Back to basics: 3 ways to improve your goal setting

If you were to ask any stranger you meet, “Hey, why do people wear hearing aids”?  I bet we can agree that they would likely look at you kind of strangely and then remark “to hear better”.

When you meet a new patient for the first time, you might casually open the conversation the same way, asking why they came to see you. I imagine you’d get a similar response. Nine times out of ten, our patients aren’t primed to give the specifics around their hearing needs and goals. So, it’s our professional duty to probe further.

“To hear better” is an example of a non-patient-focused goal, because it’s too general.  It’s focus is too broad. So, how do we establish goals that are patient-focused, needs-based, measurable and achievable? Here are my tips.

3 ways to improve your goal setting

1. Constantly refine and ask for specifics to set patient-centered goals.
   
   The first characteristic of a strong patient-focused goal is to be targeted, strategic and related to the conversation. We can refine the “to hear better” goal and make it patient-centered by asking questions about specifics (e.g., “Who or what do you want to hear better?”, “Is there a problem we’re looking to solve?”).
   
   
2. Answer the “why” to reflect real life.
   
   This aspect of goal planning makes the goal real. Answering the ‘why’ allows you to focus on how hearing loss is impacting your patient’s real-life. 
   
   For example, the patient might need to hear better because hearing loss is damaging their relationships, or hearing loss makes it difficult to be effective at work. These ‘Why’s’ are important to discuss with your patient when goal setting.  Remember for practitioner and patient alike, this can be a difficult conversation. 
   
   If I were to take a guess why great goals aren’t always set is because people struggle to talk about their feelings.  It’s that thing we hear about called vulnerability. In my opinion, this is where hearing care and healing truly begin. 
   
   
3. Make goals measurable, even the real-life ones.
   
   In our audiology clinics, out of best practice or habit, we might first turn to tests to begin measuring goals. If we start broadly, with the goal being “to hear better,” we could use the audiogram and functional gain to measure. But how much does this measurement reflect or relate to real life?
   
   The Quick Speech-in-Noise (QuickSIN) test has great face validity but is just a quick estimate of SNR loss. Last, to be comprehensive, we have our pre- and post- inventories like the Abbreviated Profile of Hearing Aid Benefit (APHAB) which do a nice job of quantifying the subjective parts of communication. All of these are our clinical tools to measure success.   
   
   Maybe you’ve tried the above and want to change things up. This might sound a bit unconventional, but you could ask your patients (and definitely involve friends, family and care givers in the conversation) to literally ‘count’ or track certain behaviors.
   
   For example, we’ve all heard of communication partners becoming exasperated because the patient is constantly asking for repetition throughout the day. Here you can actively involve the communication partner and have them both count how often repetition is needed to focus the clinical work on the behavior change. You can ask them to track the number of repetition requests and see if it lessens after the fitting.
   
   Or, maybe the patient isn’t even aware when conversations are being initiated by a partner, causing deep strain on the relationship. Here you can ask them to track the number of times the patient doesn’t respond or says  “What?” to their partner to measure if awareness increases with hearing aid use.
   
   I find these approaches helpful on a few different levels; they are easy to understand, communicate and implement, they open the door to set set realistic expectations about amplification and focus on the ‘two-way street’ of good communication, and while measuring success they also create an opening to highlight other important assistive technologies like Roger™, streaming devices and so much more.    
   
   

Pulling it all together

Now that we’ve reviewed these strategies, remember to constantly refine general desires into specific goals. Use your style and what motivates you to most effectively connect with people and guide the conversation. You know that hearing care will always start with wanting “to hear better.”

It is our professional calling to probe further and find out ‘what’, ‘where’, ‘when’, and ‘who’ the patient wants to hear better. Set up the ‘how’ with measurable and achievable targets. Of course, defining the ‘why’ is the inspiration to continuously motivate that person to thrive. While a hearing aid fitting is a point in time, the work of improving hearing abilities never really ends. Having refined goals as a starting point, and an ongoing reference, ensures the patient and you as the guide are undeniably set up for success.   

---

We invite you to read a previous blog article, Four motivational interviewing techniques to help increase hearing aid uptake.