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HAAP Workshop #1

Lessons 1 - 4

Hearing

Aid

Center

Apprentices will be able to:• Recognize and exhibit professionalism in their role as a Hearing Aid

Specialist.• Discuss the differences between ethics and laws.• Discuss ethics as the concept applies to professional practice.• Identify laws appropriate to their jurisdiction that are applicable to

the practice of hearing instrument dispensing.• Describe sound as vibratory energy.• Identify the physical attributes of sound.• Discuss decibels in the various notations.• Describe the graph that demonstrates the average auditory area of

the ear• Relate the physical attributes of sound to their psychoacoustical

correlates.

Learning Objectives

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YOUR FUTURE – YOUR PROFESSIONLesson 1

What is a profession?

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Profession

What is professionalism?

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1. Appearance

2. Competency

3. Interactions

4. Work Ethic

5. Accountability

The Five Components of Professionalism

• Business Casual– Slacks/Skirts/Khakis

– Blouses/Button-ups/Polos

• First Impression

Appearance

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Appearance Examples

Competency is the attainment of job proficiency that encompasses the knowledge, skills, and attitudes required to perform the

specific tasks of a profession.

Professional competency must grow as a result of the hearing aid specialist’s ability to learn and grow through experience, lifelong

learning, and continuing professional development.

Competency

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• Membership in state/local/national organizations– Helps you be aware of legislative issues, CE opportunities,

networking, and career advancement– Some have journals with articles– Code of Ethics

• Continuing Education (CE’s or CEU’s)– Your Responsibility!– May be required as part of your ability to maintain your state issued

license– Keep your learning broad-based (not just restricted to your vendors)

• Develop your professional library!– Books and Journals

• Free Journals: The Hearing Review & The Hearing Journal

Competency – Professional Development

• Mentor

• Warehouse Employees

• Members

• Other Professionals

– Costco Staff from Other Warehouses

– Physicians

– Audiologists

• Clinical Documentation

Interactions

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• Positive Attitude

• Respect

• Twelve-month Commitment

Interactions - Mentor

• Hearing Aid Attendant

• Other Dispensers

• Supervisors

• Managers

Interactions – Warehouse Employees

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• Costco Staff from Other Warehouses

• Physicians

• Audiologists

Interactions – Other Professionals

• Clinical practice and member safety require effective communication and collaboration among healthcare providers

• Excellent documentation reflects excellent care.

• One method of documentation is the “SOAP” note.– Subjective, Objective, Assessment, and Plan

– Costco HAC’s have adopted an Outcome Note Protocol that utilizes the SOAP note format.

• Another method is the “HEAR” note.– History, Evaluation, Assessment, Recommendations

• Develop the habit of immediately and accurately documenting all encounters with your members – This must be completed immediately following the member’s appointment.

Interactions – Clinical Documentation

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• Professional communication must be accurate and delivered in a timely way.

– This allows all collaborators to perform their roles effectively and appropriately.

– Complete, concise, contain only relevant, concrete, accurate statements

• All communication regarding your members must be completed with respect for their rights, privacy, and in a way that protects their personal health identifiers (PHI) in compliance with all laws and regulations.

Interactions –Professional Communication & Collaboration

• Work Ethic Qualities

– Member Service

– Quantity & Quality of Work

– Communication

– Teamwork

– Initiative

– Personal Credibility

– Flexibility

Work Ethic

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• Member Service is Job #1!

– Smile, greet and thank every member sincerely.

– Make eye contact when listening and speaking.

– Use formal language when talking with members.

– Behave in a friendly and professional manner.

– Dress in neat, clean, and professional attire.

– Answer the phone by the 3rd ring and return all voicemail by the end of the business day.

Work Ethic – Member Service

• Showtime Ready

– Hearing Aid Center

– Booth

Work Ethic – Member Service

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• Limit Errors

• Focus on excellence

• Work within appointment time guidelines / Manage your time effectively

• Maintain a sense of urgency

• Demonstrate infection control procedures

• Actively participate in department focuses and benchmarks.

Work Ethic– Quantity & Quality of Work

• What are the Hearing Aid Department Benchmarks?

– Test Protocol

• Fitting Protocol

• Return %

• Capture Rate

• Penetration

• Dryer Penetration

Work Ethic – Q & Q: Benchmarks

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• Give Members your full attention

• Limit interruptions while others are communicating.

• Be open to direction, coaching, and criticism

• Express your self clearly and in an organized manner.

• Communicate in a positive, timely, and effective manner.

Work Ethic- Communication

• Assist others when they need help

• Respect other’s ideas, opinions and/or solutions

• Express disagreement constructively

• Display a positive “can-do” attitude

Work Ethic - Teamwork

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• Seek out learning and/or growth opportunities

• Volunteer to help in other areas

• Be able to work independently

• Identify what needs to be done and do it

• Look for ways to improve productivity and/or the business

Work Ethic - Initiative

• Choose behaviors that are consistent with the code of ethics

• Take responsibility for your actions and work

• Respect company property and information

• Demonstrate good judgement

• Demonstrate truthfulness

• Be dedicated to quality results

Work Ethic – Personal Credibility

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• Be open to new procedures and processes, as well as the perspective of others.

• Be willing to take on other tasks and duties.

• Be knowledgeable and utilize all of our products/vendors to accommodate members hearing loss and lifestyle needs.

Work Ethic - Flexibility

• An obligation or willingness to accept responsibility or to account for one's actions

• Who are your accountable to?

– Members

– Costco Wholesale

• HAAP Report Cards

• HAAP Hours Logs

Accountability

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• Sent in Week 1 of each period.

• To be filled out for the period that just closed.

– Example: Report card sent in Week 1 of Period 1 should be filled out for Period 13.

• Must be completed by Friday of Week 2 each Period.

• Is sent to the W###Aid@costco.com email.

• This is your responsibility to complete each period!

HAAP Report Cards

• Must be completed each Period by Friday of Week 2 for the previous period

• One sheet will be your hours log for your entire apprenticeship

• Once you have shared your log with your trainer, they will have access for your entire apprenticeship

• This is your responsibility to complete each period!

HAAP Hours Logs

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HAAP Hours Logs

ETHICS AND LAWSLesson 2

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EthicsRules of behavior based on what is

morally good and bad

What are ethics?

• Concepts/Terms equated with ethics:

– Morals

– Values

– Beliefs

– Customs

– Habits

– Conduct

– Way of LifeFrom the Greek word “Ethos” which means “Custom or Use of Character”

What are Ethics?

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• Personal Ethics– Ingrained as the result of one’s education, life experiences, family,

parental, and social upbringing.

• Professional Ethics– Codified in writing as Codes of Conduct or Ethics.– Rules and Principles that govern the behavior of the members of the

profession.

• Organizational Ethics– Involve the management of relationships with members and the

public under a set of principles of conduct.

• Business Ethics– Provide a framework or set of standards of behavior intended to

prevent unfair competition or personal gain resulting from business decisions or transactions.

Classified Categories of Ethics

• International Hearing Society (IHS)

• American Academy of Audiology (AAA)

Professional Ethics

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Business Ethics – Costco Wholesale

• Know the laws associated with dispensing hearing aids.

• As a licensed hearing aid specialist it is your responsibility to know, keep updated, and apply the laws surrounding hearing aid dispensing.

Business Ethics – Obey the Law

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• Member Service is Job #1

– Smile and greet each member by name

• Answer the phone by the 3rd ring

• Give every member your best work

• Honor your commitments

• Sometimes telling a member “No” is taking care of the member

Business Ethics – Take Care of Our Members

• Breaks and lunches must be taken at the appropriate times

• Apply Safety and Infection Control Protocols

• The Golden Rule

Business Ethics – Take Care of Our Employees

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• Give your vendor representatives your full attention

• Don’t ask the vendors for “special” favors

– Advanced Remakes (Custom)

– Advanced Replacements (BTE)

– Reversing L&D’s

Business Ethics – Respect our Suppliers

Business Ethics – Reward our Shareholders

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• While laws in general are different from ethics, there are some similarities.

• Law takes what are often considered current or past ethical dilemmas and institutionally through court cases and judicial decisions, legislative action, or executive order formally codifies them into a written form and formulates specific sanctions for non-compliance.

• The law is very black and white in its orientation.

Laws vs. Ethics

• FDA Regulations– Govern the manufacture and sale of hearing aids

• HIPAA– Health Insurance Portability and Accountability Act

• ARRA– American Reinvestment and Recovery Act

• HITECH– Health Information Technology for Economic and

Clinical Health

Laws that are Relevant to Hearing Aid Specialists

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• Title 21, Chapter 1, Subchapter H, Part 801, Subpart H, Section 801.420 Hearing Aid Devices; Professional & Patient Labeling

– FDA Red Flags

• Title 21, Chapter 1, Subchapter H, Part 801, Subpart H, Section 801.421 Hearing Aid Devices; Conditions for Sale

– Medical Evaluation Requirements

– Waiver of Medical Evaluation Requirements

FDA Regulations

• All HAC staff must have completed the Costco U course “HIPAA Training for Health Center Employees” before working in the department

– Protect Member privacy and security of their protected health information (PHI)

HIPAA

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• Mrs. Jones drops by the hearing aid center to report that she lost her left hearing aid. She states that she has looked everywhere for the hearing aid with no luck finding it. You process the L&D claim for Mrs. Jones and fax it into the vendor. Two days later Mrs. Jones calls and reports that she found her hearing aid and would like to cancel the replacement order.

• What do you do?

Case Study #1

• Mrs. Smith calls to inquire about her friend Dorothy’s new hearing aids. She would like to know what kind she got, what accessories Mrs. Smith chose, and what size batteries they use and how often they need to be changed. Dorothy is thrilled with her hearing aids and Mrs. Smith wants to get some just like them!

• What do you do?

Case Study #2

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• Mr. DeBris is a 58 y/o lawyer with a bilateral moderate high freq. SNHL. He is not able to function in the courtroom without his RIC style BTE’s. He has a big trial starting in three days and one of his hearing aids is dead and needs to be sent in for repair. He is desperate to hear in his case starting in three days.

• What do you do?

Case Study #3

• After testing Mr. Frank you determine that his best interests would be served by seeing a doctor prior to being fit with hearing aids. To avoid delaying getting his hearing aids you fill out a purchase agreement, ring up his order, and set a fitting appointment two weeks out. You give Mr. Frank the original copy of the medical referral form and tell him to let you know if he can’t get into an ENT prior to the fitting appointment. Mr. Frank returns for his fitting appointment and states that while he did see the ENT he did not obtain medical clearance. The ENT wanted to run additional tests and his insurance would not cover them and he could not afford to do them at this time.

• What do you do?

Case Study #4

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• Your member arrives 25 minutes late for their 60 minute hearing test appointment. Your ½ hour lunch is scheduled immediately following this appointment with another appointment scheduled to begin directly after your lunch.

• What do you do?

– Don’t forget – Member Service is Job #1

Case Study #5

ACOUSTICSLesson 3

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• The branch of physics specializing in sound

• Sound is a form of energy which originates when a force creates vibration in the molecules of a solid, liquid, or gas

• Sound travels in waves

• For the purpose of hearing, most waves will travel in air and are independent of the movement of the air

Acoustics

• A simple repeated alternation of compression and rarefaction

– Compression – when air molecules are pushed together

– Rarefaction – when air molecules are spread farther apart than normal

Pure Tone

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• The number of complete compression –rarefaction cycles per second

– Units = cycles per second or Hertz (Hz)

• Low frequency pure tones have a long wavelength and a long period

• High frequency pure tones have a short wavelength and a short period

Frequency

• Amplitude graphically describes the intensity of the energy of a vibrating body. Usually expressed in decibels (dB).

Amplitude

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• Wavelength is the distance between one wave crest or trough to the next.

– High frequency sounds are shorter than low frequency sounds

Wavelength

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• Phase is a term used to describe the position in the cycle of one sound wave relative to another.

– In phase = compressions and rarefactions are synchronized.

• Two tones of the same frequency and intensity presented 180° out of phase, cancel each other out. The result is NO SOUND!

• Phase plays an important role in a person's ability to localize a sound source.

– Difference in phase for sounds arriving at both ears allows us to this.

• In phase signals arriving binaurally result in binaural summation.

Phase

• At sea level, sound waves travel in air at about 1100 feet per second - or more than 760 mph.

• Sound travels faster as the density of a medium increases– 4 x faster in H2O– 15 x faster in steel

• All sounds travel at the same speed through the same medium

Speed of Sound

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• Resonance is the natural tendency for an object to vibrate with greater amplitude at one frequency than at others when a driving force is applied.

Resonance

Resonance

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• Reflection is a characteristic of environment

– Flat hard surfaces reflect sound more than uneven or soft surfaces

• Reverberations are sounds that are reflected from the walls, floor, or ceiling of a room.

Reflection

• Absorption is the opposite of reflection.

• The amount of absorption depends on moisture content and temperature.

Absorption

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• Complex wave is the acoustical combination of several different pure tones presented simultaneously.

• Waves can fully or partially cancel or enhance each other.

Complex Wave

• Sound pressure is the deviation from the ambient atmospheric pressure caused by a sound wave.

• The commonly used units for sound pressure measurements are dynes per square centimeter (dynes/cm2) and micro Pascal's (µPa).

• Weakest sound that an average normal ear can hear is at 0.002 dynes/cm2

• Strongest sound that an average normal ear can tolerate is at 1,000 dynes/cm2

Sound Pressure

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• Sound pressure is the deviation from the ambient atmospheric pressure caused by a sound wave.

• The commonly used units for sound pressure measurements are dynes per square centimeter (dynes/cm2) and micro Pascal's (µPa).

• Weakest sound that an average normal ear can hear is at 0.002 dynes/cm2

• Strongest sound that an average normal ear can tolerate is at 1,000 dynes/cm2

• Applied to Hearing Aid Fittings:

• As the tip of the instrument goes deeper in the ear canal, the physical space or volume between the tip of the aid and the TM decreases, resulting in a higher sound pressure level produced by the fitting

Boyle’s Law

• A logarithmic scale that translates the range of 0.002 dynes/cm2 to 1,000 dynes/cm2 into a range of 0 to 140 decibels (dB).

• Decibels cannot be added together or subtracted - must be combined exponentially.– When the sound pressure level (SPL) is doubled, the dB value is

not.• The number of decibels increases by 6 as a result of the exponential

summation

• Like temperature, decibels need a reference to define them.– dB SPL, dB HL, and dB SL are some of the ways we define the

decibel

The Decibel

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• Inverse-square law - the intensity is inversely proportional to the square of the distance from the source of sound.– Sound intensity progressively decreases as it moves farther

away from its origin.

• Each doubling of distance from the source results in a 6dB decrease– Can create a big difference in one’s ability to hear soft speech,

especially unvoiced consonants (/s/, /f/, /th/, for example).

The Decibel – Sound Pressure Level (SPL)

• The dB designation used by the audiometer

• The sound pressure level representing 0 dB is different at each frequency, with 0 dB considered to be the average best hearing level for each stimulus.

The Decibel – Hearing Level (HL)

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• Refers to the dB level above the member’s threshold at any frequency.

• For example:

The SRT obtained at 45 dB HL, WRS was done at 30 dB SL

45 dB HL+ 30 dB SL = 75 dB HL

The Decibel – Sensation Level (SL)

PSYCHOACOUSTICSLesson 4

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A branch of science dealing with the perception of sound, the sensations produced

by sounds, and the problems of communication

Psychoacoustics

You Hear a Sound

Your Ear Picks Up the Sound

The Sound Travels to Your Brain

The Brain Interprets the

Sound

The Brain Signals the Body to Take Action

The Body Takes Action

• Normal human ear can respond to a range of frequencies from approx. 20 Hz to 20,000 Hz.– It does not hear equally well at all

frequencies– Most sensitive to sounds between 3K

and 4K Hz.

• Auditory system follows a power function, not a linear function.– Shown as a logarithmic scale in which a

10 dB increase in intensity doubles the loudness over most of the audible range• Lower frequencies require more intensity

to be perceived as equally loud as higher frequencies.

Intensity/Loudness

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• The curved lines in the figure represent equal loudness contours which demonstrate equal loudness perception at different frequencies.

• Frequency and intensity ranges, the auditory area, are measured with an audiometer.

Frequency/Pitch

• Critical Bands represent the frequency resolution abilities of the ear.

• In a normal ear, critical bands are about ⅓ octave wide and enable the discrimination between two frequencies that are relatively close together.

• This is what allows someone to differentiate between “ith” and “if.”

Critical Bands

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• Auditory localization is a term used to describe judgment on the location, distance, movement, and size of a sound source, based on auditory cues.

• Azimuth is the term used to describe the location relative to the head using degrees as the measurement unit, with 0°being directly in front of the listener.

Localization

• September 5, 2017 – Lessons 5 – 8

• Costco U Quizzes

• IHS Quizzes

• Portfolio Assignments from costcohaap.com

• Flashcards!!!!!

• Observe your Mentor – Get in the Booth.

What’s Next?

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• Ethic. (n.d.). Retrieved August 26, 2016, from http://www.merriam-webster.com/dictionary/ethics

• International Hearing Society. (Ed.). (2016). Professional Training Textbook in Hearing Health Sciences. Plymouth, MI: Macmillan Learning Curriculum Solutions.

• International Hearing Society (Ed.). (2016). Professional Training Workbook in Hearing Health Sciences. Plymouth, MI: Macmillan Learning Curriculum Solutions.

• Profession. (n.d.). Retrieved August 25, 2016, from http://www.merriam-webster.com/dictionary/profession

• Professionalism. (n.d.). Retrieved August 26, 2016, from http://www.merriam-webster.com/dictionary/professionalism

References