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From Customer Satisfaction to Customer Bliss.ppt

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					From Customer Satisfaction
    to Customer Bliss
 Optimizing Your Customer’s Experience


      Sergei Kochkin, Ph.D.
      Better Hearing Institute
             Topics to be Covered

 Defining   consumer satisfaction

 Importance    of consumer satisfaction

 What's    important to the end user

 Actions   to improve customer satisfaction
    Defining Customer
       Satisfaction
What is customer satisfaction &
        what is benefit?
        Aim of Marketing

The aim of marketing is to acquire,
retain and satisfy customers. Those
firms (practices) which understand
the needs of their customers and
seek to satisfy them tend to be more
successful than those which do not.
Meaning of Satisfaction & Benefit

   Benefit:
    • Enhance well being
    • To be helpful or advantageous to
    • To improve or gain advantage


   Satisfaction:
    • To gratify the need, desire or expectation of

    • To fulfill a need or desire
Some Synonyms for Satisfaction

                                      Fulfillment
                                      Fulfillment
                  Comfort
                  Comfort
Adequacy
Adequacy
                                  Serenity
                                  Serenity
  Acceptability
  Acceptability   Happiness
                  Happiness
                                  Peace of mind
                                  Peace of mind
Agreeability
Agreeability        Gladness
                    Gladness
                                      Keen pleasure
                                      Keen pleasure
  Sufficiency
  Sufficiency  Gratification
               Gratification
                                      Cloud nine
                                      Cloud nine
     Contentment Delight
     Contentment Delight
                        Euphoria           Ecstasy
                                            Ecstasy
Well being
Well being              Euphoria
                                       Bliss
                                       Bliss
          Amusement
          Amusement         Elation
                            Elation      Exhilaration
                                          Exhilaration
 Relief
 Relief
           Cheer
           Cheer        Rapture           Heaven
                                          Heaven
                        Rapture
      What is Customer Satisfaction?
 Whatever     the customer says it is.

 Theextent to which hearing aid benefit
  meets consumer needs.

 Clinical   definition (Vanderbilt Report II):
     "a change between unaided and aided
      speech communication ability"
 What is Customer Satisfaction?
“Customer satisfaction not only
involves assuring the quality of the
product or service provided, but also
meeting the consumer's need as an
individual.”

Douglas Heath - consultant
              The Key to Growth &
                Competitiveness
   To Satisfy is to meet consumer needs:
       Consistently generate satisfied customers.
       Will give you their repeat business.
       Will promote your business for you.


   To accelerate growth we need to create "blissful"
    customers

   "Blissful" customers will become apostles for
    your business.
Importance of Customer
     Satisfaction




 Business is made up of the largest
     group of volunteers in the
       world......customers!
Consumer Satisfaction is Important to Health
         of Hearing Aid Industry
     Would you repurchase brand of hearing aid?
Consumer Satisfaction is Important to Health
         of Hearing Aid Industry
   Would you recommend hearing aids to your friends?
Consumer Satisfaction is Important to
   Health of Hearing Aid Industry
 Would you recommend the dispenser who fit Your H.A.?
Reasons for Non-purchase of
   Hearing Instruments




                  $19 billion dollar loss to
                  audiologists & dispensers
Impact of Dissatisfied Customers


 Deming  proved that a dissatisfied
 customer tells 16 other people but a
 satisfied person only 8 others.

 Negative word-of-mouth has blocked
 close to 4 million from purchasing our
 product in the U.S.

 Potential   $19 billion loss to dispensers.
Impact of Customer Dissatisfaction
 No   initial sale of the product

 No   repeat purchase of the product

 Negative   word-of-mouth advertising

 Less   referral business

 More   bad debt write-offs
Impact of Customer Dissatisfaction

 Higher   employee turnover & absenteeism

 Lower    staff morale

 Lower    compliance with instructions

 More   malpractice suits

 Lower    profitability
What Customers Want
Relative Importance of Factors on Overall
          Consumer Satisfaction




                               Top 4 explain 96%
                               of variance in
                               overall
                               satisfaction.
                    Impact of Improving Multiple Environmental
                   Listening Utility (MELU) on Overall Satisfaction
                                        (All hearing aid owners n=2,572)



                 100                                                                    89 90 89
                  90                                                               82
                                                                           78 77
                  80
                                                                  66
% Satisfaction




                  70
                                                      58 56
                  60                           51
                  50
                  40                     37
                  30               27
                           18 19
                  20   9
                  10
                   0
                       0   1   2    3     4     5      6     7     8       9   10 11 12 13 14
                                   Number of Listening Situations Satisfied
Relative Importance of Factors on
 Overall Consumer Satisfaction
    Summary of Consumer Needs –
          Four Methods
   Factors </= 40% satisfaction.

   Factors most related to overall customer
    satisfaction.

   Improvements sought in hearing instruments.

   Reasons why hearing instruments are in the
    drawer.
    Factors < / = 40% Satisfaction

   Hearing in noise
   Hearing instrument usage in large groups
   Hearing instrument usage on telephones & cell
    phones
   Hearing instrument usage at concerts and
    movies
   Whistling, feedback and buzzing
   Comfort with loud sounds
       Factors Most Related to Overall
           Customer Satisfaction
   Benefit at a good value

   Better sound quality

   Better Reliability

   Multiple Environmental Listening Utility (MELU)
        Hearing Aid Improvements Sought by Current
               Hearing Aid Owners (n=2,428)
               (Highly desirable scores =4-5 on 5 point scale)



             Speech in noise                          95
         Better sound quality                       88
        Less whistle/buzzing                       85
                  Lower price                      84
           More soft sounds                       83
      Longer lasting batteries                    82
    Work better on telephone                      82
    Loud sounds less painful                      81
             Speech in quiet                      81
          Better fit & comfort                   79
            Should have VC                       77
Longer money back guarantee                     74
         Less costly to repair                  73
                            0    10   20   30    40   50   60   70   80   90 100
                                            % highly desirable
  Hearing Aid Improvements Sought by Current
         Hearing Aid Owners (n=2,428)
              (Desirable scores =4-5 on 5 point scale)



     Easier to regulate volume                72
                  Mask tinnitus               71
                Easier to clean              66
     Work better on cell phone              63
         Better sound to music             62
Should not break down as much             56
                  Less visibility        52
         Easier battery change          48
        2-5 year payment plan        34
           Should have remote        32
              More fashionable     28
                          Color   21
             Lease hearing aid 15
                               0   10 20 30 40 50 60 70 80 90 100
                                            % highly desirable
 Improvements Sought in Hearing
         Instruments

 Speech  intelligibility in noise
 Better sound quality
 Less whistling & buzzing (feedback)
 Lower price
 More soft sounds audible
  The Consumer’s
   Perspective:
“Why My Hearing Aids
 Are in the Drawer”
             Methodology


 National surveys of U.S. Hearing aid
  Market since 1989.
 National family opinion panel
  80,000 households
  13,492 hearing-impaired households
 Detailedquestionnaire 2,720 hearing
  aid owners.
 Response rate 83%
              Methodology

 Consumers   who own a hearing aid but
  NEVER wear it = hearing aid in the
  drawer.
 Hearing aids in drawer = 16.2%
  respondents.
 Told to explain why non-use in MarkeTrak
  survey.
 Received 348 letters.
 Content coding yielded 567 comments.
          Hearing Aids in the Drawer are
         Related to Age of the Instrument
               But a third are New Hearing
                       Instruments
         120
                 325,000 1-4 years
         100

         80
Volume
 (000)




         60

         40

         20

           0
               1 2 3 4 5   6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
                           Age of hearing aid (years)
What are the top 3 reasons
why hearing aids are in the
         drawer?
          Reasons for Non-Use

 Poor   benefit (30%) - 268,507
         Reasons for Non-Use
               Poor Benefit
“I threw it away it was worthless to me”

“I don’t see much difference with them. I feel I
   was sold one under false pretense. Don’t feel
   I really needed one”

“There is no improvement in my hearing with
  the aids. Where there is a slight
  improvement in my hearing, it is minimal.”
        Reasons for Non-Use
             Poor Benefit
“I don’t wear the aids at all. The
  problems appears to be clarity of
  words. Volume is OK but I can’t
  distinguish words”

“I have not been able to wear the H.A.
  since the day I received it. It was made
  wrong and the Company said there was
  nothing wrong with it.”
         Reasons for Non-Use
               Poor Benefit
“It is not worth the trouble or expense for
   the small difference in hearing. I wish I
   had my money back.”

“_____ aims at taking old people’s money
  for little value.”

“All the aids do is amplify the sound that I
  can’t discriminate with an aid in the ear.”
        Reasons for Non-Use
             Poor Benefit
“When ______sold me the H.A., I was
 confident it would help me hear better.
 When I received it and wore it every
 day, it did not make my hearing any
 better. So, I don’t wear the HA and feel
 like I wasted my money. I tried to
 return it and the person did not seem to
 want to help me. I am quite dissatisfied
 with the whole experience.”
        Reasons for Non-Use
             Poor Benefit

“I can’t hear high pitch sounds with the
  behind the ear model.”

“H.A.s amplify everything but human
 voices which is what you need to hear.”

“____plugs are not worth the price.”
           Reasons for Non-Use

   #1. Poor benefit (30%) - 268,507


   #2. Background noise (25%) - 229,383
         Reasons for Non-Use
           Background Noise
“I will not wear my H.A. because it increases
  background noise. And therefore, after a
  while I get a headache and get somewhat
  nervous.”

“It catches all the sound on the road, TV,
  etc at the same time.”

“Background noise is distracting.”
         Reasons for Non-Use
           Background Noise
“H.A.s don’t work when there is a lot of
  background noise. This is when you need
  them to work.”

“Background noise really drives him crazy.”

“My problem is with background noise. All
 my H.A.s do is amplify so they are of little
 help.”
        Reasons for Non-Use
          Background Noise
“I don’t wear my H.A. because I need it at a
  dance, restaurants, and large groups.
  All the H.A. does is increase all sound
  including background sounds. No help.”

“Sudden loud noise is a killer.”

“H.A. amplify other sounds so much that I
  actually feel pain.”
        Reasons for Non-Use
         Background Noise
“If someone drops a spoon on the table it
  is like a rifle going off.”

“Hate them. They don’t work for me. All
 sounds are amplified. Never knew
 there were so many. I can’t adjust the
 H.A. constantly to every noise.”
           Reasons for Non-Use

 #1. Poor benefit (30%) - 268,507
 #2. Background noise (25%) - 229,383

   #3. Fit & Comfort (19%) - 169,431
          Reasons for Non-Use
                Fit & Comfort
“My hearing aids are too big for my ears.”

“It is uncomfortable and my wife says I don’t
   listen to her anyway.”

“It hurts my ears.”

“I do not like the feel of it in my ear.”
         Reasons for Non-Use
              Fit & Comfort
“I don’t wear my H.A. because they plug
  up my ears and feel uncomfortable.”

“My H.A. has the tendency to fall out when
 I am working hard in hot weather.”

“It’s hard to keep it in my ear. I travel for
  business a lot and can’t risk it falling out
  of my ear.”
           Reasons for Non-Use

 #1. Poor benefit (30%) - 268,507
 #2. Background noise (25%) - 229,383
 #3. Fit & Comfort (19%) - 169,431


   #4. Negative side effects (11%) - 99,048
         Reasons for Non-Use
         Negative Side-effects
 Ears  that hurt
 Too much pressure in the ears
 Blisters in ears
 Rashes in ears
 Itching ears
 Dizzy
 Nervous
         Reasons for Non-Use
         Negative Side-effects
 Ears  that sweat
 Builds up wax in inner ear
 Headache
 Hair gets caught in hearing aid
 Infections in ear
 Problems chewing or swallowing
 Plugs up ears
          Reasons for Non-Use

 #1. Poor benefit (30%) - 268,507
 #2. Background noise (25%) - 229,383
 #3. Fit & Comfort (19%) - 169,431
 #4. Negative side effects (11%) - 99,048


   #5. Price & cost (10%) - 93,839
        Reasons for Non-Use
             Price & Cost
“I bought the H.A. when I was teaching. I
  had trouble hearing student’s
  questions. Since retiring I have stopped
  using them. They were costing too
  much for what good I was able to get
  from them.”

“Programmable H.A. would be desirable
  but they cost too much.”
        Reasons for Non-Use
             Price & Cost
“My current H.A. are broken & I am
 unable to afford the cost of a
 replacement. They are too old for
 service.”

The expense of owning and maintaining
 are too great.

HMO does not cover for HA. Price is
 high.
           Reasons for Non-Use
                Price & Cost
“I enjoyed my H.A., but they burned up in a
  house fire and I can’t afford another one.”

“I wish an aid would be developed to allow
  us to hear natural sound and an aid with a
  reasonable price.”

“If I could afford it, I would buy a different
  brand.”
        Reasons for Non-Use
             Price & Cost
“My H.A. was never dependable. Taking
 it in for an adjustment was only a
 headache as it never performed very
 long. Had to be looked at again. The
 last time I had trouble, the office
 wanted to send it to _____ at $200 &
 just to check it, plus another $200 to
 repair it.”
    Minor Reasons for Non-Use

 #6. Don’t need help (8%) - 72,987
 #7. Broke or does not work (8%) - 68,814
 #8. Sound quality (6%) - 57,329
 #9. Won’t wear - unspecified (6%) - 57,556
 #10. Volume control adjust. (5%) - 44,314
 #11. Whistling & feedback (4%) - 39,100
 #12. Nuisance / hassle (4%) -38,371
 #13. Poor service (3%) - 28,673
 #14. High frequency Loss (3%) - 26,067
    Minor Reasons for Non-Use

 #15. Stigma of wearing (3%) - 26,037
 #16. Profound hearing loss (3%) - 23,460
 #17. Work in limited situations (3%)-23,460
 #18. Uncomfortably loud (2%) - 27,114
 #19. Battery life (2%) - 19,186
    Very Minor Reasons for Non-Use
          1% or less of mentions
   Does not work on          Family pressure
    phone                     Feels like ear plugs
   Monaural aids             Poor directivity
    inadequate                Low gain
   Expectations not met      Lost hearing aids
   Has Tinnitus              Ear wax problem
   Manual dexterity          Rare social user
   Forget to use
             Key Findings

 907kinactive hearing aid owners in the
 United States (1997).

 Key    reasons:
     Poor benefit
     Background noise
     Fit and comfort
Dispenser has control over hearing
       aids in the drawer

#   1. Poor benefit:
    Use programmable technology (analog or DSP)
    Pre-post benefit measurement
    Real ear measurement
    90 day post fitting customer satisfaction survey.
    100% money back guarantee
    Aural rehabilitation
      Significant impact on hearing aid satisfaction.
      Return rates been shown to be cut in half.
 Dispenser has control over hearing
        aids in the drawer
#   2. Hearing in noise
    100% use of dual microphones – not just in high-end
     product
    DSP for comfort in noise
    Volume control necessary for some segments
    Manual omni/directional switch necessary for some
     consumers
    Binaural fitting for bilateral loss customers (85% rate
     in US- much lower in Europe)
    Deep-fitting CICs give some benefit.
    Aural rehabilitation
 Dispenser has control over hearing aids
             in the drawer


 #3.   Fit and Comfort
   Extreme vigilance during impression taking.
      Multiple shell impressions if necessary with
        “best” going to the manufacturer.
      Silicon material considered superior.
   Explore emerging soft shell technology for difficult
    cases.
   Rework within office.
   Assess manual dexterity and visual acuity
    considerations relative to hearing aid style.
   14 or 30 day trial post-fitting subjective measure of
    fit and comfort.
What Can the Industry Do
 to Improve Customer
     Satisfaction?
Customer Satisfaction is a
     Complex Issue
What Needs are we Trying
to Meet in the Hearing Aid
         Market?
      We are Not in the Business of Selling
                 Hearing Aids!
          We are here to meet deep seated human needs

   To improve speech intelligibility
   To improve hearing in all listening situations
   To improve communication
   To enhance belongingness
   To facilitate acceptance
   To reduce free-state anxiety
   To increase comprehension
   To enhance enjoyment of life
   To enhance psychological well-being
   sometimes even SAVE LIVES
     Develop a Mission Statement for
              Your Practice

   Involve all staff & make sure they understand and
    buy into the mission.

   Make it idealistic.

   Talk from your heart.

   Display it prominently.

   Hand out to each customer as if it were a contract.
    Sample Mission Statement

Our mission is to improve the quality of your life,
to improve the relationship between you and
your family, to enhance your ability to belong
and contribute to your community. We will do
everything possible to assure your satisfaction
with our service and our product. If you are not
completely satisfied we are not satisfied.

The staff of XYZ Audiovestibular Services
Use the Findings From the NCOA Study
     Become very familiar with the executive
      summary of the study
         Kochkin & Rogin. Quantifying the Obvious : The
          impact of hearing aids on quality of life (Hearing
          Review, Jan. 2000)

     Counsel your potential clients on the benefits
      of hearing aids.
         Talk about the powerful human benefits
         Spend less time selling technology or size

     Develop a presentation of the key results
      (e.g. Powerpoint)
         Use my PowerPoint presentation if you want
Use the Findings From the NCOA Study
     Develop a small quality brochure on the key
      benefits of hearing aids:
         Your business
         Local Association
         National Association

     Begin collecting powerful human interest
      stories from your practice which are related to
      quality of life changes and use them to "sell":
         Part of your counseling protocol
         Radio/public appearances
         Quotes in direct mail pieces
Use the Findings From the NCOA
             Study

   Develop 10-15 minute professional video on
    "real" quality of life changes using your State
    and National Organizations.
       CNN type human interest vignettes
       Key findings of NCOA study
       Multi-function video
          Physician education
          Consumer outreach
          Local media outreach
    Use the Findings From the NCOA
                 Study
   Share the information with physicians and
    managed care facilities who refer to you.
       In person
       Direct Mail
       Business newsletter


   Use the information in your community
    speeches.
What Hearing Instrument Features lead to
Enhanced Consumer Satisfaction/Benefit?


 Signal  processing strategies
 Directional instruments
 Consumer control of the instrument (VC)
 Innovations in transducers
 Cerumen management systems
 Shell technologies
             General Technique

   Establish satisfaction & benefit norms

   Measure satisfaction & benefit across
    technologies

   Compare each technology to norm group
    (MarkeTrak)

   Determine generic hearing instrument features
    which lead to end-user success
         Analog Programmable Hearing
          Instrument Omnibus Survey

   Ten manufacturers

   13 technology samples

   All survey respondents (U.S.)

   Instruments
       MarkeTrak Satisfaction Survey
       Abbreviated Profile of Hearing Aid Benefit
   Average sample size 368 (nearly 5,000 subjects)
     Typical Usage Satisfaction by
           Generic Feature
(Composite score: overall, value, sound quality, 1-on-1, reliability, perceived benefit)



                                                                      N.S.
  Multi-environmental Value
Satisfaction by Generic Feature
  (Composite score: 9 listening situations, noise, directionality)




                                                  N.S.


                                                  N.S.
Total Subjective Benefit by
      Generic Feature
   (Composite APHAB score: EC, BN, RV)



                                         N.S.



                                         N.S.
         Satisfaction by Technology on
              Overall Satisfaction

                                      64
                                        69
                                           76
          Overall
                                             79
                                                  90


                                             78
                                             78
                                              83
Improves hearing
                                                  87
                                                       95
        Type of hearing aid
 MarkeTrak (Av erage)
                    0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
 WDRC - CIC
 Single Channel/Memory Prog.            Percent satisfied
 Multiple M emory/Channel Prog.
 Multiple M emory/Microphone Prog.
 Satisfaction by Technology on Sound
                Quality

                                          61
                                          62
                                            67
    Sound quality                             74
                                                    83

                                         56
                                           63
                                            66
 Natural sounding                            70
                                               74

                                 40
                                          61
                                    47
Whistling/feedback                      61
          Type of hearing aid            65
   MarkeTrak (Av erage)
   WDRC - CIC
                      0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
   Single Channel/Memory Prog.
   Multiple M emory/Channel Prog.         Percent satisfied
   Multiple M emory/Microphone Prog.
     Satisfaction in Difficult Listening
         Situations by Technology

                                    56
                                         69
                                      61
Place of worship                      61
                                        67

                                    56
                                           71
                                      61
      Outdoors                         66
                                        67

                                    55
                                    54
                                    54
             Car                     57
       Type of hearing aid                67
MarkeTrak (Av erage)
WDRC - CIC         0      10   20   30     40    50   60      70   80   90   100
Single Channel/Memory Prog.               Percent satisfied
Multiple M emory/Channel Prog.
Multiple M emory/Microphone Prog.
     Satisfaction in Difficult Listening
         Situations by Technology

                                  45
                                   49
                                  45
 Restaurant                      42
                                             67

                            34
                                        58
                             40                                      Type of hearing aid
 Telephone                    43                              MarkeTrak (Av erage)
                               45                             WDRC - CIC
                                                              Single Channel/M emory Prog.
                       26
                                                              Multiple Memory/Channel Prog.
                            34
                                                              Multiple Memory/M icrophone Prog.
                       26
Large Group            27
                                   51


              0   10        20      30        40    50   60      70    80    90    100
                                             Percent satisfied
                      Conclusions

   High-performance programmable analog
    instruments - outperform non-programmable
    instrument on key factors:
       Overall satisfaction
       Likelihood of repurchase
       Positive word-of-mouth
       Quality of life
       Value (even with higher price)
       Reliability
       Perceptions of benefit
       More listening situations
                  Conclusions

 Ingeneral the more advanced features the
  better:
      programmable
      multiple compression channels
      multiple memories, responses (stronger effect)
      multiple microphones (strongest effect)
      multiple signal processing strategies
Omni versus Directional
 Hearing Instruments
 MarkeTrak VI (October 2002 HR)
Customer Satisfaction Improvements of at Least 15% Due to
        Dual-microphone (Directional) Technology
                      (H.I. < 6 years of age)
    Summary of Impact of Directional
  Microphones on Customer Satisfaction

                                Omni-directional   Directional (dual
                                programmable vs    mic) vs omni-
                                non-programmable   directional
Overall satisfaction                   7%                  17%

Factors - 20% improvement               0                    3

Factors - 15% improvement               0                   17

Factors - 10% improvement               2                   33

Top 10 factor improvement               5                   10

Net listening situations imp.           6                   12
Net perf/value factors imp.             8                   11

Net total differences                  27                   42
 Digital Hearing Instrument Study

 Multiple manufacturer products were studied.
 Results of first large-scale study on satisfaction
  with DSP hearing aids:
       Single European based manufacturer
       200 single mic
       296 multiple mic
       Compared to 418 MarkeTrak (analog) norms
       Average age of instruments 7-8 months
   Consumer completed MarkeTrak survey
       45 ratings of hearing aid and dispenser
             Significant Differences
     Overall, Consumer Behavior & Dispenser
Factor              Single Mic    Multiple Mic & Multiple mic
                    & MarkeTrak   MarkeTrak      & Single Mic

Overall                                      
satisfaction
Quality of life                              
Recommend HA                      
Recommend HHP                  
Repurchase HA                    
Wear hearing aid                           
Dispenser service              
                       Significant Differences
                             Product Features
Factor                          Single Mic            Multiple Mic & Multiple mic
                                & MarkeTrak           MarkeTrak      & Single Mic

Fit/comfort
Ease VC adjust.                                   
Visibility                                                           
Packaging
Freq. Cleaning
Warranty
Ease Battery Chg.                                     
On-going expense                                                      

 Factor in yellow denotes top ten correlate of overall satisfaction.
  Consumer Need for a Volume Control

                                                            Yes
                          Yes                               35%
                          28%




 No
46%                              No
                                40%

                     Not sure                               Not sure
                      26%                                    25%



      Single Microphone               Multiple Microphone
Customer Satisfaction is related to
         Need for a VC
        % Overall satisfaction
         Desire for Volume Control?                     93
  100     Yes     Not sure  No
                               81                 79
  80
                                        60
                     57
  60
           42

  40


  20


   0
                Single                       Multiple
                       Number of Microphones
                        Significant Differences
                          Performance Factors
Factor                          Single Mic            Multiple Mic &       Multiple mic &
                                & MarkeTrak           MarkeTrak            Single Mic

Benefit                                                                   
Reliability
Sound clarity                                                           
Natural sounding                                      
Sound of voice                                                         
Soft sounds
Loud sounds                                           
Whistling/feedback                                    
     Factor in yellow denotes top ten correlate of overall satisfaction.
                     Significant Differences
                Performance Factors (Cont.)

Factor                        Single Mic           Multiple Mic          Multiple mic
                              & MarkeTrak          & MarkeTrak           & Single Mic

Value                                            
(price/perf.)
Directionality
Use in Noisy Sit.                                   
Battery Life                                          




   Factor in yellow denotes top ten correlate of overall satisfaction.
                      Significant Differences
                        Listening Situations
Factor                        Single Mic           Multiple Mic           Multiple mic
                              & MarkeTrak          & MarkeTrak            & Single Mic

One-on-one                                                                
T.V.
Small Groups                                                              
Listening to
music
Place of worship
Outdoors                                                               
Leisure activities
    Factor in yellow denotes top ten correlate of overall satisfaction.
                    Significant Differences
               Listening Situations (Cont.)
Factor                       Single Mic           Multiple Mic        Multiple mic
                             & MarkeTrak          & MarkeTrak         & Single Mic

Car
Restaurant                                                         
Concert/movie                                     
Workplace                                         
Telephone
Large group                                                          


     Factor in yellow denotes top ten correlate of overall satisfaction.
                 Summary of Key Findings

                                    Single Mic   Multiple
                                       DSP       Mic DSP
Overall customer satisfaction          +3%        +17%
improvement (vs. MarkeTrak)
Factors with 10%+ improvement           4           14
(vs. MarkeTrak)
Top ten consumer factors improved       0           6
(vs. MarkeTrak)
Net listening situations improved       -1          4
(vs. MarkeTrak)
Net performance/value factors           -2          6
improved (vs. MarkeTrak)
Significant differences                 1           14
(single vs. multiple microphone
DSP)
                 Conclusions

 Performance     in noise:
     Key reason why hearing-impaired do not buy
      hearing aids (MarkeTrak).

     #1 hearing aid improvement sought by
      hearing aid users (United States)

     #1 hearing aid improvement sought by
      hearing aid users (German study).

     #2 reason why our customers place their
      hearing aids in the drawer (MarkeTrak).
             Conclusions

 Consumer    studies now demonstrate the
  superiority of multiple microphone
  hearing aids over omni-directional only
  aids.
 Customer satisfaction with directional
  hearing instruments equal to consumer
  electronics : 81%.
 Consumer research supportive of
  dozens of small clinic/lab studies or
  theoretical papers.
                 Conclusions
   Performance in noise:
     Key reason why hearing-impaired do not

      buy hearing aids (MarkeTrak).

       #1 hearing aid improvement sought by
        hearing aid users (United States)

       #1 hearing aid improvement sought by
        hearing aid users (German study).

       #2 reason why 907,000 of our customers
        placed their hearing aids in the drawer
        (MarkeTrak V).
             Recommendations

   Fit all qualified candidates with directional
    hearing aids (BTE, Full concha, half shell).

   If not available, ask manufacturers to extend
    directional feature to lower priced product (not
    just high end programmable.)
               Recommendations

   Make sure your patient can live without VC or
    directional/omni-directional switch.

       Completely automatic aids are tremendous feature for
        some, but not all, consumers.

       Lack of control could dramatically impact satisfaction
        especially for experienced user.

       Independent research shows 77% of consumer WANT
        a volume control.
 Recent Research with MicroWaxbuster
Demonstrates it Will Dramatically Reduce
      Hearing Aid Service Rates




MicroWaxbuster Cutaway   CIC with MicroWaxbuster
                         installed
                              7,000,000 small receiver study at Knowles : receiver
                              replacements are 8 times less likely if the manufacturer
                              was a heavy user of the Waxbuster or MicroWaxbuster
                              than if they used none.
                             100   100
Receiver Replacement Index




                                           88
                              90
                              80
                              70                     66
                                                              60
                              60
                                                                      48
                              50
                              40
                              30
                                                                                 18
                              20                                                       13
                              10
                               0
                                   None   1-9%     10-19% 20-29% 30-49% 50-69%        70%+
                                                Waxbuster/MicroWaxbuster Usage
      Study # 2 – 90,000+ Consumers

 Database  query of one US manufacturer.
 24 month study across three styles of
  hearing instruments: CIC, ITC, ITE.
 Consumers segmented:
     Age of instrument – 1-24 months
     MicroWaxbuster usage or None.
 Trackedreceiver replacements in
 corporate service files.
                            Receiver replacement rates per 100 CIC
                                   hearing aids (n=21,345)

                            45
                                     MicroWaxbuster
                            40
Receiver Replacement Rate




                                     No Wax Guard
                            35
                                     Poly. (No Wax Guard)
                            30
                                     Poly. (MicroWaxbuster)
                            25
                            20
                            15
                            10
                             5
                             0
                                 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
                                                              Age of Hearing Aid (Months)
                             Receiver replacement rates per 100 ITC
                                    hearing aids (n=47,316)
                             30
                                      MicroWaxbuster
Receiver Replacement Rates




                                      No Wax Guard
                             25
                                      Poly. (No Wax Guard)
                                      Poly. (MicroWaxbuster)
                             20

                             15

                             10

                              5

                              0
                                  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
                                                               Age of Hearing Aid (Months)
                                  Receiver replacement rates per 100 ITE
                                         hearing aids (n=21,647)
                             30

                                          MicroWaxbuster
                             25           No Wax Guard
                                          Poly. (MicroWaxbuster)
Receiver Replacement Rates




                             20           Poly. (No Wax Guard)


                             15



                             10



                              5



                              0
                                  1   2     3   4   5    6   7     8   9   10   11   12   13   14    15   16   17   18   19   20   21   22   23   24
                                                                                Age of Hearing Aid
                  Conclusions

 Increased use of cerumen management products will
  have a positive impact on the market place.
 Offer this as a strongly recommended option to your
  patients/customers.
 Both manufacturers and dispensers should recognize
  increased profits by selling this optional component
  while reducing within-warranty repairs.
 Consumers for a small additional fee, will experience:
    Greater reliability in their product,

    Resulting in fewer hearing instrument repairs,

    Reduced frustration and therefore,

    Increased consumer satisfaction.
              Shell Technology


       industry adopted dental industry
 1960's
 approach - acrylic shell.
     Hardness factor of 90 point Durometer Shore D
     Little changes since development
     More of a serious problem with ITC/CIC and aids
      deeply inserted in the bony portion of the ear.
     Difficult to achieve good acoustic seal with jaw
      motion.
     Internal mechanical feedback pathways
         Soft Shell Technology


 Improved    fit & comfort

 Improved    fit with torturous ear canals

 Other   potential benefits:
     > gain before feedback
     < displacement of hearing aid
Technology is Only as Good as the
         Weakest Link
 Shell   technology

 Advanced  fitting protocols that assure
 optimization of benefit for the consumer
 versus default settings

 Impressionlesshearing aids (3-D digital
 models of the ear canal)
Systematic Feedback From the End User is a
           Key to Improvement

   Subjective and objective satisfaction/benefit
    measures from the end user:
       Compare a technology to a norm
       Compare technologies
       Measure change over time
       Evaluate outcomes in different "real life" situations
   Document reduction in disability
       Potential importance for third party payment
       Improving physician referrals
       Shaping consumer expectations
       Trouble shoot unsuccessful fittings
Systematic Feedback From the End user is a
           Key to Improvement




 Can we move forward into the
 future without comprehending
 where we are or where we have
 been?
              MarkeTrak Customer
               Satisfaction Norms
 Available since 1991.
 National Family Opinion Panel
       Screening survey (80,000 households)
       Hearing difficulty
       Hearing aid owners
 Identified 13,000 + households with at least one
  person with hearing difficulty
 Detailed surveys
       3,000 hearing aid owners
       3,500 non-owners with hearing difficulty
       80%+ response rate
 MarkeTrak Customer Satisfaction
             Norms
 Hearing    aid owners
     41 Likert scale items on satisfaction with
      hearing aids & service

     5 Behavioral items (repurchase, hours aid
      worn, quality of life)
         MarkeTrak Norms:
Select Customer Satisfaction Factors
          MarkeTrak Norms:
Customer Satisfaction in Select Listening
              Situations
 Percent of Consumers Receiving Follow-up
 Customer Satisfaction Survey
 (H.I. < 6 years compared to H.I. <1 year in age).

                   Post-survey method
                                                                           58.9
           None
                                                                          57.2
                                            21.1
   Verbal office
                                            21.5
                                9
            Mail
                                8.7
                             5.3
  Written office
                               7.1
                        4.1
          Phone                                                  Age of H.I.
                       2.6
                                                               H.I.< 6 years
                       1.7
Computer office                                                H.I.< 1 year
                        3
                   0    5      10 15 20 25 30 35 40 45 50 55 60 65 70
                                      Percent hearing instrument owners
Overall Satisfaction Improves with Post-fitting Survey
Follow-up
(H.I. < 6 years compared to HI < 2 years).


                         Post-survey method
                                                                                   Age of H.I.
                                                       54                       < 6 years
                None
                                                            57                  < 2 years
                                                                      62
        Verbal office
                                                                 60
                                                                                  68
                 Mail
                                                                                        71
                                                                                   69
       Written office
                                                                                         72
                                                                           64
              Phone
                                                                                   69
                                                                   62
    Computer office
                                                                  61

                        30          40          50           60                   70             80
                                      Percent overall customer satisfaction
                Recommendations

   Pre-post benefit on EVERY patient:
       Subjective test : APHAB or HHIE
       Objective test : HINT, QuickSIN (Etymotic)


   Customer Satisfaction survey at least 90 days
    after fitting.
       Shows you care
       Permits insights when tied to patient information
       Damage control of practice
     Some Final Considerations

 Measuring   performance helps drive
 success.

        effective measurement how can
 Without
 we assure we have optimized the
 customer’s hearing experience?

 Without effective measurement how can
 dispenser’s grow in their wisdom on behalf
 of the consumer?
           From:
 Evidence for the Binaural
Advantage Using Customer
Satisfaction & Benefit Data.
  (Kochkin, Kuk 4/1997)
U.S. Binaural Hearing Instrument Owner
           Population Trend

                                 80
                                           Total Owners                                                74        74
                                                                                                            70
                                 70
                                                                                   65        65   64
                                           Total Owners - Current year   61             60
% of Hearing Instrument Owners




                                 60
                                                                  51          52
                                 50                        47


                                 40                  37


                                 30           25
                                      22
                                 20

                                 10

                                 0
                                       1984            1989         1991       1994      1997      2000      2004
    Why Such Remarkable Binaural
          Growth in U.S.?
   Paradigm shift in mid 80's by industry and
    hearing professionals.
       "Two ears are better than one" (therefore two hearing
        aids)
       Based on clinical & field studies

   Hearing professional education
       Consumer education
       Marketing
          brochures
          posters
          public relations
Basic Reasons for Fitting Binaurally
   Sound localization
   Threshold for speech reception
   Group & noisy situations
   Head shadow effect
   Loudness summation
   Auditory deprivation
   Litigation (malpractice)
   Balanced hearing
   Sound quality
   Customer satisfaction & subjective benefit
      Knowles Binaural Satisfaction
                 Study
2    samples of bilateral loss subjects
     MarkeTrak - (n=1,124)
     High performance hearing aids - (n=3,279)

 Compare   binaural and monaural
 satisfaction/benefit results.

 Difference   scores on key factors.
Satisfaction with Directionality of Hearing Aid for 5 Samples of
  Bilateral Loss Subjects Fit Either Monaurally or Binaurally.
 Monaural vs. Binaural Customer
Satisfaction (Key factors impacted)
                     Conclusions

   Binaural advantage
       Strong binaural advantage independent of
        technology.
       High performance product show stronger binaural
        effect.
       Directionality, sound quality & some listening
        situations

   Remainder of world is behind US in binaural
    penetration:
       Europe -30-45%
       Japan - 10%
                           Actions
   Fit all qualified customers binaurally. (e.g.
    symmetrical loss)

   Use aggressive binaural selling protocol to
    demonstrate IMPORTANCE of binaural hearing:
       Demonstrations with education
       Master hearing aids
       During audiological testing
       Try 2..if you don't like return one.

   Binaural tutorial and consumer selling points
    (English and Spanish):
       www.betterhearing.org (market research section).
                    Actions

 Binaural   Selling Protocol (cont.):
     Request signed legal form :
       indemnifying you against legal action
       because of consumer refusal to follow your
        advice
       consumer understands potential for
        "auditory deprivation" in unaided ear.
       consumer understands 15 reasons why 2
        hearing aids are better than one.
                       Actions

 Binaural    Selling Protocol (cont.):
     Refuse to sell monaurally.
       Truly impressive --- shows you have strong
        convictions.

     Use the words "hearing system" not hearing
      aid.

     Give discount on hearing system.
        Customer Requirements –
             5 dimensions
   Reliability - the ability to provide what was
    promised.

   Responsiveness - the willingness to help
    customers promptly.

   Assurance - the knowledge and courtesy you
    show to customer; ability to convey trust,
    competence and confidence.
     Customer Requirements –
          5 dimensions
 Empathy  - the degree of caring and
 individual attention you show to your
 customers.

          - the physical facilities and
 Tangibles
 equipment and your appearance.
                 Some Suggestions

   Complete customer service workshops
       audiologists/dispensers
       office staff – receptionist

 Handling inquiries, handling leads, effective
  selling, customer relations
 How to handle the difficult customer
 What to do when mistakes are made
 AAA "best practices" training - great promise
       Reception training kit
       Physician referral – also through BHI.
An excellent
starting point for
your whole staff.
     Highlights
   Adjusting to the customer
   Uniqueness of each customer
   Selling skills
   Your attitude & success
   Importance of self-esteem
   Phone relations
   Effective listening
   4 minutes to make an
    impression
   Games customers play
   Angry customer
   Negotiation
   Becoming creative
   Your image
   Handling stress
   Handling change
   Customer rights
Amount of Counseling Time Spent with Hearing Aid Users During
Last Hearing Instrument Purchase
(H.I. < 6 years compared to H.I. < 1 year).



           Percent of users                             Modal time is half hour
      35
                                                                    H. I. User
      30                                                      New < 6 years
                                                              Experienced < 6 years
      25                                                      All <1 year

      20
                                    31.7
                                    31.4
                                   29.2



      15                                      25.2
                                              25.1
                                              24.3




                                                        20.7
                                                        19.8
      10                                               18.3
                       14.4
                      12.8
                       13




       5



                                                                   5.7
                                                                  4.6
                                                                  4.4



                                                                            4.3

                                                                            4.3
                                                                            3.4
             3.3
            2.2
            2.2




       0
             None       0.25         0.5       0.75       1          2        3+
                              Counseling time spent (hours) with users
Customer Satisfaction Ratings are Related to Time
Spent in Counseling
(H.I. < 6 years compared to H.I. < 1 year).


                               H. I. User
                   80    New < 6 years
                         Experienced < 6 years
                   70
                         All <1 year
                   60
Percent of users




                   50

                   40




                                                                 68



                                                                            68
                                                                           67
                                                                65
                                                                           65




                                                                                       65
                                                       64
                                              63




                                                       62
                                                               60
                                             59
                                                      59




                                                                                      59
                   30
                                            54




                                                                                 53
                                      52
                                     48
                          45
                         42
                                42
                        39




                   20

                   10

                   0
                        None     0.25         0.5      0.75       1         2         3+
                                           Counseling time spent (hours)
Consumer Education Can Reduce
           Returns

 31 dispenser study
 289 subjects - all new patients randomly
  assigned:
       Half received normal counseling
       Half also received Dr. Richard Carmen's
        Consumer Handbook on Hearing Loss
 Dispenser prescribed 3 chapters to read
  before end of 30 day trial followed by
  discussion.
 Return rates were as follows:
       16.3% control group (no book)
       8.8% subjects receiving book
              Counseling Training

 Counseling skills need to be upgraded
 Certification program
       Video training
       Adjunct degree - MS in counseling
       Recommendation - Rogerian Counseling


   Au.D. to have value perhaps should have more
    counseling

   Post fitting group - key to returns
www.knowleselectronics.com




 Recommended
   Readings:
 J. Abrahamson - post
     fitting group
     sessions.
 C. Palmer & E. Mormer
    - Systematic
    counseling protocol
 C. Edwards - pediatric
    population
    You are Only as Good as the Weakest
          Link in Your Community
   U.S. Industry plagued by negative publicity
       Ralph Nader
       60 minutes - ripping off elderly
       FDA/FTC
       Rip-off Alert - 7 new scams (Family Circle 6/24/97)
       Hearing aids don't work articles
       Recent Washington Post article on taking advantage
        of the elderly --- and not allowing returns when
        dissatisfied.


   You are judged by the competence of your
    competitor down the street.
Current Nonowner Attitudes Toward U.S.
 Hearing Health Distribution Channels
                                     Attitude
                  Trust in doctors    12.2            38.3                       49.6


             Trust in audiologists    12.1               51.5                       36.4


               Trust in HA dealers             39.7                       53.4                7


 HA sellers customer oriented                 37.9                      49.1               13.1


     HA sellers take advantage                37.6                      48.3               14.2


              Exposure to TV ads      10.6     17.7                      71.6


              Truth in advertising           30.3                      58.5                11.1


            30 day trial knowledge    7.5                       80.3                       12.2


             Attitude                0%       20%        40%           60%        80%        100%
Negativ e    Neutral    Positiv e
                                                             Percent
  “People buy from people...
people they like, they trust, they
 respect; no one buys from an
            enemy."


      Sales Manager - Dupont
You are Only as Good as the Weakest
      Link in Your Community

 Continued    need to upgrade educational
  standards
 Standardize state requirements
 Industry must be own watch dog -
  perhaps have ethics board
 Encourage sharing of techniques which
  improve customer satisfaction:
     industry award ceremonies
     recognition
    Comprehensive Fitting Protocols

   Move toward an industry standard for fitting
    hearing aids
   From first contact to post fitting
   Equivalent of industry recognized ISO 9002
   Large public chains moving toward such a
    standards.
   Will probably be needed for managed care
    relationships.
 Comprehensive Fitting Protocols

 Modelsof hearing aid success
 needed:
     Matching technology with consumer
      hearing loss characteristics at the
      point of sale.
        Basic Recommendations

   Pre-fitting counseling and needs assessment.
   Objective measurement of hearing loss.
   Establishment of contract with consumer.
   Hearing aid validation using real ear.
   Use of hearing aid analyzer (verification that HA
    meets specifications).
   Patient interaction to optimize fitting.
   Objective & subjective measure of benefit.
   Documentation of benefit to consumer and perhaps
    physician.
   Expectations relative to benefit.
   Post fitting customer satisfaction survey.
   Basic aural rehabilitation
              Sample Protocol
         Washington University School of Medicine

   Established appropriate prescriptive REIG (corrected
    for mixed HL (>20% of A-B gap) and/or binaural
    summation (<3-5 dB))

   REM for nonlinear hearing aids with input levels of
    50, 65 and 80 dB with speech-weighted composite
    noise (analog) or modulated ANSI noise (DSP)
    provides appropriate gain and smooth frequency
    response. Printout placed in chart.

   REM for linear hearing aid with input level of 65 dB
    with speech-weighted composite noise (analog) or
    modulated ANSI noise (DSP) provides appropriate
    gain and smooth frequency response. Printout placed
    in chart.
               Sample Protocol
           Washington University School of Medicine

   Assessed performance of directional microphone by
    looking @ differences in REAR @ 00 and at azimuth of
    greatest null. Printout placed in chart.

   Assess functionality of DSP NR circuitry using
    appropriate bias signals.

   RESR90 using a pure-tone sweep corresponds to
    appropriate frequency-specific SPL level for loudness
    judgment of “loud, but OK.” Printout placed in chart.

   Loudness judgment of 50 dB composite noise is “very
    soft” or “soft”
                  Sample Protocol
             Washington University School of Medicine

     Loudness judgment of 65 dB composite noise is
      “Comfortable, but slightly soft,” “comfortable,” or
      “Comfortable, but slightly loud.”

     Loudness judgment of 85 dB composite noise is “loud,
      but OK.”

     Measure aided thresholds @ 500, 1000, 2000 and 4000
      Hz using FM signals @ 00*

     Measure unaided and aided HINT (dBA) in Quiet with
      sentences @ 00*

* Currently under consideration
               Sample Protocol
           Washington University School of Medicine

   Measure unaided and aided HINT RTS in Noise with
    Sentences and Noise @ 00*

   ANSI-96 reveals <10% THD; ANSI-92 reveals smooth
    coupler response @ 50-80 dB SPL. Printout placed in
    chart.

   Potentiometer or programmed settings are in the chart.

   Discuss and/or recommended Aural Rehabilitation
    and/or ALDs.


* Currently under consideration
                 Sample Protocol
            Washington University School of Medicine

 APHAB, COSI or Wash U Questionnaire (unaided, aided
  and benefit) and placed in chart.

   Called patient 2-3 days post-initial fit.

   Customer satisfaction survey (3-6 months after fitting) –
    Kochkin recommendation.
Best Practices Discussion
         Items
      Benefit is Critical to Market Growth
 High   benefit is related to:
     High customer satisfaction
     High brand retention

 High  customer satisfaction :
     Leads to positive-word-of-mouth
      advertising
     And therefore market growth
    Benefit is Critical to Market Growth
 Important to focus on the dispenser’s role
 in optimizing consumer benefit.

        consumer benefit is 44% HL
 Current
 problem resolution in U.S. How can we
 improve to 65% benefit in 5 years?
          Selection/verification/validation
                Some Considerations

   Convene committee of industry’s brightest to
    develop/recommend “best practices” hearing
    instrument selection/verification/validation
    protocol
       Medwetsky found wide variability in protocols in 60
        practices.
       “might be a great need for a best practices standard
        that is widely accepted and used by all hearing care
        professionals”.
       Standards may be available but not utilized (e.g.
        ASHA guidelines for hearing aid fitting for adults)
       Washington University School of Medicine Protocol
        (attached for your review and consideration)
         Selection/verification/validation
               Some Considerations

   Fitting formula have become more sophisticated
    but they are still a starting point. How many
    dispensers use the default settings versus
    attempt to optimize individual benefit at the point
    of sale?

   There will be significant differences in outcome
    measures both in terms of speech intelligibility
    and subjective consumer preference depending
    on which prescriptive formula is used. (See
    January 2003 Hearing Review)
      Selection/verification/validation
            Some Considerations


   May be significant interactions between
    prescriptive formula, individual hearing loss
    characteristics, style/circuit of hearing
    instrument, and perhaps even the personality
    of the end-user.

   Advanced multivariate research (e.g. use of
    artificial intelligence software) could lead to
    the development of a prescriptive decision
    tree which would assist the hearing care
    professional in optimizing benefit for the end-
    user.
   Selection/verification/validation
         Some Considerations


 Does the lack of wide scale adoption
 and/or usage of real ear measurement
 impact benefit?
   50% of HIS own

   75% of audiologists own
    Selection/verification/validation
          Some Considerations


 Does the lack of wide scale adoption
 and/or usage of hearing aid analyzers
 impact benefit (e.g. measurements on
 the functionality of the hearing
 instrument). Is a listening test enough?
   59% of HIS own

   85% of audiologists own
        Selection/verification/validation
        Some Considerations

 Assureaudibility of important sounds
 (especially speech) and loud sounds
 should be comfortable:
     44% satisfaction with loud sounds comfortable in a
      custom industry is unacceptable.


 How  does a consumer leave a dispenser’s
 office with hearing aids that are too loud?
        Selection/verification/validation
        Some Considerations


 Measurement of unaided and aided speech
  intelligibility in quiet and noise. The difference
  is benefit (see January 2003 Hearing Journal):
    Why do the minority of dispensers and

     audiologists measure benefit routinely?
    Subjective (APHAB), or objective (HINT,

     QuickSIN) tests widely available.
 Share benefit scores :
       with consumers helping to shape realistic
        expectations.
       with physicians to build your practice.
    Selection/verification/validation
          Some Considerations

 Does  the use of patient focused 360
 sound field aided testing have a positive
 impact on maximizing individual
 benefit?
   Preliminary research shows < fitting

    time
   No impact on APHAB benefit scores

   Possible significant impact on return

    rates.
   Selection/verification/validation
         Some Considerations

 Should  we establish contracts with
 consumers promising certain levels of
 benefit in quiet and noise based on our
 knowledge of the consumer’s hearing loss
 characteristics?

 Should   consumers be made to pay for
 hearing instruments with little or no
 measurable benefit? (e.g. speech
 intelligibility improvement).
         Selection/verification/validation
               Some Considerations


   Measurement of longer term customer
    satisfaction (3+ months after fitting).
      Minority- 18% do any form of formal

       follow-up.

   Issue of value assures that the
    consumer expenditure of energy (time,
    money) is exceeded by the dispensers
                                          Dispenser
    energy expenditure (time, service,                Consumer
    product).
       Selection/verification/validation
             Some Considerations

   Industry associations should validate the best
    practices in order to gain wide scale
    acceptance of a “golden” or “best practice”
    protocol:
      Customer satisfaction

      Consumer benefit

      Profitability

      Dispenser morale

      Practice growth

      Referrals

      Return rates
      Selection/verification/validation
            Some Considerations

 Turnbest practices protocol into
 equivalent “Good Housekeeping Seal of
 Approval”. Implicit in such a seal is a
 “benefit guarantee” to the consumer.

 Shouldhearing aid dispensing outlets
 earn such a “best practices seal of
 approval” through an independent
 audit?
     Similar to ISO 9002 quality certification
             Best Practices
 What   best practices methods have you
  found which?
    Improve customer benefit

    Improve customer satisfaction

    Reduce return rates

 Best practice methods:
    Verifying hearing aid performance

    Validating hearing aid benefit

    Setting expectations

    Patient counseling
      Some Methods for Improving
        Satisfaction 10%-20%
   More counseling time with consumer.
   Creating realistic expectations especially given
    very high consumer expectations of DSP.
   Any form of outcome measure (benefit).
   Use of VC especially for experienced user.
   Directional hearing aids as standard technique
    for improved communication in noisy situations.
   More patient focused techniques for optimizing
    benefit.
   Creating more perceived value for the
    consumer.
                   Value               Dispenser
                                                   Consumer




 The secret to success (customer bliss)
 is value:
     Energy expenditure from dispenser
      (product, time, service) must exceed
     consumer's expenditure (money, time)


 Satisfaction   = balanced expenditure.
                               Value

   Key factors to end-user when evaluating HA
    outcome:
       Perception of benefit

       Multiple environmental listening utility (MELU)
          Performance in noise
          Not just one-on-one in quiet

       Sound quality

       Reliability
             What is Value?

 Serviceprovided + performance of hearing
 instrument (benefit)

         to how much was paid for the
 Relative
 product & service
          What is value?

          Price of hearing
          Price of hearing
Value =
Value =   aids/service
          aids/service
          -----------------------------
          -----------------------------
          Benefit = need fulfillment
          Benefit = need fulfillment
      Benefit APHAB= Unaided -- aided
      Benefit APHAB= Unaided aided
                      ----------------------
                      ----------------------
                      Unaided
                      Unaided

      = % reduction in disability.
      = % reduction in disability.
      =$$ paid per % disability reduction.
      =$$ paid per % disability reduction.
                Customer Satisfaction is Highly Related to $$$
                Spent per 1% Improvement in Hearing Disability



               100
                95
                90
                85
                80                                                                         Overall
                75
Satisfaction




                70                                                                         Benefit
                65                                                                         Value
                60                                                                         Poly. (Overall)
                55
                                                                                           Poly. (Benefit)
                50
                45                                                                         Poly. (Value)
                40
                35
                30
                25
                     5   15     25   35   45   55   65   75   85   95   125    200   500

                              Price ($$) spent per 1% disability improvement
Overall Customer Satisfaction as a Function of Price
        and Hearing Disability Improvement
                (Statistical Model)




                                               Overall
                                               Customer
                                               Satisfaction (%)




                                       Price
 Hearing disability
 improvement (%)

                                      R2=.86
Hypothetical Situations - Value


Handicap
            Price   Value    Comments
Reduction


                            Consumer's
                            hearing got
   -25      1000     -40
                            worse & lost
                              money



                            Low benefit at
   10       500      50
                              low price




                             Great benefit
   100      5000     50
                            at a high price
Satisfaction is Related to the Age of
      the Hearing Instrument


                 70
                 60
                 50
  Satisfaction




                 40
                 30
                 20
                 10
                  0
                      <1   1      2-5      6-9      10-14   15+
                               Age of Instruments
…and to Hearing Aids in the Drawer

               35
               30
               25
 % in drawer




               20
               15
               10
                5
                0
                    1   2   3   4     5     6     7     8    9   10-   15+
                                                                 14
                                Age of Hearing Instruments
           Recommendations

 Maintain contact with past consumers.
 Develop marketing and incentive programs to
  assure that technology in consumer’s ears is < 5
  years old.
 Friends of consumers will judge newer
  technology based on consumer’s perceptions of
  10 year old technology.
 Critical to work with consumers to keep hearing
  instruments out of the drawer.
    A Word About Expectations

             are critical when you
 Expectations
 serve customers.

 Meet   them to satisfy the customer.

 Exceed then to make the customer
 love you.
   A Word About Expectations

    unrealistic expectations--in
 Set
 essence,

 promises   you can never hope to keep--
 then:

 yourcustomers will hold you beneath
 contempt.
                     Expectations

   Model expectations protocol is needed
       Written form
       Video (role play)
       "Best practices"


   Basic primers on expectations
       High Performance Hearing Solutions - Vol 1.
        Counseling.Realistic Expectations - A Key to Success
        (P. Stypulkowski) – www.knowleselectronics.com
       Rose Allen – www.audiologyonline.com 5/20/02
 What Can You do to Move
From Customer Satisfaction
 to Customer Bliss in Your
         Practice?
                     Personalize

 Choose one or two areas and work on them in
  your practice.
 Find out what your customers think about you!
       Formal survey
       Breakfast chat with customers
 Question or evaluate everything you do & were
  taught to do in fitting hearing aids.
 Encourage employees to recommend
  improvements.
 Reward suggestions & improvements.
                  Personalize

 Add to my list of ways of improving
 satisfaction:
     Test equipment
     Methods of testing
     Paradigms on candidacy
     Fitting algorithms
     Methods of optimizing fitting (e.g. use of 360
      degree sound field)
      Our Role is To Assure the
    Customer’s Life is Improved by
        Our Product & Service

 Assure that your clients have achieved
  significant benefit with their hearing aids.
 Assure that your customer is satisfied with
  their hearing instruments.
 Three areas of possible improvement:
       Minimize hearing aids in the drawer.
       Use technology and processes which enhance
        increased customer satisfaction.
       Basic best practices

				
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