The document discusses the need to scale post-operative care for cochlear implant (CI) recipients given rising global populations and numbers of CI candidates. It notes increasing indications for CIs and greater access to information is driving more demand. Maintaining the current care model is unrealistic due to lack of trained personnel and costs. The solution proposed is to fundamentally change the care delivery system by applying scalability principles like online registration, remote consultations, digital upgrades and conferences to free up experts' time for more personalized care. Implementing scalable processes and services can help concentrate human resources on empathy and discussion to improve treatment levels.

1. Scalability of post-operative care
for CI recipients
Dr. Dr. h.c. Monika Lehnhardt
Moscow, May 1st, 2012

2. Situation Analysis
World population is growing
World population is ageing
Technological advances at an increased speed
Open, easy, cost free access to information via Internet
Participative decision making in health care
Incidence of deafness unchanged
Quality of life an important factor
Need for life-long care for CI recipients indisputable
Economical constraints

3. Consequences
Increasing number of CI candidates every year
Indication broadening constantly (e.g. elderly population,
￭ severely hearing impaired, single sided deafness …)
Awareness of availability of effective treatment for deafness
spreading (candidates, parents, children of parents searching in the
￭ Internet for objective information and exchange experience on Social
Platforms)
Self-confidence of candidates and their spokesmen improving based
on acquisition of knowledge and social interaction
Dramatic / exponential growth of existing CI recipients pool demanding
life-long care
Germany now 20 k – in three years 60 k
Worldwide estimate now 240 k – in three years 720 k

4. Options
Do nothing = unacceptable
Would seriously damage the validity of CI as a cost
effective and beneficial treatment for the deaf
Add personnel and equipment = unrealistic
Lack of trained personnel (training is time consuming
and expensive, equipment is also expensive, requires
additional space, which is difficult to create)

5. Options
Expand service of CI manufacturers = not economical
Accept the challenge and adapt the business model =
Change the structure of the care-giving system fundamentally =
the evident solution
(John Niparko, G.O’Donoghue, 2008)

6. Scalability is the Solution
Definition:
a) achieve the same results with less effort
b) achieve more /better results with the same effort
Economy of scale =
Adaptability of costs in relation to turnover =
reduction of fixed costs
e.g. mobile working stations, less office space, people working from home, people
with no fixed salary working on project basis, eliminate higher costs for printed media
by (partly) replacing them with digital information

7. Scalability successfully implemented
SKYPE (developed in Estonia) :
people establish their own telephone base
Facebook: > 600 Million users
cost free, as efficient as Windows from Microsoft
Scalable software for hospital management suitable
for highly varying numbers of patients
Cloud computing in health care –
see SynXplatform presented by Microsoft in March
2011

8. Scalability of production
Introduction of automated processes
to reduce manual work and herewith risk of
human failure to improve the reliability of
devices and reduce cost of production

9. Scalability in CI surgery
Techniques have changed significantly over the last 28 years
incision size, flap shape, approaches, insertion of the electrode array,
suturing, imaging techniques, computer aided surgery
Time for surgery reduced from 3 hours to 1 ½
In the future possibly robots will “do the job” faster and more reliable
(David Proops, Suzdal, December 2011)

10. Application of scalability concept
in post-operative care for CI-recipients
Registration Online
￭ no need of manually filling in cards,
mailing, collecting, copying…
￭ Central Computing of data at an
independent organization to get reliable
statistics about CI recipients
(e.g. Switzerland, Belgium,
Netherlands, Austria, UK)

11. Application of scalability concept
in post-operative care for CI-recipients
Share intra-operative measurement
data to create first maps
cooperation between clinic/operating room
and fitting centre
Tele-fitting sessions
experienced expert maneuvers the software
programme on the hardware
of the less experienced in another location
Upgrades
fitting of new speech processor via Internet
connection between the experienced and
less experienced audiologist

12. Application of scalability concept
in post-operative care for CI-recipients
Failure Reporting Online
CI systems will report about their functionality and
about eventual problems online and will receive
online instructions how to fix the problem or suggest
competent resources where to find a solution

13. Application of scalability concept
in post-operative care for CI-recipients
Re(Habilitation) Online
Exchange of experience amongst
experts and parents in LiveOnline
Rooms across countries and language
barriers e.g.
PORA! Training programme for Russian
speaking therapists
Voskresnyj Poldnik – Sunday meetings
for Russian speaking parents

14. Application of scalability concept
in post-operative care for CI-recipients
Online consultation of surgeons, therapists and
other experts for parents seeking advice

15. Continue Conferences LiveOnline
Increase the sustainability of conferences
by continuing in the Internet environment
Weblogs – Interactive Communication – Presentations –
Preparation of next conference

16. Conclusion
Apply scalable processes and services
to free human resources and have
them concentrate on providing what
can only be provided by human beings
EMPATHY
Have the experts not waste their time in extensive and expensive
travelling, in working with instruments and equipment, applying mainly
their manual skills, but have them spend quality time in talking with their
clients / patients to improve the level of care and with colleagues on an
intra- and interdisciplinary basis to develop new ideas how to improve
medical treatments for people in need.

17. Thank you for your attention and
please feel free to comment
in my personal weblog
www.monika-lehnhardt.net