Program Evaluation

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The primary goal of any hearing loss prevention program must be to reduce, and eventually to eliminate, hearing loss due to workplace exposures. While management may have the best intentions of implementing this goal and a company's hearing loss prevention program may have the appearance of being complete and complying with OSHA's requirements, the program may not achieve this goal. A thorough evaluation of the effectiveness of all of the program's components is necessary to determine the extent to which the hearing loss prevention program is really working.

Management and program implementors should conduct periodic program evaluations to assess compliance with federal and state regulations and to make sure hearing is being conserved. There are two basic approaches to follow in program evaluation: (1) assess the completeness and quality of the program's components, and (2) evaluate the audiometric data. The first approach can be implemented using checklists, such as those found in Appendices A and B. Appendix A can be used to assess compliance with each provision of OSHA's noise standard, and Appendix B is useful for identifying gaps in the program which could limit the program's effectiveness. Checklists such as these can serve as important tools in the evaluation process.

The second approach is to evaluate the results of audiometric tests, both for individuals and for groups of exposed employees. Each individual's current test should be compared to the baseline test to see if an OSHA standard threshold shift or NIOSH significant threshold shift(3) has occurred. Previous audiograms for that individual should be inspected also and compared to each other and to the current test results to identify hearing loss progressions that may not have reached the severity of the OSHA standard threshold shift.

Audiometric data for groups of noise-exposed employees should also be evaluated using criteria other than the OSHA standard threshold shift. This usually involves statistical procedures to assess variability in population hearing levels, and usually requires computerized audiometric data. A well protected exposed population will show the same hearing levels as a non-exposed population, when matched for age and other factors. Different manifestations of variability can provide information on the extent to which workers are losing their hearing, and can assist in pointing out the trouble spots in the hearing loss prevention program. For further information on audiometric database analysis, readers should consult the suggested readings at the end of this section.

In addition, a working group of the American National Standards Institute has drafted guidelines for analyzing audiometric data to evaluate hearing loss prevention program effectiveness-ANSI S12.13, Draft Standard for Evaluating the Effectiveness of Hearing Conservation Programs. The procedures of this standard are most useful in determining that the audiometric data are consistent and lack much variability; that the database has integrity. If year-to-year audiograms show changes that are due to poor audiometry and not to changes in hearing, it will be impossible to use the audiometric data to determine whether or not the hearing loss prevention program is successful.

The reader is also referred to the chapter on Emerging Trends and Technologies for a discussion of the use of attitude surveys to assess the effectiveness of hearing loss prevention intervention strategies.

Management Responsibilities

Management needs to dedicate sufficient resources for a comprehensive program evaluation to the program implementor responsible for the hearing loss prevention program. Management should see that this individual is adequately trained to conduct hearing loss prevention programs and to analyze data. Management must ensure that periodic evaluations of the program actually take place.

Managers need to be committed to act on the outcome of the program evaluation. They must be willing to acknowledge and solve the problems which may require the dedication of both financial resources and personnel. They must also be willing to institute and carry out disciplinary measures for noncompliance. Another important responsibility of management is to be attentive to the comments and reactions of exposed employees and to make use of their feedback during the program evaluation.

Program Implementor Responsibilities

Program implementors must be willing to commit the time and resources needed to conduct a thorough evaluation. They need to be able to perform the mechanics of audiometric database analysis, or they must be willing to engage the assistance of an outside contractor or consultant. They should look for early threshold shifts, such as the NIOSH significant threshold shift, and not wait until the shift becomes as severe as an OSHA standard threshold shift.

Those who perform the program evaluation must be willing to ask questions, seek out elusive information, and interact with all members of the hearing loss prevention program team. For example, they may need to call for audiometric retests, make sure that recommendations for treatment or evaluation have been followed, and to assure that necessary changes in hearing protection have been implemented. They must communicate their findings to management and to the affected employees.

Employee Responsibilities

As with many other components of the hearing loss prevention program, the primary responsibility of employees is to provide feedback to the program implementor and to management. For effective program evaluation to take place employees need to communicate their hearing loss prevention problems, and explain why they are unwilling or unable to wear their hearing protectors. They need to make their needs known to higher management if they are unable to obtain replacement hearing protectors. Employees should notify the technician or audiologist if they have a problem understanding the instructions for taking the audiometric test, and they should report any medical problem that affects their hearing. Finally, they need to draw attention to changes in the noise levels produced by their equipment, or any malfunctioning noise control devices. Evaluation of the program, just like the conduct of the program, requires a team effort.

Further Reading

ANSI [1991] Draft Standard for the Evaluation of Hearing Conservation Program Effectiveness. New York, NY American National Standards Institute. ANSI S12.13

Melnick W [1984]. Evaluation of industrial hearing conservation programs: A review and analysis. American Industrial Hygiene Assoc. Journal, 45:459B467

Royster LH, Royster JD [1988] Getting started in audiometric database analysis. Seminars in Hearing 9: 325B337..

Royster JD, Royster LH [1986]. Audiometric database analysis. In: Berger EH, Ward WD, Morrill JC, Royster LH, eds. [1986] Noise and Hearing Conservation Manual. 4th ed. Akron, OH: American Industrial Hygiene Assoc., Chapter 9.

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