All chapters
Audiology Practice Β· Staff Training
Motivational Interviewing
on the Phone
A step-by-step training guide for front office staff. No prior experience needed β work through each chapter in order and you'll finish knowing exactly what to say, when to say it, and why it works.
1
Foundation
Why the way you talk matters
Before any scripts or techniques, you need to understand the single most important thing about patient phone calls β and why most front office training gets it wrong.
The problem with most phone training
You can't convince someone to care about their hearing
Traditional phone training focuses on overcoming objections, handling pushback, and "closing the booking." The implicit goal is to persuade the patient.
But here's what the research on human behaviour tells us: people change when they hear themselves say why they want to change. Not when someone else tells them to.
Motivational Interviewing (MI) is built on this insight. It's a communication method developed in clinical psychology that works by helping people articulate their own reasons to act β rather than being sold to.
But here's what the research on human behaviour tells us: people change when they hear themselves say why they want to change. Not when someone else tells them to.
Motivational Interviewing (MI) is built on this insight. It's a communication method developed in clinical psychology that works by helping people articulate their own reasons to act β rather than being sold to.
Key insight
Your job on the phone is not to convince the patient. Your job is to create the conditions in which they convince themselves. That shift in mindset changes everything about how you speak.
What this looks like in practice
The difference between pushing and guiding
Imagine two callers with the same hesitation: "I'm not sure I really need to get it checked yet."
β Pushing
"Hearing loss gets worse if you ignore it, so it's really important to get tested sooner rather than later."
Sounds like a lecture. Patient feels pressured. Resistance increases.
β Guiding
"That makes sense. What's made you start thinking about it at all?"
One open question. Patient starts articulating their own reasons. You listen.
Remember this
Ambivalence is normal. Most patients calling an audiology practice feel two ways at once β "I probably should get this checked" AND "but it's probably fine / too expensive / too scary." That's not a problem to solve. It's a conversation to have.
Chapter 1 Β· Check your understanding
A patient says "I'm not sure I really need to get checked." What is the MI-informed response?
β Exactly right. An open question invites the patient to reflect on their own reasons β which is far more powerful than any information you could give them. Notice that the correct answer doesn't mention hearing loss, urgency, or anything clinical.
Not quite. Options 1, 3, and 4 all involve you doing the work of persuasion β telling the patient why they should come in. MI works the other way: you ask an open question and let the patient find their own reasons. The answer is option 2.
2
Core Skills
The OARS framework
MI is built on four core communication skills. Learn these four and you have everything you need to handle almost any patient call.
O
Open questions
Questions that can't be answered yes or no. They invite the patient to talk.
"What's been making you think about your hearing lately?"
A
Affirmations
Genuine recognition of a patient's effort, courage, or insight. Specific β not generic praise.
"It takes real courage to make that call β I'm glad you did."
R
Reflective listening
Mirroring back what the patient said β feeling, content, or both. Shows you heard them.
"So it sounds like conversations at work have been the hardest part."
S
Summarising
Collecting what you've heard into one picture, then confirming it before moving on.
"So β changes for about two years, your family has noticed, and you'd like to understand what's going on. Does that sound right?"
Common mistake
Don't use OARS as a checklist. It's not "ask one open question, then move on." Great MI phone calls weave these skills together naturally. You might reflect three times before you affirm once. The goal is for the patient to feel genuinely heard β not processed.
Going deeper on Open Questions
The single most important skill to build first
Open questions are the engine of MI on the phone. The moment you ask a well-framed open question and stay quiet, you've done more than any script can do.
The key is that your question must invite reflection β not just information.
The key is that your question must invite reflection β not just information.
Closed / shallow
"Do you have trouble hearing in noisy places?"
Answers: "Yes" or "No." Conversation dies.
Open / reflective
"What situations have been most challenging for you?"
Answers: a story. You learn what actually matters to them.
Starter phrases that work
"What's beenβ¦" Β· "How has it beenβ¦" Β· "Tell me aboutβ¦" Β· "What would it mean to you ifβ¦" Β· "What's been holding you back fromβ¦"
Chapter 2 Β· Check your understanding
Which of these is the best open question to ask a new caller?
β Perfect. "What's been making you think about your hearing at this point?" is open, invites reflection, and β crucially β asks about their internal motivation. That last part is gold: it's asking them to tell you why they care. That's the change talk you're listening for.
Not quite. Options 1, 2, and 4 can all be answered in one word. They don't give the patient space to reflect or share their story. Option 3 is the right answer because it invites the patient to articulate their own reasons for calling β which is exactly what MI aims for.
3
Listening Skills
Change talk β the signal you're listening for
Once you're asking better questions, you need to know what to listen for. This chapter teaches you to hear the moments of readiness hiding in every patient's words.
What is change talk?
The patient's own reasons, in their own words
Change talk is any language a patient uses that signals movement toward acting β even slightly. It's often quiet, buried in a long sentence, or disguised as a complaint.
Your job is to hear it, reflect it back, and amplify it β not ignore it and keep reading from a script.
Your job is to hear it, reflect it back, and amplify it β not ignore it and keep reading from a script.
| Type | What it sounds like | Signal |
|---|---|---|
| Desire | "I'd love to be able to hear my grandkids properly." | DARN |
| Ability | "I think I could make Tuesday morning work." | DARN |
| Reasons | "My wife keeps saying I should get it checked." | DARN |
| Need | "I've been meaning to do something about this for ages." | DARN |
| Commitment | "I'm going to make an appointment this week." | CAT |
| Activation | "I'm ready to do something about this." | CAT |
| Taking steps | "I already looked up your website before calling." | CAT |
The respond rule
When you hear change talk β stop and reflect it. Don't keep reading from your script. Say: "So it sounds like you've actually been thinking about this for a while and just needed to make the call." Then pause. That reflection often leads directly to a booking request from the patient themselves.
The flip side β sustain talk
What to do when patients give you reasons NOT to change
Sustain talk is the patient's language of staying the same: "It's too expensive," "I'm too busy," "It probably isn't that bad." This is completely normal β it's ambivalence in action.
The instinct is to counter it. Don't. Arguing with sustain talk increases resistance. Instead, acknowledge it and explore both sides.
The instinct is to counter it. Don't. Arguing with sustain talk increases resistance. Instead, acknowledge it and explore both sides.
The double-sided reflection
"On one hand, [the barrier they named], and on the other hand, [the desire or concern they also mentioned]."
Example: "On one hand the cost feels like a lot right now, and on the other hand you mentioned how much you're missing in those team meetings."
Example: "On one hand the cost feels like a lot right now, and on the other hand you mentioned how much you're missing in those team meetings."
Chapter 3 Β· Check your understanding
A caller says: "I've been meaning to call for months but kept putting it off." What type of change talk is this, and what do you do?
β Spot on. "Been meaning to call for months" = Desire + Need. The correct move is to reflect: "So it sounds like part of you has been ready for a while." Then pause. Let them sit with it. Don't rush to book β that silence is where they often say "Yes, I really should do this."
Not quite. "Been meaning to call for months" is classic Need + Desire change talk β the patient is expressing that they recognise the need and want to act. Option 3 is correct. Rushing to book (option 4) skips the reflection that makes the difference. And option 1 misreads it entirely β this is not sustain talk.
4
In Practice
The anatomy of a great call
Now let's put it all together. This chapter walks you through a complete new patient call β step by step β with the MI reasoning behind each move.
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01Warm, genuine greeting AffirmationSet the tone immediately. Use your name and the practice name. Sound like a person β not a phone system."Good morning, [Practice Name], this is [Name] speaking β how can I help you today?"
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02Open question β before anything else Open QBefore you ask about insurance, availability, or anything logistical β ask them why they're calling. Let them talk first."What's been going on with your hearing that brought you to call us today?"
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03Listen fully β do not interruptThis is the hardest step for many people. Resist every urge to fill silence. Let the patient finish completely. Often, their most important reason comes in the second or third sentence.
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04Reflect what you heard ReflectionMirror back the feeling or content β not word for word, but in your own words. This confirms you heard them and often unlocks more."So it sounds like it's been most noticeable in group conversations β and it's starting to affect things at work."
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05Affirm genuinely AffirmationOne specific, honest affirmation. Not "great!" β something that acknowledges what they actually just shared."It takes real courage to make this call β a lot of people put it off for years. I'm glad you reached out."
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06Summarise and confirm SummaryCollect everything you've heard into one clear picture and check it. This is your signal that you're ready to move to the booking."So β you've noticed changes mainly in noisy places for about a year, your partner has picked up on it too, and you'd really like to get a clear picture of what's going on. Does that sound right?"
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07Offer the next step β naturallyOnly now do you offer to book. It should feel like the obvious next move β because you've built to it. Not a pitch."I'd love to get you in with one of our audiologists β they'll give you a thorough picture of what's happening. We have availability on [day] β would that work for you?"
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08Close warmly and confirm detailsConfirm the appointment, give them any practical info they need, and close the call as warmly as you opened it."Wonderful β we'll see you [day] at [time] with [audiologist]. Our address is [address]. Is there anything you'd like to know before you come in?"
Full call β example in one view
// Patient calls with general inquiry about hearing
You: "Good morning, [Practice], this is [Name] β how can I help you today?"
// Open question β before anything else
You: "What's been going on with your hearing that brought you to call us today?"
Patient: "I've just been really struggling in meetings at work. My wife says I have the TV too loudβ¦"
// Reflection β don't interrupt, then mirror back
You: "So it sounds like it's mainly been noticeable at work and at home β and it's been affecting your daily life in a real way."
// Affirmation β specific, genuine
You: "It takes a lot to make that call β I'm really glad you did."
// Summary β collect and confirm
You: "So β you've been struggling in meetings and your wife has noticed it at home. You'd like to understand what's going on. Does that sound right?"
// Offer β natural, not a pitch
You: "Our audiologists do a thorough assessment β about an hour β that gives a complete picture. We have [day] available β would that work for you?"
Reflection prompt
Think about a recent phone call that didn't go well. At what point in this 8-step sequence did it go off track?
No right or wrong answer. This is for your own learning.
5
Difficult Calls
Handling objections with MI
Every objection is a form of ambivalence. The patient isn't saying "no forever" β they're saying "I'm not ready yet and here's what's in the way." Your job is to understand the barrier, not argue against it.
The fundamental rule
Acknowledge before you respond. Always. If you jump straight to a solution or counter-argument, the patient feels unheard and resistance rises. Two to three words of acknowledgement before anything else changes the entire dynamic of the call.
Objection 01
"It's too expensive."
βΎ
Cost
"I completely understand β it's a real consideration. Can I ask, what are you hoping to get out of the appointment first? There may be options we haven't talked about yet."
Why this works: You acknowledged the concern (no dismissal), then asked an open question that shifts focus back to their goal. You've opened the door to funding or financing without mentioning it yet β because you haven't assumed which solution fits.
Objection 02
"I'll think about it."
βΎ
Ambivalence
"Of course β it's a big decision. What would help you feel more confident about taking that next step?"
Why this works: "Call us back when you're ready" ends the conversation and places all the weight on the patient. This response keeps the door open and asks them to name what they actually need. Listen carefully to the answer β it will tell you exactly what the real barrier is.
Objection 03
"My hearing isn't that bad."
βΎ
Minimising
"That makes sense β a lot of people feel that way. What have the people around you been noticing? Sometimes those closest to us pick up on changes before we do."
Why this works: You validated their perspective (no argument), then gently used an external frame of reference β what others are noticing β which is often more persuasive than clinical facts. You didn't say "but hearing loss gets worse" β that's the righting reflex.
Objection 04
"I'm too busy."
βΎ
Schedule
"Absolutely β life gets full on. What would make it easier to fit in? We have early mornings, after-work, and Saturday slots β I'd love to find something that actually works for your schedule."
Why this works: You affirmed their reality without judgment, then asked what would help β before listing options. That small sequence matters. Listing options first feels like a pitch. Asking first feels like problem-solving together.
Objection 05
Angry or upset caller
βΎ
Escalate if needed
"You're right to be frustrated, and I'm really sorry that happened. Can I make sure I fully understand what occurred so I can take care of this for you right now?"
Three steps β in this order: (1) Acknowledge the emotion specifically. (2) Apologise without making excuses. (3) Ask an open question to understand the situation before proposing any solution. Never jump to solutions when someone is emotionally activated β they won't hear it.
Chapter 5 Β· Check your understanding
A patient says "I've looked into hearing aids and they're way too expensive." Your first response should be:
β Correct. Option 2 acknowledges the concern first, then redirects with an open question. Options 1, 3, and 4 all jump straight to information or persuasion β before the patient feels heard. That approach triggers resistance, not openness.
Not quite. Options 1, 3, and 4 all start with information or persuasion β before acknowledging the patient's concern. That triggers the patient's resistance. Option 2 is right: acknowledge first, then ask an open question. The open question matters too β it refocuses on their goal, not the cost.
6
Outbound Calls
Outbound calls & patient recall
Outbound calls are different from inbound ones β you're interrupting someone's day. MI becomes even more important here, because you need to earn the right to the conversation before you can offer anything.
The outbound mindset shift
On an inbound call, the patient came to you β there's already some motivation. On an outbound call, you're calling them. Your first job is not to book an appointment. Your first job is to make them glad you called. That means: warm, brief, no pressure, genuine care.
The 4 types of outbound calls you'll make
Know which type you're on before you dial
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RAnnual review recallPatient is overdue for their yearly check. Open with care, not urgency. Ask how they've been.
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FPost-fitting follow-upCheck in after a hearing aid fitting. This is a warm call β they're a recent patient. Celebrate their progress."Hi [Name], it's [Name] from [Practice] β just checking in after your fitting last week. How are you finding the aids so far?"
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NNo-show follow-upPatient missed an appointment. No guilt, no lecture. Pure empathy and a gentle offer to rebook."Hi [Name], this is [Name] from [Practice] β I just wanted to make sure everything's OK and see if you'd like to find another time."
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WWaitlist activationA slot opened up. Exciting for the patient β but check they're still ready before assuming."Hi [Name], great news β we've had a cancellation and I wanted to check if you'd still like to come in. Are you still keen to get that appointment sorted?"
Annual review recall
"Hi [Name], this is [Name] from [Practice]. Hope I haven't caught you at a bad time?"
// Give them an easy out β it builds trust, not avoidance
[If fine to talk:]
"I'm reaching out because it's been about a year since your last visit β we just like to check in."
// Open question β before the offer
"How have you been finding things with your hearing lately?"
// Reflect β Summarise β Offer
[After they respond:]
"It sounds like [reflection]. A quick review makes sure everything's still right for you β it's usually just 30 minutes. We have [day] β would that work?"
No-show follow-up
"Hi [Name], this is [Name] from [Practice]. I noticed you had an appointment on [date] and we weren't able to connect β I just wanted to make sure everything's OK."
// Pause β let them respond. No lecture. No guilt.
"Absolutely β no problem at all. Life gets busy. We just want to make sure you're getting the care you need."
// Open question β explore the barrier
"What would make it easier to find a time that works for you?"
HIPAA / Privacy reminder (US practices)
On voicemails, never include clinical information β no mention of hearing, appointments, or test results. Safe voicemail: your name, practice name, phone number, and a request to call back. Nothing else.
Chapter 6 Β· Check your understanding
You're calling to follow up on a missed appointment. The patient answers and immediately says "Oh, I'm so sorry, I completely forgot." Your response should be:
β Right. Option 3 does three things: dismisses any guilt ("no problem"), frames the call as care-focused ("we just want to make sure you're getting the care you need"), then asks an open question about what would make it easier. That last piece is crucial β it surfaces any real barrier rather than assuming rescheduling is simple.
Not quite. Option 1 moves too fast to rebooking. Option 2 is actually guilt-inducing β the opposite of what MI calls for. Option 4 is passive. The right answer is option 3, which combines empathy, care framing, and an open question about barriers β all in one response.
7
Mastery
Your daily MI practice
MI is a skill, not a script. It improves with deliberate practice and honest reflection. This chapter gives you everything you need to keep growing after you finish this training.
The 10 phone golden rules
Pin this somewhere you'll see it every day
- 01Smile before you pick up β callers hear it in your voice
- 02One open question before any information β every single call
- 03Let the patient finish β never interrupt, even if you know the answer
- 04Reflect before you respond β every time, without exception
- 05Roll with resistance β arguing increases resistance, always
- 06Acknowledge before you solve β feelings before solutions
- 07Never give clinical advice β that is the audiologist's role
- 08Document every call in the OMS before moving on
- 09End every call with a clear next step β never leave it vague
- 10If in doubt β ask, don't assume
How to improve after every call
The 60-second call debrief
You don't need a coach to improve. After any call that felt hard, ask yourself these three questions:
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?Did I hear any change talk?If yes β did I reflect it and build on it? If no β did I ask enough open questions to give it a chance to emerge?
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?Where did I feel the urge to argue or push?That moment is your righting reflex showing up. What would a reflection have sounded like instead?
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?Did the patient feel heard?Would they describe this call as "someone really listened to me" β or "someone tried to book me in"?
The one thing to focus on first
Don't try to master all of OARS at once. For your first two weeks: focus only on open questions. Ask one open question before any information on every single call. That one shift alone will change your conversion rate, your patient satisfaction scores, and your own enjoyment of the work.
Final reflection
Which one MI skill from this training will you commit to practising every day for the next two weeks?
Share this with your supervisor as a simple accountability commitment.
Final check Β· The whole picture
A caller says: "I've been putting this off for two years β I know I should do something but I keep finding reasons not to." What do you do first?
β Perfect. This caller has rich change talk ("I know I should do something") AND sustain talk ("I keep finding reasons not to"). Reflect the change talk first, then ask an open question about the barrier. That invites them to work through their own ambivalence out loud. That's MI at its best.
Not quite. The caller has genuine change talk β "I know I should do something" β buried in ambivalence. Option 3 reflects it back and asks about the barrier. Option 1 moves too fast. Option 2 is the righting reflex. Option 4 accidentally reinforces avoidance. Answer: option 3.
