btec level 4 diploma for hearing care assistant

Principles of Communication Skillsfor the Hearing Care Assistant Unit Code: F-505-5891

BTEC Level 4 Diploma for Hearing Care Assistant

Document Title: F/505/5891 Principles of Communication Skills for the Hearing Care AssistantPublished: 05/03/2020Version: 1.0Date of next schedule review: 05/03/2021 Owner: HCA Course Lead

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F/505/5891 Principles of Communication Skills for the Hearing Care Assistant

Contents

Chapter 1 Introduction to Communication 4

1.1 Introduction to communication skills with customers 5

1.2 The power and potential of communication 5

1.3 Effects of poor communication 5

1.4 The power of good communication 6

1.5 Unlocking the potential of communication 6

Chapter 2 Planning Successful Communication 7

2.1 General features of communication 8

2.1.1 Features of communication 8

2.1.2 Objectives of communication 8

2.1.3 Situation or context 9

2.1.4 Barriers to communication 11

2.2 Planning process 13

2.2.1 Six simple questions 13

2.2.2 Planning 15

Chapter 3 Practical Communication Skills 17

3.1 Speaking 18

3.1.1 The personal qualities of speaking skills 18

3.1.2 The vocal qualities of speaking skills 20

3.2 Listening 22

3.2.1 Reasons to listen 23

3.2.2 Good listening 24

3.2.3 Aids to good listening 25

3.3 Body language 29

3.3.1 Space 30

3.3.2 Touch 32

3.3.3 Orientation and posture 33

3.3.4 Head nods 34

3.3.5 Facial expressions 34

3.3.6 Eye movements 35

3.3.7 Gestures 36

3.3.8 Verbal and non-verbal communication conflict 37



Contents

3.4 Telephone skills 38

3.4.1 Difficulties with the telephone 38

3.4.2 Telephone rules 41

3.4.3 Making a business telephone call 41

3.4.4 Answering a business telephone call 43

3.4.5 Dealing with difficult calls 44

3.5 Business letters 44

3.6 Dealing with difficult customers 47

3.6.1 Things to remember when dealing with difficult customers 49

Chapter 4 Customer Record Keeping 50

4.1 Why do you need to practise accurate customer record keeping? 51

4.2 Legal record keeping requirements 51

4.3 What does good look like? 52

4.3.1 Screening audiogram 52

4.3.2 Clinical notes 52

4.3.3 The Fitting appointment 53

4.3.4 Follow Up appointment 53

4.3.5 Service appointments 53

4.4 Conclusion 53



Chapter 1 Introduction to Communication




1.1 Introduction to communication skills with customersAs healthcare practitioners, we have responsibilities to our customers and to the practice where we are employed. The achievement of several objectives relating to these twin responsibilities depends on good communication, and staying ahead in the competitive market means striving to make good communication less hit and miss.

1.2 The power and potential of communicationWe can all hold a conversation and know how to be polite, but just as learning to work an otoscope does not equip one to diagnose hearing loss, there is more to delivering good communication than politeness. Specific techniques have been developed to make practitioner-customer interactions more effective. Sophisticated communication techniques can be a very useful tool to maximise customer satisfaction, team performance and the individual practitioner’s contribution to the ongoing success of the practice.

1.3 Effects of poor communicationBefore new techniques can be mastered, it is vital to eliminate substandard interactions. There is research to suggest that communication in the consulting room is sometimes inefficient and unsatisfying for the customer. Primary care research has been performed to examine this issue in general medical practice, which is not vastly different to audiology practice – practitioners work in a highly pressured environment, which can lead to stress. Dealing with customers can itself be a source of stress. Even those who communicate well in normal circumstances may not do so when under pressure. That does not mean that most of us are failing to meet minimum standards most of the time – far from it, but it does mean that some customers are leaving us less than satisfied with the service they receive.

Every time this happens there are knock-on effects for the practice. Customers have a great deal of choice of hearing aid provider. Customer surveys have demonstrated that – of all of their in-store experience – the consultation makes the most impression on customers. Remember that from a communication perspective, the consultation starts when you greet the customer and doesn’t end until you have said goodbye. If they leave you happy, they are likely to have very positive things to say about their whole experience at the practice – and pass on that positive message to friends and family.

However, dissatisfied customers may leave the practice never to return. Research has shown that dissatisfied customers make more efforts to share their views with others than do satisfied customers. Therefore, if a single customer perceives they have received poor service we may lose the loyalty of more than one person.




1.4 The power of good communicationAt the upper end of the scale, effectively planned and executed communication strategies can be a source of competitive advantage. Customer satisfaction is a vital determinant of loyalty, and by maximising satisfaction your practice can retain its customers and attract new ones through recommendation.

1.5 Unlocking the potential of communicationWe can go further than ensuring customers are satisfied with the service they receive. As we go on to discuss in this section, communication techniques can enhance the customer’s decision making so they follow your recommendations, choose the best products to meet their needs, look after them according to instructions and hence are more satisfied with the hearing aids they buy.

From the employer’s perspective, effective communication increases the efficiency of consulting room time, the number of satisfied customers, the number of transactions and long-term customer loyalty.



Chapter 2 Planning Successful Communication




2.1 General features of communication2.1.1 Features of communication

The ability to converse is one of our greatest, if not the greatest asset. Constant learning and practice in this area is essential for all of us because if we are able to communicate our ideas, thoughts, and our business and social messages more clearly, and more completely to whoever is prepared to listen, then we are certain to be more successful in any situation.

There are many areas of our lives where understanding the process of communication, the power of language and the skill of persuasion will enable us to get more of what we want and therefore the opportunity to live a more enriched life. We are talking here about influence and if you look back at your past you will begin to realise that every success and every failure can be attributed to your ability to communicate and influence others.

2.1.2 Objectives of communication

Communication is often described as the process of passing information from one place, or person, to another.

It is a process that we all use minute by minute in our business and social lives. So, if we have so much practise at communication then why does it often go wrong and sometimes fail altogether. The answer lies in understanding what happens when we communicate in a face-to-face situation.

Whenever we are writing or speaking, trying to persuade, inform, explain, convince or educate or any other objective behind the particular communication we are engaged in, we always have four general objectives.

1. To be received (heard or read).

2. To be understood.

3. To be accepted.

4. To prompt action (e.g. change of behaviour or attitude).

When we fail to achieve any of these objectives, we have failed to communicate. This can lead to frustration and resentment in one or both parties.




Exercise 2.1 – Failed communicationThink of recent communication that you have had when you failed to communicate. What factors do you believe contributed to that failure?

We will discuss some of the factors which can influence the success or failure of communication.

2.1.3 Situation or context

One person may say, ‘Don’t you understand English?’. Remember that English is only a code which expresses the thoughts in our head, and a code can only be understood if both parties give the same meaning to the symbols that are used. The meanings that we give to words result from the way we each interpret the world around us, and for each of us that world is seen and understood differently.

Just as the words may be interpreted differently by different people, so the same person may attribute different meanings to the same words at different times and in different contexts. Communication always takes place within a situation or context. The situation or context will have a history and particular characteristics which will make it different from any other situation or context.




Exercise 2.2 – Learning from experienceThink of a time when you thought that you knew what was going to be said by the other party. What prompted that feeling of anticipation and was it correct?

In learning to communicate we learn to recognise similarities in situations so that we can learn from our experiences. This enables us to know what to do or what to expect in certain situations. This is beneficial but can also lead to mistakes, for example when we assume a situation is familiar and say and do what we assume to be correct, we may have failed to pick up important clues which would identify our actions to be incorrect.



2.1.4 Barriers to communication

Whatever communication task we are planning, our individuality is the main barrier to effective communication. Several of the following arise from individuality.

Differences in perception

The way we view the world is largely determined by our past experiences. People of different ages, nationalities, cultures, education, occupations, gender and so on will each have different perceptions and will each perceive situations differently.

Jumping to conclusions

Sometimes we assume we know what is happening and then we often see what we expect to see and hear what we expect to hear rather than what is actually going on. This may lead us to jump to conclusions and put two and two together to get five.

Stereotyping

As we learn from our experiences, we run the risk of treating different people as if they were the same: ‘Once you have met one audiologist you have met them all.’ or ‘Customers under 60 are not interested in hearing aids.’.

Lack of knowledge

It can be difficult, but vital in the role of HCAs, to communicate effectively with someone whose knowledge of the particular subject of discussion is considerably less than yours. How do you make sure customers understand the need to follow rehabilitation advice before they leave?

Lack of interest

One of the greatest barriers to overcome is the receiver’s lack of interest in your message. Where the lack of interest is obvious and understandable you must work particularly hard to angle your message to appeal to the interests of the receiver. This is relevant for example when communicating the benefits of a hearing aid to a customer. It is not surprising that they generally have no interest in technology, so as the practitioner you have to convey design or performance features in a way which attracts their attention.

Emotions

Any strongly felt emotion is liable to prevent anything but the emotion being communicated. Therefore we should try to avoid communicating when a strong emotion is liable to make us incoherent or when it will distort what we mean to say.

Personality

A clash of personalities is one of the most common causes of communication failure in a one-to-one situation. With colleagues and regular customers this can be a really important issue. We may not be able to change other people’s personality, but we must consider our own personality to see if a change in our behaviour may result in more satisfactory relationships.

Environmental barriers

The environment where you are communicating can have a profound impact on whether your message is heard as it can affect not only how much of the message is received but also the receptiveness of the receiver. This applies not only in one-to-one situations, but when you are making a presentation to a group, or communicating a message via a medium – say an advertisement in a newspaper.





Exercise 2.3 – Barriers to communicationFor each of the listed barriers to communication list ways to overcome these barriers. For example, how would you communicate with someone who shows a lack of interest in the subject? Do this for each one of the barriers.




2.2 Planning process2.2.1 Six simple questions

Whatever communication task you are about to undertake, asking these six simple questions before you start will give your communication a better chance of success and make the task easier.

Why? (Purpose)

• Why am I communicating?

• What is my real reason for writing or speaking?

• What am I hoping to achieve?

• What do I want the listener to do as a result of my communication?

Who? (Receiver)

• Who exactly is my listener or reader?

• What sort of people are they? Personality? Education? Age? Status?

• What do they already know about the subject of my message?

• How are they likely to react to the content of my message?

Where and When? (Place and Context)

• Where will they be when they receive my message?

• At what point in the total communication does my message come? Am I replying to something they have raised? Or will my message represent the first they have heard about this issue?

• What is my relationship with the receiver? Is the subject of my message the cause of controversy between us?

What? (Subject)

• What exactly do I want to say?

• What do I need to say?

• What do they need to know?

• What information can I omit?

• What information must I include in order to be: – Clear? – Concise? – Courteous? – Constructive? – Correct? – Complete?

The six Cs of effective communication.




How? (Tone and Style)

• How am I going to communicate my message? With words? Or pictures? Or both? Which words? Which pictures?

• Which medium of communication would be most appreciated?

• How will I organise the points I want to make?

• How am I going to achieve the right effect?

In some cases the answers to these six questions will come quickly. But beware – it is very easy to jump to conclusions, to see the issue only from your point of view and therefore to forget that your listeners or readers may see things differently.

Exercise 2.4 – Planning communication 1In preparation for your next planned communication, structure your communication by asking these six questions of yourself about your subject. Make any changes that you feel are appropriate.




2.2.2 Planning

Only when you have given some thought to these six essential questions are you ready to start planning your message. Although these have clearly relevance to giving a presentation or planning a training session, they are also relevant to customer communication (for example, you might use this process to create well-structured advice for a first time hearing aid user.

Stage 1 Purpose

What are you trying to achieve by your message?

Stage 2 Brainstorming

Using post-it notes, index cards, paper or your PC, record all the ideas or points which you think you need to make.

Stage 3 Chunking

Consider your list and look for links between the pieces of information. Organise your notes into clear groups. These groups will probably become paragraphs in your finished message. Remember that all paragraphs should have only one main idea.

Stage 4 Sequencing

Place the groups of information into a clear sensible order which will be easy to follow.

• Chronological order-presents the material in the order in which it occurred in time.

• Order of importance-descending order of importance starting with the most important point to gain the reader’s attention, or ascending order of importance starting with the least important point.

• Ascending order of complexity-simple ideas first followed by increasingly difficult or complex material.

• Descending order of familiarity-moving from the known towards the unknown.

• Cause and effect-linking events based upon because this happened then that happened.

Stage 5 Outline

After working through the first four stages you may have a plan of your finished message, if not it is essential to produce this plan which you can then use to work from.

Stage 6 First Draft

Write your first draft to yourself, grouping the material into the opening or introduction, the main body of the message, and the close or call to action.

Stage 7 Final Draft

Now comes the time to put yourself in the shoes of the receiver. Read your draft through their eyes aiming for a concise easily understood style.




Exercise 2.5 – Planning communication 2In preparation for your next planned communication and using your work from Exercise 2.4 structure your communication by using these seven stages. Make any changes that you feel are appropriate. Find a friend or colleague, present your version and enlist feedback.



Chapter 3 Practical Communication Skills




3.1 SpeakingPerhaps because we learn to speak before we can write and because it is such a large part of everyday life, we are liable to take speaking for granted.

3.1.1 The personal qualities of speaking skills

Clarity

To be a good speaker you need to be able to express your ideas clearly. Your language should be simple and your material organised so that it can be easily followed. Of course, you may have to use technical language or jargon in some situations, but you should take care to explain the terms that may be unfamiliar to your audience.

Sincerity

Sincerity is one of the most important characteristics of a speaker. This really means being natural. You should strive to be yourself as much as possible in all situations.

Empathy

Probably the best way to be courteous and polite is to put yourself in the other person’s place. Try to make yourself feel what the other person is feeling. Putting yourself in another person’s place helps you to establish empathy for that person and this will help you to be understanding and customer.

Accuracy

Ensure that the words that you use say exactly what you mean. Any facts you quote should also be correct.

Relaxation

When our muscles are tense we have difficulty expressing ourselves naturally and we may perform some movements that are the result of our tension. Try to breathe in a natural manner, many people stop breathing normally when stressed and this increases muscular tension.

Eye Contact

In Section 3.3, we will look at the importance of body language and eye contact in greater depth.




Exercise 3.1 – Eye contactRecall a speaker whom you saw make little or no eye contact with his or her listeners. What impressions did this speaker give to you?

Speakers who never look at their listeners may be conveying messages that they are not interested in their listeners.

Exercise 3.2 – Improving speech 1Ask your friends and colleagues what personal qualities of your speech could be improved upon, how to do it and what benefit it will have? Collect feedback from at least three people.




3.1.2 The vocal qualities of speaking skills

How many people have heard themselves on a recording and thought how much they dislike the sound of their own voice? If that is you, the good news is that you can change the way you speak and the first step is to be aware of the factors which affect the sound of your voice.

Speech requires a complex manipulation of the diaphragm, lungs, chest, vocal chords, mouth, tongue and lips. Think of the vocal chords as rubber bands stretched across the interior of your voicebox (larynx). As air from the lungs is forced through the larynx the vocal chords vibrate and sound is produced. The sounds are affected by the vocal chords, then successively the jaw position, the interior of the mouth, the tongue, teeth and lips.

To ensure the sounds you produce are clear your throat must be relaxed, your jaw must not be taut or rigid and your lips must be flexible and capable of assuming a variety of positions.

Volume

The right volume depends on the situation. You should note the following:

• The location (whether in a small or large room, indoors or out) will affect how well your words can be heard.

• Background noise.

• The size of the group you are speaking to.

Pitch

When your vocal cords are stretched tight the sound will be higher as the air is forced past them. This causes them to vibrate similar to someone plucking a taut elastic band. When people are tense or frightened their vocal cords get stretched and their voices tend to squeak.

Diction and Accent

Diction is the way you pronounce words and to some extent is affected by your accent. People from different areas will have different diction, for example someone from the North will have different diction to someone from London. Do not confuse diction with accent. Whatever accent you have you should always pronounce your words clearly. Interestingly, good diction is generally considered to be the result of being well educated.

Tempo

The good speaker varies their pace according to the relative importance of what they are saying. Speaking very quickly conveys a sense of urgency to the listener. It may also make it difficult to be understood and you may not pronounce each word clearly. Conversely, you cannot afford to speak so slowly that your listeners become bored. Ideally, unimportant words and phrases are spoken quickly while important words or phrases will be spoken more slowly.

Tone

Variations in tone are often associated with pitch and speed in giving emphasis to your speech. Tone can be described as the inflection, or ‘up and down’ movement of your voice.

The tone of voice that you use can reveal your attitudes and emotions. In fact, by altering the tone the same word can have completely different meanings. Take for example the word ‘good’. By varying the tone it could mean a compliment, as in a job well done, or an insult, as with a sarcastic tone.




Exercise 3.3 – Improving speech 2Ask your friends and colleagues what vocal qualities of your speech could be improved upon, how to do it and what benefit it will make? Find at least three people’s feedback.




3.2 ListeningThe majority of training courses to improve communication skills focus on improving people’s ability to transmit information more effectively; to write more clearly and concisely and to speak with more confidence and sensitivity to their audience. However, many studies suggest that it is most people’s ability to receive information that is in need of improvement.

Listening tests have shown that the average person can remember only 50 percent of what they have heard immediately afterwards, and only about 25 percent two months afterwards.

Many people assume that we are automatically capable of listening from the day we are born and hence do not need to be taught how to listen. You may be able to recall instances when people you talk to, and you too, just go through the motions of listening. In reality you may be thinking of other things or thinking what you might say next.

Exercise 3.4 – Listening 1Recall a conversation that you had recently, attempt to recall what you heard. What percentage were you able to remember?

Listening is crucial to good communication because unless somebody listens to the message and understands it, there is no communication, only noise.




3.2.1 Reasons to listen

Exercise 3.5 – Listening 2List the ways that being a better listener helps ensure better communication?

Effective listening produces many beneficial results:

• Improved relationships – effective listening gives the speaker the opportunity to gather facts and ideas and to release hostility. You will understand them better as you listen and they will appreciate your interest in them.

• Encouragement to others – when others note that you listen to them in a non-threatening manner they will usually try to understand you better by listening more effectively to you. Your effective listening often results in making others better listeners.

• Resolution of problems – disagreements and problems can best be solved when individuals listen carefully to each other. This does not mean that they agree with each other, they must merely show that they understand the other person’s point of view.

• Obtaining all the information – to solve problems and make decisions effectively, it is necessary to obtain as much relevant information as possible. Effective listening will usually motivate the speaker to continue talking and provide you with enough information to make an accurate decision.

• Better understanding of people – effective listening will give clues on how people think, what they feel is important and why they are saying what they are saying.




Exercise 3.6 – Listening 3From the previous exercise, which beneficial results will be particularly useful for you and why?

3.2.2 Good listening

Activity

If you are interested in finding out how well you listen answer the following questions?

1. Do you pay full attention; do you look at the speaker as well as listen to what they are saying?

2. Do you keep your mind on the topic continuously and follow the train of thought being presented?

3. Do you restrain yourself and do not interrupt or stop listening when you hear something you believe to be wrong?

4. Do you try to be sure that you are considering the other person’s point of view before you comment, answer or disagree?

5. Do you place yourself in the room so that you are certain you can hear clearly?

6. Do you listen for underlying feelings as well as facts?

7. Do you take no notice of a speaker’s appearance and watch out only for the ideas they are presenting?

8. Do you try consciously to work out the logic and rationality of what is being said?

9. Do you allow for your own prejudices and feelings as you evaluate what the speaker has to say?

10. In discussion, are you willing to let the other speaker have the last word?




As you work to improve your listening performance, the preceding 10 questions should act as a guide for they include the most significant listening problems which occur in personal and organisational communication.

3.2.3 Aids to good listening

Perhaps the simplest way of ensuring good listening is to concentrate on the speaker. The guidelines suggested here include ways of improving concentration.

Be prepared to listen

Listening is not a passive skill but one that requires active hard work. Communication is a two-way process and so we must share the responsibility for effectiveness with the speaker.

Being prepared to listen also means adopting the right attitude; ready to maintain attention, increase awareness and elicit comprehension.

Keep an open mind

Specifically, being aware of your own prejudices. Otherwise you may ignore those messages that do not fit your personal bias. Try not to feel threatened or insulted by messages that contradict your beliefs, attitudes or values.

Open minded also means ignoring someone’s appearance and manner of presentation and not jumping to conclusions about their personality. Just because you don’t like their look and then make decisions about them too early you may miss something important. If you know your own prejudices, you are more likely to control them and to take them into account.

Be interested

Look for ways that the message might be relevant to you, your job or your interests. Listen attentively for ways that you can benefit from what is being said. The other benefit of listening attentively is that by adopting an interested posture you encourage the speaker. You can imagine how difficult it is to talk to someone who looks bored.

Resist distractions

We all know that our attention is fluctuating and selective and that it is very easy to ‘switch off’. Our natural attention curve is high at the start of a presentation and drops as the presentation continues to increase again at the end. Knowing this you make a special effort to pay attention in the middle of a message.

Help the speaker

It has already been mentioned the importance of appearing interested and there are other ways that the listener can encourage the speaker. The listener can make very brief comments or actions that convey the idea that they are interested and want the speaker to continue.




Listener responses• Nodding the head slightly.

• Looking at the speaker attentively.

• Commenting ‘I see’, ‘Uh-huh’, ‘Really?’, etc.

• Reflecting back to the speaker your understanding of what has just been said. ‘You feel that...’

Take notes

If the message is essential to you, you will need to make notes to remember key points. Remember that in making those notes you succumb to a distraction so be flexible. Sometimes it may be better to listen attentively and then make notes afterwards.

Reflect

Reflecting back the speaker’s own ideas shows that you are really listening to what they are saying and allows you to check that you have really understood what the speaker meant to say.

Reflecting phrasesIf you don’t understand what has been said or you want the speaker to elaborate on a point, try to introduce the thought with a reflecting phrase, such as:

• You said...

• You mentioned...

• You suggested before...

• You described...

After repeating the idea, follow with a question beginning with:

• Who?

• What?

• Where?

• When?

• Why?

• How?

Reflecting phrases are designed to give you a second chance of receiving something you missed the first time round.




Appropriate questions

There are a number of different types of questions we can use (see Table 3.1) although open and closed are the most commonly used.

Table 3.1 Types of questions and their use

Question Type Uses Examples

Closed Answer yes/no. Summarises and checks understanding of facts. Brings conversation back on course.

Is that Mr Smith? Are you in Kent?

Specific To gain specific pieces of information. Usually just one correct answer. Direct question.

How long have you had a hearing aid? When did you last have your hearing tested?

Leading Used in influencing situations to encourage positive responses. Gives the answer that you are looking for. Can be used to relax individual, build rapport.

You do think that is a good idea, don’t you? Earlier you said that... didn’t you?

Loaded Similar to leading but has a perceived threat to it based on the perceived status or role of the one asking the question.

Colleague says ‘Good course isn’t it?’ You may openly agree or disagree. Course tutor says ‘Good course isn’t it?’ You may feel inclined to agree based on your perception of the implication of disagreeing.

Open Cannot be answered with yes/no. Often posed as a statement used to establish rapport, open up a topic or to discover feelings of others.

Tell me about... Please describe... What happened next? What do you think about...?

Reflective To prompt further information after asking open questions. Takes the last word of the answer.

How was dinner? Alright Alright? (Questioning tone of voice)

Mirror Again to prompt further information. Takes their words and re-arranges into an open question.

How was your dinner? Alright What was alright about it?

Hypothetical To test reactions and feelings. Usually starts with ‘What if’ or if... then.

What if money were no object?

Rhetorical Asking a question for effect. Not expecting an answer. But it does open the mind file of the other person.

Now, what shall I do next? (Knowing that only you will decide.) I wonder how I can use different question types?




Closed questions are used for eliciting facts and verifying information. They can be answered with ‘yes’ or ‘no’, or just a few words: for example, ‘How long is it since you had a hearing test?’, ‘Do you prefer this or that model?’ or ‘Am I right that you want to use hearing aids for socialising?’.

Open questions are very useful for putting customers at ease, establishing trust and clarifying their expectations. Open questions encourage a descriptive answer and often start with ‘what’, ‘why’ or ‘how’. Examples include: ‘What sort of activities will you be using your hearing aids for?’, ‘What do you think of...?’, ‘How do you feel in those?’ or ‘How much time do you spend watching the television?’.

Open questions invite a descriptive answer, but some people may try to answer them with a very short answer. Another approach to gaining more information is to ask customers to describe something to you. For example, ‘Could you tell me a little more about what your work involves?’.

Leading questions are useful to confirm you have made the correct assessment of customers’ requirements, and to encourage them to make a decision. For example, ‘So you would definitely like an in the ear style so it is unobtrusive?’.

Beware of being too probing with your questions early in the encounter – people vary in how well they express themselves and how much they want to reveal. Some may prefer a brisk business-like approach, while others want caring, personal attention. A question which is too probing or personal will cause anxiety and defensiveness and can damage the trust you have taken care to establish.

Stay quiet

A necessary skill of effective listening is not interrupting the speaker. Sometimes a pause can be misinterpreted that the speaker has finished.




Exercise 3.7 – Practice makes perfectUtilising the good listening skills from this chapter, apply them when communicating with friends or colleagues. What are the benefits you note from being a better listener?

3.3 Body languageA favourite sport of many people is people watching. Have you ever tried to work out what sort of person someone is from the way they are dressed? Have you ever watched two people talking outside of listening distance and tried to guess from their gestures, facial expressions and manner of walking and standing what they might be talking about and how they feel about one another?

Whether we are aware of it or not, each of us spends a lot of time decoding body language. These body movements should be considered in relation to the overall message and are frequently the means by which the emotional side of our communication is revealed.

The non-verbal messages of a speaker tend to reveal the degree of sincerity, conviction, honesty, ability and knowledge. The body language of the receiver also reveals a lot about them. It provides instant feedback to the speaker and tells them how their message is being received.




Exercise 3.8 – Body language 1List the different components of body language that you are aware of. Are there any particular components that you feel are more significant in communication, and why?

3.3.1 Space

Each of us has spaces that we feel are our own. You may recall the story of Goldilocks and the complaint from the bear that, ‘Someone has been sleeping in my bed!’. While it is a child’s story it reflects a real sense of possession and invasion of privacy.

3.3.1.1 Territory

Most animals exhibit territorialism, the need to stake a claim on a particular area of space. Some believe this is an instinctive need that all animals have to guard their territory. We see this in humans as we erect fences around our property to protect our home. We see this in public spaces for as long as there is freedom to choose most people will tend to sit as far away from strangers as possible.




Exercise 3.9 – Personal spaceHow close does a stranger have to stand beside you to make you feel uncomfortable? Does this distance vary depending upon the context, for example if you are on a bus or train or shopping?

3.3.1.2 Personal space

In an attempt to carry our territory around with us we develop a sense of personal space. This distance that we are prepared to interact with others varies dependent upon how well we know someone and the activity or type of communication taking place.




These distances fall into four types:

1. Intimate distance

Close Phase: this is reserved for very close friendships, for children with parents and for making love.

Far Phase: close enough to touch, but not acceptable for people not on intimate terms, unless circumstances, like a crowded elevator, force it. In this case, other behaviour – tensing muscles, avoiding eye contact – sends the message, ‘I am sorry to intrude on your personal space.’. If the rules of acceptable behaviour are broken trouble can ensue.

2. Personal distance

Close Phase: this distance is reserved for more than a casual friend. Contact is possible, but more difficult.

Far Phase: provides a degree of personal privacy to an encounter yet still close enough for a personal discussion.

3. Social distance

Close Phase: is used for impersonal business and casual conversations. This distance can be manipulated to indicate superiority or domination without having to speak any words.

Far Phase: is used for more formal social and business relationships. When an individual reduces the distance they are signalling a willingness to be more personal.

4. Public distance

Close Phase: suitable for informal gatherings such as a manager talking at a staff meeting or a lecturer talking to a room of students.

Far Phase: usually reserved for politicians and public figures since it provides the necessary security and emphasises domination.

3.3.1.3 Status

In most offices, space is directly related to status. The higher the position that they hold the larger the office. Acquisition of your own space can be seen as a status symbol. Would you rather have your own office that may be smaller or a larger office that you share?

3.3.2 Touch

Touching is obviously related to the idea of personal space. Although it was probably among the earliest forms of communication we tend to be very cautious in our use of touch as a means of communication. In times of sorrow it can be one of the most effective methods of communicating sympathy or protection. A common form of touching that is used in our society is the handshake.




Exercise 3.10 – Contact in communicationHow do you use touch and does it aid or hinder your communication? How might you use it more effectively?

3.3.3 Orientation and posture

We can influence communication and signal our attitudes not just by our proximity to others but by the position and posture we adopt. Experiments show that people who want to cooperate will tend to sit or stand side by side whereas if they feel in opposition they will tend to sit opposite each other. To facilitate easy cooperative conversation have the other person sit at a 90 degree angle to you or along the same side of the desk or table.

Similarly, body posture can communicate social status or the desire to be dominant or submissive. Hunched shoulders and a lowered head may signal shyness and inferiority. Standing erect with head tilted back and hands on hips may indicate superiority and self-satisfaction.

All people have different styles of walking, standing, sitting, moving and so on, which may reflect past and present roles, as in the case of a politician or police officer, or they may reflect a person’s self-image, self-confidence or emotional state.




Exercise 3.11 – Body language 2In meeting someone for the first time, what body posture do you regularly adopt? What do you think this signals to the other person? Is this the most effective posture for the situation?

3.3.4 Head nods

In most Western countries we move our head up and down to indicate agreement or to encourage another person in what they are saying or doing. As we saw in Chapter 3, a good listener will use head nods as a means of encouragement.

3.3.5 Facial expressions

Facial expressions, of all the body movements, are the ones we are most able to control. While a person’s face may provide a continuous commentary on their reaction to your message they should be read in relation to the words and the other body movements that are a more reliable source of information.




3.3.6 Eye movements

The movements of the eyes perform a number of functions in personal communication.

To gain feedback – people look while listening to get visual messages to supplement the words to help them understand what they are hearing. People look while talking to get feedback on the person’s reactions to the message they are receiving. It is a commonly held belief that, if a speaker looks at you while talking, then not only will the other person think the speaker is really interested in them, but that the speaker is more confident.

To indicate interest – when two people are engaged in conversation they make regular eye contact. These glances vary in length but we tend to look twice as much while listening as while talking. The duration of the look is related to the level and kind of interest. The more interested we are in the subject or the other person the more eye contact we make. Long periods of looking can also indicate a desire for intimacy with an individual. Research shows that the distance between speaker and listener is significant; if interacting far apart they tend to make more eye contact as if to compensate for the greater distance.

To show attraction – pupils normally dilate (get larger) in darkness and in response to some drugs, experiments have shown that pupils dilate when we look at something that excites or arouses us. Not only does pupil dilation indicate arousal and interest, but it also makes a person appear more attractive.

To synchronise speech – the speaker will tend to look away just as they start talking, this may be to reduce the amount of incoming information enabling them to concentrate more fully on planning and organising what they are going to say. When they are speaking fluently they tend to make eye contact and when they are at the end of what they are saying they will give their listener a prolonged gaze. This enables them to see how the listener is reacting to what has been said and to signal they have finished what they wanted to say.




Exercise 3.12 – Facial expressionsAsk a friend or colleague to watch your facial expressions and eye movements closely as you carry on a conversation and feedback which ones you utilise. Which ones were you consciously aware of using?

3.3.7 Gestures

Communicating information – a thumbs up or OK signal with thumb and index finger are examples of the way in which gestures can be used to supplement the meaning of words or even replace speech altogether. While the meaning of gestures often varies between cultures, there appear to be some gestures that have the same meaning in many cultures and can be considered to be universal.

Supporting speech – people tend to move their hands, body and head continuously while speaking and these movements are closely coordinated with their speech. These gestures are often used to give emphasis and meaning to words, to point to people and objects and to give illustrations of shapes and sizes or movements. Gestures also help two or more people synchronise their speaking; who has not raised their hand in order to ask a question?

Communicating emotion – there appear to be a few specific gestures like hands raised to the mouth in surprise or shaking a fist which have been found to accompany particular emotions across many cultures.




Expressing relationships – behavioural researchers have found that we often tend to adopt or ‘mirror’ the gestures and body movements of other people with whom we are talking. This mirroring is usually completely unconscious and goes unnoticed by the participants and can reflect mutual interest or shared points of view.

Expressing self-image – you may convey to others the image you have of yourself by your gestures. People with an extrovert personality may unconsciously convey this to others by wide, energetic gestures; whereas shy and more retiring personalities may use fewer gestures that will be smaller in size and restricted to the area close to their body.

3.3.8 Verbal and non-verbal communication conflict

Everything you do communicates information to others. The friend who greets you warmly, but then looks at their watch frequently indicating that you may not be as welcome as you first thought.

Whenever the meaning of the non-verbal message conflicts with the meaning of the verbal message, we are more likely to believe the non-verbal message.

Exercise 3.13 – Methods of communicationAsk a friend or colleague how much your verbal communication matches your non-verbal communication. In what ways could this be enhanced?




3.4 Telephone skillsNowadays, even with SMS, email and the Internet, the telephone is still probably the most common means of communication in business, and used efficiently it has several advantages.

• It is fast.

• It allows people to converse even when they are unable to meet.

• It is a great leveller: status, physical appearance and surroundings don’t show.

• It is a great focuser: it removes the social and emotional distractions of face-to-face encounter.

3.4.1 Difficulties with the telephone

The telephone, despite all its convenience and speed, also has the power to rapidly convey a poor impression of the individual and organisation and to create irritation.

Exercise 3.14 – Telephone communicationList the ways of inefficient use of the telephone that you have experienced.

Then telephone three organisations and make notes of how you are dealt with. What impression did you get of each organisation?




3.4.1.1 Cost savings

At first inspection telephone calls seem cheaper than sending a letter. To calculate the true cost of sending a letter one must take into account the staff time involved and the overheads as well as postage. When accounting for all these factors the telephone can seem inexpensive in comparison. However, telephone calls do not necessarily save time – and we have all heard the maxim, ‘In business, time is money’. Everyone has endured the irritating waste of time caused by inefficiency on the telephone:

• Wrong or engaged numbers.

• Being passed from department to department in an attempt to find someone that can answer the query.

• Being left on hold, even if there is nice background music.

• Having to listen to a menu of options before we can press a button to make a choice.

• The person required not being available and having to listen to their message before we can leave one.

• Difficulty trying to get an outside line.

Any of these time wasters can take longer than it takes to write a letter.

3.4.1.2 First impressions

Commonly, the first contact a caller has with an organisation is with the person that answers their first telephone call. That person can innocently create a bad initial impression of the organisation which can be very difficult to overcome. This may be done through a lack of courtesy, a lack of knowledge about the organisation, or a lack of knowledge of how to use the telephone.




Exercise 3.15 – First impressionsWhat would you do on the telephone in order to make a positive first impression if someone were to phone your organisation?

As most telephones transmit only sound, there is an inherent inefficiency in transmitting only oral communication. We have already seen how important non-verbal messages can be in complementing the verbal message. Facial expressions, gestures and posture help to convey the true meaning of words and are often a source of feedback in face-to-face conversation. This feedback allows misunderstandings to be instantly corrected. Without this visual communication and consequent feedback these problems are typical of telephone conversations:

• Words are misheard.

• Words are missed.

• The message is misunderstood because the visual feedback is missing.

• The conversation somehow just doesn’t seem to flow.




3.4.2 Telephone rules

Be Brief – A lack of confidence often causes people to rabbit on and to talk for longer then they would in face-to-face conversations. However, being too brief can make you appear abrupt and discourteous.

Speak Clearly – Pronounce and articulate your words clearly to counteract the poorer acoustic of the telephone line and the absence of visual communication to help the listener.

Speak More Slowly – When your voice is being mechanically transmitted the words can seem to move together faster. That is why it is a good idea to slow your speech down. The listener may be trying to take notes, and this is especially true of messages left on answering machines. When leaving a phone number do so slowly as the person on the other end may be trying to write the number down.

Be Courteous – Your tone of voice is critical in conveying a courteous and cheerful impression as are the words that you use. Even if you are not being seen, your facial expression affects your tone of voice. That is why it is important to smile!

Adding Value – Think of ways in which you can be more helpful. If it will benefit a caller, invite them to come to your place of work. Will you be able to do more face-to-face than over a telephone line? What other services that your organisation provides can you suggest to the caller? And if you’re really unable to help, sound sincere and not uninterested.

3.4.3 Making a business telephone call

Before

• Answer the six questions regarding effective communication.

• Focus on your outcome, what you want to achieve?

• Make notes of the main points you must include and any dates or facts you may need to refer to.

• Have all relevant files and correspondence ready to refer to and your computer is on and on the appropriate screen.

• Have paper ready for your own notes.

• Know the name of the person you need to speak to.

• What is the best time to make this call?

• Dial the number carefully so you do not waste time by dialling a wrong number.




During

• Give a greeting, state your name and organisation and the name of the person you would like to speak to. An example is; ‘Good morning, My name is Jackie and I represent Bloggs Hearing Centre, can I speak to Mr Richards?’.

• Wait patiently, you may be put through to a secretary or department and have to repeat your greeting.

• State your subject clearly, giving enough information to put the recipient in the picture.

• Keep it short. What is the minimum amount of time you can spend ensuring you achieve your purpose?

• Refer to your notes.

• Take notes, especially the name of the person to whom you are speaking.

• Pause to receive feedback and check if your message is understood.

• If you are leaving a message present the main points, don’t just ramble on providing every detail you can recall.

• Be polite and thank the person for their help even if you did not achieve the outcome you wanted.

After

• Fill in your notes so you will understand them at a later date.

• Put any relevant dates for further action or follow up in your diary.

• Forward the relevant information to everyone concerned with the matter.

Controlling the flow of conversation

• Be sure you know exactly what you want the call to achieve.

• Take the initiative.

• Begin every call with a verbal handshake by saying who you are and why you are calling.

• Mirror and match the conversation style and key words of the person to generate greater rapport.

• Keep your line of argument simple.

• Keep the conversation flowing by asking plenty of questions.

• Search for areas of agreement rather than points of difference.

• Offer alternatives when seeking agreement.

• Use silence for emphasis and to prompt the other person to respond.




3.4.4 Answering a business telephone call

Before

• Know how the telephone system works, including how to transfer calls. This avoids frustrating the caller by cutting them off.

• Keep near each telephone: – A pen or pencil – A message pad – An appointment diary, if appropriate.

• Focus on your outcome, what you want to achieve?

• Stop talking to anyone else and try to reduce the background noise before picking up the receiver.

During

• Give a greeting, state your name and organisation. Many organisations have a standard practice for greeting callers and it is vital to know the house rules.

• Wait till the call is connected before speaking. A common fault is to start speaking before the call is connected, causing the caller to miss a portion of your greeting.

• Be prepared to answer the query, take a message, or transfer the call.

• Listen carefully to the caller and take notes if necessary. These will form the basis of either your action or your message that you will pass on.

• Ask the caller to slow down or spell names and addresses if they are unclear and read them back.

• Don’t be distracted by things going on around you and don’t hold two conversations at the same time.

• Agree what happens next, especially if you are taking a message for someone else.

After

• Fill in your notes so you and/or the recipient will understand them at a later date.

• Act on the notes immediately while the matter is clear in your mind.

• If you have a message for someone else, put the date and time of the call on the message and deliver it promptly or place it in a prominent position where it will not be missed.

• Update any necessary documents and put dates in the diary.

Being a good telephone listener

• Make a conscious effort to pour all your energy into listening. Don’t listen on autopilot or while doing something else.

• Eliminate as many external distractions as possible and ignore what is going on around you.

• Eliminate as many internal distractions as possible. Stray thoughts about other matters don’t help you in being a good telephone listener.

• Take notes to help keep you focused.

• Demonstrate to the speaker that you are paying attention by making regular continuity noises. Don’t have them ask, ‘Are you still there?’.

• Keep your emotions in check. Getting emotional interferes with your ability to listen carefully.



3.4.5 Dealing with difficult calls

Things to remember

• Always personalise the conversation by introducing yourself and getting the caller’s name.

• Always volunteer to help rather than wait to be asked.

• Always reflect the caller’s feelings (‘I can understand how annoying that must have been.’).

• Always let the caller let off steam until their anger is vented.

• Always show you are taking a serious interest by playing back the details of the complaint in your own words.

• Always encourage callers to voice all the complaints frustrating them.

• Always finish by summarising what you’ve offered to do and agree it with the caller.

Things to avoid

• Don’t take the complaint personally, be as objective as you can and avoid getting angry yourself.

• Don’t offer excuses or look for sympathy; don’t blame on a third party or unusual circumstances. That is your problem not the customer’s.

• Don’t suggest or agree to a solution, or accept responsibility, until all the facts have emerged.

• Don’t attempt to reason with someone until their anger has reduced.

• Don’t assume the caller’s complaint is unique. Research shows that for every person who complains there are six who don’t. Never fool yourself into thinking they are the only person to have had this problem.

• Don’t agree to do something you are not in a position to deliver, if necessary offer to call the customer back after you have taken advice.

3.5 Business lettersLetters that get results do not just happen, like every other form of effective communication they have been thought about. To plan your letter you will need to review the background that has led to the need for a letter. This will often mean reviewing previous correspondence.

In all these letters you are acting as an ambassador for your organisation, trying to maintain, build or rebuild goodwill. Whatever type of letter you are writing you should keep the anticipated reader reaction in mind, as it is this which will help you determine how to write your letter.

A business letter normally consists of eight parts.

On business letters the name and address of the sender are printed, the name usually in much bolder type. The letter head usually spans the whole page or is positioned in the top right hand corner. It usually contains the company’s trading name, address, post code, telephone and fax numbers and web address.




1. Heading or letterhead

As a result of legislation it must also include;

• Company’s trading name.

• Its status as a limited company.

• List of company directors if founded after 23 November 1916.

• Address of its registered office.

• Registration number of company.

• Location of registration.

These are usually placed at the bottom of the page.

2. Date

This is usually placed two or three spaces under the last line of the sender’s address. The recommended method of writing the date is day, month, year.

3. References

So that letters can easily be filed and traced for reference purposes, it is advisable to provide a reference code. References are usually entered above or level with the date on the left hand side and are composed of:

• First: initials of letter writer (in capitals).

• Second: initials of typist.

• Third (if relevant): reference to a particular file.

In all cases they should be quoted when replying to a letter.

4. Recipient’s, name, position and address

Usually placed two or three spaces below the references with open punctuation. Where possible, the address should be confined to three or four lines to avoid starting the body of the letter too far down the page.

5. Salutations and complimentary closes

These refer to the formal opening and closing of the letter’s message and there are certain conventions that should be followed. Where the person’s proper name is not used then ‘Yours faithfully’ is the appropriate complimentary close.

Dear SirDear SirsGentlemenDear MadamDear Mr SmithDear Ms JonesDear Mrs BennettDear Dr WolfDear AmieDear David




6. Subject heading

Strictly speaking each and every business letter should deal with one subject. Therefore it should be possible to sum up the subject in a brief and helpful heading which assists the reader in immediately knowing what the letter is about. The subject heading should be placed between the salutation and the body of the letter.

Hear Now Ltd Oland Mills Bedford MK45 9AT

20 April 2004

Ref. No: Our ref: Your ref:

The Manager Owens Hearing Centre Gypsy Lane Hitchin SG34 2QW

Dear Sir,

Ryan Smith

Replying to your letter of 11 April, we are pleased to inform you that Mr. Ryan Smith has been employed by this firm for the last five years.

Through that time he has been an efficient, honest and capable member of our staff. We have therefore no hesitation in providing a reference to you and wish him all the best in the future.

Yours faithfully,

Philip Morgan Company Secretary





7. Signature

It is accepted practice to type the name of the sender in case the signature is illegible. The designation of the writer is then written immediately below the name.

Yours faithfully,

Joe BloggsJoe Bloggs Hearing Aid Audiologist

8. The body of the letter

The body of the letter should be written in a clear and concise manner with correct paragraphing and punctuation.

Each paragraph should express a separate item in the letter. It is possible that a paragraph may consist of only one sentence, but be aware that too many short paragraphs can ruin the appearance of a letter.

Punctuation should be used to help understanding. A common mistake is too liberal use of commas. Be aware that this may lead the reader to believe that the writer is unsure about the purpose of the various punctuation marks.

3.6 Dealing with difficult customersWhen dealing with someone you may label as a difficult customer it is important to realise that of all the people who may want to return due to a problem or complaint, the majority will not bother returning to you. So what do they do?

It is estimated that a happy customer will tell two or three others about their pleasant experience, whereas an unhappy customer will tell 10 to 20 people about their experience. The message here must be to exceed customer expectation to prevent unhappy customers as you will probably not get the chance to rectify their complaint.

Consider the real cost of an unhappy customer. They will tell 10 to 20 people about their experience. This may mean that you have lost 20 lifetimes of purchases from the people they have told about their experience. Consider that when you debate the cost of rectifying the customer’s complaint.

Let us consider the rare instance where we have failed to meet or exceed the customer’s expectations; what should we do? The first thing to consider is; What outcome do you want from this interaction? If it is to create a satisfied customer then keep this in mind through all your communication with the customer.




Exercise 3.16 – Customer complaintsRecall a time when you dealt with a customer complaint. Recalling the situation what elements of your communication worked well and what would you alter if you were to do it again? How did your initial attitude set the tone of the interaction?




3.6.1 Things to remember when dealing with difficult customers

Things to do

• Personalise the conversation by introducing yourself and using the customer’s name.

• Volunteer to help rather than wait to be asked.

• If possible move the customer to a more private area of the practice. If the cause of their problem is a clinical or visual matter, it is essential to maintain confidentiality. This also minimises the impact of an angry customer on other customers.

• Reflect the customer’s feelings (‘I can understand how annoying that must have been.’).

• Allow the customer to let off steam until their anger is vented. Don’t hurry them. Sometimes being able to talk about a problem completely diffuses the emotion, making it easier to agree a solution.

• Show you are taking a serious interest by playing back the details of the complaint in your own words, and asking questions for clarification. Open questions enable you to uncover root causes of problems – just as you do in questioning customers about lifestyle issues during a dispense. Remember sometimes people report one problem, but the real underlying problem only emerges as the conversation continues.

• If possible take notes so you get the details right. It increases the customer’s frustration if they are asked to repeat themselves, and these notes are invaluable if you have to investigate the source of a problem.

• Encourage customers to voice all the complaints that are frustrating them. The customer’s explanations may reveal misunderstandings about the product they were dispensed or the service they received. In most cases these misunderstandings are caused by poor communication by the dispenser, so it does little to restore confidence in the service if you simply point out flaws in the customer’s argument. In most cases it is better to use reasoned explanation, which both impresses them with your knowledge and helps to reduce the level of emotion.

• Finish by summarising what you’ve offered to do and agree it with the customer.

• Ensure that you can deliver whatever you have offered to do.

Things to avoid

• Don’t take the complaint personally, be as objective as you can and avoid getting angry yourself.

• Don’t offer excuses or look for sympathy; don’t blame on a third party or unusual circumstances. That is your problem not the customers.

• Don’t suggest or agree to a solution, or accept responsibility, until all the facts have emerged.

• Don’t attempt to reason with someone while they are still angry.

• Don’t assume the caller’s complaint is unique. Research shows that for every person who complains there are six who don’t. Never fool yourself into thinking they are the only person to have had this problem.

• Don’t agree to do something you are not in a position to deliver, if necessary offer to call the customer back after you have taken advice.



Chapter 4 Customer Record Keeping




4.1 Why do you need to practise accurate customer record keeping?1. To provide excellent standards of care to your customers.

2. To ensure continuity of care for customers.

3. To protect yourself from disciplinary action in the event of a complaint.

4. To protect yourself from legal action from customers.

The quality of customer records is important for several reasons:

• It is evidence of high quality clinical care.

• It enables continuing professional development.

Good quality records are the cornerstone of high quality clinical care. Good quality records enable continuity of care for customers, both in terms of their ongoing relationship with an individual dispenser (or HCA) but also where there is a change in the dispenser responsible or involves more than one healthcare professional in the overall care regime of your customers.

Accurate records enable dispensers and others to:

• Understand previous clinical decisions.

• Track changes in the nature and extent of hearing loss over time.

• Ensure the recommendations are appropriate for that individual.

4.2 Legal record keeping requirementsThere are legal and regulatory standards to which all healthcare professionals need to comply.

All healthcare professionals are required to comply with the general provisions of the Data Protection Act. However, additional provisions within the Data Protection Act and the standards required by the Health & Care Professions Council increase the requirements placed on healthcare professionals and their employers. The legal obligations arise from s69 of the Data Protection Act and from the Access to Health Records Act 1990. Section 69 of the Data Protection Act extends the definition of ‘heath professional’ to anyone registered with the Health & Care Professions Council (s69(1)(h)).

As such, records that relate to the physical or mental health of an individual which has been made by or on behalf of a health professional in connection with the care of that individual are deemed to be ‘health records’ under the Data Protection Act. The impact of this is that any data that are held in a heath record are considered to be sensitive personal data and, in addition to the general provisions of the Act (to which dispensers and dispensing companies should already be complying) dispensers and their employers will need to comply with the specific requirements set out in Schedule 3 to the Act.

In addition, the provisions of the Access to Health Records Act 1990 (and the additional provisions in the Data Protection Act relating to access to health records) will also apply. Over and above the access rights that individuals already have in terms of the data that might be held on them, this Act gives additional rights to access and places requirements on relevant professionals to provide explanations of the records held. The Health & Care Professions Council then sets standards in relation to how health records are maintained. These are set out in standard 10 of the Standards of Conduct, Ethics and Performance and also in the generic standards contained within the Standards of Proficiency.



4.3 What does good look like?In general terms the areas that tend to cause problem are more in the style and detail of the notations.

4.3.1 Screening audiogram

Audiograms, accurate to all aspects of BSA procedure are the core of our management of our customers. However, the role of the HCA excludes them from certain procedures leaving the audiogram, even temporarily, incomplete. These audiograms MUST be signed, dated and annotated as a ‘screening audiogram’. This is then an acceptable part of the customer record. Subsequent audiograms must be independently complete and not a supplement to a previous audiogram.

4.3.2 Clinical notes

• Keep it clinical! Keep to the subject.

• Do not use ambiguous symbols such as ticks and crosses. Make definitive statements – yes and no.

• Blanks and dashes are not sufficient – state if a procedure was or was not carried out.

• Be defensive minded – treat every record as if it were destined for scrutiny by the regulator or your hearing aid dispenser. This activity will actually engender the good practices that prevent circumstances that result in complaints.

• A customer signature is an acknowledgment that the events have happened but may not be an acceptance that the advice given was sound advice.

• Probably the best advice on record keeping on all levels – clinical, professional, ethical and defensive is – If it is not recorded – it did not happen!

Handwriting

Illegibility is unacceptable, it’s not an exam, there’s no rush, that it is only readable by you is as useless as not keeping records in the first place.

Space = opportunity

Every space on your standard case record card is designed to contain information, some purely helpful, some essential, ALL add to the good management of your customer.

Areas of Difficulty – (the REAL case history!)

If your standard record card lists single word or phrases such as TV, car, church etc, you must elaborate – This small space was never meant to be more than an aide memoir to subjects for discussion.

Highlighting one or more without comment is completely insufficient in recording the customers’ thoughts, feelings and degree of importance to them these situations may cause. It must be a pointer to more information you cannot possibly remember later in to the management of all your customers.

We are all aware how important these discussions are to the creation of desire to seek solutions. But six months in, when the customer’s motivations are wavering, reiterating the customer’s actual words to remind them of why they first consulted you is invaluable in re-energising their attitude. With a good account, a colleague could achieve this, as effectively.

Only a little further into the customer journey comes the fitting appointment. This information is just as important to relate at this crucial time to affirm the motivations that led to the purchase and set the mind of your customer on the positive track to finding solutions to their difficulties.




4.3.3 The Fitting appointment

It is argued that the fitting appointment is more crucial to the success of the management of your customer than the dispensing consultation carried over by the dispenser. During this crucial hour you must deliver on verbal promises, achieve perception of benefit or at least that benefit is envisaged as achievable. The healthcare professional must instill a sense of confidence in the customer, Instill competence in new skills, supply information and, impart the feeling that the customer is getting value for money. The healthcare professional must meet or exceed the customer’s expectations.

Each part of the fitting consultation merits notation. It affirms delivery, records what the customer may have further need of help, consolidates the positive outcomes.

These notes would involve, for example:

Otoscopy – both ears clear for fitting.

Physical fit – customer reports reasonable comfort, pleased with look, secure fit, no evidence of jaw movement.

Fit/remove – customer attempted three times – competent.

VC – explained.

Battery fit – competent.

Cleaning – supplied/explained clean kit.

Program button – auto only until familiar – review next time.

System programmed to 1st fit – review next time.

Agreed rehab/wear program – review progress at follow up.

Follow up – agreed four weeks, earlier if difficulties.

Dated and signed – a must have!

4.3.4 Follow Up appointment

For follow up appointments the same principles apply. A separate and detailed record should be kept proving the appointment met the current requirement. Record that otoscopy is carried out and the observations that resulted.

4.3.5 Service appointments

As this can occur anytime in the lifespan of the customers wear history it is advised that the fundamentals of examination are carried out and recorded. Audiometry must be performed whenever the customer reports a change in hearing and of course audiometry is always preceded by otoscopy – record activity and results.

A ‘useful’ account of the customer’s reasons for asking for attention, what action was taken including a brief account of any adjustments performed to correspond to ‘computer activity’. What outcomes were achieved and a quotation of how the customer considered the outcome will support future discussions if the complaint is ongoing and concluded with any agreed future action and timescale.

4.4 ConclusionAll healthcare professionals, registered dispensers and Hearing Care Assistants contribute to the care and therefore the recording of that care of their customers. A high standard of record is an absolute minimum, not a level to which all just aspire.


btec level 4 diploma for hearing care assistant

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