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Too many graduates, not enough jobs: are we heading for Speechpathageddon?

15 April 2016 By David Kinnane Leave a Comment

“Too many universities pumping out too many graduates for not enough jobs.”

I hear this a lot. But I don’t buy it.

What people usually mean when they say things like this is that there aren’t enough traditional public hospital and government-funded community speech pathology positions for everyone. True. But it doesn’t mean we’re heading for crisis.

Muddled thinking

Many speech pathologists who lament the glut of graduate speech pathologists also talk about the desperate shortage of speech pathology services and the inability of current service providers/models to deliver them.

Does this make sense? Think about it for a minute.

Malcolm Turnbull does not rent videos

I’m an optimist and in some ways a traditionalist (and middle-aged and white and male). Despite theoretical access to Netflix, I still rent weekly DVDs (Go Civic!) and call them “videos”, to the embarrassment of my children. And I value the history and many of the traditions of the speech pathology profession.

Without wanting (in any way/ever/at all) to sound like Malcolm Turnbull, I think there has never been a more exciting time to be a speech pathologist. But we need to face some sobering facts, be open to acquiring new skills, and adjust our thinking first, if we are to stay successful.

How?

1. Feel the fear…

Privatisation, service fragmentation, increased local competition, tight margins, and information overload. Cold realities for many of us, especially – but not only – in private practice.

Globally and locally, more and more things are becoming commodities. And I’m not just talking about steel or wheat or coffee (mmm, coffee). But health-related and other white collar services, too. If you don’t believe me, spend a few minutes with Google to look at the disruption that’s taking place in the legal and accounting sectors because of globalisation, offshoring and outsourcing. And if you think it’s just the unskilled stuff that’s being outsourced to places like India, the Philippines and China, you’re wrong.

Alan Binder, Princeton economist, published a terrifying essay back in 2005 where he made the following prediction:

“In the future, and to a great extent already in the present, the key distinction for international trade will no longer be between things that can be put in a box [i.e. products] and things that can’t [i.e. services]. It will, instead, be between services that can be delivered electronically over long distances with little or no degradation in quality, and those that cannot…And there is little doubt that the fraction of services that can be delivered electronically will grow.”

Since this prediction, we’ve of course seen the beginnings of Telehealth, a slew of speech pathology blogs, product marketplaces marketing products and (so far fairly limited) electronic services to the (global) public, social media platforms, webinars and podcasts. And who know’s what’s next?

Are we really that far off from the day when we’ll need to compete for local clients against speech pathologists and similar professions in other countries offering cheaper, web-based interventions? If you think it will never happen – that speech pathology will somehow rise above the globalisation of services – take a look at what’s already happening in the international market for internet-based accent modification and voice services. Then think objectively about whether at least some of your other face-to-face services could be provided just as effectively by a qualified professional overseas via the Internet.

2. …do it anyway

Thomas Friedman, in his bestselling 2005 book, The World is Flat, identified three broad categories of people who will be able to resist the trend for services to be automated, digitised, commoditised and outsourced. He called these folk “the untouchables”:

(a) People who are really special or specialised (even if they can’t call themselves that). People that perform functions in ways so special that they can never truly be outsourced. This small category may include the very top speech pathology researchers and clinicians. The rock stars of the profession.

(b) People who are “localised” or “anchored”. This category is much bigger and includes people who provide services that must be done in a specific location and/or because they require face-to-face, personalised contact and interaction with a client. Notably, they include some people working in high-end jobs (e.g. dentists) as well as low-end jobs (cleaners).

(c) People in traditional middle management who are able to adapt to change and take advantage of it. Friedman calls these workers the “New Middlers”.

If Friedman is right about where things are heading (and I think he is), few of us can afford to be complacent. We need to act, and we’ll have to do it outside our comfort zones.

3. Acquire new skills to thrive

Friedman argued that, to survive commodification, professionals must adapt and develop skills over and beyond the bare definition of professional competence. He identifies eight categories of professional “New Middlers”. Broadly paraphrased, and applied to speech pathology, they are:

Collaborators/Orchestrators: Speech pathologists who can work with diverse teams around the world. Travellers, with excellent people and networking skills. Speech pathologists with special additional expertise, e.g. in project management, research and design, marketing of health services, data sharing and storage, and/or privacy/security. People who can take a complex idea and work as part of a team to turn it into an accessible product or service for clients.

Great Synthesisers: People who anticipate future client needs and come up with solutions by synthesising disparate bodies of knowledge and skill-sets. A good example in speech pathology is people who can connect clinical expertise with technology skills to deliver effective remote services electronically; or bring researchers and clinicians together with medical or acoustic engineers to develop evidence-based products and services for specific populations.

Great Explainers: Speech pathology-related managers, researchers, writers, teacher, producers, writers, journalists and editors who are good at explaining things in Plain English. Speech pathologists who see the complexity but can explain it to a general audience simply and a lack of jargon. People who can face the the public, governments, other speech pathologists, clients, and others, explain what the evidence says, what we can (and can’t) do, how it may benefit different people, and how much it will cost. “How to” and “go to” people. In a profession like speech pathology, with a platform powered by low-cost blogging and social media tools, great explainers may acquire global influence.

Great Leveragers: Speech pathologists who can design and use technology, e.g. to help other speech pathologists work more efficiently. Speech pathologists who understand client-care from first contact to discharge and spot inefficiencies in the way some things are done. People who see a problem, stop the specific problem, and then design a system to prevent the problem from happening again. People who create technology solutions to make us more productive, less isolated and, thus less likely to waste time reinventing wheels.

Great Adapters: Friedman calls these people “Versatilists”. They are the “Swiss-army knives” of speech pathology. People who can apply a depth of skill (like specialists) to a progressively widening scope of situations and experiences, gaining new competencies, building relationships and assuming new roles. People who constantly learn and grow professionally. People who invest in themselves, learn and then teach others. People with solid technical skills but also good insight into clients’ needs and wants. People more focused on acquiring skills than attaining prizes and letters after their names.

Purpose People: Friedman called this category of people “the Green People” – people who are environmentally conscious. But, in the context of speech pathology, I think my broader term is more appropriate. These are people who set up for-purpose (not-for-profit) networks, collaborations and organisations to get out and deliver services not currently met by the government or the market, perhaps in developing countries. The Trinh Foundation is an such example. Organisations outside of speech pathology include Pencils of Promise and charity: water. They achieve not just success, but also significance.

Passionate Personalisers: People with a pure passion for what they do, and a creative touch that no-one has ever thought of adding. Anyone who can take a traditional speech pathology role and give it something personal, authentic and special while remaining professional. This is one reason I go on about the need for more diversity in the profession (and, no, I don’t just mean more blokes).

Maths Lovers: Speech pathologists with a flair for numbers. People who can parse big data, create and execute algorithms, crunch numbers, interpret statistics, and analyse outcomes. People with advanced skills in algebra, data interpretation, probability, statistics, and calculus.

Great Localisers: You’ve probably heard the saying, “Think global, act local”. These are the speech pathologists who will take all the best global tools and tailor them to the needs of their local communities and practices. It might be speech pathologists who take the latest international research findings and adapts them for Australian clients. It might be the local speech pathologist who is able to spend more time on clinical work with reduced “failures to attend” by hiring a virtual assistant and/or using an online system to manage bookings and follow up with clients a day before their appointment. It might be simply using existing online tools like Survey Monkey and Google Docs to monitor the quality of their services and to stay in better touch with clients’ needs and expectations. Or it might be spending more time developing management plans with clients, and less time looking for the “nuts and bolts” worksheets and other resources by using a service like Teachers Pay Teachers or Speechtivities.

These aren’t mutually exclusive. They can be mixed-and-matched. For example, a speech pathologist may run a successful clinic as a great adapter, localiser and personaliser, and also acquire an international following as an explainer. Some speech pathologists may provide traditional clinic-based services to clients and also create apps, digital products, online courses and services for clients and colleagues.

Unless you’re lucky enough to be an irreplaceable speech pathology icon, chances are your best shot at continuing success is by providing top notch, face-to-face, evidence-based, personalised, hands-on, thorough and client-centred care, focusing on serving local communities. But more of us should also think about the tremendous opportunities technologies give us to deliver our services in innovative ways to clients without access to quality local services.

Many of Friedman’s categories remind me of some of the brilliant speech pathologists in practice today. These include experienced colleagues in my local area, leading speech pathologists I don’t know but follow online on places like Twitter and LinkedIn, and academics whose work I’ve read to blog about.

Some categories play more to the strengths of some of the newer (and younger) members of our profession, including of course many of our talented graduates. I’m all for innovation and trying new things. But we need to ensure newer members of our profession get the clinical support and skills they need to find their feet and to discover their passions. More importantly, we need to be vigilant and open eyed about the realities of the “market” to ensure our new graduates are not exploited.

4. Adopt an abundance mindset

One of the best books I read in business was The Seven Habits of Highly Effective People by Stephen Covey. Despite the hype, it’s actually a terrific, practical read for anyone running a practice (or thinking of starting one).

As far as I know, Covey was the first author to cotton onto the importance of adopting an “abundance mentality”. This is simply accepting the view that there are enough resources, opportunities and clients for everyone to succeed in life. Its opposite is the depressing “scarcity mindset”, where we decide we’re in a zero-sum game, a dog-eat-dog world, in which some speech pathologists will win at the cost of others – perhaps by using deceptive tricks like testimonials and by cutting prices and professional corners. A ruthless race to the bottom.

As my suburban practice grows, I refuse to think small. But I don’t want to run a McClinic or cut professional corners, either. I want to be part of a self-confident, self-regulated profession composed of ethical, resourceful, creative, resilient, proactive, intelligent, and diverse people who are in speech pathology for the right reasons: our clients.

With the support of our professional bodies, I’m convinced we can succeed. But we’ll need to support and value each other as our world and profession changes. Especially our new graduates.

Principal sources:

(1) Friedman, T.L. (2006). The World is Flat: The Globalised World in the Twenty-First Century. Penguin Books, London.

(2) Covey, S. (2004). The Seven Habits of Highly Effective People. Simon & Schuster, New York, New York.

Image: https://tinyurl.com/j7f69x5 and https://tinyurl.com/h5g6mfc

Dealing with negative online reviews: evidence-based strategies for speech pathologists

4 April 2016 By David Kinnane Leave a Comment

Online review sites are fairly new in speech pathology and healthcare generally. Australian examples include Whitecoat and the NDIS-inspired Care Navigator.

Negative reviews hurt

Negative reviews on sites like these – or on social media platforms like Twitter and Facebook – hurt. They may make us angry, anxious, embarrassed, sleepless – even sick. They can decimate team morale and confidence. They can tarnish reputations. They can lose us business. In extreme cases, they can even drive practices into the ground.

To compound the problem, speech pathologists are constrained by legal and ethical rules about advertising (e.g. testimonials) and client privacy. In practice, these limit our ability to respond to negative reviews, even if the reviews are exaggerated, incorrect, anonymous or even fabricated.

Review sites are here to stay

Consumers have a right to be informed about their treatment options. Despite all the risks of review sites for speech pathologists and other health professions, it’s clear regulators (and some self-regulatory bodies) in Australia see review sites as an important way of promoting consumer rights.

Speech Pathology Australia’s Advertising FAQs state that:

“advertising is not considered to include…comments made by a patient/consumer about a practice or a practitioner where the comments are made on a social media site or account or patient/consumer information sharing site or account which is not used to advertise a health service, and that site or account is not owned, operated or controlled by the practice or practitioner referred to in the comments”.

Similarly, the advertising guidelines that apply to regulated health practitioners like occupational therapists and physiotherapists in Australia state that:

“There are many opportunities for consumers or patients to express their views online that are not affected by the National Law restriction on testimonials in advertising. Patients can share views through their personal social media such as Facebook or Twitter accounts or on information sharing websites or other online mechanisms that do not involve using testimonials in advertising a regulated health service.

For example, consumer and patient information sharing websites that invite public feedback/reviews about experience of a regulated health practitioner, business and/or service are generally intended to help consumers make more informed decisions and are not considered advertising of a regulated health service.”

Although hard to forecast with certainty, it’s likely that managing online reviews will be an increasingly important part of business for speech pathologists in private practice.

What do we know about negative reviews?

We can learn from the experiences of business owners who’ve been dealing with online reviews for years: owners of restaurants and hotels. These businesses have had to deal with sometimes very harsh reviews on sites like Yelp, Urbanspoon/Zomato, Menulog, OpenTable, and TripAdvisor. A growing body of research exists about these reviews. It shows:

1. Online reviews matter. Online reviews: (a) can attract a wide audience (Hennig-Thurau et al., 2004); (b) are perceived by consumers as credible and trustworthy (Flanagin & Metzger, 2013); and (c) play an important part in shaping client opinions and purchasing decisions (Sparks and Browning, 2010).

2. Online reviews can help improve the quality of services. In traditional management literature, customer complaints are often seen as positive because they give the business a chance to fix problems and improve services (e.g. Reynolds and Harris, 2005).

3. Reviews can also hurt you, your team, and your business. As noted above, negative reviews about your business can affect you, your reputation, your business, your employees and contractors; can affect your morale, health and finances; and may attract the attention of third parties, including government regulators and industry associations.

4. Consumers post negative reviews for lots of reasons and in different ways. Online reviews may be posted for personal, social and even commercial reasons. The trigger is usually a negative experience. The decision to post an online review depends on lots of factors, e.g. a client’s motivations, past experiences, general attitude to complaining, age, and familiarity with the Internet (e.g. Yagil, 2008). Posting reviews may provide an emotional release (e.g. to allay anger, embarrassment or disappointment, or even to provoke laughter), seek “revenge” for a perceived slight, or even the hope of economic gain (Cantallops and Salvi, 2014). Some may be heat-of-the-moment “rants”. Others may be fair descriptions of legitimate concerns. Some will be trivial. Others may allege civil wrongs (e.g. negligence) or even criminal acts. Some may be exaggerated. Others may be completely fabricated (e.g. by ex-employees with a gripe, or unethical competitors). Some are short. Others are encyclopedic. Some will be shared with one or two followers. Others may go viral. Some will be posted by named people you know. Others may be anonymous. Service quality is very much in the eye of the client, rather than the provider (e.g. Sparks, 2001).

5. Online reviews can be personal. They may name and single out individual staff (e.g. Bradley et al., 2015). They may even be discriminatory or defamatory.

So how can speech pathologists in private practice manage negative online reviews?

Again, we can learn from the experience of hospitality businesses. As with restaurants, most speech pathology private practices are small businesses with limited time and resources to dedicate to online review management. In this context, the research identifies four broad categories of strategies employed by businesses to manage negative reviews:

(A) Preventative strategies

Improve your services. In theory, improving the quality of your services will reduce problems, complaints and the risk of negative reviews.
Conduct “real time” checks on client satisfaction to identify and, if possible, fix small problems before they become big problems (e.g. Johnston and Fern, 1999).
Manage client expectations about your services.

These are sensible ideas. But, owing to the intangibility of services and the variability of client perceptions, expectations and preferences, preventative strategies are never going to eliminate the risk of negative reviews entirely (e.g. Sparks, 2001).

(B) Protective strategies

The emphasis of these strategies is to shape – not prevent – complaint behaviours to minimise damage to your business.

Give your clients clear encouragement and guidance as to where and how to comment and complain. This can be offered orally, via a leaflet, on your website, or an email. For example, I have a feedback and complaints policy I share with all clients.
Include a request in your feedback and complaints policy that complaints first be presented to staff or the practice directors before being posted online.
Have a physical and email suggestion box for anonymous comments and complaints.
Provide short in-house satisfaction questionnaires and reward clients for using these, rather than going online.
Monitor online reviews and respond:
- privately by email or, better yet, with a phone call or face-to-face open discussion; or
- publicly.

In the hospitality industry, public responses are increasingly viewed as a vital reputation management strategy. Review sites like Yelp and TripAdvisor have even published guidelines on how to do it. These guidelines encourage restraint, courtesy, a focus on specific concerns and an emphasis on the business’ positive qualities.

Jay Baer, author of “Hug your Haters: How to Embrace Complaints and Keep your Customers” says that when you don’t answer a complaint it decreases customer advocacy by up to 60%: when you answer a complaint it increases advocacy by 25%. Customer advocacy – i.e. the client advocating for your service.

Complaint-handling studies (e.g. Davidow, 2003; Bitnet et al., 1990), show that effective public responses often include:

acknowledgement of the problem(s) raised;
an apology for the business’ contribution to it;
an explanation for its occurrence; and
a commitment to take appropriate preventative or remedial action.

Two important points on public responses for speech pathologists:

It can make sense, from a business perspective, to respond to negative reviews in a constructive way, acknowledging the client’s concerns (even if you don’t agree with them). However, it’s also important to support staff and others affected by the review, recognising that there are always at least two sides to any story (e.g. Jung & Yoon, 2014).
As noted above, speech pathologists must comply with their codes of ethics and legal obligations when responding publicly. This means, among other things, that speech pathologists cannot disclose any sensitive, health-related or personal information about clients or their care, which means we need to be very careful when responding in a public forum. I’ve given some thought on how best to do this.

Most review sites have moderation guidelines or terms of use that prohibit defamatory or offensive comments. For example, Whitecoat’s Moderation Guidelines and Care Navigator’s Terms of Service (see Sections 9 and 12). If you feel a review breaches those guidelines, you should alert the review site citing specific breaches and ask that the offending review be removed.

(C) Positive strategies

In hospitality, it’s common for businesses to actively encourage positive reviews from happy clients. Evidence shows that this tactic can help push negative reviews down the list and “off the page” and also result in a more balanced picture of the business (e.g. Sparks and Browning, 2011). It can also help build staff morale.

Unfortunately, actively encouraging positive reviews is not an option for speech pathologists in Australia. As with regulated health professionals, we’re not allowed to encourage testimonials or positive comments from clients for ethical reasons.

Speech pathologists can – and should – gather and share unsolicited positive feedback with staff to bolster morale. But we cannot encourage or take active steps to share this kind of feedback with the public as this would fall foul of our advertising rules.

(D) Palliative strategies

These emotion-focused strategies seek to counteract the negative emotions and stress caused by negative reviews. Examples of these strategies include things like:

building physical resilience – going for jogs, joining gyms, etc.;
enlisting support from colleagues, families and friends, including through professional networks and bodies (online and offline);
recognising that reviews are transient, surmountable, and often of limited consequence in themselves;
providing professional and emotional support to any staff affected by a review; and
stress management activities, e.g. yoga, meditation, etc.

Although simple and perhaps obvious, these strategies provide powerful ways to combat feelings of powerlessness and isolation, and to keep the real effects of negative reviews in perspective.

Bottom line

Online review sites are here to stay and can help members of the public to make informed choices about their healthcare. Online reviews can help speech pathologists to improve their services. But they can also inflict significant emotional and financial stress on owners and staff.

Preventative, protective, and palliative strategies, like those used in the hospitality industry, may help speech pathologists in private practice to manage negative online reviews and their effects. But we need to take care when responding publicly to ensure we act ethically and in accordance with our privacy and other legal obligations.

Principal source: Bradley, G.L., Sparks, B.A., Weber, K. (2015). The stress of anonymous online reviews: a conceptual model and research agenda. International Journal of Contemporary Hospitality Management, 27(5), 739-755.

Related products and articles:

Image: https://bit.ly/1RWHO8h

The future of speech pathology: can we predict the unpredictable?

31 March 2016 By David Kinnane Leave a Comment

A. We’re all fortune-tellers

Everything in speech pathology – from assessing a client’s needs, delivering therapy, deciding to start or close a practice or service, or hiring staff – involves forecasting.

The art and science of forecasting has been a hot topic in Australian speech pathology this year as many of us participate in the Speech Pathology 2030 – making futures happen project.

B. But can we beat a chimpanzee?

There’s a major conceptual problem with long-term forecasts:

In a 20-year study, Wharton Professor Philip Tetlock famously demonstrated that the average expert is only slightly better at predicting the future than a dart-wielding chimpanzee – especially on complex questions looking more than 5 years into the future.
Former banker, academic and best-selling author, Nassim Nicholas Taleb, tells us that history is determined (or at least significantly shaped) by dramatic “black swans” – events so far outside our experience, we can’t even imagine them until they happen.

So is a project to predict the future of speech pathology in Australia doomed to fail?

Not necessarily.

C. 11 key principles of “Superforecasting”

Recently, Tetlock and colleagues have demonstrated that some ordinary people consistently beat chance with their predictions by more than 60%. He calls these people “Superforecasters”.

So what can we learn from Superforecasters to improve our predictions about the future of our profession? Here are 11 principles – heavily paraphrased – from my Easter reading of Tetlock’s 2015 book about Superforecasting:

1. Adopt the right mindset

Superforecasters tend to be:

cautious;
humble;
non-deterministic: they reject the idea that events are fated;
open-minded;
intelligent with a need for critical thinking;
reflective;
numerate;
pragmatic;
analytical;
supportive of diverse views;
used to working with many grades of “maybe”;
thoughtful updaters – when facts change, they change their minds; and
intuitive psychologists who check their own thinking to catch cognitive biases.

Sounds like several speech pathologists I know. Good news!

2. Make predictions SMART

Speech pathologists are trained to set SMART goals for clients: i.e. making our goals specific, measurable, attainable, relevant and time-bound. But, like most people, we’re not so good when it comes to making predictions about uncertain future events.

Learning to forecast requires practice. To improve, we need clear feedback that leaves no ambiguity about whether our predictions are correct. There’s no point predicting that “technology will probably change speech pathology materially in some areas and will maybe leave others fundamentally unchanged” unless we define exactly what we mean by “probably”, “materially”, “in some areas”, “maybe” and “fundamentally” and specify exactly how and to what degree we think change will affect specific areas and leave others unchanged. Otherwise, it will be impossible for our speech pathology “descendants” to test whether our predictions were correct.

3. Focus on worthwhile questions

Forecasting experts and critics like Taleb and Tetlock agree that there is no evidence that geopolitical or economic forecasters can predict anything ten years out beyond the excruciatingly obvious (e.g. “Speech pathology will be affected by technology changes” or “There will be conflicts”). The accuracy of expert predictions declines towards chance five years out. This has a few implications:

If we try to plan for a future beyond 2021, we should plan for surprises. That means we should plan for adaptability and resilience – for example, we shouldn’t put all our eggs in one basket. We should plan for the effects of more stringent and less stringent regulation, for example. We should plan for multiple “bad things” to happen at once. As Eisenhower said “Plans are useless, but planning is indispensable”.
As Taleb posits, we should, where possible, design systems that are “antifragile” – not only resistant to shocks but strengthened by them. This costs money, however. We have to prioritise.
We shouldn’t waste time and money on easy “clock-like” questions where basic rules of thumb will get us close to the answer.
We should also be wary of wasting time on predictions about issues that are so uncertain we’ll never be able to beat the dart-throwing chimp. For example, it’s much easier to forecast our future scope of practice in 2020 than 2050. (Could anyone have predicted accurately in 1980 how the profession in Australia would look today?)
We should break complex problems into manageable sub-problems. This is part of making SMART predictions.

4. Be foxes, not hedgehogs

2500 years ago, Archilochus, the Greek warrior poet is said to have written that a “fox knows many things, but the hedgehog knows one big thing”. Foxes beat hedgehogs when it comes to forecasting. In fact, hedgehogs tend to do slightly worse than random guessing!

To be foxes, we need more than one idea – we need to seek out information and ideas from many sources. We then need to aggregate and synthesise information using intuition and critical thought.

5. Consider inside and outside views

No profession, era or situation is 100% unique. From an outside perspective, we share of lot of similarities with other professions. For example, when looking at the possible effects of technology or increased privatisation of the profession, we need to ask how often do these sorts of things happen in situations of this sort? We then need to think about how speech pathology is different from other examples and precedents.

6.Don’t over- or under-react to emerging evidence and trends

The best forecasters tend to be incremental updaters, often moving their predictions of the likelihood of an event happening in increments of 5% or less. But good forecasters also know how to make big jumps in estimates when compelling new evidence demands it.

7. Work together, encourage diversity, egalitarianism, and challenge groupthink

Teams of forecasters are consistently more accurate than individuals. But we need to avoid groupthink: we need diversity – a particular challenge in speech pathology – and to challenge each others’ ideas regardless of the status of the participants. We also need to treat others with mutual respect when critiquing ideas (Tetlock calls it “constructive confrontation”). The more diverse the teams, the greater the chance that some members will possess scraps of information or relevant experience that others don’t.

Managing teams well to anticipate future events is notoriously difficult. Famous baseball coach Tommy Lasorda once said: “Managing is like holding a dove in your hand. If you hold it too tightly you kill it, but if you hold it too loosely, you lose it.”

8. No plan survives reality – agree big goals but empower each professional to improvise when necessary to pursue them

For big strategic decisions about our future, we need a “mission command” mentality. Broad strategies can and should be agreed after incorporating input from stakeholders. But frequent and rapid tactical decisions can be shaped only on the spot by people on the ground according to estimates of local conditions.

Decision-making power needs to be pushed down so that those of us at the coal face can respond quickly to change. Leaders should set goals – but not tell front-line clinicians how to achieve them.

In other words, as a profession, we need to decide what we want to accomplish. But – and this is a very big but – we should not tell individual speech pathologists how to achieve those goals. This is consistent with the philosophies of innovative organisations like 3M (the inventor of Post-it-Notes) and Amazon. For example, Amazon’s CEO, Jeff Bezos mandates that all employees should “have backbone; disagree and commit….Leaders are obligated to respectfully challenge ideas when they disagree, even when doing so is uncomfortable and exhausting”.

9. Look for clashing forces at work in each problem

For every good policy argument, there is usually a counter-argument to be considered. The tricky thing is to identify, weigh and synthesise all the arguments in a nuanced way, rather than locking ourselves into a binary argument that one or another view is correct in all cases. Nuance matters in big decisions.

10. Plan but then act!

It is not enough to dither indefinitely, trying to avoid mistakes as the world changes around us. We have to make decisions and take action, even if we don’t have all the information to know how things will turn out.

11. Learn from mistakes and wins, but avoid hindsight bias

We should own our failures and conduct unflinching post-mortems, rather than trying to justify mistakes. We also need to study our successes – were they based on sound analysis or merely flukes?

D. Bottom line

Forecasting is difficult, even in the short-term. It’s impossible to lay down binding rules. Guidelines like those above are the best we can do in an unpredictable world. And, even with guidelines, we must be prepared to break them when the circumstances demand it.

Principal source: Tetlock, P. & Gardner, D. (2015). Superforecasting: The Art and Science of Prediction. Random House Books, London. See also: www.goodjudgment.com

Further reading: Taleb, N.N. (2012). Antifragile: Things that gain from disorder. Random House Books, New York, New York. An excellent, (but exhausting) read!

Image: https://bit.ly/1ROAxHB

5 steps I took to comply with Speech Pathology Australia’s advertising rules

20 March 2016 By David Kinnane Leave a Comment

Unlike many of our fellow allied health professionals, speech pathologists aren’t registered health practitioners in Australia. If we want to be respected in the same way as physiotherapists and occupational therapists – and I think we do – we need to be at least as professional as the regulated health professions.

Regulated health practitioners, like OTs and physios, are subject to Codes of Conduct on various matters, including advertising.

The good news is that Speech Pathology Australia (SPA) has implemented its Code of Ethics-Advertising Policy (3.03), which in many ways brings speech pathology advertising rules into line with the standards applied to registered health professionals. Helpfully, SPA has also published some FAQs to explain some of the measures.

The bad news is that, since the rules came into force on 1 July 2015, we all have to do a bit of work to make sure we comply and stay compliant.

I completed my compliance audit after the introduction of the rules, and wanted to share some specific steps I took to comply with the rules.

1. Yank those testimonials

Why: testimonials are subjective, inherently anecdotal, easy to make up and to quote selectively, and hard to verify independently. They’re also manipulative: they’ve been shown to persuade people to buy stuff they don’t need. They’re a staple of self-improvement workshops and the home shopping channel for that very reason. They have no legitimate place marketing health services to vulnerable people with health needs – especially people with communication problems.

I have never used testimonials on my website or elsewhere. But I had allowed some clients and friends to rate me on Facebook. I had to delete those – which was a bit tricky – for some reason, I couldn’t delete the review function without losing my map on Facebook which was annoying to say the least. I have also now changed my website comments function so I get a chance to moderate comments before they are posted.

2. Ditch any “specialist” claims

Why? In Australia, the speech pathology profession doesn’t yet recognise any categories of specialist practitioners. In professions like medicine and law, you can become a specialist. But it takes lots of work and involves proving your expertise through a recognised accreditation process. Here’s what that looks like for lawyers in New South Wales, Australia.

Unless and until similar measures are introduced for speech pathologists, it’s misleading and deceptive to claim you are a specialist.

You can say you have lots of experience working with particular kinds of clients. You can say you have a special interest in helping people with specific speech pathology needs. But you’re not a specialist (e.g. you can’t call yourself a specialist paediatric speech pathologist).

I searched my blog and social media profile for anything that might suggest I claimed to be a specialist. When in doubt, I deleted the offending content.

3. Monitor what others say about you

This all sounds a bit paranoid. And I don’t really care that much about what people say about me.

But I don’t have a choice anymore. Why? I’ve got the ability to moderate and edit comments. I have a professional obligation to delete testimonials on platforms under my control. I have a legal obligation to avoid misleading and deceptive conduct – including false claims.

To mitigate my risk here, I now moderate all comments on my blog, and monitor social media comments and mentions daily (except Sundays). I now have a social media policy to cover staff conduct. I’ve also implemented house rules on my business Facebook page, which clearly set out my expectations of people interacting with the page (including the “no testimonials” rule). Finally, and as much as I hate vanity Googling, I’ve set up a Google name alert for my clinic and name to monitor comments made in places outside my control.

4. Tear up those discount vouchers, gift cards and coupons

Why? They encourage people to use your service, even if they don’t need it. And they’re tacky.

I don’t advertise with vouchers or gift cards – mainly because I think they come across as cheap and nasty, so I didn’t need to change my practice here. But I am going to think more about whether my future sponsorships of local events, e.g. school events that could be perceived as encouraging over-use of my service. I don’t think I have an issue – I tend to just hand over money in return for being listed in the list of sponsors, but it’s something I’ll review with each sponsorship arrangement.

5. Re-think the qualifications you cite when marketing services

B.Bus (Accounting), LLB (Hons.), MSLP, MSPA, CPSP, NP, MANZCN, Solicitor of the High Courts of Australia and Hong Kong…

My full qualifications are a bit of a mouthful and many of them have no direct relevance to speech pathology.

So I don’t use them all when I’m marketing speech pathology services. Instead, I go with SPA’s recommendation: David Kinnane, MSLP, MSPA, CPSP. Full stop.

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Speech pathologists: my top 10 tips for managing client expectations

14 March 2016 By David Kinnane Leave a Comment

Word of mouth can build your practice. Or destroy it.

Are you always meeting or exceeding your clients’ expectations of your service? If not, are you doing enough to manage them?

Over the years, I’ve reviewed thousands of consulting and other service contracts. I’ve also been embroiled in several disputes (for clients!) that boiled down to a simple misunderstanding about the services provided.

Here are my top 10 tips for managing client expectations to reduce complaints, avoid disputes, and to build trust with your clients:

1. Be clear on your scope of service. Does the client understand what you do (and don’t do)?

Lots of people have never been to a speech pathologist before. Maybe they booked in because a teacher told them to. Perhaps, it was a doctor, occupational therapist, dentist or other health professional. Maybe their friend or relative recommended you.
Take the time to explain what speech pathologists do. Don’t expect clients to understand differences between speech pathologists and other allied health professionals such as occupational therapists or educational psychologists.
Explain what you do. Most speech pathologists don’t try to be all things to all people. Our scope of practice is simply too wide. What do you do best? What are your special interests and passions?
Explain what you don’t do. For example, I don’t offer feeding and swallowing services in my clinic. If these issues are flagged in the questionnaire or in the initial assessment, I refer the client on to someone with special training in those areas.

2. Be clear about what you expect from the client

Encourage full and frank disclosure in a safe environment. Understandably, some clients may withhold sensitive information until they know, like and trust you.
Have a booking policy that sets out your expectations about attendance and cancellations.
Have a homework summary sheet that emphasises the need to practice the communication skills worked on in therapy.
For motor-based therapies, inform your client about principles of motor learning and neuroplasticity so they understand why they need to work hard outside the sessions.
Be specific about how much practice you want and how often. Follow-up to find out how they went with the homework. If necessary, tweak the homework plan to suit the client.

3. Agree on the scope of your assessment

Demystify the assessment process. Outline how it will work. For example, this is what I tell parents of toddlers.
In your first session, spend some time with the client reviewing the client’s questionnaire and interview responses. Agree the scope of the assessment. Will it cover speech, language, literacy, voice, fluency and/or dysphagia?
What’s worrying the client the most?
What are the client’s key challenges?
What’s most affecting the client’s participation in the real world? Don’t assume that it’s the client’s most noticeable problem.

4. Double-check: does the client want your help?

Treatment without informed client consent is assault.
Do not assume that the client wants you to treat them.
Inform the client about treatment options – including no treatment – the risks and potential benefits of each, and the evidence base for different treatments.
Inform your clients about risk factors and connections between different communication issues. For example, inform children with speech sound issues about the heightened risk of later literacy issues.
If a client has multiple issues, explain why you recommend treating one of them first, e.g. stuttering over speech sounds or speech versus language.
If you cannot provide the service needed, help the client find someone who can. Have a referral policy to emphasise your independence and integrity.

5. Agree on a time-bound therapy plan

Outline your management plan Plain English in the assessment report. Avoid pointless long words.
In the first therapy session, summarise the report and check that you are all on the same page. Be open to revising the plan to accommodate client priorities.
Most clients want a specific time-frame for therapy. Even for severe disorders, I like to offer a short block of initial therapy (say 5 sessions), followed by a review to check progress and to review the management plan.

6. Agree on how you will communicate, and how often

Will you send out interim progress reports? If so, how often? Make sure you don’t overload the client with reports they didn’t ask for (or want).
Has the client consented to receiving reports and other communications by email, or only by post or hand delivery?
Has the client consented to receiving SMS appointment reminders?

7. Know your audience(s)

Check whether your report is to go to the client only, or to others (e.g. schools, employers, etc). Does the client want to see the report first?
When working with children with separated or divorced parents:
- check for Family Court or other custody arrangements about the client’s health care;
- send copies of your reports and other communications to both parents (or other carers) – unless there is a Court or other order or arrangement prohibiting it; and
- if the attending parent asks you not to send the report to the other parent, find out why and assess whether you need consent from both parents to treat the child. If in doubt, don’t treat until you are sure you have all the required consents.
When working with older teenagers, check whether the report should be addressed to the parents, the teenager or both? (Check the age of consent for health treatment in your location.)
If writing for multiple audiences, address both appropriately. For example, if writing for a client with aphasia and their neurologist, present the report using aphasia friendly principles, and then present more detailed data in an appendix for the neurologist.

8. Understand the purpose(s) of your report

Who will be reading the report and for what purpose?
Is the report:
- just for the client’s information?
- a second opinion?
- required to secure funding?
- going to be used in an insurance claim or legal proceedings?
Does the client (or other recipient) have specific requirements for the contents or even formatting of the report?

9. Measure progress and report it to the client

Will you send out interim reports, or something less formal?
How are you measuring whether your therapy is working?

10. Agree on discharge criteria

Have you communicated the length of the proposed therapy block to the client?
Have you given the client the opportunity to give you feedback on their progress?
How will you know when the treatment goals have been achieved?
What are your discharge criteria? Are they the same as your client’s?

Principal source: Maister, D., Green, C.H., Galford., R.M. (2000). The Trusted Advisor. Free Press, NY, NY.

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