It’s not me, it’s the equipment… or is it? Testing perceptions using data.

Mrs Larissa Ralph1

 1Royal Children’s Hospital, Parkville, Australia


The issue

Automated auditory brainstem response (AABR) screening devices are engineered to ensure a very high degree of accuracy of a screening result.  The Victorian Infant Hearing Screening Program uses the same make and model of AABR screening device statewide.

Screening can be impacted by the operator’s choice of baby, the screening environment and their trouble shooting capacity. Hearing screeners anecdotally report that some devices perform more favourably than others. This can lead to users actively choosing the favoured device and avoiding the less preferred devices.

The question

Is the screeners perception that one screening device performs better than another supported by evidence?

How the question was answered

Hearing screeners from one screening location provided their ranking of performance of each screening device at their site, and reasons for their rankings. A most favoured and least favoured screening device were identified. Data downloads from the most and least favoured devices were obtained reflecting a period of 5 weeks and a total of 355 screens.

What the analyses showed

Hearing screeners reported experiencing higher myogenic interference, longer screen times and more positive (refer) results when using the least-preferred device.

Analyses of objective data from the most and least preferred devices indicated no significant differences between devices on screen duration (t=-1.2, p=.22) and rate of referral results (x2=2.9, p=.09). The most preferred device recorded higher levels of myogenic interference than the least preferred device (t=6.6, p<.01).

Conclusions reached

Screening devices deemed to perform better by users do not perform better on objective measures. Data can be used as a tool to manage perceptions of device performance that possibly are affected more by factors independent of the device itself.


Larissa Ralph is a Senior Area Manager with the Victorian Infant Hearing Screening Program (VIHSP).  Larissa has over 10 years of healthcare management experience, across both private and public sectors, leading high performing teams.  VIHSP screens the hearing of newborn babies in their first weeks of life.  Larissa oversees program delivery at 20 maternity services that account for approximately 35,000 births per year.  The program aims to promote early detection and intervention to improve outcomes for babies with hearing loss.