Q.No. 4 (Marks 15)

After reading the hearing aid process taking place at a clinic (given below) you have to perform following:

1. Develop the process flow diagram for the following process of getting hearing aid from a clinic. (7 Marks)
2. Identify the activities that provide value to the customer and the non-value adding activities. (4 Marks)
3. Of the non-value adding activities, are there any activities that you directly could eliminate, combine or change? (4 Marks)

Use five different symbols for start (circle), activity (box), decision-point (rhomb), waiting-time (D) and direction of flow (arrow).

One can get some assistance by asking the following questions:

• Where does the process begin?
• What is the very first thing that happens to initiate the process, and who is doing what?
• What happens next and who is doing what?
• Is there a decision to be made after step X? If so, what are the branches that the process might take after this decision?
• Regarding the last step performed by function X, is there another function performing the same step on simultaneously and if so, what is it, and who is doing what?
• What are the inputs and outputs associated with step X?

Avoid following:

• Omitting activities in the process flow, particularly those in the support functions.
• Omitting feedback loops.
• Not labeling inputs and outputs.
• Portraying the flow the way it Should Be rather than the As Is.

Description of the process of getting a hearing aid

John has realized that his hearing is not what it used to be. His wife keeps telling him that he never hears what she says and that she has to shout to be heard. Finally John calls the Ear, Nose and Throat Clinic (ENT-Clinic) at the local hospital to find out what they can do for him.

A receptionist at the ENT-Clinic answers Johns call. Since she has to be pretty loud to be heard by John she tells him that he probably needs to have his ears examined by an ear, nose and throat specialist doctor. She also says that the queues are long to see the doctor and that he will have to wait for six months before he can be examined. John accepts the ear examination appointment which will take place six months from now.

Six months later John is at the ENT-clinic. The ear, nose and throat specialist doctor examines Johns ears. It takes about 20 minutes for the doctor to say if it is a medical or an audiological impaired hearing. In Johns case it was an audiological impaired hearing, which can be helped with a hearing aid. If it would have been a medical problem an ear surgery could have helped. The doctor needs an audiogram to further analyze Johns impaired hearing (for example regarding what frequencies that he does not hear). The doctor sends John to an audiological assistant at the Hearing Clinic. The doctor sees to that and a case-book is made on John. The case book will be updated each time John is getting treatment at the hospital.

When John is home again he calls the Hearing Clinic to make an appointment with an audiological assistant to get an audiogram taken. The receptionist at the Hearing Clinic gives John an appointment one week later. At this hospital the hearing clinic is not located in the same building as the ENT-clinic.

One week later the audiological assistant at the Hearing Clinic lets John take a standard hearing test (ton & tal audiogram). It takes about 15 minutes. When they are finished the audiological assistant sends it by internal mail to the doctor at the ENT Clinic.

When the doctor at the ENT-Clinic gets the audiogram he studies it for about 10 minutes and finds that he does not need any more tests. Johns hearing can only be helped by a hearing aid. He sends this message back to the audiological assistant.

When the audiological assistant gets the message she calls John and explains that John could get a better hearing ability with a hearing aid. John decides to get the hearing aid. To get it he is invited to a pre-information at the hearing clinic. The next pre-information group is in three weeks time, and John books this time.

Three weeks later John and his wife arrive at the pre-information at the Hearing Clinic. There they meet a group of other patients with their relative. A hearing pedagogue informs about the function of the ears and what persons with impaired hearing hear and the problems they have. She also tells about how to talk and behave to decrease these problems and how a hearing aid works. An audiological assistant then talks to each of the patients together with the pedagogue and analyses the patients audiogram. They ask the patient which type of hearing aid he or she wants and suggest other complimentary aids that might be helpful for this patient. If the patient wants other aids (aids connected to the TV or the telephone etc.) the audiological assistant prescribes this. This works as a kind of order to a hearing engineer to install the equipment in the patients home. When the engineer gets the order he calls the patient to book a time for installation. It takes about 3 months to get the aids installed. John gets a prescription for an aid to get the TV sound direct into his hearing aid. To get the hearing aid he gets an appointment with an audiological assistant at the Hearing Clinic for a conversation and a cast to get the right shape of the ear inset. The assistants are overloaded with work and cannot see John until 3 months later.

The conversation and cast appointment takes about 45 minutes. The audiological assistant and John have a conversation about Johns situation and what he needs and wants. She makes a cast of Johns ear and sends it to a firm which produces hearing aid insets. The assistant books John for a cast and hearing aid fitting four weeks later. At that time the assistant has got Johns inset from the manufacturer by mail.

The fitting takes about 75 minutes for John and the audiological assistant. By the help of the audiogram the assistant can tell which hearing aids that probably suits John. John tries a couple of different types and chooses one that he will take home for four weeks to try. This is an important time for the patient since it takes many hours for a patient to be accustomed to the sound and handling in day to day situations. They book a new appointment four weeks later for a follow-up.

At the follow-up meeting the audiological assistant and John evaluates how the aid works for John. If the aid is not satisfactory the patient tries another type for about four to six weeks time and then comes back for another follow-up meeting. Each patient makes as an average 4.6 follow-up visits they have found the right type of hearing aid. Each of these visits takes 45 minutes.