How to Foster Person-Centered Care

Knowing how to foster person-centered care is not the same as applying it in practice. In fact, many students find it challenging to manage the technical side of a client’s hearing loss, such as going over the audiogram, explaining the results to the client, and making recommendations, while at the same time listening actively to understand the client's unique needs, hopes and challenges.

A number of tools are available that can help hearing care professionals quickly get to the core of the client’s issues, listen actively to what the client is saying, assess their motivation for rehabilitation and reflect on how the appointment went with a view to improving the quality of their care.

Students will typically be familiar with one or more of these tools. You can expect them to apply some of the tools when they come into clinical supervisor clinics.

Below are examples of tools and interview guides that can help students focus conversations on the client's perspective, their motivation to change and strategies for successful rehabilitation. 

The Ida Institute's Reflective Journal enables clinicians to gain deeper insight into their own clinical practice and to understand their own behavior. By spending just a few minutes to reflect on the interaction with one client before meeting the next one, clinicians can become more effective and reduce stress as they identify ways to make their consultations more client-focused.

Audiology students may have been introduced to this tool at university and would benefit from using it in the clinical supervisor clinic, to understand and improve their own practice. 

The Ida Motivation Tools are three simple, but highly effective clinical tools that can help audiologists shed light on client motivation and ambivalence. They can be used to help encourage people with hearing loss to take responsibility for their actions and make appropriate behavioral changes. Some audiology students will be familiar with these tools when entering clinical supervisor clinics and would benefit from mentoring and guidance as they try them out with clients.

The Four Habits Model was not developed by the Ida Institute but aligns with the Institute’s philosophy and efforts to foster person-centered care in the hearing care profession and has therefore been included in this overview. Also, some clinical supervisors may find that students who come to their clinics are familiar with this model.

The Four Habits model aligns communication skills with content skills, also known as "habits". The model identifies four patterns of behavior used by clinicians to conduct mutually satisfying and effective medical interviews that result in good biomedical and functional outcomes of care. The habits are:

• Invest in the beginning
• Get the client’s perspective
• Show empathy
• Invest in the end

The Four Habits are organized sequentially, focusing on events that typically take place during a medical interview. They are seen as interdependent so that each habit sets the stage for subsequent habits employed later in the interview.

Each habit is organized into families of skills, techniques and pay-offs and presented alongside evidence and case studies that illustrate the habit in practice.

In the model, distinctive and describable behaviors and skills are outlined that provide a step-by-step approach for students attempting to blend the logic of testing and clinical problem solving, with social interaction. 

The Calgary Cambridge approach to the medical interview is not an Ida Institute tool but has been included here as it aligns well with the Institute's philosophy. The  Institute is in the process of adapting the Calgary Cambridge methodology to audiology. The resulting Time. Tasks. Talk. Structuring Patient-Centered Communication tool will replace this brief introduction to Calgary Cambridge method.

It has always been difficult to integrate communication skills with other essential clinical skills. When communication skills are taught separately to content skills, learners confront two apparently conflicting models of the medical interview:

• A communication model describing the process of the interview
• The "traditional medical history" describing the content of the interview

The Calgary-Cambridge approach aims to improve the way communication skills are introduced to students by placing the process skills within a comprehensive, clinical method. The medical interview is structured in a logical fashion, and appropriate communication skills are matched with each element. In this way, person-centered care is incorporated into the process and the content aspects of the medical interview. 

The 5A’s Behavior Change Model was not developed by the Ida Institute but has been included here as it aligns with the Ida Institute’s philosophy of fostering person-centered care in the hearing care profession. Clinical supervisors may also find that some students have been taught this method when they come to their clinics.

The 5A’s model was developed by National Cancer Institute (NCI) investigators from the literature on smoking cessation. It provides a series of evidence-based clinician behaviors for supporting a patient with chronic disease to develop an action plan for how to accomplish behavior change. The 5A’s are:

• Assess - health behavior and self-efficacy
• Advise - costs and benefits of change
• Agree - to health goals collaboratively
• Assist - with identifying barriers and strategies to overcome them
• Arrange - follow-up visits, home calls, reminders

Research and experience contend that no amount of recommending, persuading or stressing a client will affect a behavior change. The person has to be motivated from within. The 5A's model is often taught to audiology students as a method for supporting a client to develop an action plan and to affect the behavior changes necessary to manage the communication difficulties arising from hearing loss. 

The Ida Institute has adapted the 5A's model for audiological practice in collaboration with our network of hearing care professionals. In doing so, we have added a 6th "A" to the framework (Affect) in order to round off the interview and consider whether the affect of the intervention was appropriate.