Albert Einstein's Approach to Hearing Care

Dig through any stack of motivational posters or manager-mugs and you’ll soon find this famous observation by Albert?Einstein:

“Insanity is doing the same thing over and over and expecting different?results.”

A useful trope in countless change management meetings, Einstein was talking about hearing?care.

No,?really.

To this end, Einstein’s famous quote was presented in the recent?UKHCA Conference?to underpin moves to change occupational hearing health. The contention is that the current approach to hearing surveillance as a component of hearing healthcare is failing.

At WorkScreen, we think “failing” is a strong word and is debatable in itself, since the UKHCA conference was well attended, millions of UK workers are under active hearing supervision, and we are discussing it here on the interweb. Nevertheless, there is always room for improvement, and we’re certainly not qualified to argue with?Albert.

Einstein’s Theory of Change Applied to Hearing Tests

If insanity is doing the same thing over and over and expecting different results, there are two schools of thought about implementing change to affect a different result: make?techno-clinical?changes or make?behavioural?changes.

1. Techno-Clinical Change = use new technology and methods to improve test results – i.e. “build a faster horse”.
2. Behavioural Change = adopt new approaches to maximise what is available – typically by improving accessibility or information – i.e. “teach everyone to ride”

In terms of hearing surveillance and occupational hearing tests, a techno-clinical change could mean changing the nature of the test, for instance by adopting a different basis for each test and measure of hearing health. Meanwhile, behavioural changes could be to alter the way testing is delivered, implemented or used to provide more useful information. These approaches are not necessarily mutually exclusive, but it has to be observed that a faster horse may be more challenging to ride. Especially if the faster horse is significantly different and turns out to actually be a?camel.

Voltaire’s Perfection Theory Applied to Hearing Tests

Clearly Einstein was not the only big brain thinking ahead, since Voltaire also had something to say when contemplating change for the?better:

“the perfect is the enemy of the?good”?

Where workplace hearing tests are concerned, today’s baseline with respect to improvement is?–

• Hearing tests should be conducted by a “competent” individual – i.e. with suitable training.
• Audiometry has been the benchmark hearing test for over 100 years.
• Of the 30 million workers in the UK, 90% do not receive hearing tests and just 10% may do so (based on the?HSE?estimates for hearing surveillance).
• At WorkScreen, we estimate 40-50% of new clients have never had a hearing test before.
• Typical on-site occupational hearing test charges are sometimes ￡four-figures per day
• The leading alternative technology for occupational hearing screening is OAE – which is generally acknowledged to have some benefits and some disadvantages compared to audiometry. This is something for another post, but safe to say, OAE is a newer technology, based around a different test.

It is also true to say that – like many professions – Occupational Health is short of?staff.

This all means that while great strides have been taken since the Noise at Work Regulations (2005) came into force, a great majority of workers (the “90%”, above) are not getting a hearing test. (We’d argue the vast majority should, since hearing ability affects everyone’s safety and wellness at?work.)

As a result, the broad appreciation and understanding of hearing health – including its impact on productivity – suffers. In fact, WorkScreen’s experience since 2018 suggests that access to hearing tests in the workplace is constrained by?cost, availability and operational?factors.

Meanwhile access to hearing surveillance and (a significant proportion) of the cost is a function of access to qualified technicians to administer the test. Which is why costs invariably go up for?night shifts, just as availability plunges in the opposite?direction.

Implementing Effective Change Easily

So would positive change be delivered by introducing new methodologies that concentrating the provision of basic surveillance hearing tests into the hands of a few specialist providers (a subset of today’s providers). Who have to charge for their time and specialised new-fangled equipment, with the end result that better results are provided to fewer?people?

In fact – going back to Einstein – since in this scenario access to hearing tests at work continues to be controlled by hearing test providers – does this scenario provide any change from the status-quo: particularly from the patient’s?perspective?

Or – just as quality cannot be created by inspection and health is improved through personal action, not by testing -.is positive change a case of empowering more people to understand their hearing health? Improving access to basic hearing checks and information empowers an understanding of the risks and an active interest in this important aspect of our holistic?health.

Parallels: Blood Pressure & Hearing

To understand where WorkScreen currently sits in this debate, consider that it used to be commonplace to visit the doctor or nurse to have our blood pressure?measured.

The game changer in recent years has not been the development of?Narrowband auscultatory blood pressure measurement.?Using sound to assess blood pressure is impressive – but providing access to quality, low cost blood pressure testers based on a venerable technique, that anyone can use, anytime, anyplace now helps vastly more (millions) of people understand and assess their vascular health on a daily basis. It’s important to have access to and know your numbers!

So if we really want to see change in hearing health, it starts with getting screening and basic testing more accessible, so that a few gatekeepers and keyholders do not determine availability of testing. The results, the meaning and the learning then follows. This is the?WorkScreen mission?– or in a nutshell: everyone who needs a hearing test should get one.

And if you’re still not sure, ask yourself this:?“if you want to mobilise a nation: would it be more effective to give 20 people Ferraris. Or everyone a?bicycle?”