The Impact of Hearing Loss on Safety, Quality, Patient Experience and Outcomes

Podcast Transcript

Paul Bryson:

Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology - head and neck surgery.  

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.  

Today I'm joined by our returning guest, Dr. Sarah Sydlowski, Associate Chief Improvement Officer at Cleveland Clinic and audiology director of our hearing implant program. Dr. Sydlowski, welcome back to Head and Neck Innovations.

Sarah Sydlowski:

Of course. Thanks so much for having me.

Paul Bryson:

I encourage everyone to go back and listen to Dr. Sydlowski's previous Head and Neck Innovations episodes on Hearing Health Perspectives and Cochlear Implant Updates. But for our new listeners, let's start by having you share some background on yourself, where you're from, where you trained, and how you came to Cleveland Clinic.

Sarah Sydlowski:

Sure, absolutely. Well, it feels like a long time ago now because I'm coming up on my 15th anniversary this fall actually, which is really hard to believe. But I originally trained for my clinical doctorate and audiology at the University of Louisville. I went to the Mayo Clinic in Arizona to finish my training, and that was really where I developed a passion for research and thinking about how we can make things better for the patients in our care. So I went back for my PhD at Gallaudet University in Washington D.C, and then wrapped up my education by pursuing my MBA because I was interested in the business of healthcare and again, just really how we can collaborate and communicate with people across the organization who are trying to improve care. So I did that at Case Western about five years ago. But yeah, really happy to be here at Cleveland Clinic. This has been an organization that I think brings together all the things that I care about most in an environment where we can provide outstanding care for our patients and really advance the field.

Paul Bryson:

Well, I appreciate that, and just as an observer of your career, it's really been inspiring the way that you have been able to integrate things that you're passionate about and your MBA background brings such a unique perspective to your continuous improvement work, but also some of the business and clinical impacts of hearing loss and cochlear implants. So it's been really cool just as a colleague and somebody in the head and neck department to just see you build your career and how it's changed over the years.

Sarah Sydlowski:

Yeah, I appreciate that. It's definitely a non-traditional career path, but I love what I'm able to do. And like you said, it really brings together all the things that I enjoy most and I think in a way that makes a difference for patients and for Cleveland Clinic. So I feel very fortunate to be able to do that.

Paul Bryson:

Well, your passion and enthusiasm certainly shine through, and today's topic is relevant for both your work with hearing loss as well as your focus on enterprise continuous improvement, and that's the importance of proper communication to patients with hearing loss. Beyond audiology, where do you see the most significant impact of unaddressed hearing loss on patient experience within the hospital or clinic setting?

Sarah Sydlowski:

Yeah, so I'm so excited to be able to talk about this today because I really think it's an underappreciated aspect of healthcare. People just don't think about the fact that you have to be able to hear your healthcare providers and to be able to communicate effectively in order to take action on their recommendations. And hearing loss is the third most common chronic health condition for older adults. If you live long enough, the incidence is 100%. And so this is something that impacts a huge number of our patients, and because it's something that's really invisible, I think oftentimes providers won't even recognize that they're interacting with someone who might be experiencing a difficult time hearing.

Even if patients are able to have a good conversation and discern what they're hearing, what we don't always appreciate is how hard they're trying to do that they might be using a lot more energy and effort. And if that energy and effort is going toward listening and hearing and communicating, it's being pulled away from other things which could include understanding their condition or what their provider wants them to do about it.

And so hearing loss just affects every single aspect of someone's experience from interacting with the valet when they drop their car off to seeing the MA who might be rooming them and asking some questions to scheduling the appointment actually. Even before they get here I should acknowledge that making that appointment could be more difficult, getting prescriptions after the fact, trying to follow up with questions. There isn't an aspect of your experience in a health system that isn't impacted by your ability to hear and communicate.

Paul Bryson:

Yeah, you touch upon a grade point, right? You'll spend a lot of time with someone, but we don't always assess their understanding maybe of the visit or how compliant they may or may not be. What's your hearing loss? How might that influence compliance to recommendations or just treatment adherence in general of are there studies looking at that?

Sarah Sydlowski:

Yes, there have been some studies that have looked at that, and one of the reasons that I have such an interest in this, as you said, it really intersects between audiology and then also my other area of interest, which is safety, quality, patient experience, continuous improvement. Hearing loss has a big impact on many of the things that are important to us as a healthcare system. When we talk about being the best place to receive care anywhere, it means providing care in a way that patients can be compliant, as you mentioned, and can understand what they need to do in order to stay healthy or to manage an illness.

And so some of these studies, what they have looked at is what's the impact that hearing loss can have? And some of the areas that studies are beginning to suggest there's a connection is being able to be compliant with that care, but also being satisfied with the communication that they're getting from their doctor, from their nurses, which is also something that's really important for healthcare organizations because we're monitored on that. We are tracked and we have goals and targets that we're trying to hit in terms of how satisfied patients are. That's obviously a really important part of care.

There's also been some studies that suggest that there are higher rates of complications in older adults who have hearing loss, potentially a higher number of readmissions that can happen, and we can really only speculate as to why that is, but I would imagine some of that may be from not fully understanding what needs to happen after they go home and being really clear and confident about what they need to focus on or why they need to focus on that. And so it just surprises me honestly that more healthcare systems haven't thought about the relevance that hearing loss has because it's important for patients, it's important for caregivers, it's important for the organization, and it's definitely important for providing the best possible care and for Cleveland Clinic being a world-class leader in the care that we provide.

Paul Bryson:

So when you think about it from this system level, it touches everything. So where is our system kind of began? And are there any other models that you're really impressed with across the country? Like who's doing a great job and how does one approach this?

Sarah Sydlowski:

I think there's a lot of variability, and I see good work in pockets. There are lots of different ways that teams are approaching this. For example, some teams are really aware that when you are having a surgery, it makes patients feel a lot more comfortable if when they're coming back into the operating room, they're able to hear their care team or when they first wake up after coming out of anesthesia, their hearing device is on and the volume is at a comfortable level.

So there are some systems where I've seen a focus on making sure that that equipment is available. It's not left out in a waiting room with families. Some teams have developed little boxes that have labels so that they know that that equipment will be available, or they take the time to talk with a patient about, well, how do I put a battery in? How do I turn that on? How do I make sure that when you wake up you can hear what's going on around you? That's something that's really important.

I think a first step and something that we've been focused on here at the Cleveland Clinic, it's just raising awareness to know how important this even is. And so we've spent some time collaborating with teams across the organization and looking at our annual compliance training. Caregivers will now see that there are sections that are specifically focused on how to best serve patients who have hearing loss.

One of the misconceptions that we needed to address was that any patient with hearing loss uses American Sign Language. It's actually a really small percentage of more culturally deaf patients who may rely on assigned language as opposed as to a spoken language. For many of our adult patients, they have lost their hearing gradually over time, and they may rely on other modes of communication to help them to hear their best. And so our system didn't necessarily recognize that well.

We've started to do some work to try to improve that. We still have a ways to go, and the first step in that is using our medical records to really identify who even has hearing loss, who needs that extra support. Although I think it's also important to realize that any of the good communication tips that we would comment on benefit everyone. There's no harm to using that with every single patient, but there's lots of benefit to using these approaches with patients who really need those extra steps.

So I can't say that I can point to a system including us who has figured it out completely, but I do feel a lot of pride in that. We're recognizing there's a lot of opportunity here, and I'm really excited to see that we're getting a lot more outreach from different hospitals, from some of our patient care advocates, from other providers who are recognizing, hey, this is really important to my patient's care and to their outcome, and how can you help us do it even better? So I expect that we will continue to lead the way, and I'm really excited about that.

Paul Bryson:

Yeah. Well, I mean, they're lucky to have you. I think just with your background and hearing loss and awareness of it, I mean, it brings sort of a different level, I would say, of sympathy and empathy for how we engage with patients and how we might make that better. So yeah, I look forward to seeing how that turns out. Also, I wanted to switch gears a little bit. I know the hearing Implant program team was well-represented at some recent meetings, and I believe it was the American Alliance of Cochlear Implantation. Can you share some highlights from this aspect of your work?

Sarah Sydlowski:

Yeah, we were really excited. Earlier this year, we had the opportunity to have some of our best representation. We've had actually at the American Cochlear Implant Alliance meeting in Boston, and most of the work that we were able to present aligned with what I think is probably one of our biggest focuses, and that's increasing access to cochlear implants and making sure that more patients know about it and know how to connect with that care.

So we had some presentations on increasing access to cochlear implants by making our program more efficient. We've introduced some shared medical appointments, which have allowed us to see more patients, but also I think has really improved the patient experience because new cochlear implant candidates have the chance to interact with others who are in a similar place on their journey.

We also had a great presentation on how patients that we have implanted under expanded indications are doing. So patients who align with best clinical practices that are supported by our association's guidelines, but for whom insurance coverage and even FDA labeling haven't kept up yet. And the answer is they do really well. And so it has given us a lot of confidence in being able to continue to push that envelope.

We also had some presentations on the impact that insurance denials are having on our ability to connect people to care, as well as some innovative approaches we're taking to help the non-implant team members that we have to recognize and identify patients earlier, such as measuring how well they're hearing with hearing aids outside of a sound booth. And as we continue to scale and spread that that will mean that more and more hearing care providers can recognize these patients and suggest a cochlear implant to them sooner when it can be of the most help.

Paul Bryson:

Yeah, that's pretty cool. I mean, I think the real life use cases are really, really good. Like you said in the booth, things may be one way, but when people are going about and using it in real life, I think that's really powerful. And then I wanted to follow up, so shared medical appointments. That's not new to our system, but I wondered what's the experience with the cochlear patient or candidate? We've thought about it in our own division for different things, and we always worry that people may not feel like they get some of the individual attention that they are sometimes seeking for complex decisions like a cochlear implant, you name it. But what's the response been to shared medical appointments for this?

Sarah Sydlowski:

To be honest, I had the same concerns before we started. We first introduced these back in 2016, 2017, and so we were able to actually publish on some of the results a few years ago, and we were so surprised and really gratified that patients love it. They had nothing but good things to say. And some of the things that stood out were that the fact that they were able to share the experience with others, and not even the candidate themselves, but their spouse or partner or individual who was their caregiver or support person, they really benefited from learning from others who were trying to support someone with hearing loss.

And so there was a lot of value there. People commented that other candidates ask questions they didn't necessarily think of. And we actually, one of the side benefits, we didn't publish on this piece, but we noticed that we had fewer people dropping out of the process. And I think it was because they had that shared experience and saw others experience the same thing. My hypothesis is that that really sort of supported them and buoyed them up during a difficult time.

So COVID of course, had changed our ability to do that. And so we've revisited it in the last couple of years with a few big changes to how we're doing it to try to continue to build on that and to innovate and to think about it a little bit differently. We've learned a lot, and I think that we are now at the point where we're able to start scaling outside of main campus to make it even more convenient for patients to access what we find to be a really valuable approach.

I hope that anyone listening who's interested in learning how to communicate more effectively with patients can visit our website, which is clevelandclinic.org/patientcommunication. At that site, we have a really valuable video that summarizes a lot of what we've talked about today in terms of how communication impacts the patient experience. And even more importantly, we have a lot of really great communication tips that are very valuable for healthcare providers, but really anyone who interacts with patients in the healthcare organization to optimize how they speak, how they face the patient to have some good tips and tools and resources that they can use. It's just a quick one-page, one-stop shop to get a lot of good takeaways. So I'd highly recommend clevelandclinic.org/patientcommunication.

Paul Bryson:

Yeah, I wanted to have a followup on the shared medical appointments, and you said you had less people drop out, and I wonder if there's some power in having other people with a similar problem be there to actually validate the benefits. And sometimes you think, oh, well, I'm seeing the surgeon, or I'm seeing the cochlear implant team, they want me to get this implant. But it's really nice to see somebody who's maybe on the other side of it and can vouch for the good and maybe some of the challenges, right?

Sarah Sydlowski:

Oh, absolutely. I think that's really important. We do also have a patient advocate program where we're able to match a candidate with someone who has a similar background, a similar hearing history, and who we expect will have similar outcomes because we can tell them the technicalities of going through the process, but there's nothing like hearing from somebody who's lived it and they know what it's like to go home with that cochlear implant processor, the struggles that you face, the experiences that you have, what helped them get over some of the early hurdles. So that's extremely valuable, and I think considering our team in that broader lens of healthcare providers, but also recipients has made us a much stronger program.

Paul Bryson:

Well, I really appreciate you coming on. As we wrap up today, any take-home points, anything we should keep our eye on? The cool thing about having you on is I always feel like we naturally have a segue into the next time that you're on the podcast, because just today we can talk about the system things that we could do for patients with hearing loss, and even just an update on the shared medical appointments and how more lessons learned. So anything else you want to highlight before we wrap up? We always cover such good ground when you're on.

Sarah Sydlowski:

Yeah, no, I've loved the conversation. Of course, it's really fun to share the successes that we have and the things that we're trying, but I also hope that anyone listening who works with another healthcare system that maybe this also gets them excited about spreading this message of how impactful hearing and hearing loss is. I think this is an area that is largely unexplored and where we have huge opportunities to make a big impact, and there's nothing I like more than figuring out how we can make things better, but it's nothing that we can do alone. So I'm excited to keep spreading the word so that we can partner with others to change healthcare for patients with hearing loss.

Paul Bryson:

Well, it's been great to have you. And for our listeners, for more information on our hearing implant program, I'm in hearing loss services at Cleveland Clinic. Please visit clevelandclinic.org/audiology. That's clevelandclinic.org/audiology, and to connect directly with a specialist or to submit a referral, call 216 444 8500. That's 216 444 8500. Dr. Sydlowski, thanks for joining Head and Neck Innovations.

Sarah Sydlowski:

Thanks again for having me.

Paul Bryson:

Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website clevelandclinic.org/podcasts. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you listen to podcasts.  

Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.