Renée Lefrançois is passionate about helping organizations boost their hearing conservation programs (HCPs), remain compliant, and protect workers from hearing loss. She is the director of audiology at SHOEBOX Ltd., a provider of hearing testing solutions based in Ottawa, Canada, with an office in Paris, France, and a consult/remote audiometer developmental team located in Israel.
Since joining the company just under 10 years ago, Lefrançois has helped SHOEBOX grow to supervise over 150 HCPs for small, medium, and enterprise organizations. In addition to program supervision and case review, she currently holds the National Hearing Conservation Association (NHCA) alternate liaison position for the ANSI/ASA S3 working group, which focuses on standards covering audiometry and testing outside of a booth.
To learn more about Lefrançois and her take on industry issues, please read the Faces of EHS interview below:
Q: How did you get your start in the field?
The first 15 years of my audiological career were spent in hospital settings specializing in cochlear implants. Once I made the move over to SHOEBOX, my areas of practice shifted to diagnostics, supporting clinical trials and research, and notably, providing review and supervision services to occupational health users of SHOEBOX. Clinical review of test results and supervision of each organization’s hearing conservation program by an occupational audiologist or physician is mandated by OSHA 1910.95, and subsequently, there is certainly no shortage in need for occupational audiologists.
Q: Who has been your biggest influence in the industry?
Dr. Robert (Bob) Dobie was an otolaryngologist with a special interest in occupational health who provided important counsel to leading hearing conservation organizations such as OSHA, NIDCD, NIOSH, ISO, and the WHO. He moved many key clinical hearing conservation issues forward over the past several decades, including updating the OSHA-listed age-correction factors applied to many organizations’ hearing test results. This may seem like a small endeavor, but due to the complexities of generalizing group results to specific individuals (e.g., a 64-year-old male has different correction factors than a 61-year-old female worker), this is quite a complex endeavor.
Age-correction factors can be inherently controversial from a clinical standpoint, but Dr. Dobie was able to provide clear direction here to physicians and audiologists alike. He authored such important works as a textbook entitled, “The Medical-Legal Evaluation of Hearing Loss” and more than 200 other peer-reviewed publications. Sadly, Dr. Dobie passed away in 2019, but his impressive legacy will continue to make significant impacts in hearing conservation for years to come.
Q: What’s your best mistake, and what did you learn from it?
My best mistake in hearing conservation has been to erroneously assume that I can successfully find all the information needed myself in written format online or in journal articles. I learned quickly, thanks in large part to discussions with fellow occupational audiologist Dr. Kirsten McCall, that those working in the field are among the best resources for connecting the lines between the various regulatory, research, and certification entities involved in hearing conservation, and the premise behind some of the guidance and regulations.
Q: What are some of the biggest issues at your organization?
From a clinical standpoint, a key issue that my team is continually evaluating and discussing is how much clinical assistance to an organization’s hearing conservation program is the right amount. In an ideal world, each patient presenting with a “problem audiogram” in a testing year would be able to consult with a clinician to help identify and address possible contributing factors. We know that due to the considerable number of individuals who present with problem audiograms annually for assorted reasons, this is not feasible for most organizations.
At SHOEBOX, we pride ourselves on offering remote employee consultations on a case-by-case basis, which allows for private and protected consultation time and can be significantly advantageous in helping to provide the most impactful recommendations for that individual.
Q: What’s your favorite and least favorite part about working in the industry? Would you change anything?
My favorite part about working in the industry is witnessing the impressive commitment of many health and safety professionals in their dedication to their teams. I have seen leaders go above and beyond to help individuals who demonstrate hearing shifts, including accommodating various hearing scenarios like hyperacusis (sensitivity to loud sounds), hearing aids, post-ear-surgery individuals, etc.
My least favorite aspect of working in hearing conservation is that there are still individuals who believe that having “low to no” recordable hearing shifts in a testing year is a sign of success. Unless it is a small organization with less than 40 employees in their hearing conservation program, the opposite is true.
The identification of recordable hearing losses in groups exposed to 85 dB (A) 8-hour time-weighted average (TWA) is the sign of a healthy and effective HCP. If there is a program with 300 employees exposed at or above the OSHA action limit, having no recordable shifts in a given year is typically a red flag that changes in hearing are being missed or inappropriately classified. The purpose of hearing testing is to identify changes in hearing that may be impacted by the work environment. Recordable shifts often do not indicate causality on behalf of the employer but identify those who demonstrate changes in hearing. These changes in hearing could potentially be halted in progression with appropriate action.
Individuals can be more (or less) susceptible to permanent hearing loss due to noise exposure based on factors such as genetics, co-morbidities with other health conditions, certain medications or combination of medications, or having differently shaped external ear canals that make in-ear hearing protection insertion more difficult.
Q: What are your thoughts on safety culture? How can company leaders make safety a value within their organization?
A safety culture that is openly discussed and viewed as collaborative (as opposed to punitive) between employers and employees is one that we see a higher level of compliance towards. An unexpected benefit of bringing hearing testing in-house is that both HCP managers and employees report feeling more engaged in the process, with a higher level of understanding in terms of cause and effect of the proper insertion of hearing protection. With a higher level of engagement from employees, compliance levels often benefit from both annual testing and overall protection aspects.
Q: What safety concerns or issues do you think need more prioritization in EHS programs?
I feel strongly that HCP managers should not be penalized for reporting recordable hearing shifts. In OSHA’s 2002 Final Rule to the changes applied to the Noise Standard at that time, the organization published results on the expected hearing loss recordability rates across industries when organizations follow all the OSHA 1910.95 noise mitigation and protection recommendations. Many are surprised to learn that the expected published values were listed as between 2.2-3.1% of all employees in an HCP.
With higher levels of noise exposure, we would expect a higher percentage of recordable shifts, but even those industries that are just above the action level or have employees with only sporadic exposure to loud noise should typically (depending on the number of employees in the program) have a non-zero number of recordable hearing shifts in a year. With the lower cut-off of recordable shifts that we encounter with SHOEBOX customers, a good landmark would be that each organization’s recordability rate for hearing loss be 0.4% or above on an annual basis.
Q: How will new safety technologies influence the work being done by EHS professionals?
The relatively new availability of in-house automated audiometry has been demonstrated to have a wide positive impact on hearing conservation programs. Organizations have reported significant cost savings in terms of not having to contract service providers as well as minimizing lost employee productivity related to the testing process, improved employee engagement in their HCP, and improved flexibility in providing pre-employment, intake, annual, and retest audiograms.
Moving on from the just the audiogram, having a HIPAA-compliant web portal that provides automatic triage based on industry-leading test indicators is a key strength of the offering of SHOEBOX in occupational health. This individualized portal is provided with every SHOEBOX audiometer and is also a protected conduit to view results reviewed by the organization’s clinician(s) and provide a space for consultation with them.
Q: What are you most proud of?
I am most proud of being a part of team that pushed a new way of thinking forward in occupational health hearing testing. Collaborating with the health and safety teams both remotely and during our on-site visits has been such a pleasure, and my team has learned quite a bit from our interactions in terms of program implementation and testing challenges.
I know that SHOEBOX’s technology and clinical services have contributed to halting, or even reversing, hearing loss due to noise exposure. Furthermore, thanks to our medical triage in the portal, we have been able to appropriately refer individuals with potentially life-altering conditions such as the presence of tumors along the auditory nerve or sudden sensorineural hearing loss (SSNHL), thus positively altering the hearing and overall health outcome of those individuals.
Q: Anything else you’d like to add?
Thanks to healthier lifestyles and advances in modern medicine, life expectancy is currently experiencing a remarkable increase around the globe. It will not be abnormal for many of your current employees to live 100 years or longer. With the increase in life expectancy comes a heightened importance in lifelong communication abilities in which hearing levels play a crucial role.
Now that we are well equipped with innovative and highly effective hearing testing, review, and follow-up recommendation pathways for employees in HCPs, we can all make a real difference in the quality of life of our teams, both now and for decades to come.
Are you or a colleague an EHS professional interested in being profiled for the Faces of EHS series? Please contact Joe Bebon at JBebon@BLR.com.