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From Customer Satisfaction to Customer Bliss Optimizing Your Customer

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Title: From Customer Satisfaction to Customer Bliss Optimizing Your Customer


1
From Customer Satisfaction to Customer
BlissOptimizing Your Customers Experience
  • Sergei Kochkin, Ph.D.
  • Better Hearing Institute

2
Topics to be Covered
  • Defining consumer satisfaction
  • Importance of consumer satisfaction
  • What's important to the end user
  • Actions to improve customer satisfaction

3
Defining Customer SatisfactionWhat is customer
satisfaction what is benefit?
4
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.

5
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

6
Some Synonyms for Satisfaction
7
What is Customer Satisfaction?
  • Whatever the customer says it is.
  • The extent to which hearing aid benefit meets
    consumer needs.
  • Clinical definition (Vanderbilt Report II)
  • "a change between unaided and aided speech
    communication ability"

8
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

9
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.

10
Importance of Customer Satisfaction
  • Business is made up of the largest group of
    volunteers in the world......customers!

11
Consumer Satisfaction is Important to Health of
Hearing Aid Industry
12
Consumer Satisfaction is Important to Health of
Hearing Aid Industry
13
Consumer Satisfaction is Important to Health of
Hearing Aid Industry
14
Reasons for Non-purchase of Hearing Instruments
15
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.

16
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

17
Impact of Customer Dissatisfaction
  • Higher employee turnover absenteeism
  • Lower staff morale
  • Lower compliance with instructions
  • More malpractice suits
  • Lower profitability

18
What Customers Want
19
Relative Importance of Factors on Overall
Consumer Satisfaction
20
Impact of Improving Multiple Environmental
Listening Utility (MELU) on Overall Satisfaction
(All hearing aid owners n2,572)
21
Relative Importance of Factors on Overall
Consumer Satisfaction
22
Summary of Consumer Needs Four Methods
  • Factors lt/ 40 satisfaction.
  • Factors most related to overall customer
    satisfaction.
  • Improvements sought in hearing instruments.
  • Reasons why hearing instruments are in the drawer.

23
Factors lt / 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

24
Factors Most Related to Overall Customer
Satisfaction
  • Benefit at a good value
  • Better sound quality
  • Better Reliability
  • Multiple Environmental Listening Utility (MELU)

25
Hearing Aid Improvements Sought by Current
Hearing Aid Owners (n2,428)(Highly desirable
scores 4-5 on 5 point scale)
26
Hearing Aid Improvements Sought by Current
Hearing Aid Owners (n2,428)(Desirable scores
4-5 on 5 point scale)
27
Improvements Sought in Hearing Instruments
  • Speech intelligibility in noise
  • Better sound quality
  • Less whistling buzzing (feedback)
  • Lower price
  • More soft sounds audible

28
The Consumers PerspectiveWhy My Hearing
Aids Are in the Drawer
29
Methodology
  • National surveys of U.S. Hearing aid Market since
    1989.
  • National family opinion panel
  • 80,000 households
  • 13,492 hearing-impaired households
  • Detailed questionnaire 2,720 hearing aid owners.
  • Response rate 83

30
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.

31
Hearing Aids in the Drawer are Related to Age of
the InstrumentBut a third are New Hearing
Instruments
325,000 1-4 years
32
What are the top 3 reasons why hearing aids are
in the drawer?
33
Reasons for Non-Use
  • Poor benefit (30) - 268,507

34
Reasons for Non-UsePoor Benefit
  • I threw it away it was worthless to me
  • I dont see much difference with them. I feel I
    was sold one under false pretense. Dont 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.

35
Reasons for Non-UsePoor Benefit
  • I dont wear the aids at all. The problems
    appears to be clarity of words. Volume is OK but
    I cant 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.

36
Reasons for Non-UsePoor 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 peoples money for
    little value.
  • All the aids do is amplify the sound that I
    cant discriminate with an aid in the ear.

37
Reasons for Non-UsePoor 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 dont 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.

38
Reasons for Non-UsePoor Benefit
  • I cant 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.

39
Reasons for Non-Use
  • 1. Poor benefit (30) - 268,507
  • 2. Background noise (25) - 229,383

40
Reasons for Non-UseBackground 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.

41
Reasons for Non-UseBackground Noise
  • H.A.s dont 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.

42
Reasons for Non-UseBackground Noise
  • I dont 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.

43
Reasons for Non-UseBackground Noise
  • If someone drops a spoon on the table it is like
    a rifle going off.
  • Hate them. They dont work for me. All sounds
    are amplified. Never knew there were so many. I
    cant adjust the H.A. constantly to every noise.

44
Reasons for Non-Use
  • 1. Poor benefit (30) - 268,507
  • 2. Background noise (25) - 229,383
  • 3. Fit Comfort (19) - 169,431

45
Reasons for Non-UseFit Comfort
  • My hearing aids are too big for my ears.
  • It is uncomfortable and my wife says I dont
    listen to her anyway.
  • It hurts my ears.
  • I do not like the feel of it in my ear.

46
Reasons for Non-UseFit Comfort
  • I dont 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.
  • Its hard to keep it in my ear. I travel for
    business a lot and cant risk it falling out of
    my ear.

47
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

48
Reasons for Non-UseNegative Side-effects
  • Ears that hurt
  • Too much pressure in the ears
  • Blisters in ears
  • Rashes in ears
  • Itching ears
  • Dizzy
  • Nervous

49
Reasons for Non-UseNegative 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

50
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

51
Reasons for Non-UsePrice Cost
  • I bought the H.A. when I was teaching. I had
    trouble hearing students 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.

52
Reasons for Non-UsePrice 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.

53
Reasons for Non-UsePrice Cost
  • I enjoyed my H.A., but they burned up in a house
    fire and I cant 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.

54
Reasons for Non-UsePrice 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.

55
Minor Reasons for Non-Use
  • 6. Dont need help (8) - 72,987
  • 7. Broke or does not work (8) - 68,814
  • 8. Sound quality (6) - 57,329
  • 9. Wont 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

56
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

57
Very Minor Reasons for Non-Use1 or less of
mentions
  • Does not work on phone
  • Monaural aids inadequate
  • Expectations not met
  • Has Tinnitus
  • Manual dexterity
  • Forget to use
  • Family pressure
  • Feels like ear plugs
  • Poor directivity
  • Low gain
  • Lost hearing aids
  • Ear wax problem
  • Rare social user

58
Key Findings
  • 907k inactive hearing aid owners in the United
    States (1997).
  • Key reasons
  • Poor benefit
  • Background noise
  • Fit and comfort

59
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.

60
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

61
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.

62
What Can the Industry Do to Improve Customer
Satisfaction?
63
Customer Satisfaction is a Complex Issue
64
(No Transcript)
65
(No Transcript)
66
What Needs are we Trying to Meet in the Hearing
Aid Market?
67
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

68
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.

69
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

70
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

71
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

72
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

73
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.

74
(No Transcript)
75
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

76
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

77
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)

78
Typical Usage Satisfaction by Generic Feature
(Composite score overall, value, sound quality,
1-on-1, reliability, perceived benefit)
N.S.
79
Multi-environmental Value Satisfaction by Generic
Feature
(Composite score 9 listening situations, noise,
directionality)
N.S.
N.S.
80
Total Subjective Benefit by Generic Feature
(Composite APHAB score EC, BN, RV)
N.S.
N.S.
81
Satisfaction by Technology on Overall Satisfaction
82
Satisfaction by Technology on Sound Quality
83
Satisfaction in Difficult Listening Situations by
Technology
84
Satisfaction in Difficult Listening Situations by
Technology
85
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

86
Conclusions
  • In general the more advanced features the better
  • programmable
  • multiple compression channels
  • multiple memories, responses (stronger effect)
  • multiple microphones (strongest effect)
  • multiple signal processing strategies

87
Omni versus Directional Hearing Instruments
  • MarkeTrak VI (October 2002 HR)

88
Customer Satisfaction Improvements of at Least
15 Due to Dual-microphone (Directional)
Technology (H.I. lt 6 years of age)
89
Summary of Impact of Directional Microphones on
Customer Satisfaction
90
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

91
Significant Differences Overall, Consumer
Behavior Dispenser
92
Significant Differences Product Features
Factor in yellow denotes top ten correlate of
overall satisfaction.
93
Consumer Need for a Volume Control
94
Customer Satisfaction is related to Need for a VC
95
Significant DifferencesPerformance Factors
Factor in yellow denotes top ten correlate of
overall satisfaction.
96
Significant Differences Performance Factors
(Cont.)
Factor in yellow denotes top ten correlate of
overall satisfaction.
97
Significant DifferencesListening Situations
Factor in yellow denotes top ten correlate of
overall satisfaction.
98
Significant Differences Listening Situations
(Cont.)
Factor in yellow denotes top ten correlate of
overall satisfaction.
99
Summary of Key Findings
100
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).

101
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.

102
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).

103
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.)

104
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.

105
Recent Research with MicroWaxbuster Demonstrates
it Will Dramatically Reduce Hearing Aid Service
Rates
CIC with MicroWaxbuster installed
MicroWaxbuster Cutaway
106
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.
107
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.
  • Tracked receiver replacements in corporate
    service files.

108
Receiver replacement rates per 100 CIC hearing
aids (n21,345)
109
Receiver replacement rates per 100 ITC hearing
aids (n47,316)
110
Receiver replacement rates per 100 ITE hearing
aids (n21,647)
111
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.

112
Shell Technology
  • 1960's industry adopted dental industry 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

113
Soft Shell Technology
  • Improved fit comfort
  • Improved fit with torturous ear canals
  • Other potential benefits
  • gt gain before feedback
  • lt displacement of hearing aid

114
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
  • Impressionless hearing aids (3-D digital models
    of the ear canal)

115
(No Transcript)
116
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

117
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?

118
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

119
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)

120
MarkeTrak NormsSelect Customer Satisfaction
Factors
121
MarkeTrak NormsCustomer Satisfaction in Select
Listening Situations
122
Percent of Consumers Receiving Follow-up Customer
Satisfaction Survey (H.I. lt 6 years compared to
H.I. lt1 year in age).
123
Overall Satisfaction Improves with Post-fitting
Survey Follow-up(H.I. lt 6 years compared to HI lt
2 years).
124
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

125
Some Final Considerations
  • Measuring performance helps drive success.
  • Without effective measurement how can we assure
    we have optimized the customers hearing
    experience?
  • Without effective measurement how can dispensers
    grow in their wisdom on behalf of the consumer?

126
(No Transcript)
127
From Evidence for the Binaural Advantage Using
Customer Satisfaction Benefit Data. (Kochkin,
Kuk 4/1997)
128
U.S. Binaural Hearing Instrument Owner Population
Trend
129
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

130
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

131
Knowles Binaural Satisfaction Study
  • 2 samples of bilateral loss subjects
  • MarkeTrak - (n1,124)
  • High performance hearing aids - (n3,279)
  • Compare binaural and monaural satisfaction/benefit
    results.
  • Difference scores on key factors.

132
Satisfaction with Directionality of Hearing Aid
for 5 Samples of Bilateral Loss Subjects Fit
Either Monaurally or Binaurally.
133
Monaural vs. Binaural Customer Satisfaction (Key
factors impacted)
134
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

135
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).

136
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.

137
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.

138
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139
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.

140
Customer Requirements 5 dimensions
  • Empathy - the degree of caring and individual
    attention you show to your customers.
  • Tangibles - the physical facilities and equipment
    and your appearance.

141
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.

142
An excellent starting point for your whole staff.
143
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

144
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145
Amount of Counseling Time Spent with Hearing Aid
Users During Last Hearing Instrument Purchase
(H.I. lt 6 years compared to H.I. lt 1 year).
Modal time is half hour
146
Customer Satisfaction Ratings are Related to Time
Spent in Counseling (H.I. lt 6 years compared to
H.I. lt 1 year).
147
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

148
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

149
www.knowleselectronics.com
  • Recommended Readings
  • J. Abrahamson - post fitting group sessions.
  • C. Palmer E. Mormer - Systematic counseling
    protocol
  • Edwards - pediatric population

150
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151
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.

152
Current Nonowner Attitudes Toward U.S. Hearing
Health Distribution Channels
153
People buy from people... people they like, they
trust, they respect no one buys from an enemy."
  • Sales Manager - Dupont

154
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

155
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156
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.

157
Comprehensive Fitting Protocols
  • Models of hearing aid success needed
  • Matching technology with consumer hearing loss
    characteristics at the point of sale.

158
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

159
Sample ProtocolWashington University School of
Medicine
  • Established appropriate prescriptive REIG
    (corrected for mixed HL (gt20 of A-B gap) and/or
    binaural summation (lt3-5 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.

160
Sample ProtocolWashington University School of
Medicine
  • Assessed performance of directional microphone by
    looking _at_ differences in REAR _at_ 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

161
Sample ProtocolWashington 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 _at_ 500, 1000, 2000 and
    4000 Hz using FM signals _at_ 00
  • Measure unaided and aided HINT (dBA) in Quiet
    with sentences _at_ 00

Currently under consideration
162
Sample ProtocolWashington University School of
Medicine
  • Measure unaided and aided HINT RTS in Noise with
    Sentences and Noise _at_ 00
  • ANSI-96 reveals lt10 THD ANSI-92 reveals smooth
    coupler response _at_ 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
163
Sample ProtocolWashington 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.

164
Best Practices Discussion Items
165
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

166
Benefit is Critical to Market Growth
  • Important to focus on the dispensers role in
    optimizing consumer benefit.
  • Current consumer benefit is 44 HL problem
    resolution in U.S. How can we improve to 65
    benefit in 5 years?

167
Selection/verification/validationSome
Considerations
  • Convene committee of industrys 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)

168
Selection/verification/validationSome
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)

169
Selection/verification/validationSome
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.

170
Selection/verification/validationSome
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

171
Selection/verification/validationSome
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

172
Selection/verification/validationSome
Considerations
  • Assure audibility 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 dispensers office
    with hearing aids that are too loud?

173
Selection/verification/validationSome
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.

174
Selection/verification/validationSome
Considerations
  • Does the use of patient focused 360 sound field
    aided testing have a positive impact on
    maximizing individual benefit?
  • Preliminary research shows lt fitting time
  • No impact on APHAB benefit scores
  • Possible significant impact on return rates.

175
Selection/verification/validationSome
Considerations
  • Should we establish contracts with consumers
    promising certain levels of benefit in quiet and
    noise based on our knowledge of the consumers
    hearing loss characteristics?
  • Should consumers be made to pay for hearing
    instruments with little or no measurable benefit?
    (e.g. speech intelligibility improvement).

176
Selection/verification/validationSome
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 energy expenditure (time,
    service, product).

177
Selection/verification/validationSome
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

178
Selection/verification/validationSome
Considerations
  • Turn best practices protocol into equivalent
    Good Housekeeping Seal of Approval. Implicit in
    such a seal is a benefit guarantee to the
    consumer.
  • Should hearing aid dispensing outlets earn such a
    best practices seal of approval through an
    independent audit?
  • Similar to ISO 9002 quality certification

179
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

180
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.

181
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182
Value
  • 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.

183
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

184
What is Value?
  • Service provided performance of hearing
    instrument (benefit)
  • Relative to how much was paid for the product
    service

185
What is value?
186
Customer Satisfaction is Highly Related to
Spent per 1 Improvement in Hearing Disability
187
Overall Customer Satisfaction as a Function of
Price and Hearing Disability Improvement(Statisti
cal Model)
Overall Customer Satisfaction ()
Price
Hearing disability improvement ()
R2.86
188
Hypothetical Situations - Value
189
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190
Satisfaction is Related to the Age of the Hearing
Instrument
191
and to Hearing Aids in the Drawer
192
Recommendations
  • Maintain contact with past consumers.
  • Develop marketing and incentive programs to
    assure that technology in consumers ears is lt 5
    years old.
  • Friends of consumers will judge newer technology
    based on consumers perceptions of 10 year old
    technology.
  • Critical to work with consumers to keep hearing
    instruments out of the drawer.

193
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194
A Word About Expectations
  • Expectations are critical when you serve
    customers.
  • Meet them to satisfy the customer.
  • Exceed then to make the customer love you.

195
A Word About Expectations
  • Set unrealistic expectations--in essence,
  • promises you can never hope to keep--then
  • your customers will hold you beneath contempt.

196
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

197
What Can You do to Move From Customer
Satisfaction to Customer Bliss in Your Practice?
198
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.

199
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)

200
Our Role is To Assure the Customers 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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