Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education.

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

Exploring the Networking of Academic Health Science Leaders: How and Why Do They Do It?

PURPOSE: Networking is essential to leadership effectiveness in the business context. Yet little is known about leadership networking within the academic health science context. If we are going to train academic leaders, we must first understand the relational, network-based activities of their work. The purpose of this study was to explore how academic health science leaders engage in networking activities in the academic health science context. METHOD: A constructivist grounded theory approach guided our study. The authors interviewed 24 academic health science leaders who were enrolled in the New and Evolving Academic Leadership program at the University of Toronto and used social network mapping as an elicitation method. Interviews, which were conducted between September 2014 and June 2015, explored participants' networks and networking activities. Constant comparative analysis was used to analyze the interviews, with attention paid to identifying key networking activities. RESULTS: Academic health science leaders were found to engage in 4 types of networking activities: role bound, project based, goal/vision informed, and opportunity driven. These 4 types were influenced by participants' conception of their role and their perceived leadership work context, which in turn influenced their sense of agency. CONCLUSIONS: The networking activities identified in this study of academic health science leaders resonate with effective networking activities found in other fields. The findings highlight that these activities can be facilitated by focusing on leaders' perceptions about role and work context. Leadership development should thus attend to these perceptions to encourage effective networking skills.

Simulation as a toolkit-understanding the perils of blood transfusion in a complex health care environment.

BACKGROUND: Administration of blood is a complex process requiring vigilance and effective teamwork. Despite strict policies and training on blood administration, errors still occur and can lead to mistransfusion with adverse patient outcomes. We used an in situ simulated scenario within an operating room (OR) to identify weaknesses in the current process and hazards that could contribute to mistransfusion. METHODS: A process checklist of critical steps of safe transfusion was developed based on a large academic centre's internal hospital policy and practice. Ten standardized operating room scenarios were conducted involving management of postoperative bleeding. Scenarios lasted 20 min or until blood transfusion was started. Debriefing followed immediately. Video recordings were reviewed, scored, and evaluated for team performance. Latent safety threats were identified. Focus groups further helped to identify rationale for decisions made. Participants completed questionnaires to evaluate the exercise. RESULTS: Forty-three experienced OR professionals participated. Of the 19 steps identified as essential for the safe administration of blood components, the median number of steps correctly completed per team was 11. The largest number of errors occurred when different team members interacted and during the immediate pre-transfusion check. We report that this type of learning immediately increased participants' self-reported ability to perform in a team (90%) and to improve clinical care (88%). CONCLUSIONS: In situ simulation is valuable in identifying common susceptibilities in blood administration error in a complex healthcare organization. Administrators and clinicians may wish to use simulation as an opportunity for system improvement in the delivery of quality care.

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

BACKGROUND: Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. PURPOSE: Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. RESEARCH DESIGN: A cross-sectional approach was used to obtain online and paper-based concept ratings. DATA COLLECTION AND ANALYSIS: Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. RESULTS: There was a significant difference in the mean ratings for clients and clinicians for the concepts understanding and meeting client needs, conveying device information by clinician, supporting choices and shared decision making, and factors in client readiness. Three concepts-understanding and meeting client needs, conveying device information by clinician, and supporting choices and shared decision making-were rated as more important by clients than by clinicians. One concept (ie, factors in client readiness) was rated as more important by clinicians than by clients. CONCLUSIONS: The concepts rated as most important by clients and clinicians are consistent with components of several existing models of client-centered and patient-centered care. These concepts reflect the clients' perception of the importance of their involvement in the decision-making process. A preliminary model of client-centered care within the hearing aid uptake process and implications for clinical audiology are described.

Innovations in workplace accessibility and accommodation for persons with hearing loss: using social networking and community of practice theory to promote knowledge exchange and change.

BACKGROUND: Despite widespread availability of assistive technology and the role of occupational therapists and audiologists in workplace health, little is known about how these groups influence the health of workers with hearing loss. OBJECTIVE: Based on a previously conducted study, this paper explores the need for networking and community of practice theory to promote knowledge sharing and use between occupational therapists, audiologists, educators, regulators, workers, and employers. METHODS: Five occupational therapists and five audiologists participated in in-depth interviews. Grounded theory was used to investigate the processes that hinder or support these professionals in addressing the accommodation needs of and workplace accessibility for workers with hearing loss. RESULTS: Constraints to addressing the needs of workers with hearing loss included: lack of knowledge about professional practice processes, lack of networking, lack of knowledge on current research, and lack of knowledge on the realm of expertise of audiologists by occupational therapists and of occupational therapists by audiologists. CONCLUSIONS: Innovations in workplace practice in hearing loss require engagement of occupational therapists, audiologists, and employers in knowledge transfer, networking, and learning. This column introduces two theories that may guide the use and development of evidence, knowledge, and expertise toward innovations in hearing work practice.

Factors in client-clinician interaction that influence hearing aid adoption.

The influence of client-clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider-patient interaction on health outcomes. The purpose of this study was to identify factors in the client-clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client-clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client-clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction.