(eBook PDF) Audiology Practice

Management 3rd Edition by Brian J.

Taylor
Go to download the full and correct content document:
https://ebooksecure.com/product/ebook-pdf-audiology-practice-management-3rd-editi
on-by-brian-j-taylor/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

(eBook PDF) International Tax Primer 3rd Edition by

Brian J. Arnold

http://ebooksecure.com/product/ebook-pdf-international-tax-
primer-3rd-edition-by-brian-j-arnold/

(eBook PDF) Economics 3rd Edition by Mark P. Taylor

http://ebooksecure.com/product/ebook-pdf-economics-3rd-edition-
by-mark-p-taylor/

Nonneoplastic Dermatopathology 2nd Edition Brian J.

Hall - eBook PDF

https://ebooksecure.com/download/nonneoplastic-dermatopathology-
ebook-pdf/

(eBook PDF) Equine Ophthalmology 3rd Edition by Brian

C. Gilger

http://ebooksecure.com/product/ebook-pdf-equine-
ophthalmology-3rd-edition-by-brian-c-gilger/
(eBook PDF) Equine Ophthalmology 3rd Edition by Brian
C. Gilger

http://ebooksecure.com/product/ebook-pdf-equine-
ophthalmology-3rd-edition-by-brian-c-gilger-2/

(eBook PDF) Differential Equations with Matlab 3rd

Edition by Brian R. Hunt

http://ebooksecure.com/product/ebook-pdf-differential-equations-
with-matlab-3rd-edition-by-brian-r-hunt/

(Original PDF) Introduction to Audiology 13th by

Frederick N. Martin

http://ebooksecure.com/product/original-pdf-introduction-to-
audiology-13th-by-frederick-n-martin/

(eBook PDF) Introduction to Audiology Today by James W.

Hall

http://ebooksecure.com/product/ebook-pdf-introduction-to-
audiology-today-by-james-w-hall/

Taylor and Hoyt's Pediatric Ophthalmology and

Strabismus 6th Edition Christopher J. Lyons - eBook PDF

https://ebooksecure.com/download/taylor-and-hoyts-pediatric-
ophthalmology-and-strabismus-ebook-pdf/
Audiology Practice Management

Third Edition

Brian J. Taylor, AuD

Director of Clinical Audiology
Fuel Medical Group, LLC
Camas, Washington
Adjunct Assistant Professor of Audiology
A.T. Still University
Arizona School of Health Sciences
Mesa, Arizona

Thieme
New York • Stuttgart • Delhi • Rio de Janeiro
Executive Editor: Delia DeTurris
Managing Editor: Elizabeth Palumbo
Director, Editorial Services: Mary Jo Casey
Production Editor: Sean Woznicki
International Production Director: Andreas Schabert
Editorial Director: Sue Hodgson
International Marketing Director: Fiona Henderson
International Sales Director: Louisa Turrell
Director of Institutional Sales: Adam Bernacki
Senior Vice President and Chief Operating Officer: Sarah Vanderbilt
President: Brian D. Scanlan

Library of Congress Cataloging-in-Publication Data

Names: Taylor, Brian S., editor.
Title: Audiology practice management / Brian S. Taylor, AuD, Director, Taylor Audiology LLC,
Golden Valley, MN, United States.
Description: 3rd [edition]. | New York : Thieme, [2018] | Revison of: Audiology / [edited by]
Holly Hosford-Dunn, Ross J. Roeser, Michael Valente. c2008. 2nd ed. | Includes
bibliographical references.
Identifiers: LCCN 2017032616| ISBN 9781626232549 (print) | ISBN 9781626232556 (ebook)
Subjects: LCSH: Audiology—Practice.
Classification: LCC RF291 .A93 2018 | DDC 617.80068–dc23
LC record available at https://lccn.loc.gov/2017032616

© 2019 Thieme Medical Publishers, Inc.

Thieme Publishers New York

333 Seventh Avenue, New York, NY 10001 USA
+1 800 782 3488, customerservice@thieme.com

Thieme Publishers Stuttgart

Rüdigerstrasse 14, 70469 Stuttgart, Germany
+49 [0]711 8931 421, customerservice@thieme.de

Thieme Publishers Delhi

A-12, Second Floor, Sector-2, Noida-201301
Uttar Pradesh, India
+91 120 45 566 00, customerservice@thieme.in

Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda.

Edifício Rodolpho de Paoli, 25⍛ andar
Av. Nilo Peçanha, 50 – Sala 2508,
Rio de Janeiro 20020-906 Brasil
+55 21 3172-2297 / +55 21 3172-1896
www.thiemerevinter.com.br

Cover design: Thieme Publishing Group

Typesetting by DiTech Process Solutions

Printed in India by Replika Press Pvt Ltd 54321

ISBN 978-1-62623-254-9

Also available as an e-book:

eISBN 978-1-62623-255-6

Important note: Medicine is an ever-changing science undergoing continual development.

Research and clinical experience are continually expanding our knowledge, in particular our
knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or
application, readers may rest assured that the authors, editors, and publishers have made every
effort to ensure that such references are in accordance with the state of knowledge at the time of
production of the book.
Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the
part of the publishers in respect to any dosage instructions and forms of applications stated in the
book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying
each drug and to check, if necessary in consultation with a physician or specialist, whether the
dosage schedules mentioned therein or the contraindications stated by the manufacturers differ
from the statements made in the present book. Such examination is particularly important with
drugs that are either rarely used or have been newly released on the market. Every dosage
schedule or every form of application used is entirely at the user’s own risk and responsibility.
The authors and publishers request every user to report to the publishers any discrepancies or
inaccuracies noticed. If errors in this work are found after publication, errata will be posted at
www.thieme.com on the product description page.
Some of the product names, patents, and registered designs referred to in this book are in fact
registered trademarks or proprietary names even though specific reference to this fact is not
always made in the text. Therefore, the appearance of a name without designation as proprietary
is not to be construed as a representation by the publisher that it is in the public domain.

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or
commercialization outside the narrow limits set by copyright legislation, without the publisher’s
consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction,
copying, mimeographing, preparation of microfilms, and electronic data processing and storage.
Contents
Preface
Contributors

Section I Core Principles

1 Basic Management Principles for Audiologists
Brian J. Taylor

2 An Introduction to Business Analytics, Administration, and

Ethics
Brian J. Taylor

3 Human Resources
Sarah Laughlin

4 Accounting for Audiologists

Robert M. Traynor

5 Quality Improvement: The Controlling Principle of Practice

Management
Harvey B. Abrams

6 Clinical Education in Audiology

Tricia Dabrowski

7 Clinical Report Writing Using SOAP Notes

Alicia D.D. Spoor

8 Infection Control
A.U. Bankaitis

Section II Practical Applications

9 Credentialing, Contracting, Coding, and Payment
Bopanna B. Ballachanda

10 Pricing Strategies in Clinical Practice

Amyn M. Amlani
11 Entrepreneurial Audiology: Sales and Marketing Strategies in
the Consumer-Driven Health Care Era
Brian J. Taylor and Donald W. Nielsen

12 Improving the Acceptance Rate of Amplification: A Benefit to

Patients and Practices
Thomas R. Goyne

13 Changes in Health Care Documentation: A Clinical Process

Perspective
Dania A. Rishiq

14 Valuation and Exit Strategy

Craig A. Castelli

Index
Preface
With the exception of a select forward-thinking pioneers—those
renegades from the 1970s who despite heavy criticism from their
professional organizations ignored the rules stipulating audiologists
could not sell hearing aids and opened their own dispensing clinics—
early generations of audiologists had impeccably strong clinical and
research skills, but generally lacked a solid business foundation. Perhaps
this was a sign of times. Like many other ancillary health care
professions at the time, it was common in the early days of audiology,
right through the turn of the century, to make a comfortable living testing
and fitting hearing aids on a few dozen patients per month. It was very
possible to ignore the basic tenets and principles of basic business
management and still run a profitable business that centered on the
delivery of hearing aids.
How the world has changed over the past few years! Today, as health
care becomes more consumer focused and hearing aid technology
commodified, strong practice management skills are more essential than
ever. Strong practice management skills are critically important for
audiologists, who by virtue of their state license play an active role in the
medical area. Yet, simultaneously, because many of the services provided
to the public are not reimbursed by third-party payers, they have a large
presence in the retail world. Since audiology is truly a blend of the
medical and retail, strong practice management skills combining both
facets are cornerstones of operating a sustainable business, especially as
we move into this new era of consumer-driven health care. In today’s
more competitive world, practice management expertise is just as
important to audiologists as knowledge of research methods and a
rigorous clinical acumen. Most would agree we live in a more
complicated world in which there is more competition and greater
change. Moreover, we now live in a world where one negative patient
experience can be broadcasted to the entire world through social media.
Because all of us seem to live under the microscope of consumer
advocacy groups, third-party payers, or shareholders looking out for their
investment, using sound business management principles to guide the
day-to-day operation of our clinics is imperative.
 This textbook represents the collective knowledge and expertise of
audiologists and assorted industry experts who have learned to practice
in a more competitive marketplace. If the contents of the chapters in this
textbook could be broken down into overriding themes, it would be these
two components: management and leadership. In simple terms,
management is the ability to do things right, while leadership is the
ability to do the right things.
In other words, effective management skills are largely comprised of
attention to detail and the ability to focus on skills and behaviors that
culminate in improved results for the business, results being defined in
terms of improvement to patient satisfaction and benefit, plus bottom-
line financial results. These management skills, as several chapters in
this text show, can be applied to human resources, marketing, finance—
even quality control.
On the other hand, the other overriding theme of this text focuses on
leadership skills. If we loosely define leadership as the ability to do the
right things, then practically every chapter in this book forces us to
assume a leadership position. In the face of automated technology, stiffer
competition, and increasing demands from consumers, being an effective
leader means taking initiative, practicing with a high degree of integrity,
and sometimes taking a thoughtful stand for your values. Those
concepts, it is hoped, are woven throughout this textbook. Even though
test equipment, hearing instrument technology, and clinical procedures
may change with the times, many of the practice management principles
outlined here are likely to remain relevant for decades. Let this material
be a source of knowledge and inspiration as you move through your
career. May it be a resource you refer to again and again as you
thoughtfully combat the challenge of the moment. For even as times
change, principled management and leadership skills are everlasting.

Brian J. Taylor
Contributors
Harvey B. Abrams, PhD
Senior Research Consultant
Starkey Hearing Technologies
Eden Prairie, Minnesota

Amyn M. Amlani, PhD

Professor and Chair
Department of Audiology and Speech Pathology
University of Arkansas for Medical Sciences
Little Rock, Arizona

Bopanna B. Ballachanda, PhD

Consultant
Interacoustics USA
Albuquerque, New Mexico

A.U. Bankaitis, PhD

Vice President
Clinical Audiologist
Oaktree Production, Inc.
Chesterfield, Minnesota

Craig A. Castelli
CEO
Caber Hill Advisors
Chicago, Illinois

Tricia Dabrowski, AuD

Associate Processor
Clinical Coordinator
A.T. Still University
Arizona School of Health Sciences
Mesa, Arizona
Thomas R. Goyne, AuD
Audiologist
Oracle Hearing Group
Consultant
Aberdeen Audiology
Adjunct Professor
Salus University
Wayne, Pennsylvania

Sarah Laughlin, MS
Director
Human Resources
Fuel Medical Group
Camas, Washington

Donald W. Nielsen, PhD

Audiology University Advisor
Fuel Medical Group
Camas, Washington

Dania A. Rishiq, PhD

Assistant Professor
Department of Speech Pathology and Audiology
University of South Alabama
Mobile, Alabama

Alicia D.D. Spoor, AuD

President
Audiologist
Designer Audiology, LLC
Highland, Maryland

Brian J. Taylor, AuD

Fuel Medical Group, LLC
Camas, Washington
Adjunct Assistant Professor of Audiology
A.T. Still University
Arizona School of Health Sciences
Mesa, Arizona

Robert M. Traynor, EdD, MBA

Adjunct Professor of Audiology
University of Florida
Gainesville, Florida
CEO/Audiologist
Audiology Associates of Greeley, Inc.
Greely, Colorado
 Section I 1 Basic Management
Principles for
Audiologists
Core Principles 2 An Introduction to
Business Analytics,
Administration, and
Ethics
3 Human Resources
4 Accounting for
Audiologists
5 Quality Improvement:
The Controlling
Principle of Practice
Management
6 Clinical Education in
Audiology
7 Clinical Report Writing
Using SOAP Notes
8 Infection Control
1 Basic Management
Principles for Audiologists
Brian J. Taylor

Abstract
Audiologists spend four years of their post-baccalaureate education
learning the essential details of diagnostic and rehabilitative audiology,
yet when they enter the workforce they are often called upon to operate a
business. Many audiologists learn quickly that the skills and expertise
required to evaluate the auditory system do not equate to running a
sustainable business. The purpose of this chapter is to provide clinicians,
imbued with technical knowledge about Audiology, several practical
insights about the daily operation and management of a clinic. In wide-
ranging detail, topics such as how to run a staff meeting, how to coach
staff and how to use key performance indicator (KPI) data to make
business decisions are provided in this chapter.
Keywords: effective management principles, four essential behaviors of
managers, key performance indicators (KPIs), productivity, efficiency,
benchmarking, executive dashboard, business culture

1.1 Learning Objectives

• To understand the basics of effective management of an office staff
and culture.
• To hone the ability to select a group of key performance indicators
(KPIs) that help improve and sustain an audiology practice.
• To effectively manage an audiology practice using KPIs and
benchmarking data.

1.2 Introduction
Businesses do not manage themselves. It takes people to make them hum.
Even though low-cost, high-speed computers make it incredibly easy to
generate reports about your business, and computerized audiometry and
hearing aid–fitting algorithms are a ubiquitous part of clinical practice,
basic management skills are necessary for creating and sustaining any
business. As this chapter outlines, basic effective management skills are
about hiring, coaching, and retaining good people—people who can
administer, oversee, and run all the elements of a business from back
office accounting and scheduling to how clinical time with patients is
allocated. Managers do not have to be experts in any of these areas, but
they must know how to draw the best performance from each person on
the staff. The tasks that define management are the lifeblood of any
practice, and many times they are simply ignored by people with the title
of manager who often have the very best of intentions. Effective
managers, as this chapter will explain, take the time to build strong
relationships with their staff. The by-product of these professional
relationships is trust, which in turn leads to improved financial results and
higher patient satisfaction. In addition, effective managers are passionate
about incremental improvement. The best managers expect their staff to
become better at a wider range of tasks and responsibilities. This means
managers have to be good coaches and delegators.
Another substantial part of effective management is putting key
performance indicators (KPI) data to good use. KPIs are important in
managing any sustainable business. KPIs are yardsticks. Like any good
measurement tool, KPIs help us gauge performance and identify areas
that need extra attention. This chapter provides audiologists, especially
those with little formal business education, with a working definition of
effective management using KPIs. A major theme of this chapter is that a
relatively small group of about a dozen KPIs are an essential part of
managing a successful audiology practice. The most useful KPIs for
managing retail-oriented and medically oriented practices will be defined.
Best practice benchmarks and how to use them to hire, coach, and train
your staff are also covered.

1.2.1 Avoiding Assembly Line Thinking

With the advent of modern technology, particularly computers and
automated software, it has become commonplace to rely on “assembly
line thinking” to manage a business. “Assembly line thinking” is best
described as a penchant for creating a finely crafted process to
accomplish the myriad of tasks involved in running a business. The
assembly line, courtesy of Henry Ford’s desire to make the automobile
available to the masses, is an example of sheer efficiency that still amazes
nearly a century later. The growth of American industry during the last
century lies in its wide scale adoption in just about every other business
over the past 100 years, including health care businesses, like audiology
and hearing aid dispensing. We have applied assembly line thinking to
just about every area of life. In addition to health care, public schools,
restaurants, and even airport security have adopted these practices. On its
own, process-oriented assembly line thinking is helpful in running an
audiology practice; however, without paying careful attention to the
people overseeing the assembly line, this narrow view of management is
shortsighted and ineffective. No matter the processes required to run your
business, as this chapter aims to point out, it is highly motivated,
competent people that run these processes. In short, if you want your
business to be more efficient, pay very close attention to who you hire,
how you coach and train them, as well as who you retain in your business.
To get better results, which in the long run must be the mantra of any
manager, focus on improving the quality of the people who comprise your
staff. At the end of the day, managers must be good at two things: getting
results and retaining the staff that generate those results. Without results
generated from good staff, your business will never turn a profit or
achieve a high standing in the community.

Pearl ✓
The two most important aspects of effective management are getting
results and retaining the best staff to obtain these results.

1.3 The Four Essential Behaviors of Effective

Management
All businesses exist to create and serve customers. No matter how skilled
you are, your business would cease to exist without customers. To
generate the revenue and profits essential to keeping your business open,
effective managers know they have to coax high performance from their
staff. In an audiology practice, where we usually refer to customers as
patients, high performance comes in many forms: It is the front desk staff
filling your schedule with revenue-generating opportunities. It is your
ability to price your products and services properly so that customers
perceive the value. It is the ability of other clinicians or your staff to listen
and appropriately meet the needs of their customers. The list goes on and
on, but the important point is that the results in your business are defined
by the performance of the people who comprise your staff, and their
performance, in turn, is defined by their behavior.
When we use the term behavior we mean their moment-to-moment
activity: how they answer the phone, what they say to patients, and their
tone of voice when discussing test results. All of these are observable
behaviors that eventually culminate in results. It is the responsibility of
managers to define and teach to their staff these behaviors that result in
superior performance and results. Results, of course, are revenue and
profits, and patient outcomes. But from a manager’s perspective, stellar
results are nothing more than the by-product of outstanding performance.
The key point is that results are driven by the behavior of everyone in the
business. By definition, if behavior is observable, then you can measure
it. Thus, a KPI is nothing more than a means to measure behavior.
Because there are dozens, perhaps hundreds, of behaviors associated with
performance, there are dozens, perhaps hundreds, of KPIs that could be
measured. Another important facet of effective management is prioritizing
the KPIs that are most critical to results. Prioritizing KPIs is discussed
later in this chapter.

Pearl ✓
Behavior = Performance = Results.
One primary responsibility of a manager is to define the behaviors that
generate improved performance and ultimately lead to peak results.

If you believe that behaviors are the key to results, then it is helpful to
identify a group of behaviors that constitute performance. There are key
behaviors of each staff that need to be defined by managers, but more
fundamental is defining the effective behaviors of managers. For
managers, there are four key behaviors that are believed to result in better
performance. Let us examine each of these key drivers of effective
management behavior.
• Know your people. The better you know the strengths and
weaknesses of each person on the staff, the more likely you are to
obtain a higher level of performance. Beyond knowing the work-
related strengths and weaknesses of each staff member, knowing
 your people entails really knowing your people. Know the names of
their children, know their hobbies, and know what makes them tick
as an individual. The manager behavior that encapsulates knowing
your people is the ability to conduct weekly one-on-one meetings.
Taking 30 minutes per week to meet with each staff person to
genuinely chat about the prior week’s events and the upcoming
week’s tasks is a great way to practice knowing your people. A big
part of being an effective manager is creating an atmosphere or
culture of trust. Trust is the glue that holds a staff together and the
way to foster it is to get to know the people on your staff—know
them on a personal basis, not just as an employee. A strong,
personal relationship will foster trust, and trust will drive results.
• Talk about performance. If results are driven by day-to-day
performance, then it is logical for managers to want to discuss all
aspects of performance. It is imperative for managers to deliver
ongoing feedback to staff about their performance. If you are a
manager, feedback is nothing more than sharing your opinions and
thoughts about day-to-day performance and behavior. If you desire
a high-performing staff, you have to talk about the details of how
high performance looks to each person on your staff. Feedback is
the vehicle that allows managers to continually talk about
performance in a constructive way. There are two types of feedback
and both are important. One is positive feedback. It entails
communicating to staff about the beneficial things they are doing.
For example, when you observe a staff person working well with a
patient, let them know. You might say something like, “I really like
the way you made eye contact with that patient. Keep it up.”
Feedback is not really praise, rather it is simply communicating
about behavior and performance. When you catch your staff doing
something good, tell them about it.
The other type of feedback is called constructive or personal adjustment
feedback. Managers who have trusting relationships with their staff—
those who conduct effective one-on-ones—can deliver constructive
feedback in an effortless manner. Constructive feedback is all about
helping the staff improve. You are simply using your observations to
communicate about their performance in a nonthreatening way. Let us say
that you observed an audiologist spending too much time talking and not
enough time listening with a new hearing aid patient. You might say, “I
noticed that your last patient was rolling his eyes when you did all the
talking the last 5 minutes of the appointment. He looked like he had some
questions and you left the room quickly. I know we are really busy today,
but what could you have done differently?” Allowing the audiologist to
talk/assess their behavior in a nonthreatening way is a great way to guide
the staff to incremental improvement. When delivered in a constructive
manner among trusting staff, this type of feedback can be effortless and
effective. As a rule of thumb, positive feedback should be delivered as
much as constructive feedback.

Pearl ✓
Role power. Almost all businesses have an organizational chart.
Human beings, to work together in an organized manner, rely on them
to get things done. If you are above someone on an organizational
chart, that person is your direct report and you have role power. By
virtue of your role, you have leverage in the relationship with your
direct reports. Role power allows the manager to get things done, but
it is easy to abuse without thoughtful consideration of those reporting
directly to the manager.

• Ask for more. When people are in their comfort zone for a long
period of time, they often become complacent. Managers have a
fiduciary responsibility to the business, one that goes beyond any
personal friendships with others in the business, which staves off
complacency in your staff. This does not mean managers need to be
ruthless, but it does entail that managers encourage staff to move
beyond their comfort zone. This can be accomplished by working
directly with staff to develop new skills or bring new procedures
into the clinic. Asking for more needs to be part of routine, ongoing
development of staff. Coaching is the tool that managers use to
encourage staff to strive for professional growth. When you hire
people that want to improve their skills, coaching is relatively easy
—the manager works with the staff to identify a new skill to
acquire and the appropriate coaching is found. Keep in mind the
manager does not have to do all the coaching. Seminars,
workshops, and other forms of coaching can be used to help staff
acquire a new skill. It is simply up to the managers to help identify
the coaching and how the new skill will be utilized in the business
to improve results.
• Push work down. Pushing work down is another term for
delegation. A big part of effective management is running an
 efficient business. An efficient business is one that does more with
fewer resources. It is a business that matches the skill level of the
staff to the right task that needs to be completed. For example, an
audiologist should spend as much time doing the things needed to
generate revenue that cannot be done by other staff. If the
audiologist who is busy seeing new hearing aid patients is
constantly interrupted to clean and check hearing aids, when other
less qualified staff can legally perform that same task, the work
ought be pushed down to an assistant. To optimize patient
satisfaction and revenue generation, managers need to be on the
lookout for tasks that can be pushed down to staff with less
credentials. Audiologists need to determine what the top half dozen
or so activities they do on a daily basis contribute to the most
revenue generation, and all other activities need to be pushed down
to staff with lesser levels of formal academic training. For example,
if state licensing allows, much of the routine work associated with
cleaning and checking hearing aids could be pushed down to a
technical specialist, thus freeing time for the audiologist to see new
patients.
Taken together, these four activities—one-on-ones, feedback, coaching,
and delegation—form the back-bone of effective management. Getting
results from top-notch staff, the ultimate objective of managers gets easier
when they are executed. Even though you may have an advanced,
doctoral-level degree, effective management is mundane work done
consistently. One of the most common activities, the staff meeting, is
often done in an ineffective, haphazard manner. Let us examine how the
effective manager conducts a staff meeting and why it matters.

1.4 The Weekly Staff Meeting

The purpose of a staff meeting is to communicate to the entire staff.
Unfortunately, too many managers do not take the time to think about
how a staff meeting should be conducted. Without proper planning and
execution, a staff meeting is a colossal waste of time. Imagine a staff of
10 people. If all 10 staff make $50 per hour and the meeting lasts 2 hours,
you have expended $1,000 of fixed costs and diverted resources from
revenue-generating activities. This does not mean staff meetings are not
important. They are critical for several reasons, but it does mean they
need to be carefully planned and executed. First, effective staff meetings,
ones that are interactive and last an hour or less, need to consist of 10 or
fewer employees. As a general rule, if you have more than 10 employees
on your staff, you should break them into smaller groups with separate
managers. If you have a large staff, say 10 or more, you can all meet as a
group maybe once every 3 to 6 months, but the smaller subgroups could
meet every 1 or 2 weeks.
Second, weekly staff meetings need to have a set time frame (e.g., 60
minutes) with a set agenda. Weekly meetings should occur at the same
time each week (or month) so the staff can anticipate and plan for them.
The staff can work together to set the agenda, but someone needs to be
the designated leader of the meeting. The manager may choose to
delegate a different staff member run each monthly meeting. The meeting
needs to start on time and the leader of the meeting needs to ensure that
all topics are covered within the designated time frame. In addition, the
meeting leader is responsible for making sure everyone gets a chance to
talk and that tangents are held to a minimum. This often requires the
leader to table topics that go over their time allotment. Third, following
the meeting, the leader should email a brief summary of the meeting “to-
dos” and “next steps” to the entire staff, along with a reminder of the time
of the next scheduled staff meeting.
Finally, it is important to think carefully about the content of each staff
meeting. If you have 1 hour every month, you may only have time to talk
about two or three agenda items. When devising the content of the
meeting agenda, it is helpful to identify areas that impact the entire team.
A simple rule for addressing each item on the meeting agenda is to
remember what, why, and how.
• What is the topic everyone needs to know about or discuss?
• Why is it critical to the team to discuss it?
• How will the agenda item be implemented or used by everyone on
the team?
If you cannot answer these three questions, it is probably best to deal with
the topic in your one-on-one time. Team meetings are necessary, but they
are often mismanaged. Now that we have covered some of the basics of
effective management, let us move into KPIs and how they can be used to
manage performance and results.
1.5 Using KPIs to Do More with Less in Your
Practice
Pick up the sports section of the newspaper (or, better yet, open the ESPN
app on your smartphone) and check the box score of last night’s baseball
game between the Chicago Cubs and Milwaukee Brewers. Even though
the Brewers won, you notice three Cubs had multiple hits in the game and
their starting pitcher gave up only two hits over the entire nine-inning
game. Upon a closer reading of the box score, however, you see the
starting pitcher also had two wild pitches and the shortstop had two
errors. What the box score did not tell you, however, was these four
miscues occurred in the same inning and directly lead to the Cub’s defeat
in the final inning of play. You really needed to be at the game or
watching on TV to appreciate the intensity of the action as the game
unfolded in that final frame. The magnitude of the human errors that lead
to the dramatic downfall of the Cubs last night simply could not be
captured by the box score. This baseball analogy shows the advantages
and limitations of using numbers and statistics (in baseball, the box score
is used to summarize many of these stats) to capture performance. The
baseball box score is an example of how KPIs can provide valuable
insight into activity and results, but when these activities and results are
viewed from afar, they do not tell the complete story of the performance
of individuals and teams.
You do not have to be a baseball manager or even a fan to appreciate
how numbers can be used to evaluate performance. The objective of this
section is to show how KPIs can be used to better manage your practice.
In simple terms, like a baseball box score or your new car’s dashboard,
KPIs are nothing more than a set of numbers used to evaluate the activity,
behaviors, and performance of individuals working within your practice.
After all, no matter how sophisticated your business, people run your
business and KPIs, when properly utilized, are a proven approach to
providing better patient outcomes, maintaining your best staff, generating
more revenue, or being more profitable. Rather than making rash, gut-
level decisions about your practice, a targeted set of KPIs allow you to
make rational decisions about your practice, decisions based on facts. The
use of KPIs in the decision-making process leads to less chaos and better
results. Ultimately, however, success in your business still boils down to
the human element—someone, usually a manager, deciding what KPIs to
measure and how to use those measurements to guide the day-to-day
operations of the practice. From this standpoint, even though a group of
numbers (i.e., KPIs) may seem dry and boring to many, they summarize
the crucial activity in your practice.
As previously stated, KPIs are very similar to the stats you see in the
box score the morning after the baseball game. The box score, like the
one shown in Fig. 1.1, provides you with important insights about who
played well and who did not. Once you are familiar with what the
numbers mean, you simply glance at them and you quickly surmise what
happened in the game you missed. However, there are important
limitations of KPIs that must be considered.
Fig. 1.1 An example of a baseball box score. From Taylor B. Using Key
Performance Indicators to Do More with Less in Your Practice. Semin
Hear. 2016 Nov; 37(4):301–315.

People, usually managers of the practice, must chose the set of KPIs
that provide them with the most actionable information. Further,
managers must be able to quickly evaluate KPI data, trust that they are
representative of daily activity, and use them to guide their decision-
making. There is a process to establishing and using KPIs data that will
be covered in this chapter. This process is often referred to as “data-driven
decision-making.” Most of us would agree that making decisions about
your practice, such as what model of hearing aids to dispense and what
prices to charge are critical to long-term success; the real challenge,
however, is choosing a group of KPIs that will help us make those
decisions and then effectively coaching better performance from our staff.
In addition to choosing a set of KPIs that will enable you to operate a
more efficient practice, managers must be aware of the possibility of
over-relying on KPI data. For example, you will find managers who like
to spend inordinate amounts of time analyzing their KPIs. (In reality, you
are probably more likely to see managers who do not pay any attention to
KPIs.) With the advances in low-cost, high-capacity computers, it has
never been easier to generate data about the operations of a practice. This
can lead to paralysis through analysis, an easy thing to do when there are
so many variables to measure. After all, with today’s computers, dozens
of metrics (KPIs) can be obtained, often in real time. Even though many
practices are awash in this sea of data, effective management of people is
still critical to long-term success. This chapter will focus on why the
human elements of managing people within a business complements the
specific KPIs you decide to measure. In other words, how you use KPIs
to manage your staff is more important than the exact KPIs you measure.
Yes, KPIs are important, but an effective manager selects the KPIs that
provide the most salient information about the goals of the practice and
manages the people in the practice to better meet and exceed those KPIs.
Before going any further, let us stop and discuss the importance of
efficiency. You may have noticed in the previous paragraph the term
“operate a more efficient practice.” It is important to have clarity about
this term. Today, audiologists, especially those in private practice, face
stiff competition. Big-box retail stores, large integrated medical centers,
and even the internet are all existing business models that compete head
to head with private practice audiologists. They are formidable
competitors because many of these upstart challengers are more efficient
than private practice audiology. In this context, efficiency simply means
they get more done with fewer resources. In other words, they can
maximize their profit by reducing their costs, relative to a private
practitioner. For example, large retail chains and other big corporate
entities have more buying power. They can easily use their economies of
scale (i.e., dozens, if not hundreds, of locations) to command a very low
wholesale price for hearing aids that they resell. Other large entities might
have a recognizable brand that allows them to greatly reduce the need to
rely on costly advertising to bring customers to their stores. Buying power
and brand recognition are two variables that allow large players to operate
more efficiently.

Pearl ✓
The KPIs you manage depend on your business model. There are four
types of audiology business models. Note how the number of KPIs
changes with the type of business model:
• Retail: KPIs focus on hearing aids.
• Medical: KPIs focus on testing/diagnostics.
• Managed care/insurance: KPIs focus on the amount and timeliness
of third-party reimbursement.
• Mixed: a combination of the three models.

The question for the private practitioner though is, how can you get more
done with less, especially when it is difficult, perhaps even impossible, to
compete head-to-head on wholesale price and brand recognition? The
answer to this question rests with offering consumers with hearing loss
and communication difficulties value. Creating value and doing it
efficiently require differentiation of your professional services. For the
private practitioner, the path to greater profits rests with the ability to do
more with fewer resources. KPIs are simply the instruments needed to
ensure this goal is met. It is the responsibility of the manager to establish
the KPIs needed to accomplish the goal of doing more with fewer
resources. Some of the dimensions of “more” and “less” that could be
applied to the private practice are summarized in Box 1.1. The key to
profitability is maximizing the “more” category while reducing the “less”
category. You do not need to have a formal degree in business to
understand this definition of efficiency; as long as you select and manage
the right set of KPIs, you can do more with less.

1.6 Vision, Culture, Goals: The Foundation for

KPIs
Since KPIs help a practice define and measure progress toward their
goals, it makes sense to spend some time discussing goals. As most
professionals know, a goal is a specific, measureable, actionable, realistic,
Another random document with
no related content on Scribd:
better informed and more industrious, did for themselves a larger
portion of the transcribing required and were, therefore, freed from
the necessity of hiring their hefts.
The statutes of the universities of Prague and of Vienna permitted
the masters and the baccalaureates to secure from the university
archives, under certain pledges, the loan of the books authorised as
text-books or of works of reference, for the purpose of making
trustworthy copies of the same. The copyists were enjoined as
follows:
Fideliter et correcte, tractim et distincte, assignando paragraphos,
capitales literas, virgulas et puncta, prout sententia requirit.[305] The
practice also obtained in these universities of having texts dictated to
the students by the magisters or the Bachelors of Arts. This was
described as librum pronuntiare, and also as ad pennam dare.
In this phrase, Karoch sent word to Erfurt that ad pennam dabit his
treatise Arenga.[306]
The text-books utilised in the German universities in the thirteenth
and fourteenth centuries were as limited in range and in number as
those of Bologna and of Padua. The instruction in the medical
departments of Prague and Vienna was based in the main on the
works of Hippocrates and Galen, with some of the later
commentaries, principally from Arabian writers. In philosophy the
chief authority was Aristotle, in mathematics Euclid, and in
astronomy Ptolemy. A few works of later date were utilised, such as
the Summula of Petrus Hispanus and the De Sphæra Mundi of
Johannes de Sacro Bosco. Bosco is otherwise known as John
Holywood or Halifax. He held the chair of mathematics in the
University of Paris about the middle of the thirteenth century. The
use of his treatise for classes in Prague is evidence of a certain
interchange between the universities of books in manuscript.
An important reason for the very large membership of the
universities of the Middle Ages as compared with their successors of
to-day, is to be found in the fact that they undertook to supply not
only the higher education which belongs to the present university
curriculum, but also the training now furnished by the gymnasia or
High Schools, which were at that time not in existence. We find,
therefore, in their membership, thousands of students who were little
more than boys either in their years or in their mental development.
The universities also, on the other hand, attracted to their
membership very many students of mature age, who came
sometimes for special purposes, but more frequently because it was
only in the university towns that circles of scholars could be found,
that books were available, and that any large measure of intellectual
activity was to be experienced. As Savigny puts it: “The universities
were, during the Middle Ages, practically the only places where men
could study or could exercise their minds with any degree of
freedom.” It was inevitable therefore, that, with the generations
succeeding the discovery of printing, there should be a decrease in
the influence and in the relative importance for the community of the
universities. With the establishment of secondary schools, the
training of the boys was cared for to better purpose elsewhere; and
with the increasing circulation of printed books, it became possible
for men to come into relations with literature in other places than in
the lecture room. The universities were no longer the sole
depositories of learning or the sole sources of intellectual activity.
This lessening of the influence of the universities represented, or
was at least coincident with, a wider development of intellectual
activity and of interest in literature on the part of the masses of the
people. The universities alone would never have been in a position
so to direct the thought of the community as to render the masses of
citizens competent to arrive at conclusions for themselves and
sufficiently assured in such conclusions to be prepared to make
them the basis of action. This was, of course, partly because,
notwithstanding the large membership and the fact that this
membership represented nearly all the classes in the community, the
universities could at best come into direct relations but with a small
proportion of the people. A more important cause for such lack of
intellectual leadership is to be found in the fact that the standard of
thought and of instruction in the universities concerned itself very
little with the intellectual life or issues of the immediate time. As Biot
puts it (speaking, to be sure, of a later century): “The universities
were several centuries in arrears with all that concerned the
sciences and the arts. Peripatetics, when all the world had
renounced with Descartes the philosophy of Aristotle, they became
Cartesians when the rest were Newtonians. That is the way with
learned bodies which do not make discoveries.”
It was the dissemination of literature through the new art of printing
rather than the diffusion of education through the university lecture
rooms, which brought to the masses of the people the
consciousness of mental existence and of individual responsibility for
arriving at sound conclusions. Prior to the printing-press, this
responsibility had been left by the people with their “spiritual
advisers,” who were charged with the duty of doing the thinking for
their flocks. It was this change in the mental status of the people
which was the precursor (although at a considerable space of years)
of the Reformation.
With the beginning in Germany of the movement known as
Humanism, the representatives of the new thought of the time were
not to be found in the university circles, and had not received their
inspiration from the lecture rooms. Says Paulsen: “The entire
traditional conduct of the universities, and in particular of the
instruction in arts and theology, was rejected with the utmost scorn
by the new culture through its representatives, the poets and orators,
to whom form and substance alike of this teaching seemed the most
outrageous barbarism, which they never wearied of denouncing.” In
the Epistolæ Obscurorum Virorum, which were issued about 1516
from the band of youthful poets gathered about Mutianus at Erfurt,
the hatred and detestation felt by the Humanists for the ancient
university system raised to itself a lasting monument.
Within a few years from the publication of the Epistolæ, the
influence of the Humanists had so far extended itself as to have
effected a large modification in the systems of study in all the larger
universities. “The old ecclesiastical Latin was replaced by classical
Latin; Roman authors, particularly the poets, were made the subject
of lectures, and the old translations of Aristotelian texts were driven
out by new translations on principles advocated by the Humanists.
Greek was taken up in the Faculty of arts and courses in the
language and literature were established in all universities.”[307]
 An immediate result of these changes and extensions was an
active demand for printed texts. The Humanistic movement, itself in
a measure the result of the printing-press, was a most important fact
in providing business for the German printers during the earlier years
of the sixteenth century. The strifes and contentions of the
Reformation checked the development in the universities of the
studies connected with the intellectual movement of the
Renaissance and lessened the demand for the literature of these
studies. The active-minded were absorbed in theological
controversies, and those who could not understand the questions at
issue could still shout the shibboleths of the leaders. As Erasmus put
it, rather bitterly, ubi regnat Lutheranismus, ibi interitus litterarum.
The literature of the Reformation, however, itself did much to make
good for the printing-presses the lessened demand for the classics,
while a few years later, the organisation of the Protestant schools
and universities aroused intellectual activities in new regions, and
created fresh requirements for printed books. Within half a century,
in fact, of the Diet of Worms, the centre of the book-absorbing
population of Germany had been transferred from the Catholic states
of the south to the Protestant territories of the north, and the literary
preponderance of the latter has continued to increase during the
succeeding generations.
 CHAPTER IV.
THE BOOK-TRADE IN THE MANUSCRIPT PERIOD.

Italy.—It seems probable that the book-trade which had been

introduced into Gaul from Rome still existed during the sixth century.
F. J. Mone finds references to such trade in the chronicles of
Cæsarius of Arles.[308] In the code of laws of the Visigoths, it is
provided that copies of the volume containing the laws shall be sold
at not more than six sols.[309]
Wattenbach is of opinion that not only in Rome but in other Italian
centres some fragments of the classic book-trade survived the fall of
the Empire and the later invasions and changes of rulers, and he
finds references to book-dealers in Italy as late as the sixth
century.[310] He takes the ground that, notwithstanding the
destruction of buildings, library collections, and in fact of whole cities,
during the various contests, first with the Barbarian invaders and
later between these invaders themselves, there still remained
scholarly people who retained their interest in Latin literature; and he
points out that, notwithstanding the many changes in the rulers of
Italy between the year 476 and the beginning of the eleventh
century, Latin never ceased to remain the official language and, as
he maintains, the language of literature.
In the Tetralogus of Wipo are the following lines which have a
bearing upon this belief in the continuation of some literary interests
in Italy:

Hoc servant Itali post prima crepundia cuncti,

Et sudare scholis mandatur tota juventus.
Solis Teutonicis vacuum vel turpe videtur,
Ut doceant aliquem, nisi clericus accipiatur. [311]
 (From their cradle up all Italians pay heed to learning, and their
children are kept at work in the schools. It is only among the
Germans that it is held to be futile and wrong to give instruction to
one who is not to become a cleric.)
Giesebrecht, in his treatise De Litterarum Studiis apud Italos,
confirms this view. He refers to a manuscript of Orosius which was
written in the seventh century and which contains an inscription
stating that this copy of the manuscript was prepared by the scribe in
the Statione Magistri Viliaric Antiquarii.
This is one of the earlier examples of the use of the term statio,
from which is derived the term stationarii, indicating scribes whose
work was done in a specific workshop or headquarters, as
contrasted with writers who were called upon to do work at the
homes of their clients. As is specified in the chapter on the
universities, this term came to be used to designate booksellers (that
is to say, producers of books) who had fixed work-shops. In the Acts
of the Council of Constantinople, the scribe who wrote out the record
of the fifth Synod is described as Theodorus librarius qui habuit
stationem ad S. Johannem Phocam.[312]
In such work-shops, while the chief undertaking was the
production of books, the scribes were ready to prepare
announcements and to write letters, as is even to-day the practice of
similar scribes in not a few Italian cities and villages.
From the beginning of the seventh century, Rome was for a
considerable period practically the only book market in the world,
that is to say, the only place in which books could be obtained on
order and in which the machinery for their production continued to
exist. In 658, S. Gertrude ordered for the newly founded monastery
at Nivelle certain sacred volumes to be prepared in the city of
Rome.[313] Beda reports that the Abbot Benedict of Wearmouth, in
671, secured from Rome a number of learned and sacred works,
non paucos vel placito pretio emtos vel amicorum dono largitos
retulit. (He brought back a number of books, some of which he had
purchased at the prices demanded, while others he had received as
gifts from his friends.) Later, the Abbot repeated his journeys, and in
678, and again in 685, brought back fresh collections. The
collections secured on his last journey included even certain
examples of the profane writers.[314]
A similar instance is noted in the chronicles of the monastery of St.
Wandrille. The Abbot Wandregisil sent his nephew Godo to Rome in
657, and Godo brought back with him as a present from the Pope
Vitalian, not only valuable relics, but many volumes of the sacred
Scriptures containing both the New and the Old Testament.[315]
During the time of the Abbot Austrulf (747-753) a chest was thrown
up by the sea on the shore. It contained relics and also a codicem
pulcherrimum, or beautiful manuscript, containing the four gospels,
Romana Littera Optime Scriptum.
This term Romana Littera has been previously referred to as
indicating a special script which had been adopted in Rome by the
earlier instructors for sacred writings.
Alcuin relates of the Archbishop Ælbert of York (766-780):

Non semel externas peregrino tramite terras,

Jam peragravit ovans, Sophiæ deductus amore,
Si quid forte novi librorum seu studiorum,
Quod secum ferret, terris reperiret in illis.
Hic quoque Romuleam venit devotus ad urbem.[316]

(More than once he has travelled joyfully through remote regions

and by strange roads, led on by his zeal for knowledge, and seeking
to discover in foreign lands novelties in books or in studies which he
could take back with him. And this zealous student journeyed to the
city of Romulus.)
During the Italian expeditions of the German Emperors, books
were from time to time brought back to Germany. Certain volumes
referred to by Pez as having been in the Library at Passau, in 1395,
contain the inscription isti sunt libri quos Roma detulimus.
Wattenbach finds record of an organised manuscript business in
Verona as early as 1338,[317] and of a more important trade in
manuscripts being carried on in Milan at the same time. In the
fourteenth century, Richard de Bury speaks of buying books for his
library from Rome. The references to this early manuscript business
in Italy are, however, so fragmentary that it is difficult to determine
how far the works secured were the remnants of old libraries or
collections, or how far they were the productions of scribe work-
shops engaged in manifolding copies for sale.
It seems evident, however, that while a scattered trade in
manuscripts was carried on both by the scribes in the towns and
between the monastery scriptoria, the facilities for the production and
manifolding of manuscript copies were hardly adequate to meet the
demand or requirements of readers and students. As early as 250,
Origen, writing in Cappadocia, was complaining that he found
difficulty in getting his teachings distributed. A zealous disciple,
named Ambrosius, secured for the purpose a group of scribes
whose transcripts were afterwards submitted to Origen for revision
before being sent out through the churches. It is further related that
Origen became so absorbed in the work of correcting these
manuscripts that he could not be called from his desk either for
exercise or for meals.[318] S. Jerome, a century later, when he was
sojourning in Bethlehem, found similar difficulty. He had among his
monks some zealous scribes, but he complained that their work was
untrustworthy.[319]
Abbot Lupus of Ferrières was obliged (in the ninth century) to
apply to monks in York in order to secure the transcribing work that
he required.
In connection with this difficulty in securing books, it became
customary, when copies were loaned from libraries, to secure from
the borrower a pledge or security of equal or greater value. The
correspondence of the time gives frequent instances of the difficulty
in getting back books that had been loaned, notwithstanding the risk
of the forfeiture of the pledges. In 1020, Notker writes from St. Gall to
the Bishop of Sitten that certain books belonging to the Bishop, for
which the Bishop was making demand, had been borrowed by the
Abbot Aregia, and that, notwithstanding many applications, he had
not succeeded in getting even a promise of their return.[320] In
Vercelli, a beautiful mass book which had been loaned by the Abbot
Erkenbald of Fulda (997-1011) to the Bishop Henry of Wurzburg,
was to have been retained for the term of the Bishop’s life. After the
death of the Bishop, reclamation was made from Fulda for the return
of the volume, but without success. During the years 1461-1463, the
Legate Marinus de Fregeno travelled through Sweden and Norway
and collected there certain manuscripts which he claimed were those
that had been taken away from Rome at the time of its plunder by
the Goths. He evidently took the ground that where books were
concerned, a term of one thousand years was not sufficient to
constitute a “statute of limitations.”
Louis IX. of France is quoted as having taken the ground that
books should be transcribed rather than borrowed, because in that
way the number would be increased and the community would be
benefited. In many cases, however, there could, of course, be no
choice. The King, for instance, desired to possess the great
encyclopedia of Vincenzo of Beauvais. He sent gold to Vincenzo, in
consideration of which a transcript of the encyclopedia was
prepared. The exact cost is not stated.[321]
In 1375, a sum equivalent to 825 francs of to-day was paid for
transcribing the commentary of Heinrich Bohic on the Decretals of
1375. In the cost of such work was usually included a price for the
loan or use of the manuscript. A fee or rental was, in fact, always
charged by the manuscript-dealers. Up to the close of the fourteenth
century, the larger proportion of transcripts were prepared for
individual buyers and under special orders, one of the evidences of
this being the fact that upon the titles of the manuscripts were
designed or illuminated the arms or crests of the purchasers. After
the beginning of the fifteenth century, there is to be found a large
number of manuscripts in which a place has been left blank on the
title-pages for the subsequent insertion of the crest or coat-of-arms,
indicating that in these instances the manuscript had been prepared
for general use instead of under special order.[322]
 As already mentioned, Charlemagne interested himself, not only in
the training of scribes, but in the collection of books, but he does not
appear to have considered it important that the works secured by
him should be retained for the use of his descendants, as he gave
instructions in his will that after his death the books should be sold.
One of the oldest illuminated Irish manuscripts is that of S.
Ceaddæ. This was purchased, at what date is not specified, by some
holy man in exchange for his best steed, and was then presented by
him to the church at Llandaff. The manuscript finally made its way to
Madrid and thence to Stockholm; according to the record, it had,
before the purchase above mentioned, been saved out of the hands
of Norman pirates.[323] It is certain that very many of the monasteries
which were within reach of the incursions of the Normans were
bereft by them of such books as had been collected, although it is
not probable that, as a rule, the pirates had any personal interest in,
or commercial appreciation for, the manuscripts that fell into their
hands.
Gerbert, whose literary interests have been previously referred to,
and who is described as the most zealous book collector of his time,
tells us that he made purchases for his library in Italy, in South
Germany, and in the Low Countries, but he does not mention
whether he was purchasing from dealers or individuals. He was a
native of Auvergne, and in 999 became Pope (under the name of
Gregory V.). Abbot Albert of Gembloux, who died in 1048, states that
he brought together, at great cost, as many as one hundred and fifty
manuscripts.[324]
A certain Deopert records that he purchased for the monastery of
St. Emmeran, from Vichelm, the chaplain of Count Regimpert, for a
large sum of money (the price is not specified), the writings of
Alcuin.[325]
Notwithstanding the very strict regulations to the contrary, it not
unfrequently happened that monasteries and churches, when in
special stress for money, pledged or sold their books to Jews. As the
greater proportion at least of the sacred writings of the monasteries
would have had no personal interest for their Hebrew purchasers, it
is fair to assume that these were taken for re-sale, and that, in fact,
there came to be a certain trade in books on the part of financiers
acting in the capacity of pawn-brokers. In 1320, the monastery of S.
Ulrich was in need of funds, and the Abbot Marquard, of Hagel,
pawned to the mendicant monks a great collection of valuable
books, among which were certain volumes that had been prepared
as early as 1175 under the directions of the Abbot Heinrich. The
successor of Marquard, Conrad Winkler, in 1344, succeeded in
getting back a portion of the books, by the payment of 27 pounds
heller, and 15 pfennigs.[326] Instances like these give evidence that a
certain trade in manuscript books, in Northern Europe at least,
preceded by a number of years the organisation of any systematised
book-trade.
Kirchhoff speaks of usurers, dealers in old clothes, and pedlars,
carrying on the trade in the buying and selling of books during the
first half of the fifteenth century. In Milan, a dealer in perfumery,
Paolino Suordo, included in his stock (in 1470) manuscripts for sale,
and later announced himself as a dealer in printed books. Both in
England and France at this time manuscripts were dealt in by
grocers and by the mercers. The monastery of Neuzelle, in 1409,
pawned several hundred manuscripts for 130 gulden, and the
monastery at Dobrilugk, in 1420, sold to the Prebendary of
Brandenburg 1441 volumes.
In 1455, the Faculty of Arts of the University of Heidelberg bought
valuable books from the estate of the Prior of Worms. In 1402, the
cathedral at Breslau rented a number of books from Burgermeister
Johann Kyner, for which the Chapter was to pay during the lifetime of
said Kyner a yearly rental of eight marks, ten groschens.[327]
The Bishop of Speier rented to the precentor of the cathedral in
1447 some separately written divisions of the Bible, which were to be
held by the precentor during his lifetime only, and were then to be
returned to the Bishop’s heirs. The rental is not mentioned. The
Chapter of the Cathedral of Basel arranged to take over certain
books from the owner or donor, whose name is not given, and to pay
as consideration for the use of the same, each year on the
anniversary of the gift, 16 sols.[328]
Richard de Bury makes a reference to the book-trade of Europe,
as it existed in the fourteenth century, as follows:
Stationariorum ac librariorum notitiam non solum intra natalis soli
provinciam, sed per regnum Franciæ, Teutoniæ et Italiæ
comparavimus dispersorum faciliter pecunia prævolante, nec eos
ullatenus impedivit distantia neque furor maris absterruit, nec eis æs
pro expensa defecit, quin ad nos optatos libros transmitterent vel
afferrent.[329]
(By means of advance payments, we have easily come into
relations with the stationarii and librarii who are scattered through
our native province, and also with those who are to be found in the
kingdoms of France, Germany, and Italy; and neither the great
distances, nor the fury of the sea, nor lack of money for their
expenses has been permitted to prevent them from bringing or
sending to us the books that we desired.)
In the same work, De Bury uses the term bibliator, which he
afterwards explained as being identical with bibliopole,—a seller of
books.
The record of the production of books that was carried on in the
earlier universities, such as Bologna and Padua, is presented in the
chapter on the universities.
In connection with the very special requirements of the earlier
Italian universities, and with the close control exercised by them over
the scribes, it is evident that a book-trade in the larger sense of the
term could not easily come into existence. The first records of
producers and dealers of books of a general character were to be
found, not in the university towns, but in Milan, Florence, and
particularly in Venice. In 1444, a copy of Macrobius was stolen from
the scholar Filelfi, or Philelphus, which copy he recovered, as he tells
us, in the shop of a public scribe in Vincenza.
Blume mentions that in Venice the Camaldulensers of S. Michael
in Murano carried on during the earlier part of the fifteenth century an
important trade in manuscripts, including with the older texts verified
copies which had been prepared under their own direction.[330] The
headquarters, not only for Italy but for Europe, of the trade of Greek
manuscripts, was for a number of years in Venice, the close relations
of Venice with Constantinople and with the East having given it an
early interest in this particular class of Eastern productions.
Joh. Arretinus was busied in Florence between the years 1375
and 1417 in the sale of manuscripts, but he appears to have secured
these mainly not by production in Florence, but by sending scribes to
the libraries in the monasteries and elsewhere to produce the copies
required.
A reference in a letter of Leonardo Bruni, written in 1416, gives
indication of an organised book-trade in Florence at that time:
Priscianum quem postulas omnes tabernas librarias perscrutatus
reperire nondum potui.[331] (I have hunted through all the book-
shops, but have not been able to find the Priscian for which you
asked.)
Bruni writes again concerning a certain Italian translation of the
Bible that he had been trying to get hold of:
Jam Bibliothecas omnes et bibliopolas requisivi ut si qua veniant
ad manus eligam quæque optima mihi significent. (I have already
searched all the libraries and book-shops in order to select from the
material at hand the manuscripts which are for me the most
important.)
Ambrogio Traversari wrote in 1418 in Florence:
Oro ut convenias bibliopolas civitatis et inquiri facias diligenter, an
inveniamus decretales in parvo volumine.[332] (I beg you to make
search among the booksellers of the city and ascertain whether it is
possible to secure in a small volume a copy of the Decretals.)
The use for book-dealers of the old classic term bibliopola in place
of the more usual stationarius is to be noted.
From these references, we have a right to conclude that there
were during the first quarter of the fifteenth century in Florence a
number of dealers in books who handled various classes of
literature.
The great publisher of the fifteenth century, Philippi Vespasianus,
or Vespasiano, who was not only a producer and dealer in
manuscripts, but a man possessed of a wide range of scholarship,
called himself librarius florentinus. He held the post for a time of
bidellus of the University of Florence. His work will be referred to
more fully in a later division of this chapter.
Kirchhoff points out that the dealers of this time, among others
Vespasiano himself, were sometimes termed chartularii, a term
indicating that dealers in books were interested also in the sale of
paper and probably of other writing materials. The Italian word
cartolajo specifies a paper-dealer or perhaps more nearly a stationer
in the modern signification of the term.
The influx of Greek scholars into Italy began some years before
the fall of Constantinople. Some of these scholars came from towns
in Asia Minor, which had fallen under the rule of the Turks before the
capture of Constantinople. When the Turkish armies crossed the
Bosphorus, a number of the Greeks seem to have lost hope at a
comparatively early date of being able to defend the Byzantine
territory, and had betaken themselves with such property as they
could save to various places of refuge in the south of Europe, and
particularly in Italy. As described in other chapters, many of these
exiles brought with them Greek manuscripts, and in some cases
these codices were not only important as being the first copies of the
texts brought to the knowledge of European scholars, but were of
distinctive interest and value as being the oldest examples of such
texts in existence.
The larger number of the exiles who selected Italy as their place of
refuge found homes and in many cases scholarly occupation, not in
the university towns so much as in the great commercial centres,
such as Venice and Florence. Many of these Greeks were accepted
as instructors in the families of nobles or of wealthy merchants, while
others made use of their manuscripts either through direct sale,
through making transcripts for sale, or through the loan of the
originals to the manuscript-dealers.
A little later these manuscripts served as material and as “copy”
for the editions of the Greek classics issued by Aldus and his
associates, the first thoroughly edited and carefully printed Greek
books that the world had known. It was partly as a cause and partly
as an effect of the presence of so many scholarly Greeks, that the
study of Greek language, literature, and philosophy became
fashionable among the so-called higher circles of Italian society
during the last half of the fifteenth century.
The interest in Greek literature had, however, as pointed out,
begun nearly twenty-five years earlier. As there came to be some
knowledge of the extent of the literary treasures of classic Greece
which had been preserved in the Byzantine cities, not a few of the
more enterprising dealers in manuscripts, and many also of the
wealthier and more enterprising of the scholarly noblemen and
merchants, themselves sent emissaries to search the monasteries
and cities of the East for further manuscripts which could be
purchased.
One reason, apparently, for the preference given by the Greeks to
Venice and Florence over Bologna and Padua was the fact that the
two great universities were devoted, as we have seen, more
particularly to the subjects of law, theology, and medicine, subjects in
which the learning of the Greeks could be of little direct service.[333]
The philosophy and the poetry which formed the texts of the lectures
given by the Greek scholars attracted many zealous and earnest
students, but these students came, as stated, largely outside of the
university circles. The doctors of law and the doctors of theology
were among the last of the Italian scholars to be interested in
Homeric poetry or in the theories of the Greek metaphysicians.
Towards the middle of the fifteenth century and a few years before
the introduction of printing, a new term came to be used for dealers
in manuscripts. The scribes had in many cases naturally associated
their business interests with those of the makers of paper,—cartolaji,
and the latter name came to be applied not only to the paper
manufacturers, but to the purchasers of the paper upon which books
were inscribed. In some cases the paper-makers, or cartolaji, appear
themselves to have organised staffs of scribes through whose labour
their own raw material could be utilised, while the name of paper-
maker,—cartolajo, came to be used to describe the entire concern.
After the introduction into Italy of printing, the association of the
paper-makers with books became still more important, and not a few
of the original printer-publishers were formerly paper manufacturers,
and continued this branch of trade while adding to it the work of
manufacturing books. Among such paper-making publishers is to be
noted Francesco Cartolajo, who was in business in Florence in 1507,
and whose surname was, of course, derived from the trade in which
his family had for some generations been engaged. Bonaccorsi
turned his paper-making establishment in Florence into a printing-
office and book manufactory as early as 1472, and Montali, in
Parma, took the same course in 1482; Di Sasso who, in 1481, came
into association with the Brothers Brushi, united his printing-office
with their paper factory.
Fillippo Giunta, one of the earlier publishers in Florence, calls
himself librarius et cartolajus. It is possible that he reversed the
business routine above referred to, and united a paper factory with
his printing-office.
One result of the influx of Greek scholars, many of whom were
themselves skilled scribes while others brought with them scribes,
was the multiplying of the number of writers available for work and a
corresponding reduction in the cost of such work.
The effect of this change in the business conditions was to lessen
the practice of hiring manuscripts for a term of days or weeks, or of
dividing manuscripts into pecias, and to increase the actual sale of
works in manuscripts.
The university regulations, however, controlling the loaning of
manuscripts and of the pecias appear to have been continued and
renewed through the latter half of the fifteenth century, that is to say,
not only after the trade in manuscripts, at popular prices, had largely
developed in cities like Florence, Venice, and Milan, but even after
the introduction of printing. It would almost seem as if in regard to
books in manuscript, the system which had been put into shape by
the university authorities had had the effect of delaying for a quarter
of a century or so the introduction into Bologna and Padua of the
methods of book production and book distribution which were
already in vogue in other cities of Italy. I do not overlook the fact that
there was in Florence also a university, but it is evident that the
book-trade in that city had never been under the control of the
university authorities, and that the methods of the dealers took
shape rather from the general, common-sense commercial routine of
the great centre of Italian trade than from the narrow scholastic
theories of the professors of law or of theology.
During the twenty-five years before the art of printing, introduced
into Italy in 1464, had become generally diffused, the years in which
the trade in manuscripts was at its highest development, Florence
succeeded Venice as the centre of this trade, both for Italy and for
Europe.
The activity of the intellectual life of the city, and the fact that its
citizens were cultivated and that its scholars were so largely
themselves men of wealth, the convenient location of the city for
trade communications with the other cities of Italy and with the great
marts in the East, in the West, and in the North, and the
accumulation in such libraries as those of the Medici of collections,
nowhere else to be rivalled, of manuscripts, both ancient and
modern, united in securing for Florence the pre-eminence for literary
production and for literary interests.
Scholars, not only from the other Italian cities, but from France,
Germany, and Hungary, came to Florence to consult manuscripts
which in many cases could be found only in Florence, or to purchase
transcripts of these manuscripts, which could be produced with
greater correctness, greater beauty, and smaller expense by the
librarii of Florence than by producers of books in any other city. After
the Greek refugees began their lecture courses, there was an
additional attraction for scholars from the outer world to visit the
Tuscan capital.
 The wealthy scholars and merchant princes of Florence, whose
collections of manuscripts were given to the city during their lifetime,
or who left such collections after their death to the Florentine
libraries, made it, as a rule, a condition of such gifts and such
bequests that the books should be placed freely at the disposal of
visitors desiring to make transcripts of the same. Such a condition
appears in the will of Bonaccorsi,[334] while a similar condition was
quoted by Poggio[335] in his funeral oration upon Niccolo d’ Niccoli,
as having been the intention of Niccolo for the books bequeathed by
him to his Florentine fellow-citizens.
Foreign collectors who did not find it convenient themselves to visit
Florence, such as the Duke of Burgundy, and Matthias Corvinus of
Hungary, kept employed in the city for a number of years scribes
engaged in the work of preparing copies of these Florentine literary
treasures for the libraries of Nancy and of Buda-Pesth.
Matthias was, it seems, not content with ordering the transcripts of
the works desired by him, but employed a scholarly editor, resident
in Florence, to supervise the work and to collate the transcripts with
the originals, and who certified to the correctness of the copies
forwarded to Buda.[336] At the death of Matthias, there appear to
have been left in Florence a number of codices ordered by him
which had not yet been paid for, and these were taken over by the
Medici.[337]
In a parchment manuscript of the Philippian orations is inscribed a
note by a previous owner, a certain Dominicus Venetus, to the effect
that he had bought the same in Rome from a Florentine bookseller
for five ducats in gold in 1460.[338] Dominicus goes on to say that he
had used this manuscript in connection with the lectures of the
learned Brother Patrus Thomasius.
During the thirteenth century, there was a considerable
development in the art of preparing and of illuminating and
illustrating manuscripts. One author is quoted by Tiraboschi as
saying that the work on a manuscript now required the services not
of a scribe, but of an artist. For the transcribing of a missal and
illuminating the same with original designs, a monk in Bologna is
quoted as having received in 1260 two hundred florins gold, the
equivalent of about one hundred dollars. For copying the text of the
Bible, without designs, another scribe received in the same year
eighty lire, about sixteen dollars.[339]
The work of the manuscript-dealers in Florence was carried on not
only for the citizens and sojourners in the city itself, but for the
benefit of other Italian cities in which there was no adequate
machinery for the manifolding of manuscripts. Bartholomæus Facius,
writing from Naples in 1448, speaks of the serious inadequacy of the
scribes in that city. There were but few men engaged in the
business, and these were poorly educated and badly equipped.[340]
Facius was, therefore, asking a correspondent in Florence to have
certain work done for him which could not be completed in Naples.
Poggio writes from Rome about the same date to Niccolo in Florence
to somewhat similar effect. He speaks with envy of the larger literary
facilities possessed by his Florentine friends.[341]
Next to Florence, the most important centre for the manuscript
trade of North Italy was Milan. As early as the middle of the
fourteenth century, there is record of no less than forty professional
scribes being at work in the city. Such literary work as was required
by Genoa and other Italian towns within reach of the Lombardy
capital came to Milan. At the beginning of the thirteenth century,
when the population of the city was about 200,000, there had been
in the city but two registered copyists. More important, however, than
that of either Florence or Milan, was the manuscript trade of Venice,
the position of which city gave it exceptional advantages as well for
the collection of codices from the East as for securing the services of
skilled scribes from Athens or from Constantinople. One of the more
noteworthy of the Venetian importers of manuscripts was Johannes
Galeotti, a Genoese by birth, who made various journeys to
Constantinople, and whose special trade is referred to in an
inscription on a manuscript dating from 1450 and containing the
speeches of Demosthenes.[342]