Client Orientated Scale of Improvement, COSI and its uses for your practice.

The COSI has started to become an integral part of best practice in the last few years. What exactly is the COSI and why is it good for your Practice? The COSI is simply a very well designed piece of A4 paper or a form in one of many Audiological Software's. It is present in Noah and also in the Widex Compass software. The COSI is a place to record a Patient’s problem situations or lifestyle needs and then trace their ongoing success with a prescribed hearing system. Many Dispensers shy away from the COSI because they are not sure where it will fit either in their consultation or follow up nor do they understand how it may be the most powerful tool that they have ever used on several different and important levels.

At it's most simple level the COSI is used to record the difficulties that a Patient has in their day to day life. The crux is how you as a professional achieve this and if you use the golden opportunity that this gives to emotionally connect with the Patient. The COSI can allow you to connect with a Patient, gain acknowledgement of lifestyle impact from that Patient, manage a Patients expectations and gain agreement on a set strategy for dealing with the core issues.

So, how is this simple form going to achieve all this? Simply put, you use it to ask pertinent questions and record the answers. I hear you say I ask the problem areas already, you may, but do you ask in the right way, do you ask enough of the right questions and most importantly do you listen? The questions you need to ask need to be open ended, crucially you also have to remember that the answers you are being given may never have been voiced before. You may feel that you have heard them a thousand times, but this Patient may never have uttered them before. So do them the courtesy of listening.

Ask, “where are the areas that you have problems, the areas I would like to talk to you about are the areas that you feel cause you most problems in your daily lives and relationships. We can record five areas, but really we will concentrate mostly on three of them”. When they give you the areas, dig deeper, “so you say at the family table, who are you seated with and what type of conversation are we talking about, animated, quiet? What exactly are the problems you suffer?!

Dig deep, keep asking those open ended questions, questions that can not be simply answered with a yes or a no. When you have found out all of the information and led the Patient on a journey through that situation, ask them, How does that make you feel? If you have done your job properly they will tell you. It might be emotional, it might even be hard to listen to, but it generally will be the truth, unvarnished and direct. There may be tears, if so it may be awkward for you, I generally put my hand on their arm for a moment in order to acknowledge the pain.

Go through each situation they have recorded and do the same thing, generally you will not have to ask the loaded question again, they will tell you without prompting. At the end ask them which three problems would they most like to try to fix. When you have identified these areas, grade their current ability, ask them their expected ability and then most importantly agree a realistic final ability. Tell them directly what you feel you can do well and more importantly what you may not be able to do so well.

Why should you do this, there are several reasons, Practice efficacy, human capacity, commercial sense, but most importantly, it is the right thing to do for the Patient. You will make a strong emotional connection to your Patient, they will believe that you are interested in their problems and more importantly that you are interested in dealing with their problems. They will believe that you are an honest, compassionate and caring practitioner, if for some reason they can not do business with you, they will ensure that they will tell their friends to do business with you.

You will help them to truly recognise their difficulties and acknowledge the impact on their lifestyle. You will also manage their expectations openly and usually without Patient rancour. You will gain agreement for a course of action and in fact plan that action out. The Patient begins to talk about when's instead of ifs. You help your Patient acknowledge trauma and then lead them through it to solution, you allow them to openly express their feelings perhaps for the first time. All of this from a well designed piece of paper.

So for every type of dispenser, from the most hardened of commercial to the most Patient centred, there is a pay off from the COSI. More importantly, there is a pay off for their Patients.