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Best practice, or bloat?


In an age where differentiation through best practice competes with value for money propositions, what path should we follow in our own practices? Should we be aiming to blaze a trail by “doing more” in an attempt to set ourselves apart from other providers? Or should we be looking to streamline our models to remain competitive on price?

As hearing care develops in the years to come each of us will encounter new research and new ideas on what should or shouldn't be included in “best practice”.

But there is a temptation with best practice to include anything and everything, to confuse doing more with real world benefits significant enough to justify the cost implications to the person paying for the service – whether that's a patient, a consumer or a third party.

Is enough ever enough?

Just like the concept of "excellent service" or "continuing professional development", when is enough enough?

So these guidelines have been formulated to keep the focus on measurable benefit and relevance to the end user. It will help you decide whether something is truly "blazing a trail or bloating to fail".

Striking the right balance

Getting the right balance for best practice is like taking a suitcase on a flight.

On the one hand we have everything that we want to include in our suitcase, and on the other hand there are the restrictions placed on us by the flight operator. Try to add too much, and we're denied the chance to get to where we want to be. Likewise in hearing care, we have to strike a balance between what we want to include within our proposition, and the restrictions placed on us by consumer expectations— including expectations of cost, effort and time.

So here are some guidelines for getting the balance right.

Step 1: Draw up a shortlist

Draw up a shortlist of activities that you might include as part of your standard client experience or patient journey or protocol for "best practice". This list might be drawn up from articles you have read, training/presentations you have attended, focus group panels, or discussions with other hearing care professionals.

Step 2: Justify each activity

For each activity being considered within your shortlist, ask:

  1. What is the evidence for this particular activity? And is that evidence current, or has new technology, knowledge, or practice replaced the effective need for the activity?
  2. How does the information gained by this activity change the prescription, fitting or rehabilitation? In other words, if you didn't do it, would anyone notice any difference?
  3. Could you have gained that same information or benefit by something simpler, quicker or less expensive to implement? How reliable and repeatable is it?
  4. Which patients/clients should it apply to? Can you provide guidelines to others as to when to use it?
  5. How does the real world benefit of this activity manifest itself? Or, to put it another way, if it wasn't carried out, what would the cost (risk/loss) to the client/patient be?
  6. How significant is the benefit? How can you measure this significance? Can you measure the benefit in clinical practice and be able to report it to the end user?
  7. How much does it cost for a practitioner to carry out this activity in terms of time and resources? And what does this add to the cost of an end user journey for an average journey?
  8. Can the benefit of this activity be communicated in a way that's relevant to the public?
  9. How much would an end user be prepared to pay for this additional benefit?
  10. Are there alternatives to this component that could be substituted now or in the near future? Or should you be looking for something that would do the job better?

Step 3: Eliminate redundancy​ and overlap

Now that you have your shortlist and you have justified each activity from the end users' perspective, double-check that each activity is still needed. Some activities may overlap with other ones – for example some speech in noise assessments. In which case, can you remove one of them? Or does each one give you information leading to benefit that you would otherwise miss?

Step 4: Consider your proposition as whole

Each of your activities will combine into a total effect on the end user experience and benefit. So once you add all these activities together and you've eliminated any redundancy, ask yourself:

  1. What is the overall additional benefit to the patient of a practice carrying out these components as part of the "standard journey"?
  2. How much in total does it cost to implement? The end user will ultimately have to pay for it.
  3. So how does this relate to what an end user would expect to pay?
  4. Does 'willingness to pay" vary according to demographic?
  5. Is there a market for this?

Why it’s important to answer these questions

In an age when consumers expect commoditisation and simplicity, carrying out unnecessary procedures makes a service bloated and unnecessarily expensive, which reduces the competitiveness and attractiveness of that provider.

So the extra that a consumer is required to pay for this ‘enhanced’ service must therefore be perceived to be relevant enough to them that they would pay for it in preference to a more 'streamlined' service.

They will therefore be expecting a demonstration of “real world” benefits. So every component within the end user experience must be carefully weighed before it's inclusion as "best practice".

Because ultimately everything we do must be relevant, communicable and worth paying for – and that means perceivable benefits. Achieve this and we avoid the bloat and instead blaze a trail so bright that "value for money propositions" look pale by comparison.

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