl
inic
ians
invo
lved
This
will
incl
ude
a re
ques
t to
cont
act t
he d
epar
tmen
t in
adva
nce
of a
n ap
poin
tmen
t if a
n in
terp
rete
r is
requ
ired.
Evid
ence
W
ritte
n in
form
atio
n le
afle
ts o
r let
ters
, A
uditi
ng
47
Crit
eria
2a.
2 –
Con
sent
Q
ualit
y St
atem
ent r
atio
nale
G
ood
com
mun
icat
ion
befo
re d
urin
g an
d af
ter i
nter
vent
ion
bene
fits
patie
nts
– th
roug
h re
duct
ion
in a
nxie
ties/
conc
erns
and
enc
oura
ging
app
ropr
iate
upt
ake
of fu
rther
car
e.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Con
sent
is n
ot g
aine
d fro
m
the
patie
nt fo
r ass
essm
ent o
f th
eir h
earin
g.
Con
sent
is g
aine
d fro
m th
e pa
tient
for a
sses
smen
t of t
heir
hear
ing
and
thei
r sig
nific
ant
othe
r(s)
bei
ng p
rese
nt.
Evid
ence
W
ritte
n in
form
atio
n le
afle
ts o
r let
ters
, A
uditi
ng
48
Crit
eria
2a.
3-a.
4 –
Goo
d in
form
atio
n af
ter a
sses
smen
t Q
ualit
y St
atem
ent r
atio
nale
G
ood
com
mun
icat
ion
befo
re d
urin
g an
d af
ter i
nter
vent
ion
bene
fits
patie
nts
– th
roug
h re
duct
ion
in a
nxie
ties/
conc
erns
and
enc
oura
ging
app
ropr
iate
upt
ake
of fu
rther
car
e.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Res
ults
are
not
reco
rded
, ex
plai
ned
or g
iven
to
patie
nts
and
thei
r sig
nific
ant
othe
r(s)
follo
win
g as
sess
men
t.
Aud
iolo
gy d
oes
not p
rovi
de
any
info
rmat
ion
rega
rdin
g se
rvic
es o
ffere
d by
oth
er
agen
cies
.
Stra
ight
afte
r ass
essm
ent,
resu
lts
are
reco
rded
, exp
lain
ed v
erba
lly
and
give
n to
pat
ient
s an
d/or
thei
r si
gnifi
cant
oth
er(s
). In
form
atio
n is
pro
vide
d, b
y au
diol
ogy,
rega
rdin
g se
rvic
es
offe
red
by o
ther
age
ncie
s (in
clud
ing
volu
ntar
y se
ctor
or
gani
satio
ns).
Evid
ence
W
ritte
n in
form
atio
n le
afle
ts o
r let
ters
, A
uditi
ng
49
Crit
eria
2a.
5-a.
6 - A
cces
sibl
e in
form
atio
n W
ritte
n in
form
atio
n th
at is
cle
ar, u
p to
dat
e an
d in
a fo
rmat
that
is a
cces
sibl
e to
the
indi
vidu
al fa
cilit
ates
und
erst
andi
ng o
f the
ser
vice
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
The
writ
ten
info
rmat
ion
prov
ided
to p
atie
nts
has
not
been
dev
elop
ed in
co
njun
ctio
n w
ith s
ervi
ce
user
gro
ups,
doe
s no
t hav
e th
e cr
ysta
l mar
k pl
ain
engl
ish
appr
oval
and
is n
ot
revi
ewed
ann
ually
.
No
writ
ten
indi
vidu
al
man
agem
ent p
lan
is
prov
ided
.
All
writ
ten
info
rmat
ion
prov
ided
to
patie
nts:
-
• is
dev
elop
ed in
con
junc
tion
with
se
rvic
e us
er g
roup
s,
• ha
s th
e C
ryst
al M
ark
plai
n E
nglis
h ap
prov
al (o
r sim
ilar)
and
•
is re
view
ed a
nnua
lly
A
writ
ten
indi
vidu
al m
anag
emen
t pla
n is
pr
ovid
ed a
nd u
pdat
ed a
t sub
sequ
ent
visi
ts.
Evid
ence
A
rand
om s
ampl
e of
pat
ient
reco
rds
is c
heck
ed to
asc
erta
in w
heth
er w
ritte
n IM
Ps
are
carr
ied
out a
nd u
pdat
ed,
Min
utes
of m
eetin
gs to
revi
ew in
form
atio
n,
Cry
stal
mar
k or
sim
ilar o
n in
form
atio
n.
50
Crit
eria
2a.
7 - M
eetin
g sp
ecifi
c co
mm
unic
atio
n/in
form
atio
n ne
eds
Qua
lity
Stat
emen
t rat
iona
le
To a
void
dis
crim
inat
ion,
ser
vice
s sh
ould
mee
t the
spe
cific
com
mun
icat
ion
and
info
rmat
ion
need
s of
hea
ring
impa
ired
patie
nts
and
thei
r sig
nific
ant o
ther
(s)
acce
ssin
g th
e se
rvic
e.
1
No
elem
ents
of
the
qual
ity s
tate
men
t cr
iteria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Dea
f aw
aren
ess
and
com
mun
icat
ion
train
ing
is n
ot g
iven
to
front
line
staf
f as
part
of in
duct
ion.
All
front
line
staf
f with
dire
ct
patie
nt c
onta
ct23
rece
ive
deaf
-aw
aren
ess
and
com
mun
icat
ion
train
ing
as p
art o
f the
ir in
duct
ion,
This
trai
ning
is u
pdat
ed e
very
3
year
s.
This
trai
ning
is a
ppro
ved
by a
re
leva
nt th
ird p
arty
suc
h as
a
volu
ntar
y se
ctor
org
anis
atio
n.
The
train
ing
will
incl
ude
deaf
-bl
ind
awar
enes
s an
d al
so
unde
rline
key
are
as o
f co
mm
unic
atio
n.24
Evid
ence
S
taff
train
ing
reco
rds,
W
ritte
n po
licie
s,
Sta
ff C
PD
acc
redi
tatio
n ce
rtific
ates
.
23 In
clud
ing
call
cent
re s
taff
if ap
plic
able
24
For
exa
mpl
e, th
e im
porta
nce
of s
taff
intro
duci
ng th
emse
lves
, gre
etin
g th
e pa
tient
and
sho
win
g em
path
y to
war
ds th
e pa
tient
.
51
Crit
eria
2a.
8-a.
9 - A
cces
sibi
lity
of in
form
atio
n Q
ualit
y St
atem
ent r
atio
nale
Te
chno
logy
sho
uld
be u
sed
to e
nabl
e au
diol
ogy
staf
f to
com
mun
icat
e ef
fect
ivel
y w
ith th
e pa
tient
gro
up a
nd to
ens
ure
that
the
info
rmat
ion
is g
iven
in a
man
ner t
hat t
he
patie
nt u
nder
stan
ds.
1 N
o el
emen
ts o
f th
e qu
ality
sta
tem
ent
crite
ria a
re m
et (o
r not
ev
iden
t)
5 Fu
lly c
ompl
iant
with
goo
d to
bes
t pr
actic
e as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Up-
to-d
ate
tech
nolo
gy
is n
ot u
sed
to s
uppo
rt co
mm
unic
atio
n be
twee
n pa
tient
s an
d th
e au
diol
ogy
serv
ices
.
Prio
r to
thei
r app
oint
men
t, up
-to-d
ate
tech
nolo
gy is
use
d to
sup
port
com
mun
icat
ion
betw
een
patie
nts
and
the
Aud
iolo
gy s
ervi
ce (e
.g. e
mai
l, te
xt
phon
es, s
ms
mes
sagi
ng, d
epar
tmen
t w
ebsi
tes)
. A
t clin
ics,
up-
to-d
ate
tech
nolo
gy is
use
d to
sup
port
com
mun
icat
ion
with
pat
ient
s (e
.g. m
essa
ge b
oard
s an
d lo
op
syst
ems
in re
cept
ion
area
s an
d w
aitin
g ro
oms)
. A
ll st
aff r
espo
nsib
le fo
r the
te
chno
logi
es u
sed
prio
r to
appo
intm
ent
and
at th
e cl
inic
are
trai
ned
on h
ow to
us
e it
and
carr
y ou
t mai
nten
ance
ch
ecks
.
Evid
ence
Te
chno
logy
in p
lace
, Lo
g of
all
staf
f who
hav
e re
ceiv
ed tr
aini
ng o
n us
e of
tech
nolo
gy
52
Crit
eria
2a.
10 -
Ligh
ting
Qua
lity
Stat
emen
t rat
iona
le
Wel
l lit
room
s he
lp a
id th
e ab
ility
of h
earin
g im
paire
d pa
tient
s to
lip
read
and
impr
ove
com
mun
icat
ion
gene
rally
. 1
No
elem
ents
of
the
qual
ity s
tate
men
t cr
iteria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
All
area
s us
ed fo
r sta
ff an
d pa
tient
co
mm
unic
atio
n ar
e ex
trem
ely
dim
.
All
area
s us
ed fo
r sta
ff an
d pa
tient
co
mm
unic
atio
n ar
e w
ell l
it.
Evi
denc
e
53
Crit
eria
2a.
11 -
Invo
lvin
g si
gnifi
cant
oth
ers
Qua
lity
Stat
emen
t rat
iona
le
The
invo
lvem
ent o
f sig
nific
ant o
ther
s (e
.g. s
pous
e) in
the
reha
bilit
ativ
e pr
oces
s ca
n pr
ovid
e im
prov
ed o
utco
mes
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Sig
nific
ant o
ther
s ar
e no
t ro
utin
ely
enco
urag
ed to
pa
rtici
pate
in c
linic
al c
onta
cts.
S
igni
fican
t oth
ers
are
not
enco
urag
ed to
eng
age
with
th
e se
rvic
e.
Sig
nific
ant o
ther
s ar
e ro
utin
ely
enco
urag
ed, t
hrou
gh fo
rmal
in
vita
tion,
to p
artic
ipat
e in
clin
ical
co
ntac
ts (w
here
con
sent
has
bee
n pr
ovid
ed).
Th
ey a
re a
lso
enco
urag
ed to
eng
age
with
the
serv
ice
thro
ugh
patie
nt
foru
ms
to fa
cilit
ate
plan
ning
, sa
tisfa
ctio
n au
ditin
g an
d in
form
atio
n de
velo
pmen
t etc
.
Evid
ence
Le
tters
/writ
ten
invi
tatio
ns to
par
ticip
ate,
W
ritte
n po
licy
on in
clus
ion
of s
igni
fican
t oth
ers
in c
linic
al c
onta
cts,
Con
sulta
tion
room
s la
rge
enou
gh to
com
forta
bly
acco
mm
odat
e ad
ditio
nal p
eopl
e
54
Stan
dard
3 –
Ass
essm
ent
3a A
ll pa
tient
s re
ceiv
e an
indi
vidu
ally
-tailo
red
audi
olog
ical
ass
essm
ent w
hich
is c
arrie
d ou
t to
reco
gnis
ed n
atio
nal s
tand
ards
, whe
re a
vaila
ble,
and
incl
udes
: •
mea
sure
men
t of h
earin
g im
pairm
ent,
• as
sess
men
t of a
ctiv
ity li
mita
tions
rela
ted
to h
earin
g im
pairm
ent,
•
eval
uatio
n of
soc
ial a
nd e
nviro
nmen
tal c
omm
unic
atio
n an
d lis
teni
ng n
eeds
and
an
eval
uatio
n of
atti
tude
s, e
xpec
tatio
n an
d be
havi
ours
as
a re
sult
of
hear
ing
impa
irmen
t,
• a
rele
vant
med
ical
his
tory
R
atin
g Sc
ale
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
55
Crit
eria
3a.
1-a.
2 - A
cqui
ring
info
rmat
ion
on h
earin
g st
atus
Q
ualit
y St
atem
ent r
atio
nale
Th
e ne
ed fo
r, an
d co
nten
t of,
any
Indi
vidu
al M
anag
emen
t Pla
n re
quire
s kn
owle
dge
of a
pat
ient
’s h
earin
g st
atus
. Th
e qu
ality
of a
sses
smen
t is
mor
e lik
ely
to b
e as
sure
d if
unde
rtake
n in
acc
orda
nce
with
nat
iona
lly re
com
men
ded
proc
edur
es.
1 N
o el
emen
ts o
f th
e qu
ality
st
atem
ent c
riter
ia a
re m
et (o
r no
t evi
dent
)
5 Fu
lly c
ompl
iant
with
goo
d to
bes
t pr
actic
e as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ther
e ar
e no
writ
ten
stan
dard
pr
oced
ures
or p
roto
cols
for
asse
ssm
ent.
Writ
ten
prot
ocol
s an
d/or
pr
oced
ures
are
not
ava
ilabl
e to
all
staf
f in
the
depa
rtmen
t
The
follo
win
g ar
e es
tabl
ishe
d fo
r ev
ery
patie
nt:
• he
arin
g th
resh
olds
by
air a
nd
bone
con
duct
ion,
•
thre
shol
ds o
f unc
omfo
rtabl
e lo
udne
ss le
vels
25,
• ad
ditio
nal/f
urth
er d
iagn
ostic
pr
oced
ures
as
requ
ired.
•
a re
leva
nt m
edic
al h
isto
ry.
Ther
e ar
e w
ritte
n B
AA
/BS
A
reco
mm
ende
d pr
oced
ures
or
prot
ocol
s av
aila
ble
to a
ll st
aff i
n th
e de
partm
ent a
nd th
ese
incl
ude
air a
nd
bone
con
duct
ion
test
ing,
thre
shol
ds
of u
ncom
forta
ble
loud
ness
leve
ls,
and
tym
pano
met
ry.
Evid
ence
W
ritte
n pr
otoc
ols,
C
ase
audi
t
25
Unl
ess
clin
ical
ly c
ontra
indi
cate
d
56
Crit
eria
3a.
3-a.
4 - E
quip
men
t cal
ibra
tion
and
test
env
ironm
ent
Qua
lity
Stat
emen
t rat
iona
le
Mea
sure
s ar
e co
mpr
omis
ed if
not
gat
here
d us
ing
equi
pmen
t cal
ibra
ted
to n
atio
nal a
nd in
tern
atio
nal s
tand
ards
and
if th
ey a
re n
ot u
sed
in a
qui
et te
st e
nviro
nmen
t. 1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5 Fu
lly c
ompl
iant
with
goo
d to
be
st p
ract
ice
as in
dica
ted
by
qual
ity s
tate
men
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor
scor
e an
d co
mm
ents
Act
ions
/ co
mm
ents
G
ood
prac
tice
exam
ple
Equ
ipm
ent i
s no
t che
cked
da
ily a
nd c
alib
ratio
ns a
re n
ot
alw
ays
up to
dat
e
Ass
essm
ent i
s no
t alw
ays
carr
ied
out i
n ac
oust
ical
co
nditi
ons
conf
orm
ing
to
natio
nal a
nd in
tern
atio
nal
stan
dard
s
Equ
ipm
ent i
s ca
libra
ted
annu
ally
, and
dai
ly c
heck
s ar
e ca
rrie
d ou
t and
doc
umen
ted
to
inte
rnat
iona
l sta
ndar
ds.
Hea
ring
test
s, w
ith th
e ex
cept
ion
of d
omic
iliar
y vi
sits
, ar
e al
way
s ca
rrie
d ou
t in
acou
stic
al c
ondi
tions
co
nfor
min
g to
nat
iona
l and
in
tern
atio
nal s
tand
ards
26 -
exce
pt w
hen
the
serv
ice
has
to b
e ta
ken
to th
e pa
tient
for
clin
ical
reas
ons
(e.g
. ho
useb
ound
).
Evid
ence
C
alib
ratio
n an
d eq
uipm
ent c
heck
logs
/cer
tific
ates
26 T
o en
able
the
accu
rate
test
ing
of n
orm
al a
ir an
d bo
ne c
ondu
ctio
n he
arin
g th
resh
old
leve
ls d
own
to 0
dB
HL,
am
bien
t sou
nd p
ress
ure
leve
ls s
houl
d no
t exc
eed
any
of th
e le
vels
sho
wn
in T
able
s 2
and
4 re
spec
tivel
y fro
m B
S E
N IS
O 8
253-
1. H
owev
er, i
t is
reas
onab
le to
rela
x th
is re
quire
men
t for
BC
test
ing
so a
s to
pro
vide
for t
estin
g do
wn
to
10 d
B H
L by
add
ing
10 d
B to
the
figur
es in
Tab
le 4
.
57
Crit
eria
3a.
5-a.
6 - A
cqui
ring
othe
r inf
orm
atio
n re
leva
nt to
dev
elop
ing
an In
divi
dual
Man
agem
ent P
lan
(IMP)
Q
ualit
y St
atem
ent r
atio
nale
H
earin
g st
atus
is a
nec
essa
ry p
rere
quis
ite, b
ut is
not
suf
ficie
nt in
form
atio
n al
one
to c
onfig
ure
an In
divi
dual
Man
agem
ent P
lan
(IMP
) •
The
goal
of t
he s
ervi
ce is
to a
llevi
ate
liste
ners
’ act
ivity
lim
itatio
ns ra
ther
than
man
age
hear
ing
loss
es.
• S
ervi
ces
shou
ld s
elec
t a v
alid
ated
sel
f-rep
ort q
uest
ionn
aire
to a
sses
s ac
tivity
lim
itatio
ns re
late
d to
hea
ring
impa
irmen
t. •
Situ
atio
n-sp
ecifi
c st
ruct
ured
que
stio
nnai
res
have
bee
n sh
own
to o
ffer s
igni
fican
t adv
anta
ges
in c
linic
al s
ettin
gs o
ver m
ore
gene
ral d
isab
ility
and
han
dica
p in
vent
orie
s (e
.g. G
HA
BP
). 1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
A v
alid
ated
sel
f rep
ort
ques
tionn
aire
is n
ot u
sed
as
part
of th
e as
sess
men
t pr
otoc
ols
and
soci
al a
nd
pers
onal
info
rmat
ion
rele
vant
to
patie
nt m
anag
emen
t is
not
asse
ssed
.
Ther
e is
no
stan
dard
ised
re
cord
ing
of in
form
atio
n.
A s
elf r
epor
t que
stio
nnai
re is
a ro
utin
e pa
rt of
the
asse
ssm
ent p
roto
cols
27 a
nd is
us
ed in
con
junc
tion
with
all
info
rmat
ion
gath
ered
rela
ting
to s
ocia
l circ
umst
ance
s,
psyc
holo
gica
l im
pact
s, c
omm
unic
atio
n an
d lis
teni
ng n
eeds
and
exp
ecta
tions
. In
form
atio
n is
reco
rded
in a
sta
ndar
dise
d w
ay a
nd is
use
d to
dev
elop
the
cont
ent o
f th
e IM
P. I
nclu
ded
in th
is in
form
atio
n sh
ould
be
deta
ils o
f why
an
asse
ssm
ent
or in
terv
entio
n co
uld
not b
e ca
rrie
d ou
t.
Evid
ence
C
ompl
eted
que
stio
nnai
res,
C
ase
audi
t sho
win
g us
e of
info
rmat
ion
from
the
ques
tionn
aire
to d
evel
op IM
P,
Clin
ical
reco
rd re
view
(ran
dom
sam
ple
of c
ases
),
Ser
vice
pol
icie
s an
d pr
oced
ures
rela
ting
to s
tand
ardi
sed
gath
erin
g of
info
rmat
ion
A
ssoc
iate
d se
rvic
e ed
ucat
iona
l/pro
mot
iona
l act
ivity
.
27
Que
stio
nnai
res
will
alw
ays
be u
sed
unle
ss re
cord
ed a
s cl
inic
ally
con
train
dica
ted.
58
Stan
dard
4 -
Dev
elop
ing
an In
divi
dual
Man
agem
ent P
lan
4a A
n In
divi
dual
Man
agem
ent P
lan
(IMP
)28 is
: -
• de
velo
ped
for e
ach
patie
nt, i
nitia
lly b
ased
on
info
rmat
ion
gath
ered
at t
he a
sses
smen
t pha
se,
• de
term
ined
in c
onju
nctio
n w
ith th
e pa
tient
and
/or t
heir
sign
ifica
nt o
ther
(s),
• up
date
d on
an
ongo
ing
basi
s an
d •
acce
ssib
le to
the
clin
ical
team
.
Rat
ing
Sca
le 1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
28
Exa
mpl
es o
f an
IMP
can
be
foun
d in
app
endi
x 5
59
Crit
eria
4a.
1-a.
2 - F
acto
rs fo
r Con
side
ratio
n in
Dev
elop
ing
the
IMP
Qua
lity
Stat
emen
t rat
iona
le
An
IMP
is m
ost e
ffect
ive
if it
take
s in
to a
ccou
nt a
rang
e of
fact
ors
in a
dditi
on to
the
type
and
leve
l of h
earin
g lo
ss. A
n ef
fect
ive
IMP
als
o re
lies
on c
onsu
ltatio
n be
twee
n th
e A
udio
logy
pro
fess
iona
l, th
e he
arin
g im
paire
d pe
rson
and
his
or h
er s
igni
fican
t oth
er(s
). O
nly
whe
n al
l par
ties
are
com
mitt
ed to
the
join
t goa
ls is
an
optim
al o
utco
me
rece
ived
.
1 N
o el
emen
ts o
f th
e qu
ality
st
atem
ent c
riter
ia a
re m
et (o
r no
t evi
dent
)
5 Fu
lly c
ompl
iant
with
goo
d to
be
st p
ract
ice
as in
dica
ted
by
qual
ity s
tate
men
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Inte
rven
tion
is b
ased
on
info
rmat
ion
abou
t the
hea
ring
leve
l and
uns
truct
ured
one
to
one
disc
ussi
ons
with
the
patie
nt o
nly.
It d
oes
not
cont
ain
an IM
P.
The
IMP
is c
onta
ined
with
in
the
clin
ical
reco
rd. I
t con
tain
s de
tails
of:
• he
arin
g st
atus
, •
expe
ctat
ions
, •
soci
al c
ircum
stan
ce,
• op
tions
for r
ehab
ilita
tion
(incl
udin
g he
arin
g in
stru
men
t m
anag
emen
t),
• re
ferr
al to
oth
er a
genc
ies
and
• sp
ecifi
c go
als
asso
ciat
ed
with
ass
essm
ent
info
rmat
ion.
Th
e IM
P is
agr
eed
with
the
patie
nt a
nd s
igni
fican
t ot
her(
s) a
t eac
h ap
poin
tmen
t an
d a
copy
is m
ade
avai
labl
e fo
r the
m.
Evid
ence
S
ampl
e of
clin
ical
reco
rds,
S
ervi
ce p
olic
ies
and
proc
edur
es re
latin
g to
the
patie
nt p
athw
ay a
nd d
evel
opm
ent o
f the
IMP
.
60
Crit
eria
4a.
3 - F
urth
er D
evel
opm
ent o
f the
IMP
Qua
lity
Stat
emen
t rat
iona
le
To b
e su
cces
sful
, IM
Ps
need
to b
e fle
xibl
e. F
lexi
bilit
y w
ithin
the
stru
ctur
e of
the
IMP
is b
enef
icia
l bec
ause
the
cont
ent a
nd th
e go
als
of th
e IM
P m
ay c
hang
e ov
er ti
me,
re
flect
ing
the
posi
tive
outc
omes
of i
nter
vent
ions
. 1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
The
clin
ical
reco
rd c
onta
ins
info
rmat
ion
abou
t the
hea
ring
leve
l an
d in
terv
entio
n ag
reed
onl
y.
The
spec
ific
goal
s of
the
IMP
ar
e re
cord
ed in
the
clin
ical
re
cord
. The
pla
n in
clud
es
deta
ils o
f: •
the
deci
sion
-mak
ing
proc
ess,
•
the
impl
emen
tatio
n pl
an a
nd
• pr
opos
ed ti
mes
cale
s.
Evid
ence
S
ampl
e of
clin
ical
reco
rds,
S
ervi
ce p
olic
ies
and
proc
edur
es re
latin
g to
the
patie
nt p
athw
ay a
nd d
evel
opm
ent o
f the
IMP
.
61
Crit
eria
4a.
4 - U
pdat
ing
the
Indi
vidu
al M
anag
emen
t Pla
n (IM
P)
Qua
lity
Stat
emen
t rat
iona
le
An
effe
ctiv
e IM
P w
ill de
tail
spec
ific
actio
ns a
ssoc
iate
d w
ith a
gree
d go
als
that
take
into
acc
ount
a li
sten
er’s
soc
ial,
com
mun
icat
ion
and
liste
ning
nee
ds, i
n ad
ditio
n to
thei
r he
arin
g im
pairm
ent a
nd re
late
d ac
tivity
lim
itatio
ns, e
.g. l
ivin
g al
one
vs fa
mily
set
ting
vs s
helte
red
acco
mm
odat
ion.
The
IMP
is fl
exib
le s
o th
at d
iffer
ent g
oals
can
be
set i
f th
e pa
tient
’s c
ircum
stan
ces/
envi
ronm
ent c
hang
es.
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Info
rmat
ion
abou
t ex
pect
atio
ns, s
ocia
l ne
eds
and
or li
sten
ing
need
s ar
e no
t rec
orde
d ov
er ti
me.
Info
rmat
ion
is re
cord
ed in
th
e pa
tient
’s c
linic
al
reco
rd29
whi
ch is
upd
ated
ov
er th
e pe
riod
of th
e jo
urne
y th
roug
h th
e IM
P.
This
con
sist
s of
info
rmat
ion
abou
t the
indi
vidu
al’s
he
arin
g im
pairm
ents
, ex
pect
atio
ns (g
oals
), ps
ycho
logi
cal i
mpa
cts,
so
cial
, com
mun
icat
ion
and
liste
ning
nee
ds.
Evid
ence
C
ompl
eted
que
stio
nnai
res,
C
ase
audi
t sho
win
g us
e of
info
rmat
ion
from
the
ques
tionn
aire
to d
evel
op IM
P,
Clin
ical
reco
rd re
view
(ran
dom
sam
ple
of c
ases
),
Ser
vice
pol
icie
s an
d pr
oced
ures
rela
ting
to s
tand
ardi
sed
gath
erin
g of
info
rmat
ion
and
A
ssoc
iate
d se
rvic
e ed
ucat
iona
l/pro
mot
iona
l act
ivity
.
29 F
or th
e pu
rpos
es o
f thi
s to
ol, t
he c
linic
al re
cord
is d
efin
ed a
s in
clud
ing
NO
AH
dat
a an
d de
scrip
tive
text
.
62
Stan
dard
5 -
Impl
emen
ting
an In
divi
dual
Man
agem
ent P
lan
5a T
he In
divi
dual
Man
agem
ent P
lan
(IMP
) is
impl
emen
ted
over
a s
erie
s of
coo
rdin
ated
app
oint
men
ts w
ith th
e op
portu
nity
for r
evis
ion
of o
utco
me
goal
s at
ea
ch s
tage
.
5b W
here
pro
visi
on o
f hea
ring
aid(
s) is
requ
ired
the
serv
ice
ensu
res:
•
hear
ing
aids
fitte
d ar
e fu
nctio
ning
cor
rect
ly,
• na
tiona
lly a
gree
d pr
oced
ures
and
pro
toco
ls a
re fo
llow
ed a
t a lo
cal l
evel
, •
that
pat
ient
s ar
e of
fere
d a
hear
ing
aid
for e
ach
ear w
here
clin
ical
ly in
dica
ted,
•
perfo
rman
ce o
f hea
ring
aid(
s) is
car
eful
ly m
atch
ed to
indi
vidu
al re
quire
men
ts a
nd s
ettin
gs re
cord
ed.
5c F
ollo
win
g im
plem
enta
tion
of th
e pl
an, a
pro
cess
of o
ngoi
ng s
uppo
rt an
d m
aint
enan
ce c
ontin
ues.
R
atin
g Sc
ale
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
63
Crit
eria
5a.
1 - R
efer
ral t
o ot
her a
genc
ies/
serv
ices
Q
ualit
y St
atem
ent r
atio
nale
In
ord
er fo
r agr
eed
inte
rven
tions
to b
e ef
fect
ive,
refe
rral t
o an
othe
r age
ncy/
serv
ice
for i
nter
vent
ions
sho
uld
be p
rom
pt s
o as
to b
e ba
sed
upon
an
up-to
-dat
e ap
prai
sal
of n
eed.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Whe
re re
ferr
al to
an
exte
rnal
ag
ency
/ser
vice
is in
dica
ted,
refe
rral
is
nev
er m
ade
with
in 7
day
s of
ap
poin
tmen
t
And
/or
Info
rmat
ion
abou
t the
leng
th o
f re
ferr
al is
not
ava
ilabl
e i.e
. it i
s no
t re
cord
ed a
nd/o
r mon
itore
d.
Whe
re re
ferr
al to
an
exte
rnal
ag
ency
/ser
vice
is in
dica
ted,
re
ferr
al is
mad
e fro
m
Aud
iolo
gy w
ithin
7 d
ays
of
appo
intm
ent i
n at
leas
t 95%
of
cas
es.
Evid
ence
W
ritte
n re
cord
s,
Ele
ctro
nic
reco
rds,
A
udits
64
Crit
eria
5a.
2-a.
3 - R
ecor
ding
inte
rven
tions
and
thei
r effe
ctiv
enes
s Q
ualit
y St
atem
ent r
atio
nale
P
lann
ed a
nd c
oord
inat
ed in
terv
entio
n le
ads
to b
ette
r out
com
es. S
uch
an a
ppro
ach
requ
ires
reco
rdin
g of
inte
rven
tions
and
thei
r effe
ctiv
enes
s to
gui
de o
n-go
ing
deve
lopm
ent o
f the
IMP
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ther
e is
no
stan
dard
ised
re
cord
ing
of in
form
atio
n ab
out
non-
inst
rum
enta
l int
erve
ntio
ns
and/
or th
eir e
ffect
iven
ess
and/
or
Ther
e is
no
stan
dard
ised
re
cord
ing
of in
form
atio
n ab
out
inst
rum
enta
l int
erve
ntio
ns
and/
or th
eir e
ffect
iven
ess
The
clin
ical
reco
rd a
nd IM
P in
clud
es th
e de
tails
, ju
stifi
catio
ns a
nd e
ffect
iven
ess
of a
ll no
n-in
stru
men
tal i
nter
vent
ions
impl
emen
ted.
30
The
clin
ical
reco
rd a
nd IM
P in
clud
es th
e de
tails
, ju
stifi
catio
ns a
nd e
ffect
iven
ess
of a
ll in
stru
men
tal (
hear
ing
aid)
inte
rven
tions
im
plem
ente
d.31
Evid
ence
W
ritte
n re
cord
s,
Ele
ctro
nic
reco
rds
30
Thi
s w
ill in
clud
e re
ferr
als
to o
ther
age
ncie
s (e
.g. t
o vo
lunt
ary
sect
or, s
ocia
l ser
vice
s, a
dvan
ced
reha
bilit
atio
n; c
ouns
elin
g, a
sser
tiven
ess,
lip-
read
ing,
etc
).
31 T
his
will
incl
ude
earm
ould
s se
lect
ed, b
asic
set
tings
/aco
ustic
al c
hara
cter
istic
s of
the
pres
crib
ed h
earin
g ai
ds/s
and
adv
ance
d fe
atur
es (s
uch
as d
irect
iona
l mic
roph
ones
, no
ise
redu
ctio
n al
gorit
hms
and
mul
tiple
pro
gram
mes
).
65
Crit
eria
5b.
1 - E
nsur
ing
hear
ing
aids
are
wor
king
to s
peci
ficat
ion
Q
ualit
y St
atem
ent r
atio
nale
A
udio
logi
sts
shou
ld b
e co
nfid
ent t
hat t
he a
id is
wor
king
to s
peci
ficat
ion
befo
re fi
tting
it to
a p
atie
nt s
o th
at th
e ai
d do
es n
ot c
ause
har
m.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith
good
to b
est p
ract
ice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Prio
r to
use,
hea
ring
aids
do
not h
ave
thei
r tec
hnic
al
perfo
rman
ce te
sted
to
spec
ifica
tion.
Prio
r to
issu
e; e
very
he
arin
g ai
d ha
s its
te
chni
cal p
erfo
rman
ce
test
ed to
sp
ecifi
catio
n.32
Evid
ence
W
ritte
n re
cord
s,
Ele
ctro
nic
reco
rds,
A
udits
32
Ele
ctoa
cous
tic p
erfo
rman
ce w
ill be
test
ed d
irect
ly o
n a
test
box
or b
y us
ing
RE
M. T
he a
cous
tical
con
sequ
ence
s of
any
act
ivat
ed fe
atur
e of
the
hear
ing
aid(
s) (
e.g.
di
rect
iona
l mic
roph
ones
) are
als
o ve
rifie
d w
here
sta
ndar
d pr
oced
ures
exi
st.
66
Crit
eria
5b.
2 –
Sele
ctio
n, fi
tting
and
ver
ifica
tion
of h
earin
g ai
ds
Qua
lity
Stat
emen
t rat
iona
le
Pro
fess
iona
l bod
ies
and
natio
nal g
uide
lines
sho
uld
be fo
llow
ed to
ens
ure
prov
isio
n m
eets
the
need
s of
the
indi
vidu
al.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith
good
to b
est p
ract
ice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ther
e ar
e no
loca
l pro
toco
ls
for:
• S
elec
tion
• fit
ting
and
• ve
rific
atio
n of
hea
ring
aids
.
Loca
l pro
toco
ls s
houl
d be
in o
pera
tion
conc
erni
ng s
elec
tion,
fit
ting
and
verif
icat
ion
of h
earin
g ai
ds. T
hese
sh
ould
com
ply
with
the
late
st p
rofe
ssio
nal
body
and
/or n
atio
nal
guid
ance
.33
Evid
ence
W
ritte
n re
cord
s,
Ele
ctro
nic
reco
rds,
A
udits
33 E
.g. t
he B
AA
, BS
A a
nd S
cotti
sh n
atio
nal g
uide
lines
.
67
Crit
eria
5b.
3 - B
ilate
ral h
earin
g ai
ds
Qua
lity
Stat
emen
t rat
iona
le
Labo
rato
ry b
ased
evi
denc
e su
gges
ts th
at m
any
patie
nts
with
bila
tera
l hea
ring
impa
irmen
t gai
n m
ore
bene
fit fr
om h
earin
g ai
ds fi
tted
bila
tera
lly ra
ther
than
uni
late
rally
. E
mer
ging
evi
denc
e, p
artic
ular
ly fr
om s
tudi
es o
f ope
n ca
nal f
ittin
gs in
dica
tes
mor
e re
al li
fe s
elf-r
epor
ted
bene
fit to
o.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
patie
nts
who
are
clin
ical
ly
suita
ble
for b
ilate
ral h
earin
g ai
ds
are
offe
red
2 he
arin
g ai
ds.
At l
east
95%
of p
atie
nts
who
ne
ed a
nd a
re c
linic
ally
su
itabl
e fo
r bila
tera
l hea
ring
aid
fittin
g sh
ould
be
offe
red
2 he
arin
g ai
ds.
Evid
ence
W
ritte
n pr
otoc
ols,
E
lect
roni
c re
cord
s,
Aud
its
68
Crit
eria
5b.
4-b.
7 - H
earin
g ai
ds (R
eal E
ar M
easu
res)
Q
ualit
y St
atem
ent r
atio
nale
E
vide
nce
sugg
ests
that
hea
ring
aids
are
mos
t effe
ctiv
e w
hen
thei
r per
form
ance
is c
aref
ully
mat
ched
to th
e re
quire
men
ts o
f the
indi
vidu
al.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Rea
l Ear
Mea
sure
men
ts a
re n
ot
used
at a
ll.
Whe
re R
EM
is p
erfo
rmed
the
acou
stic
al ta
rget
is n
ever
ver
ified
at
thes
e th
ree
diffe
rent
inpu
t lev
els
(50,
65
and
80 d
B).
W
here
RE
M is
per
form
ed
mea
sure
men
ts u
sual
ly d
evia
te
from
the
reco
mm
ende
d ta
rget
at
mor
e th
an o
ne fr
eque
ncy
Rea
l Ear
Mea
sure
men
ts (R
EM
) of
hea
ring
aid
perfo
rman
ce a
re
to b
e us
ed to
ver
ify a
t lea
st 9
5%
of h
earin
g ai
d fit
tings
34, un
less
cl
inic
ally
con
train
dica
ted
for
indi
vidu
al p
atie
nts.
W
here
RE
M is
per
form
ed: t
he
acou
stic
al ta
rget
is v
erifi
ed a
t th
ree
diffe
rent
inpu
t lev
els
(50,
65
and
80
dB) i
n m
ore
than
75%
of
cas
es.
Whe
re R
EM
is p
erfo
rmed
: m
easu
rem
ents
do
not d
evia
te
from
the
reco
mm
ende
d ta
rget
at
mor
e th
an o
ne fr
eque
ncy
(in
95%
of c
ases
) unl
ess
clin
ical
ly
indi
cate
d.
The
max
imum
pow
er o
utpu
t of
the
hear
ing
aid/
s is
che
cked
(in
95%
cas
es) b
y R
EM
if
perfo
rmed
, or b
y co
uple
r m
easu
rem
ent.
Adj
ustm
ents
are
34
Exp
lain
ed w
hene
ver I
MP
’s a
re c
ompl
eted
and
reco
rded
in p
atie
nt h
eld
reco
rds.
69
mad
e, if
requ
ired,
to e
nsur
e th
at
the
indi
vidu
al;s
unc
omfo
rtabl
e lo
udne
ss le
vel i
s no
t exc
eede
d.
Evid
ence
W
ritte
n pr
otoc
ols,
E
lect
roni
c re
cord
s,
Aud
its
70
Crit
eria
5c.
1-c.
2 - A
chie
ving
ong
oing
use
and
ben
efit
from
hea
ring
aids
Q
ualit
y St
atem
ent r
atio
nale
O
n-go
ing
use
and
bene
fit fr
om h
earin
g ai
d us
e is
like
ly to
be
incr
ease
d if
the
proc
ess
of s
uppo
rt an
d m
aint
enan
ce in
clud
es ro
utin
e au
diol
ogic
al re
view
s an
d po
tent
ial f
or
upda
ting
the
IMP
. Suc
h pr
ovis
ion
is re
quire
d to
acc
omm
odat
e th
e ch
angi
ng re
habi
litat
ion
need
s of
indi
vidu
als.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
patie
nts
are
give
n fo
llow
-up
appo
intm
ents
. R
evie
w a
ppoi
ntm
ents
are
not
ac
tivel
y of
fere
d to
any
pat
ient
and
pa
tient
s ar
e ne
ver a
dvis
ed th
at
they
can
sel
f ref
er fo
r rev
iew
s or
re
pairs
.
Eac
h pa
tient
is g
iven
a
follo
w-u
p ap
poin
tmen
t fo
llow
ing
hear
ing
aid
fittin
g w
ithin
a m
axim
um
time
of 1
2 w
eeks
. A
revi
ew a
ppoi
ntm
ent i
s of
fere
d to
all
hear
ing
aid
patie
nts
ever
y 3
year
s (in
at
leas
t 95%
of c
ases
). P
atie
nts
are
regu
larly
ad
vise
d th
at th
ey c
an s
elf
refe
r for
revi
ew o
r rep
airs
at
any
tim
e.
Evid
ence
W
ritte
n pr
otoc
ols,
el
ectro
nic
reco
rds,
au
dits
71
Stan
dard
6 –
Out
com
e 6a
The
out
com
e an
d ef
fect
iven
ess
of th
e In
divi
dual
Man
agem
ent P
lan
are
eval
uate
d an
d re
cord
ed fo
llow
ing
a po
st-m
anag
emen
t ass
essm
ent o
f the
impa
ct
of in
terv
entio
n.
Rat
ing
Sca
le 1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
72
Crit
eria
6a.
1 - M
easu
ring
outc
ome
Qua
lity
Stat
emen
t rat
iona
le
The
man
agem
ent o
f hea
ring
impa
irmen
t, w
ithin
a c
ompr
ehen
sive
man
agem
ent p
lan,
invo
lves
mor
e th
an a
sim
ple
tech
nica
l mat
ter o
f hea
ring
aid
fittin
g. It
invo
lves
the
prov
isio
n of
a s
yste
mat
ic a
ppro
ach,
sup
porte
d by
evi
denc
e, w
hich
add
ress
es n
ot o
nly
the
hear
ing
impa
irmen
t, bu
t als
o ot
her r
elat
ed a
ctiv
ity li
mita
tions
, par
ticip
atio
n re
stric
tions
, and
con
sequ
ent r
educ
tions
in q
ualit
y of
life
(QO
L).
Sub
ject
ive
outc
ome
mea
sure
s, in
the
form
of d
isea
se-s
peci
fic q
uest
ionn
aire
s, c
an a
sses
s th
e im
pact
of a
hea
ring
impa
irmen
t on
the
patie
nt’s
com
mun
icat
ion
func
tioni
ng,
activ
ity li
mita
tion,
and
par
ticip
atio
n re
stric
tions
. Thi
s ca
n th
en b
e us
ed in
the
eval
uatio
n pr
oces
s to
mea
sure
how
effe
ctiv
e th
e IM
P h
as b
een.
IM
P’s
hel
p to
reco
rd m
ultip
le h
earin
g ai
d ou
tcom
es; s
uch
as fu
nctio
nal b
enef
it, s
atis
fact
ion
and
QO
L w
ithin
a s
ingl
e qu
estio
nnai
re.
Mea
sure
men
t of o
utco
me
is re
quire
d to
sha
pe fu
rther
pro
gres
sion
of I
MP
’s.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to b
est p
ract
ice
as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Val
idat
ed o
utco
me
ques
tionn
aire
s ar
e ca
rrie
d ou
t for
less
than
10%
of
patie
nts
Val
idat
ed o
utco
me
mea
sure
s e.
g. th
e G
lasg
ow H
earin
g A
id
Ben
efit
Pro
file
(GH
AB
P),
IOI-H
A a
nd C
OS
I are
use
d to
eva
luat
e th
e ou
tcom
e of
in
terv
entio
n an
d fu
rther
de
velo
p th
e IM
P in
at l
east
95
% o
f cas
es (u
nles
s cl
inic
ally
con
train
dica
ted)
.
Evid
ence
R
ando
m s
ampl
e of
cas
es,
Cas
e au
dit,
Ser
vice
aud
its.
73
Crit
eria
6a.
2 –
The
clin
ical
reco
rd a
nd in
terv
entio
n ou
tcom
es
Qua
lity
Stat
emen
t rat
iona
le
Mea
sure
men
t of o
utco
me
is re
quire
d to
: -
• ob
tain
feed
back
(inc
ludi
ng a
pro
gres
sive
evi
denc
e ba
se) o
n th
e ef
fect
iven
ess
and
bene
fit a
ssoc
iate
d w
ith th
e se
rvic
e de
liver
ed to
the
patie
nt g
roup
. •
faci
litat
e fu
rther
dev
elop
men
t of I
MP
, and
judg
e pr
ogre
ss o
n pa
tient
out
com
es.
1
No
elem
ents
of
the
qual
ity s
tate
men
t cr
iteria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith
good
to b
est p
ract
ice
as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
The
clin
ical
reco
rd
cont
ains
no
info
rmat
ion
abou
t goa
ls a
nd
outc
omes
Clin
ical
reco
rds
are
used
to fa
cilit
ate
furth
er
deve
lopm
ent a
nd ju
dge
patie
nt p
rogr
ess.
The
re
cord
s co
ntai
n in
form
atio
n ab
out t
he
exte
nt to
whi
ch th
e in
terv
entio
ns h
elpe
d m
eet t
he s
peci
fied
goal
s (o
utco
mes
)
Evid
ence
Th
e cl
inic
al re
cord
74
Sta
ndar
d 7
- Pro
fess
iona
l Com
pete
nce
7a T
he H
ead
of S
ervi
ce/C
linic
al L
ead
ensu
res
that
: •
Eac
h se
rvic
e pr
ovid
es, w
ithin
a g
over
ned
team
app
roac
h, th
e cl
inic
al c
ompe
tenc
ies
nece
ssar
y to
saf
ely
and
effe
ctiv
ely
supp
ort t
he a
sses
smen
ts a
nd
inte
rven
tions
und
erta
ken,
•
Whe
re ta
sks
are
unde
rtake
n by
non
-reg
iste
red
pers
ons
(e.g
. vol
unte
ers)
this
take
s pl
ace
with
in a
n es
tabl
ishe
d co
mpe
tenc
y-ba
sed
fram
ewor
k an
d •
Link
s w
ith e
xter
nal a
genc
ies
are
in p
lace
to p
rovi
de c
ompl
emen
tary
ser
vice
. R
atin
g Sc
ale
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
75
Crit
eria
7a.
1 - T
rain
ing
and
educ
atio
n Q
ualit
y St
atem
ent r
atio
nale
To
hel
p en
sure
a s
afe
and
effe
ctiv
e se
rvic
e, c
linic
al a
udio
logy
sta
ff sh
ould
wor
k w
ithin
thei
r agr
eed
Sco
pes
of P
ract
ice
and
have
the
skills
requ
ired
for t
heir
cont
ribut
ion
tow
ards
the
reha
bilit
atio
n of
hea
ring
impa
ired
patie
nts.
H
ealth
Pro
fess
ions
Cou
ncil
‘Sta
ndar
ds o
f Pro
ficie
ncy’
for p
ract
ition
ers
stat
emen
t det
ails
requ
irem
ents
for r
egis
tere
d pr
actit
ione
rs to
rem
ain
regi
ster
ed.
Thes
e ar
e pr
oduc
ed
for t
he s
afe
and
effe
ctiv
e pr
actic
e of
the
prof
essi
ons
they
regu
late
and
are
dee
med
to b
e th
e m
inim
um s
tand
ards
whi
ch a
re n
eces
sary
to p
rote
ct m
embe
rs o
f the
pub
lic.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor
scor
e an
d co
mm
ents
Act
ions
/ co
mm
ents
G
ood
prac
tice
exam
ple
Mos
t of t
he a
udio
logi
sts
and
clin
ical
sci
entis
ts a
re n
ot re
gist
ered
at
leas
t vol
unta
rily
with
a
regi
stra
tion
coun
cil.
All
audi
olog
ists
and
clin
ical
sc
ient
ists
are
regi
ster
ed a
t le
ast v
olun
taril
y w
ith a
re
gist
ratio
n co
unci
l.
Evid
ence
C
PD
reco
rds/
portf
olio
, R
egis
tratio
n st
atus
of c
linic
al s
taff
oper
atin
g as
inde
pend
ent p
ract
ition
ers
76
Crit
eria
7a.
2 - A
cces
s to
CPD
Q
ualit
y St
atem
ent r
atio
nale
R
egis
tratio
n bo
dies
and
som
e em
ploy
ers
requ
ire d
emon
stra
tion
of re
gula
r CP
D a
ctiv
ity. F
acili
ties
to a
cces
s C
PD
clo
se to
the
poin
t of w
ork
and
the
CP
D b
eing
rece
ived
in
asso
ciat
ion
with
col
leag
ues
is a
dvan
tage
ous.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor
scor
e an
d co
mm
ents
Act
ions
/ co
mm
ents
G
ood
prac
tice
exam
ple
Sta
ff do
not
hav
e ac
cess
to
suffi
cien
t CP
D.
All
clin
ical
sta
ff ha
ve
evid
ence
of a
cces
s to
an
appr
opria
tely
mai
ntai
ned
CP
D p
rogr
amm
e th
at
prov
ides
for a
ctiv
e pa
rtici
patio
n - n
orm
ally
run
inte
rnal
to th
e se
rvic
e (o
r in
form
al a
ssoc
iatio
n w
ith
anot
her o
rgan
isat
ion)
.
Evid
ence
C
PD
cer
tific
ates
, Tr
aini
ng re
cord
s
77
Crit
eria
7a.
3 - C
ompe
tenc
y pe
er re
view
Q
ualit
y St
atem
ent r
atio
nale
P
eer r
evie
w p
rovi
des
a us
eful
app
roac
h to
hel
p en
sure
clin
ical
com
pete
ncie
s ar
e m
aint
aine
d.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qua
lity
stat
emen
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
so
urce
s
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Com
pete
ncy
of s
taff
unde
rtaki
ng c
linic
al
proc
edur
es is
not
ver
ified
on
an o
ngoi
ng o
r sys
tem
atic
ba
sis.
Com
pete
ncy
for a
ll cl
inic
al
proc
edur
es is
ver
ified
fo
rmal
ly b
y pe
er re
view
ob
serv
atio
n at
leas
t eve
ry 2
ye
ars
for a
ll cl
inic
al s
taff
unde
rtaki
ng s
uch
proc
edur
es. O
ngoi
ng
asse
ssm
ent o
f all
clin
ical
st
aff’s
com
pete
ncy
shou
ld
also
be
carr
ied
out,
info
rmal
ly, b
y lo
cal
audi
olog
y ce
ntre
s.
Evid
ence
R
ecor
ds o
f com
pete
ncy
revi
ews
78
Crit
eria
7a.
4 - V
olun
teer
sta
ff Q
ualit
y St
atem
ent r
atio
nale
T
o en
sure
saf
e an
d ef
fect
ive
outc
omes
for p
atie
nts
it is
impo
rtant
that
ther
e ar
e sa
fegu
ards
in p
lace
gov
erni
ng th
e em
ploy
men
t and
dep
loym
ent o
f vol
unte
ers.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f as
sess
men
t sc
ore
base
d on
evi
denc
e so
urce
s
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ther
e ar
e no
def
ined
qua
lity
stan
dard
s fo
r vol
unte
er s
taff
to
wor
k to
war
ds.
Ther
e ar
e no
loca
lly a
gree
s sc
opes
of
pra
ctic
e.
Ther
e ar
e no
in-h
ouse
trai
ning
pr
ogra
mm
es.
Ther
e ar
e no
form
al re
crui
tmen
t po
licie
s
Vol
unte
er s
taff
supp
ortin
g th
e au
diol
ogy
serv
ice
shou
ld w
ork
to c
lear
ly d
efin
ed q
ualit
y st
anda
rds35
, app
licab
le to
all
such
sta
ff. T
hese
incl
ude:
•
wor
king
to lo
cally
agr
eed
scop
es o
f pra
ctic
e,
•
in-h
ouse
trai
ning
usi
ng
com
pete
ncy-
base
d fra
mew
orks
,
• re
crui
tmen
t is
com
plia
nt w
ith
natio
nal a
nd lo
cal
requ
irem
ents
.
Evid
ence
R
ecor
ds o
f com
pete
ncy
revi
ews,
V
olun
teer
sta
ndar
ds a
nd a
udit
agai
nst t
hem
, Fo
rmal
ised
in-h
ouse
trai
ning
pro
gram
mes
with
ass
ocia
ted
reco
rds,
P
olic
ies
for r
ecru
itmen
t of v
olun
teer
s.
35
http
://w
ww
.vds
.org
.uk/
tabi
d/23
2/D
efau
lt.as
px
79
Stan
dard
8 –
Mul
ti-A
genc
y W
orki
ng
8a E
ach
audi
olog
y se
rvic
e ha
s in
pla
ce p
roce
sses
and
stru
ctur
es to
ens
ure
colla
bora
tive
wor
king
with
the
appr
opria
te a
genc
y to
mee
t the
nee
ds o
f pat
ient
s th
roug
h th
e pa
thw
ay. T
hese
incl
ude:
•
soci
al,
• sp
ecia
list a
udio
logi
cal a
nd
• ot
her h
ealth
nee
ds
Rat
ing
Scal
e
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
80
Crit
eria
8a.
1- C
o-co
ordi
natin
g m
ulti-
prof
essi
onal
and
mul
ti-ag
ency
wor
king
Q
ualit
y St
atem
ent r
atio
nale
M
ulti-
agen
cy c
olla
bora
tive
wor
king
is m
ore
likel
y to
resu
lt in
ser
vice
s th
at a
ddre
ss th
e ne
eds
of th
ose
hear
ing
impa
ired
patie
nts
who
ben
efit
from
a m
ore
supp
ortiv
e, s
ocia
l en
viro
nmen
t. 1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5 Fu
lly c
ompl
iant
with
goo
d to
be
st p
ract
ice
as in
dica
ted
by
qual
ity s
tate
men
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Aud
iolo
gy d
oes
not t
akes
a le
ad
role
in s
ettin
g up
mee
tings
with
an
y co
llect
ive
repr
esen
tativ
es
from
soc
ial w
ork;
vol
unta
ry
sect
or o
rgan
isat
ions
; loc
al
volu
ntee
r sch
emes
and
pat
ient
s.
Mee
ting
are
not f
orm
al, d
o no
t ha
ppen
qua
rterly
and
are
as o
f pl
anni
ng, d
evel
opm
ent,
deliv
ery
and
audi
t of s
ervi
ces
are
not
disc
usse
d.
Aud
iolo
gy ta
kes
a le
ad ro
le in
se
tting
up
mee
tings
with
co
llect
ive
repr
esen
tativ
es fr
om
soci
al w
ork;
vol
unta
ry s
ecto
r or
gani
satio
ns; l
ocal
vol
unte
er
sche
mes
and
pat
ient
s.
Form
al q
uarte
rly m
eetin
gs
take
pla
ce a
nd th
e pl
anni
ng,
deve
lopm
ent,
deliv
ery
and
audi
t of s
ervi
ces
is d
iscu
ssed
.
Evid
ence
M
inut
es o
f mee
tings
81
Crit
eria
8a.
2 - R
efer
ral t
o ot
her a
genc
ies
Qua
lity
Stat
emen
t rat
iona
le
Hav
ing
awar
enes
s of
and
app
ropr
iate
link
s to
spe
cial
ist a
udio
logi
cal s
ervi
ces
is m
ore
likel
y to
resu
lt in
the
hear
ing
and
com
mun
icat
ion
need
s of
pat
ient
s be
ing
met
. 1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5 Fu
lly c
ompl
iant
with
goo
d to
be
st p
ract
ice
as in
dica
ted
by
qual
ity s
tate
men
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
writ
ten
prot
ocol
s or
pr
oces
ses
are
in p
lace
to
supp
ort r
efer
ral t
o an
y ot
her
serv
ices
/ age
ncie
s.
Writ
ten
prot
ocol
s/pr
oces
ses
are
in p
lace
to s
uppo
rt re
ferr
al
to th
e fo
llow
ing
serv
ices
/ ag
enci
es: -
•
Soc
ial w
ork,
•
Vol
unte
er s
ervi
ces,
•
Vol
unta
ry o
rgan
isat
ions
, •
Loca
l NH
S m
enta
l hea
lth
serv
ices
, •
spec
ialis
t aud
iolo
gica
l and
•
othe
r hea
lth n
eeds
, suc
h as
, spe
ech
and
lang
uage
th
erap
y an
d fa
lls
prev
entio
n cl
inic
s.
Evid
ence
R
efer
ral p
roto
cols
82
Crit
eria
8a.
3 –
Aud
it of
mul
ti-pr
ofes
sion
al a
nd m
ulti-
agen
cy w
orki
ng
Qua
lity
Stat
emen
t rat
iona
le
Aw
aren
ess
of a
nd a
ppro
pria
te li
nks
to o
ther
hea
lth s
ervi
ces
is m
ore
likel
y to
resu
lt in
add
ition
al h
ealth
nee
ds o
f hea
ring
impa
ired
patie
nts
bein
g m
et.
1 N
o el
emen
ts o
f th
e qu
ality
st
atem
ent c
riter
ia a
re m
et (o
r no
t evi
dent
)
5 Fu
lly c
ompl
iant
with
goo
d to
be
st p
ract
ice
as in
dica
ted
by
qual
ity s
tate
men
t crit
eria
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Aud
it of
mul
ti-pr
ofes
sion
al
and
mul
ti-ag
ency
wor
king
is
not c
arrie
d ou
t.
Aud
it of
mul
ti-pr
ofes
sion
al a
nd
mul
ti- a
genc
y w
orki
ng is
ca
rrie
d ou
t ann
ually
and
in
clud
es th
e ta
ke u
p of
refe
rral
to
thes
e ag
enci
es.
The
Aud
iolo
gy L
ead
is a
war
e of
con
cern
s th
at a
rise
from
the
audi
t and
dis
cuss
es th
ese
with
ag
enci
es in
volv
ed b
efor
e de
velo
ping
pla
ns to
miti
gate
ar
eas
of c
once
rn.
Evid
ence
A
udit
outc
omes
P
lans
83
Stan
dard
9 –
Ser
vice
Effe
ctiv
enes
s 9a
Eac
h se
rvic
e ha
s pr
oces
ses
in p
lace
to m
easu
re s
ervi
ce q
ualit
y 9b
Eac
h se
rvic
e ha
s pr
oces
ses
in p
lace
to re
gula
rly c
onsu
lt w
ith p
atie
nts
and
stak
ehol
ders
. 9c
Eac
h se
rvic
e ha
s pr
oces
ses
in p
lace
to k
eep
up to
dat
e w
ith a
nd e
mpl
oy k
ey a
udio
logi
cal i
nnov
atio
ns.
Rat
ing
Scal
e
1
No
elem
ents
of
the
qual
ity s
tate
men
t crit
eria
ar
e m
et (o
r not
evi
dent
)
2
Few
ele
men
ts o
f the
qu
ality
sta
tem
ent c
riter
ia
are
met
3
Mee
t aro
und
half
of th
e el
emen
ts o
f the
qua
lity
stat
emen
t crit
eria
4
Alm
ost f
ully
mee
ts th
e qu
ality
sta
tem
ent c
riter
ia
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Ple
ase
use
the
ratin
g sc
ale
and
exam
ples
giv
en in
the
1 an
d 5
colu
mns
as
an in
dica
tor t
o he
lp y
ou s
core
the
self-
asse
ssm
ent t
able
bel
ow. E
ach
tabl
e sh
ould
onl
y ev
er
have
1 s
elf-a
sses
smen
t sco
re. W
hen
you
perc
eive
ther
e to
be
mor
e th
an 1
asp
ect o
f the
tabl
e th
at y
ou c
ould
giv
e a
scor
e fo
r, pl
ease
use
an
aver
age
of e
ach
of th
e as
pect
s.
Crit
eria
9a1
– P
atie
nt S
atis
fact
ion
Surv
eys
Qua
lity
Stat
emen
t rat
iona
le
Mea
sure
men
t of q
ualit
ativ
e an
d qu
antit
ativ
e da
ta h
elps
to in
form
ong
oing
ser
vice
impr
ovem
ent.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(o
r not
evi
dent
)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Pat
ient
s an
d si
gnifi
cant
ot
hers
are
not
enc
oura
ged
to c
ompl
ete
surv
eys
to
dete
rmin
e sa
tisfa
ctio
n w
ith
the
serv
ice.
Pat
ient
s an
d si
gnifi
cant
oth
ers
are
enco
urag
ed to
com
plet
e su
rvey
s on
at
leas
t an
annu
al b
asis
to d
eter
min
e sa
tisfa
ctio
n w
ith d
iffer
ent e
lem
ents
of
the
serv
ice
rece
ived
. The
se in
clud
e:
• ac
cess
ibilit
y,
• pr
oxim
ity,
36
An
exam
ple
of a
sur
vey
satis
fact
ion
ques
tionn
aire
use
d by
aud
iolo
gy s
ervi
ces
is li
sted
in a
ppen
dix
8.
84
• in
form
atio
n pr
ovis
ion,
•
prof
essi
onal
ism
of s
taff,
•
care
and
trea
tmen
t and
•
over
all s
ervi
ce re
ceiv
ed.
P
artic
ipat
ion
rate
s in
the
surv
ey a
re
chec
ked,
on
an a
nnua
l bas
is, t
o en
sure
an
acce
ptab
le p
ropo
rtion
of
patie
nts
have
par
ticip
ated
and
a
repr
esen
tativ
e sa
mpl
e of
the
loca
l po
pula
tion
is c
over
ed (i
nclu
ding
ge
nder
and
eth
nici
ty).
Suf
ficie
nt a
naly
sis
and
inte
rpre
tatio
n of
the
findi
ngs
from
sat
isfa
ctio
n su
rvey
s ar
e ca
rrie
d ou
t eac
h ye
ar b
y au
diol
ogy
serv
ices
. A
ctio
n pl
ans
are
impl
emen
ted,
whe
n ne
eded
, to
addr
ess
area
s of
con
cern
ar
isin
g fro
m s
urve
ys.36
Evid
ence
C
opie
s of
sur
veys
and
resp
onse
s A
ctio
n pl
ans
85
Crit
eria
9a.
2 - G
lasg
ow H
earin
g A
id B
enef
it Pr
ofile
Q
ualit
y St
atem
ent r
atio
nale
M
easu
rem
ent o
f qua
litat
ive
and
quan
titat
ive
data
hel
ps to
info
rm o
ngoi
ng s
ervi
ce im
prov
emen
t.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Ann
ual q
uant
itativ
e an
alys
is o
n th
e qu
ality
/effe
ctiv
enes
s of
the
serv
ice
is n
ot u
nder
take
n.
Ann
ual q
uant
itativ
e an
alys
is o
n th
e qu
ality
/effe
ctiv
enes
s of
the
serv
ice
is u
nder
take
n us
ing
GH
AB
P.
Evid
ence
G
HA
BP
revi
ews
86
Crit
eria
9b.
1-b.
2 -
Info
rmin
g an
d co
nsul
ting
with
pat
ient
s Q
ualit
y St
atem
ent r
atio
nale
A
udio
logy
ser
vice
s th
at s
eek,
con
side
r and
resp
ond
to th
e vi
ews
of u
sers
will
be
mor
e lik
ely
to m
eet t
he n
eeds
of t
heir
patie
nts.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to b
est
prac
tice
as in
dica
ted
by q
ualit
y st
atem
ent c
riter
ia
Sel
f ass
essm
ent
scor
e ba
sed
on
evid
ence
sou
rces
QA
vis
itor
scor
e an
d co
mm
ents
Act
ions
/ co
mm
ents
G
ood
prac
tice
exam
ple
Ther
e is
no
cons
ulta
tion
with
pa
tient
s an
d st
akeh
olde
rs.
Res
ults
from
sat
isfa
ctio
n su
rvey
s an
d se
rvic
e Q
RT
scor
es a
re n
ever
m
ade
avai
labl
e or
dis
cuss
ed w
ith
the
publ
ic.
The
audi
olog
y se
rvic
e ha
s a
fram
ewor
k in
pla
ce to
ens
ure
regu
lar c
onsu
ltatio
n w
ith p
atie
nts
and
stak
ehol
ders
. R
esul
ts o
f sat
isfa
ctio
n su
rvey
s an
d se
rvic
e Q
RT
scor
es a
re m
ade
avai
labl
e an
d di
scus
sed
with
pa
tient
s on
an
annu
al b
asis
.
Evid
ence
C
alen
dar o
f pla
nned
con
sulta
tion
even
ts
Pub
licat
ion
of re
sults
87
Crit
eria
9c.
1 –
Res
pons
ibili
ty fo
r ide
ntify
ing
new
tech
nolo
gies
Q
ualit
y St
atem
ent r
atio
nale
U
se o
f up
to d
ate
hear
ing
inst
rum
ent t
echn
olog
y is
inte
gral
to e
ffect
ive
serv
ice
deliv
ery
and
ongo
ing
impr
ovem
ent.
N
ew te
chno
logi
es m
ake
new
mod
els
of s
ervi
ce d
eliv
ery
poss
ible
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or
not e
vide
nt)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
an
d co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
No
one
in th
e au
diol
ogy
serv
ice
is re
spon
sibl
e fo
r ide
ntify
ing,
ap
prai
sing
, loc
al d
evel
opm
ent
or im
plem
entin
g ne
w
tech
nolo
gies
.
Ther
e is
a n
amed
lead
in
Aud
iolo
gy s
ervi
ces
with
re
spon
sibi
lity
for
coor
dina
ting
the
iden
tific
atio
n, a
ppra
isal
of
pote
ntia
l ben
efits
, loc
al
deve
lopm
ent a
nd
impl
emen
tatio
n of
new
te
chno
logi
es.
Evi
denc
e
88
Crit
eria
9c.
2 –
App
rais
al o
f new
tech
nolo
gies
Q
ualit
y St
atem
ent r
atio
nale
U
se o
f up
to d
ate
hear
ing
inst
rum
ent t
echn
olog
y is
inte
gral
to e
ffect
ive
serv
ice
deliv
ery
and
ongo
ing
impr
ovem
ent.
N
ew te
chno
logi
es m
ake
new
mod
els
of s
ervi
ce d
eliv
ery
poss
ible
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Nat
iona
l mee
tings
are
not
hel
d by
au
diol
ogy
serv
ices
to a
ppra
ise
new
na
tiona
l/int
erna
tiona
l tec
hnol
ogy
deve
lopm
ents
.
Reg
ular
, nat
iona
l mee
tings
ar
e he
ld b
y au
diol
ogy
serv
ices
to a
ppra
ise
new
na
tiona
l/int
erna
tiona
l te
chno
logy
dev
elop
men
ts.
Mee
tings
incl
ude
evid
ence
fro
m p
ilots
/tria
ls w
here
the
new
tech
nolo
gy h
as b
een
test
ed.
The
anal
ysis
incl
udes
the
pote
ntia
l pat
ient
ben
efit
and
the
impa
ct th
e te
chno
logy
co
uld
have
on
wor
kfor
ce a
nd
serv
ice
deliv
ery.
Evi
denc
e
89
Crit
eria
9c.
3 –
Impl
emen
tatio
n of
new
tech
nolo
gies
Q
ualit
y St
atem
ent r
atio
nale
U
se o
f up
to d
ate
hear
ing
inst
rum
ent t
echn
olog
y is
inte
gral
to e
ffect
ive
serv
ice
deliv
ery
and
ongo
ing
impr
ovem
ent.
N
ew te
chno
logi
es m
ake
new
mod
els
of s
ervi
ce d
eliv
ery
poss
ible
.
1
No
elem
ents
of
the
qual
ity
stat
emen
t crit
eria
are
met
(or n
ot
evid
ent)
5
Fully
com
plia
nt w
ith g
ood
to
best
pra
ctic
e as
indi
cate
d by
qu
ality
sta
tem
ent c
riter
ia
Sel
f ass
essm
ent s
core
ba
sed
on e
vide
nce
sour
ces
QA
vis
itor s
core
and
co
mm
ents
A
ctio
ns /
com
men
ts
Goo
d pr
actic
e ex
ampl
e
Dep
artm
ents
can
not d
emon
stra
te
any
bene
fit to
pat
ient
s fro
m u
sing
ne
w te
chno
logy
and
new
ly –
im
plem
ente
d te
chno
logy
is n
ever
m
onito
red.
Whe
n ne
w te
chno
logy
is
impl
emen
ted,
dep
artm
ents
sh
ould
be
able
to
dem
onst
rate
tang
ible
be
nefit
s to
pat
ient
s an
d sh
ould
con
tinua
lly m
onito
r ne
wly
- im
plem
ente
d te
chno
logy
.
Evi
denc
e
90
App
endi
ces
App
endi
x 1
Gro
up M
embe
rshi
p N
ame
Rol
e
R
epre
sent
ing
Ada
m B
eckm
an
Hea
d of
Aud
iolo
gy S
ervi
ces
B
ritis
h A
cade
my
of A
udio
logy
P
lym
outh
Hos
pita
ls N
HS
Tru
st
Ang
ela
Bon
omy
Nat
iona
l Aud
iolo
gy M
anag
er
NH
S S
cotla
nd
Kat
y B
ullo
ck
P
ublic
Par
tner
ship
Offi
cer
N
HS
Qua
lity
Impr
ovem
ent S
cotla
nd
Adr
ian
Car
ragh
er
Hea
d of
Aud
iolo
gy
NH
S A
yrsh
ire &
Arr
an
Adr
ian
Dav
is
D
irect
or
M
RC
Hea
ring
and
Com
mun
icat
ion
Gro
up
Hug
h D
avis
Con
sulta
nt
M
RC
Hea
ring
and
Com
mun
icat
ion
Gro
up
John
Day
Aud
iolo
gist
Wel
sh A
ssem
bly
Gov
ernm
ent
Jo E
dwar
ds
Le
ctur
er in
Aud
iolo
gy
Q
ueen
Mar
gare
t Uni
vers
ity
Mar
tin E
vans
Con
sulta
nt
M
RC
Hea
ring
and
Com
mun
icat
ion
Gro
up
Ther
esa
Fail
Dep
artm
ent o
f Hea
lth
Del
ia H
enry
Dire
ctor
RN
ID S
cotla
nd
Phi
l Hol
t
Sen
ior A
udio
logi
st
MR
C H
earin
g an
d C
omm
unic
atio
n G
roup
M
aria
n H
oyle
S
enio
r Lec
ture
r in
Aud
iolo
gy
Bris
tol U
nive
rsity
B
ill M
cKer
row
E
NT
Con
sulta
nt
NH
S H
ighl
and
Kar
en S
heph
erd
Aud
iolo
gica
l Ser
vice
s M
anag
er
Orm
erod
s P
aulin
e S
mith
A
udio
logi
st
B
ritis
h A
cade
my
of A
udio
logy
K
evin
Wyk
e
Ass
ista
nt D
irect
or
NH
S N
orth
Wes
t
91
Appendix 2: Evidence Base Standard 1 Designed for Life: a new strategy for health and social care in Wales. In May 2005, the Welsh Assembly Government. Standard 2 Benefits of Good Communication: Reese JL. Hnath-Chisolm T. Recognition of hearing aid orientation content by first-time users. American Journal of Audiology. 2005 Jun; 14(1): 94-104. Alywahby NF. Principles of teaching for individual learning of older adults. Rehabilitation Nursing. 1989 Nov-Dec; 14(6): 330-3. Greenberg PB. Walker C. Buchbinder R. Optimising communication between consumers and clinicians. Medical Journal of Australia. Vol. 185(5)(pp 246-247), 2006. Harris M. RNID for deaf and hard of hearing people: a simple cure. Working with Older People. 2005 Jun; 9(2): 37-9. Iezzoni LI. O'Day BL. Killeen M. Harker H. Improving patient care. Communicating about health care: observations from persons who are deaf or hard of hearing. Annals of Internal Medicine. 2004 Mar 2; 140(5): 356-62, I-68 Harris M. Bayer A. Tadd W. Addressing the information needs of older patients. Reviews in Clinical Gerontology. 2002 Feb; 12(1): 5-11. DiSarno NJ. Informing the older consumer -- a model. Hearing Journal. 1997 Oct; 50(10): 49, 52. Information strategy older people, Department of Health, March 2002. Hines, J (2000) Communication problems of hearing-impaired patients. Nurs Stand. 14(19):33-7 Features of Effective Information: Toolkit for producing patient information, Department of Health, 2003. www.nhsidentity.nhs.uk/patientinformationtoolkit/patientinformationtoolkit.pdf EXTRACT: “Patients with hearing difficulties: Use written information.”
92
Measures to Avoid Discrimination: Disability Discrimination Act, 1995. ‘You Can Make a Difference’ – Improving hospital and primary care services for disabled people. Guidance from the Disability Rights Commission & Department of Health, June 2004. www.dh.gov.uk/publications Living well in later life - A review of progress against the National Service Framework for Older People, Department of Health, March 2006. Participation of Significant Others: Preminger, Jill E. Should significant others be encouraged to join adult group audiologic rehabilitation classes?. Journal of the American Academy of Audiology. 14(10):545-55, 2003 Dec. University of Louisville School of Medicine, Program in Audiology, Louisville, KY 40292, USA. Standard 3 British Society of Audiology (BSA) Procedure: Pure tone air and bone conduction threshold audiometry with and without masking and determination of uncomfortable loudness levels (2004). ISO 8253-1:1989 Acoustics. Audiometric test methods - Part 1: Basic pure tone air and bone conduction threshold audiometry. Standard 4 Kochkin S. (1999) Reducing hearing instrument returns with consumer education. Hear Rev. 6(10):18-20. Fully Equipped (2002). Assisting independence. Audit Commission Wilson, C, Stevens, D (2003) Reasons for referral and attitudes toward hearing aids: do they affect outcome? Clin Otolaryngol Allied Sci, 21(2): 142-6 Stevens, D (1996) Hearing rehabilitation in a psychosocial framework. Scand Audiol Suppl. 43:57-66 Stevenson, G (2006) Informed consent. J Perioper Pract. 16(8):384-8 Hagihara, A, Odamaki, M, Nobutomo, K, Tarumi, K (2006) Physician and patient perceptions of the physician explanations in medical encounters. J Health Psychol, 11(1):91-105 Greene, MG, Adelman, RD, Friedmann, E, Charon, R (1994) Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med. 38(9):1279-88 McCarthy, PA, Montgomery, AA, Mueller, HG (1990) Decision making in rehabilitative audiology. J Am Acad Audiol. 1(1):23-30
93
Standard 5 Souza, PE, Yueh, B, Sarubbi, M, Loovis, CF (2000) Fitting hearing aids with the Articulation Index: impact on hearing aid effectiveness. J Rehabil Res Dev. 37(4):473-81 Gatehouse, S, Stephens, SDG, Davis, AC, Bamford, J (2003) Good Practice Guidance for Adult Hearing Aid Fittings and Services. Needs Assessment Report on NHS Audiology Services in Scotland. Appendix 5 British Society of Audiology & British Academy of Audiology: Guidance on the use of real ear measurement to verify the fitting of digital signal processing hearing aids (2007).Guidelines for the Audiological Management of Adult Hearing Impairment. (Audiology Today, Vol 18:5, 2006) Hawkins DB. (1987) Clinical ear canal probe tube measurements. Ear Hear 8(Suppl. 5):74S-81S. Hawkins DB, Alvarez E, Houlihan J. (1991) Reliability of three types of probe tube microphone measurements. Hear Instrum 42:14-16. Hawkins DB, Montgomery A, Prosek R, Walden B. (1987) Examination of two issues concerning functional gain measurements. J Speech Hear Disord 52:56-63. Humes L, Kim E. (1990) The reliability of functional gain. J Speech Hear Res 55:193-197. Stuart A, Durieus-Smith A, Stenstrom R. (1990) Critical differences in aided sound-field thresholds in children. J Speech Hear Res 33:612-615. Fully Equipped (2002). Assisting independence. Audit Commission Improving Access to Audiology Services in England (2007). Dept of Health Best Practice Standards for Adult Audiology. (2001) RNID Pilot Study: Efficacy of Recalling Adult Hearing Aid Users for Reassessment after 3 Years within a Publicly-Funded Audiology Service – accepted for publication by IJA, October 2008 Bilateral Amplification: Noble, W. & Gatehouse, S. 2006. Effects of bilateral versus unilateral hearing aid fitting on abilities measured by the Speech, Spatial, and Qualities of Hearing Scale (SSQ). International Journal of Audiology. 45, 172-181. Mencher, G.T. and Davis, A. 2006. Bilateral or unilateral amplification: Is there a difference? A brief tutorial. International Journal of Audiology. 45 (Supplement 1): S3-S11. Dillon H, 2001. Hearing Aids. Boomerang Press: Turramurra, Australia p370-403 Standard 6
94
Chisholm, TH, Abrams, AB, McArdle, R (2004) Short and long-term outcomes of adult audiological rehabilitation. Ear Hear. 25(5): 414-77 Cox R, Alexander G. (1995) The Abbreviated Profile of Hearing Aid Benefit. Ear Hear 16:176- 186. Cox, R.M., and Alexander, G.C. “The International Outcome Inventory for Hearing Aids (IOI-HA): psychometric properties of the English version.” International Journal of Aud. 41(1): 30-35 (2002). Dillon H, James A, Ginis J. (1997) The client oriented scale of improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. J Am Acad Audiol 8:27-43. Gatehouse S. (1999) The Glasgow hearing aid benefit profile: derivation and validation of a patient-centered outcome measure for hearing aid services. J Am Acad Audiol 10:80-103 Gatehouse, S (1999) A self-report outcome measure for the evaluation of hearing aid fittings and services. Health Bull. (Edinb). 57(6):424-36 Gatehouse, S (2003) Rehabilitation: identification of needs, priorities and expectations, and the evaluation of benefit. Int J Audiol. 42 Suppt 2:2S77-83. Review Dillon, H, James, A, Ginis, J (1997) Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. J Am Acad Audiol. 8(1):27-43 Saunders GH, Jutai, JW (2004) Hearing specific and generic measures of psychosocial impact of hearing aids. J Am Acad Audiol. 15(3):238-48 Stark, P, Hickson, L (2004) Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. Int J Audiol. 43(7):390-8 Valente et al (2005) Ventry I, Weinstein B. (1982) The hearing handicap inventory for the elderly: a new tool. Ear Hear 3:128-134. Standard 7 Fully Equipped (2002). Assisting independence. Audit Commission HPC – Standards of Proficiency of registered Practitoners - http://www.hpc-uk.org/publications/standards/index.asp?id=42 Scottish Consumer Council (2005) The NHS and You. Health Rights Information Scotland Leaflet.
95
Department of Health (2004) The NHS Knowledge and Skills Framework and the Development Review Process. Department of Health Publications. Standard 8 Group Interventions/peer support/sharing experiences: D.B. Hawkins. Effectiveness of counseling-based adult group aural rehabilitation programs: A systematic review of the evidence. Journal of the American Academy of Audiology. Vol. 16(7)(pp 485-493), 2005. Dr. D.B. Hawkins, Audiology Section, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224; United States. Chisolm TH. Abrams HB. McArdle R. Short- and long-term outcomes of adult audiological rehabilitation. Ear & Hearing. Vol. 25(5)(pp 464-477), 2004. T.H. Chisolm, University of South Florida, Commun. Sci. and Disorders PCD1017, 4202 E. Fowler Avenue, Tampa, FL 33620; United States. Preminger, Jill E. Should significant others be encouraged to join adult group audiologic rehabilitation classes?. Journal of the American Academy of Audiology. 14(10):545-55, 2003 Dec. University of Louisville School of Medicine, Program in Audiology, Louisville, KY 40292, USA. Brewer DM Considerations in measuring effectiveness of group audiologic rehabilitation classes. Journal of the Academy of Rehabilitative Audiology. 2001; 34 53-60. Associate Professor, Speech and Hearing Science, George Washington University, 2201 G St NW, Room 421, Washington DC 20052 Lesner SA. Thomas-Frank S. Klingler MS. Assessment of the effectiveness of an adult audiologic rehabilitation program using a knowledge-based test and a measure of hearing aid satisfaction. Journal of the Academy of Rehabilitative Audiology. 2001; 34 29-39. Professor, School of Speech-Language Pathology and Audiology, University of Akron, Akron, Ohio J. Abrahamson, Olin E. Group audiologic rehabilitation. Seminars in Hearing. Vol. 21(3)(pp 227-233), 2000. Teague Veterans' Center, Temple, TX 76504; United States K S. Taylor, W E. Jurma. Study suggests that group rehabilitation increases benefit of hearing aid fittings. The Hearing Journal 1999 Vol. 52 No. 9. Service User Groups: Dibb B, Yardley L How does social comparison within a self-help group influence adjustment to chronic illness? A longitudinal study. Social Science & Medicine. Vol. 63(6)(pp 1602-1613), 2006. University of Southampton, Southampton, Hampshire SO17 1BJ; United Kingdom. Krajnc S. Krajnc M.The impact of a community-based self-help group for the elderly on their quality of life [Slovene]. Obzornik Zdravstvene Nege. 2005; 39(3): 221-7
96
Volunteer Schemes: Kapteyn, T S. Wijkel, D. Hackenitz, E. The effects of involvement of the general practitioner and guidance of the hearing impaired on hearing-aid use. British Journal of Audiology. 31(6):399-407, 1997 Dec. Department of Otorhinolaryngology, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands. Carson AJ. Evaluation of the To Hear Again Project. Journal of Speech-Language Pathology and Audiology. 1997 Sep; 21(3): 160-6. University of British Columbia, School of Audiology and Speech Sciences, 5804 Fairview Avenue, Vancouver, BC V6T 1Z3, Dahl MO. To Hear Again: a volunteer program in hearing health care for hard-of-hearing seniors. Journal of Speech-Language Pathology and Audiology. 1997 Sep; 21(3): 153-9. Western Institute for the Deaf and Hard of Hearing, Vancouver, British Columbia. Faulkner, Mark (1); Davies, Sue (2). Social support in the healthcare setting: the role of volunteers. Health & Social Care in the Community. 13(1):38-45, January 2005. (1)Department of Community Ageing Rehabilitation, Education and Research, University of Sheffield, Rotherham, UK (2)Department of Community Ageing Rehabilitation, Education and Research, The University of Sheffield, Sheffield, UK. Welsh Assembly Government (2002) Building Strong Bridges: Strengthening partnership working between the Voluntary Sector and the NHS in Wales. Cardiff: Welsh Assembly Government Seeking the Views of Service Users: Welsh Assembly Government and OPM. 2003, Signposts 2: Putting Public and Patient Involvement into Practice in Wales. Cardiff. Welsh Assembly Government Joint Working: National Service Framework for Older People in Wales. March 2006. Welsh Assembly Government, Cardiff. Audit Commission Report ‘Fully Equipped’: the provision of equipment to older or disabled people by the NHS and social services in England and Wales 2000, para 137-138. Nies, Henk Managing effective partnerships in older people's services. Health & Social Care in the Community. 14(5):391-399, September 2006. Division on Care, NIZW/Netherlands Institute for Care and Welfare, Utrecht, the Netherlands Lyon D. Miller J. Pine K. The Castlefields Integrated Care Model: the evidence summarised. Journal of Integrated Care. 2006 Feb; 14(1): 7-12. GP, Castlefields Health Centre, Runcorn. Brown L. Tucker C. Domokos T. Evaluating the impact of integrated health and social care teams on older people living in the community. Health and Social Care in the Community. 2003 Mar; 11(2): 85-94 Standard 9
97
. Appendix 3: The Individual Management Plan (IMP)
A Usable Interpretation of Individual Management Plans within Adult Rehabilitation
Questions and Answers
What is an Individual Management Plan? Individual Management Plans are a set of agreed needs and actions that aim to improve a person's participation in life by reducing the disabling effects of a hearing impairment. When first developed it will be a list of the needs you and the patient have agreed need to be addressed and a list of the actions you are going to take in an attempt to address these needs. Who has them? They will probably be developed for all patients entering a new care pathway. These may be patients who have accessed audiology services before (audio reviews) or they may be new patients (Direct Referrals or ENT HA referrals). Who develops them? The Audiologist and patient will develop the Plan together using the information gathered during the assessment and following explanation and discussion about the care options. A list of agreed needs and actions will be recorded. A copy will be given to the patient as part of their information booklet. What do they look like? Initially you will develop and record the needs and actions
And then as you begin to deliver the Plan you will add:
What do you mean 'agreed needs'? What is it that you and the patient have agreed that needs to be addressed or managed or rehabilitated. This will be based on in-depth history, discussion, hearing impairment, condition of ext/ME, expectations etc. They will be broad statements of need but will be specific to an individual
Management Plan Agreed Needs: a list of the issues that you and the patient have agreed need to be addressed/managed/rehabilitated Actions: a list of the actions you going to do or what are you going to ask somebody else to do to actually attempt to meet these needs
Completed Actions: a list of the actions you actually do at each stage Outcomes: a summary of the effects of the actions – have they met needs
98
What do you mean 'actions'? What are you going to do or what are you going to ask somebody else to do to actually attempt to meet these needs. They will be specific and directive, probably written in the future tense and attached or relevant to one or more of the needs.
What do you mean 'completed actions'? These are the actions you (or other audiologists/agencies) actually do at each stage (as opposed to plan to do). They will be directly linked to actions (very similar) and probably written in past tense.
What do you mean 'outcomes'? These will be a summary of the effects of actions and will enable you to evaluate if the actions have met the needs? Ideally these will be supported by a more formal overall outcome measure. They will be linked to needs and may often reference specific actions. They will probably be written in the present tense.
Action: Take new impression of right ear and order earmould made from softer material Completed Action: Took new impression of RT ear (2108 microflex) and arranged for fitting appointment
Examples: • Improve comfort of ear mould • Better understand the effects and implications of sensorineural HL • Investigate conductive hearing loss • Improve hearing for speech in noisy environments • Improve patients confidence in group social situations
Examples: Need: Improve comfort of ear mould Possible actions you may decide upon:
• File and polish earmould to remove uncomfortable ridge • Take new impression of right ear and order replacement ear mould • Take new impression of right ear and order earmould made from softer
material • Guide patient on correct insertion of ear mould and provide written
99
When is a management plan completed and how do we record this? The management plan is complete when there are no outstanding actions and when outcomes indicate that needs have been met. 'Management plan complete' will be added as a final statement to the bottom of the management plan and the patient will be discharged to maintenance and support services. You need to consider how you include outcomes or effects of referral to external agencies that may not have been delivered at final follow up appointments. What happens then? Some patients will then be discharged to the maintenance and support services where they are able to access audiology for repairs and maintenance and can self refer for reassessment (at this point they would re-enter a new care pathway and would have a new management plan developed).
Need: Improve comfort of ear mould Action: Take new impression of right ear and order earmould made from softer material Completed Action: Took new impression of RT ear (2108 microflex) and arranged for fitting appointment Outcome: New earmould good fit and patient reports softer material much more comfortable than previous earmoulds.
100
Audiology Adult Rehab Patient Pathway
Green - Currently within service Red - Development of Service
dix 5: List of useful we Appendix 3: The Individual Ma
STAGE 1 ASSESSMENT
Aim: Measure any hearing impairment and establish effects on
the participation in life situations
STAGE 4 EVALUATION I Aim: Evaluate the effect of
rehabilitation on an individual's participation in life situations
STAGE 3 REHABILITATION Aim: Implement Rehabilitation
Plan
STAGE 2 MANAGEMENT
PLAN Aim: Devise a plan of rehabilitation with the
objective of minimizing effects on participation
STAGE 5 GROUP
REHABILITATION Aim: Provide additional
rehabilitation and support
Discuss rehabilitation and amplification options Develop and record management plan based on comprehensive assessment
Develop first stage of information pack including copy of Plan to patient
Informal communication abilities and speech discrim PTA Structured recorded history following checklist GHABP ECHO Expectations questionnaire
MEASURE IMPAIRMENT
MEASURE EFFECT ON PARTICIPATION
MEASURE EXPECTATIONS & REQUIREMENTS
Provide and facilitate rehabilitation to meet needs and actions stated in management plan
To include provision of appropriate amplification (fit and verify) where appropriate Support in written form adding to information
Informal evaluation during communication Data-logging GHABP/GHADP II Identify need for further rehab
o Amend Management Plan
MEASURE EFFECT ON PARTICIPATION
MEASURE EXPECTATIONS & REQUIREMENTS
Direct access to peer support Counselling on longer term rehab issues Direct access to service feedback mechanism Demonstration of ALDs and
consideration for fitting Information in relation to wider
community support (local and national volunteer service
STAGE 7 MAINTENANCE,
SUPPORT, REVIEW & EVALUATION III
Aim: Ensure that the aims of rehabilitation are continued
Repair and Maintenance Service Access to full services as requested Postal or telephone questionnaire or 1year
follow up (30 mins) Periodic review (3-5-year - pilot) Ongoing peer support Service user feedback Measures of service satisfaction Evaluation of use
o Batteries o Re-tube
Beginning of Care Pathway
End of Care Pathway
STAGE 6 Evaluation II Telephone FU
Aim: Further evaluate the effects of rehabilitation
Conduct telephone FU Relate to IMP needs Repeat questionnaire (GHABP/GHADP part II or HHI) Action any outstanding needs
Appendix 4: Adult Rehabilitation Patient Pathway An Example of How the Individual Management Plan Fits within an
Audiology Adult Rehabilitation Patient Pathway
101
Appendix 5: Example of an Individual Management Plan (IMP) CASE 1 - Journal entry including Individual Management Plan Direct Referral History – Service User reported: General Service User attended alone. Self referred via GP. Main difficulties hearing at work over last 12 months. Physical Vision corrected with glasses Mobility and dexterity good Social Lives with wife and two teenage sons. No problems with hearing telephone ring or callers at door. Tend to shop and bank on-line so no recent problems hearing for these scenarios. Alarm clock and smoke alarm OK Employment Fitter by trade - worked on shop floor for 15+ years - no problems. Recently promoted to supervisor - job now involves: training/presenting, management meetings, Q&A sessions with people he supervises/line manages. Hearing problems seem to be mainly at work and since change in role. Management meetings of about 12 people around table - people vary and sometimes struggles. Monday morning meetings with staff are difficult - poor env and lots of people talking/asking questions at once. Problematic as people used to be friends and concerned they think he's changed since promotion. Training sessions in lecture theatre difficult. Has to go back and pass on info and worried he's not understood properly Lifestyle and associated hearing disabilities Mainly socialises with family. No signif problem - family tend to understand and adapt. Enjoys attending concerts about 6/year. Goes with same group of friends. Used to go to pub after but struggling more in this environment recently and tending to go straight home. Medical Sudden/progressive: had minor difficulties for a long time (?since childhood). Seems to have become worse since change in job but really only at work and with unfamiliar groups of people. No real change at home. Asymmetric: no Fluctuating: no Otalgia/ME pathology/surgery: no Ext ear pathology/irritation: no Tinnitus: yes - bilaterally all the time but doesn't notice if busy or distracted. Sometimes keeps awake at night or there if wakes up at night. Recognises it may be linked to 'worry/stress'. Rotational vertigo: no Family History: dad wore HA since middle age Noise exposure: at work but wore hearing protection. At concerts (~6/year) Head Injury: no General Health: well
102
Expectations Expects to be told he has a hearing loss but hopes hearing can be improved (surgery/medication). See ECHO for further details. Otoscopy NAD Audiometry Mild mid freq SN HL Questionnaires GHABP complete What are the scores? ECHO scores What is the scale here? Is 6.0 high? Scores Average Overall 5.3 Sub Scale Positive effect 6.0 Service and cost 5.5 Negative Features 5.0 Personal Image 4.7 Management Plan Agreed needs: Improve ability to hear colleagues when at training sessions; management meetings and Monday morning meetings at work. Build confidence in hearing ability so that you can begin to go out socially with music friends again. Manage expectations about hearing aid use. Reduce the negative impact of tinnitus. Planned Actions: Trial bilateral digital hearing aids with directional programme. Refer to voluntary sector employment advisor for support within workplace. Complete tinnitus handicap inventory and consider referral to hearing therapist following trial of hearing aid. Provide verbal and written information about the potential benefits and limitations of hearing aids Completed Actions: Took bilateral impressions and arranged hearing aid fitting appointment. Completed tinnitus handicap inventory. Referred to RNID employment advisor. Discussed expectations, benefits and limitations of hearing aids. Supported by written info in blue book. Information booklet Given to patient.
Final Follow Up Copy of Management Plan Agreed needs: Improve ability to hear colleagues when at training sessions; management meetings and Monday morning meetings at work. Build confidence in hearing ability so that you can begin to go out socially with music friends again. Manage expectations about hearing aid use. Reduce the negative impact of tinnitus.
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Planned Actions: Trial bilateral digital hearing aids with directional programme. Refer to RNID employment advisor for support within workplace. Complete tinnitus handicap inventory and consider referral to hearing therapist following trial of hearing aid. Provide verbal and written information about the potential benefits and limitations of hearing aids Completed Actions: Took bilateral impressions and arranged hearing aid fitting appointment. Completed tinnitus handicap inventory. Referred to voluntary sector employment advisor. Discussed expectations, benefits and limitations of hearing aids. Supported by written info in blue book. Fitted bilateral hearing aids with dir prog; added further written info to booklet; discussed expectations further; hearing therapy appt arranged; voluntary sector employment advisor has made contact with pt. Tinnitus advice and information provided by hearing therapist. Activated telecoil prog bilaterally; voluntary sector employment advisor has visited work place and advised;. Outcomes: Hearing in most situations has improved as has confidence in hearing ability. Location for Monday morning meetings changed and now managing well. Unable to evaluate full benefit in training centre at work yet - telecoils activated today - good benefit during training sessions at work using loop system; now meeting friends in local pub regularly; information about HL and tinnitus and increased confidence in hearing at work has reduced stress and negative impact of tinnitus. Pt has a positive and realistic approach to hearing aid use and benefit. Supported by GHABP Management plan complete People present at appt Pt attended alone Service User reports Continuing to use both hearing aids regularly. Slightly more use out of work than at previous FU. EM no longer causing discomfort Data logging Data logging supports patient reports
Hearing Aid Adjustments
1.1.1 R - none
1.1.2 L - none Other rehabilitation comments Discussed longer term management of hearing aids and access to services. Gave further written info to support this for pt information booklet. GHABP parts 1&2 % raw score % raw score Initial disability 59 Residual Disability 6 Handicap 75 Benefit 72 Use 88 Satisfaction 84 Service satisfaction questionnaire completed and given to reception
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Appendix 6: List of useful websites www.baaudiology.org www.dh.gov.uk www.mrchear.man.ac.uk www.nhshealthquality.org www.phis.org.uk www.rnid.org.uk www.scotland.gov.uk www.thebsa.org.uk www.18weeks.scot.nhs.uk http://www.vds.org.uk/tabid/232/Default.aspx http://iiv.investinginvolunteers.org.uk/
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Appendix 7 – Glossary
• Higher Frequency sounds-are high in pitch, like the right hand end of a piano, or a violin rather than the left hand end of a piano or a double bass.
• Lower frequency sounds- are low in pitch, like the left hand end of a piano, or a double bass rather than the right hand end of a piano or a violin.
• Threshold of hearing-the lowest intensity of sound that a person can detect, measured using a standard procedure and usually at a range of pure tones at various frequencies.
• Thresholds of uncomfortable loudness-the lowest intensity of sound that a person finds uncomfortably loud, measured using a standard procedure and usually at a range of pure tones at various frequencies.
• Dynamic range-the difference between threshold of hearing and uncomfortable loudness level.
• Reduced dynamic range- usually occurs when threshold of hearing is poor, but threshold of uncomfortable loudness is normal.
• Air conduction testing- threshold of hearing measured with earphones that sit over the ears. The sound therefore passes through the outer, middle and inner ear.
• Bone conduction testing- threshold of hearing measured with a bone vibrator sitting on the bone (mastoid process) behind the ear. The sound therefore bypasses the outer and middle parts of the ear, and goes directly to the inner ear.
• Sensorineural- a type of hearing loss caused by damage in the inner ear or auditory nerve, rather than in the middle ear.
• Potentiometer- A piece of electronic circuitry which can be physically altered to alter the characteristics of the circuit, e.g. the amount of amplification at high frequencies.
• DSP Digital Signal Processing. A means by which computer programming can alter the characteristics of the circuit, e.g. the amount of amplification at a particular frequency in a hearing aid.
• Compression. When the range of intensities of sound that are audible and comfortable to a normally hearing listener are “squashed” into a smaller range for a hearing impaired listener.
• Compression characteristics. Ways of defining how much, and how quickly a normal range of sounds are “squashed”
• Acoustical characteristics. Ways of defining a sound, or the way a sound is processed.
• Tympanometry. A test whereby a small tip sits in the outer part of the ear canal and measurements are made of the moving parts of the middle ear.
• Real ear measurement. When a thin tube, connected to a microphone, is inserted into the patient’s ear canal, enabling measurements of sound to be made from within the ear canal. These measurements are usually made both with, and without a hearing aid in place, in order to measure exactly what the hearing aid is doing.
• Hearing Impairment- When hearing is below that defined as normal. There are defined levels of severity of hearing impairment (mild, moderate, severe, profound) based on pure tone threshold measurement.
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• Deaf- Usually profound hearing impairment, people who refer to themselves as Deaf (with a capital D) regard deafness as a way of life rather than a disability.
• Deafblind- a person has a combination of hearing and visual impairment, and is therefore unable to use one to compensate for the other.
• Deafened - a person who loses their hearing (or acquires a hearing impairment), as opposed to a person who is born with impaired hearing
• CPD Continuing Professional Development. Ongoing education and training for a registered professional, usually as part of a structured scheme, by which they maintain clinical competence.
• Review – an appointment at which the patient’s rehabilitative needs are reassessed and their IMP recommences. Basic hearing aid repairs (maintenance) or straightforward replacement of faulty hearing aids do not constitute a review although they may highlight the need for one to be arranged.
● Audiovestibular medicine - The medical specialty concerned with the investigation, diagnosis and management of adults and children with disorders of balance, hearing, tinnitus, and auditory communication - including speech and language disorders in children.
• COSI Client Oriented Scale of Improvement. A validated interview tool to measure listening needs at assessment and outcomes after intervention, see Dillon et al 1997.
• GHABP Glasgow Hearing Aid Benefit profile. A validated interview tool to measure initial disability and handicap at first assessment, followed by use of hearing aids, benefit and satisfaction with hearing aids and residual disability at follow up. See Gatehouse, 1999.
• GHADP Glasgow Hearing Aid Difference profile. A validated interview tool to measure use of existing hearing aids and disability at re-assessment, followed by use of hearing aids, and comparative disability, benefit and satisfaction with new hearing aids at follow up. See Gatehouse, 1999
• IOI-HA International Outcome Inventory for Hearing aids. A validated questionnaire, available in many different international languages, to measure outcomes after intervention with hearing aids. See Cox and Alexander, 2002.
Appendix 8 – AASSQ Adult Audiology Service Satisfaction Questionnaire
Please complete the questionnaire below to help us improve Audiology services. Indicate your level of satisfaction for each item with a tick. Please base your responses on all of the appointments you have received over the last few months.
Overall, how satisfied are you with:
Very
satisfied Satisfied Somewhat
Dissatisfied Very
dissatisfied Accessibility Your experience communicating with the Audiology Service?
The time you waited for your appointments?
The time you waited at your appointments?
The location of your appointments? (How accessible from your home)
The postal hearing aid repair and battery replacement service?
Surroundings The signage directing you to the Audiology department?
Your welcome at reception?
The appearance of the waiting room?
The appearance of the clinic rooms?
The comfort of the clinic rooms?
Information The information you received with the appointment letters?
The written information you received at your appointments?
The information in the waiting room?
Staff The professionalism of the reception staff?
The professionalism of the audiologist?
Care & Treatment The opportunities to discuss any problems or difficulties?
Any explanations you were given?
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The assessment and management of your hearing needs?
The appropriate involvement of your significant other?
Overall The audiology service you received?
Please state below one improvement you would make to the Audiology Service or please add any comments?
Section below for completion by Audiology staff: Clinic ________________________________________________ Date ______________ Type of Appointment _________________________________________________________ Comments:
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© Crown copyright 2009
This document is also available on the Scottish Government website:www.scotland.gov.uk
RR Donnelley B60164 04/09
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QualityStandards for Adult HearingRehabilitation Services