Lately, I have been inspired by the Ritz Carlton’s use of “guest tweeters;” ladies and gentleman outside of their core communications team who take over the reigns on behalf of the organization. Having different members of the organization represent the company gives a chance to highlight regions and specific properties. Hospitals, even single facility systems, are not much different. Using guest tweeters, or “social media ambassadors” is a great way to add some dynamic range to what you are sharing online. Recently we tried something similar in our Richmond market. If success can be measured in sentiment, we felt energized by the pilot.

There are many reasons to consider cultivating social media ambassadors. For starters, no [person] is an island. Even with best efforts, it is difficult for any one person to represent an entire healthcare organization. The most seasoned healthcare communicators may still be clinically novice; having a nurse tweet for a day could be a detailed look at a clinical topic. Interviews and quotes from various departments or experts give a sense of a topic. Allowing those same groups to run the show for a few hours or days lets them to take a much deeper dive. Showcasing someone else’s voice in the mix also keeps things fresh and interesting. The way someone talks passionately about their own work is always more stimulating that listening to someone else try and represent it for them. Finally, cultivating a group of ambassadors helps organizations develop a base of pitch hitters and trusted spokes people. (I’ve written before about empowering employees to speak for the organization.)

The logistics and mechanics of a social media ambassador program is fairly straight forward. Just like any successful project, coaching and a partnership will go a long way. Start with a simple, one page document. It should include an overview of the tools (twitter, Facebook, etc) and terms (retweets, direct messages, likes, etc). It should also spell out, in lay terms, the organizations communications guidelines. For example, thank everyone, even those with negative feedback, or don’t engage in political banter. Finally, it should define expectations of what is on and what is off limits. For instance, you may want your ambassadors responding to general comments and you may ask them to avoid replying to anything negative. Perhaps you stay “on call” and formulate any replies together, ensuring that the organization is well represented along with the guest’s voice. Regardless of the plan, spell out out.

In addition to coaching the experience for online ambassadors, it is important to make sure they understand the tools they are using. Many will already be familiar with Facebook, making it easy to turn “Wellness Wednesday” over to your wellness team. They may not have administrated a page, something that is easy to walk through in a 30 minute coaching session. The same goes for Twitter. Tools like Hootsuite can help and give some control. They can also be tedious for new users to pick up quickly.

A good policy and agreement of expectations will help the governance process. That said, turning over the controls should not mean abdicating responsibility. It is important for those responsible for social media to watch the flow of the posts and conversation. Maintain close contact with your guest posters and make yourself available to answer any questions they have along the way.

Take a page from the Ritz Carlton’s play book and find some social media ambassadors. Hold their hands through the process and you’ll be well rewarded. Your social media stream will get a fresh voice, some deeper perspectives and you’ll be training a whole team of spokespeople in the process.

Note: I’ve been working on a mind map of the ideal mobile application for healthcare providers. Ideal of course being a subject measure. Part of ideal in my mind is not duplicating what already exists. For intense, UMMC has a wonderful medical encyclopedia and the iTriage app is a popular symptom checker. But what is missing? This is part of a series of posts that will explore this mind map as it develops. Specifically, this post will focus on the right side of the image below.

You know the Staples easy button? It looks something like a cartoonish giant red button that, when pressed, is supposed to solve all of your office supply problems. Well, where is our easy button in healthcare? I mean, within the laws of physics, can we at least have a way to do what other industries have been taking for granted for a decade? Even in 1999, I could use a computer and find a flight to Reykjavík, Iceland. Fast forward to today and the Open Table application. OpenTable.com is a great restaurant reservation site, and their mobile app takes things a step further. Using your phone’s GPS, it is able to show you which restaurants near you have, well, open tables in the near future. Who hasn’t had the “where do you want to eat tonight?” fight…er…lovely conversation?

So if I can book a flight to Iceland and find the first available restaurant table near my hotel, all with my iPhone, why can’t I do the same for a doctor’s appointment? As another in my series of “someone please build this”, I’m asking: Someone please build an easy button for healthcare.

When you, or someone you care about is unwell, it is all about access.

We in the healthcare community often balk at the idea of consumerism in healthcare. Patients are people, consumers are shoppers. People need high touch, along with physical and emotional care. However, we can take a few lessons from the retail side of the world. In retail, it is all about “conversion”, getting people to go from browsing to buying. One of the easiest ways to do that is to remove barriers. Don’t make it hard for people to purchase what they want (thank you Amazon Prime). In healthcare we call this “access”; how do we make it easy for patients to use health services.  When you have a sick child, picking up the phone and being told the next appointment is two days away is not access. The same applies to new patients looking for a doctor. (The average wait to see a dermatologist in the US is between six months to a year!)

For a while, I have been pondering what I call the “virtualization of urgent care”. Urgent care, at least in this example, is defined as important but not emergency: waking up with a bad cold or sinus infection, a rash is worse than yesterday, a sick child. In those cases, the normal course of action is to call the doctor’s office, and if you are lucky you might get an appointment in the next few days. By that time you might be well, or you might decide to go somewhere else, like a doc-in-a-box walk in urgent care center, or the emergency room.

Enter the healthcare easy button. Whip out your mobile phone, launch an application and press the button. The GPS fires up and determines your location and the nearest open appointments. You pick the one that best suits your needs and press “reserve”. It is that easy. When you arrive, all the paper work is done and you simply check in.

Those well versed in the healthcare IT world have already started punching holes in this plan. How will you ever retrieve open appointment data? How will you get a new patient scheduled? What are the security and privacy risks? Truthfully, those were valid concerns….a decade ago. To be blunt, there is no excuse for the lack of consumer technological advancement in healthcare. (Getting nerdy in 3…2…1) There are health information standards like HL7 that allow for the creation of and update of patient visit records in the A segments with additional information in customizable Z segments. Bottom line, it can be built easier than one might think.

From a business prospective, this is a model that probably makes more sense for integrated health systems with wide offerings of primary and urgent care. However, savvy communities might also realize that independent physicians could bond together in a sort of co-op, offering to accept each other’s patients in an urgent care scenario. Every walked into a restaurant with no tables and have the host suggest someplace else down the street?

As my mind map above suggests, there are a lot of other features that can make for a rich mobile experience. I’m looking forward to exploring some of those ideas in future posts. Almost all of them have something in common: looking at the retail and consumer experience and applying to the healthcare model. That doesn’t mean we have to lose anything about the patient experience. On the contrary, I would suggest that helping people find access to care is a form of emotional support and am improvement in the patient experience. So, someone please build us a healthcare easy button!

A few weeks ago I had the privilege of being asked to write a guest blog post for Odom Lewis, a healthcare communications staffing and recruiting firm. Angelia from Odom asked me to comment on Dr. Bridget Duffy’s ever-inspiring presentation from the 2009 Gel Conference. Some may recall that I wrote about Dr. Duffy’s talk here on this blog in June 2010.

In short, since most of us are not doctors, or may not even be conscious while we are being attended to, it is very hard to gauge the quality of the clinical attention we are receiving. However, every person has the ability to gauge their healthcare experience. When providers make the patient experience a strategic goal, everything else will follow: clinical outcomes, revenue, market share, etc.

For most of us, auto mechanics are a bit of a mystery. The oil light comes on, we drive to the dealership, they work some voodoo and we drive away under the impression that things are running smoothly under the hood. Unless you have the know-how, there isn’t a way to verify the quality of the work that is done. That is probably why savvy dealerships started offering fancy waiting areas – coffee, danishes, flat screen TVs and high speed Internet. If we can’t judge the craftsmanship, maybe we’ll make our service decisions based on the waiting experience. The interesting thing is that medicine is not much different.

Want to read the rest? Head over to the Odom Lewis blog.

Enter the idea of accountable care. Many industry experts are already envisioning a near future when providers will move from reaction to proaction. Rather than being paid to treat the symptoms that walk in the door, doctors may get paid for keeping you out of the office. A practical example is obesity. Instead of being reimbursed to treat the side effects of obesity (asthma, diabetes, joint pain, etc), a doctor may get paid for helping a patient achieve a healthy lifestyle and losing weight.

There is still something missing from this equation. And that is where your social graph comes in. A lot of us do healthy things all the time. According to Foursquare, the geolocation based social network, I have “checked in” to my gym 57 times since early March. I have gone to the farmer’s market 15 times this year. I have attended four medical education seminars (ok, those were work-related, but I still learned something). Here’s the rub, my doctor doesn’t know any of that. If he is going to be responsible for my complete health, shouldn’t those things factor in?

So, continuing my “someone please build this” series of blog posts, here is my latest plea: someone please build a conduit between my social graph and my health record. Let me opt in and chose which things I share online which should also go into my EMR to become available for anyone treating me. Tools like Foursquare come to mind as an obvious choice. Since it is based on location, it takes some of the effort out of participating; it just knows where you are. So when I check in to the gym, wouldn’t it be great if my health record was updated too?

My good friend and HCSM guru, Dana Lewis pointed out the power of twitter hashtags. What if we were able to define a specific, personal tag, say #NicksHealth. Every time I want to include a twitter update in my health record, I tag it with #NicksHealth. Last week, I had surgery on my knee to repair an ACL injury. Every day for the first week, I took a picture and loaded it into Flickr, the social photo sharing site and posted a link to the picture to Twitter. If I were able to tag it with #NicksHealth then my doctor would have a series of images showing the progression of my range of motion, wound healing, etc. When I update my Facebook page with details from physical therapy, that information could populate my medical record, along with my Foursquare checkins – my doctor would see just how compliant I have been with his rehab orders.

It doesn’t all have to be healthy. Providers need a complete snapshot of our lifestyles if they are going to suggest a course of care. Perhaps through incentives, competition or other means, patients may be encouraged to also share things that are less healthy. “I ate a burger tonight, with fries…and bacon…lots of it. #NicksHealth” – My doctor should probably know how often that happens in relation to my trips to the gym.

There are, of course, some challenges to this idea; including the burden of combing through all the data. Physicians may already feel like they have information overload. Without an accountable care model in place today, there is not much to entice them to pour over patients’ social graphs. In time, we will also need software that can automatically sift through the updates and present them in a meaningful way to physicians. However, the first step remains building the connection.

Every major social network has an API, or Application Programer’s Interface. APIs are a way to move data into and out of systems. If you use a twitter client like Tweetdeck or Twitter on your iPhone, you are using the Twitter API. Health providers, when considering their online offerings, would be wise to build in API functionality to online health portals.

Let people chose which data they want to share with their medical record. Providers can incentivize participation through reduced co-pays, social competition, etc. In return they get a rich flow of lifestyle information. When accountable care, meaningful use, EMRs and social graphs come together it will be a win for us all.

Imagine a social site, a game of sorts, that rewards doctors and clinicians for improving outcomes, reducing costs and improving a patient’s experience. Docs are a competitive lot, they worked hard to get where they are and that kind of drive doesn’t end at graduation from medical school. “Dr. Smith just prescribed a less expensive alternative.” Oh yeah? “Well, my patient just got out of the hospital a day under the national average length of stay.” Can you see the peer pressure building?

Unfortunately this site doesn’t exist…yet. Imitation is the sincerest form of flattery right?

Have you checked out the Foursquare social network? It is a social game, you (or rather your GPS equipped mobile phone) tells Foursquare where you are and Foursquare tells your friends. If you are out on the town and want everyone to get together at your favorite watering hole, you log into Foursquare, update your location and blast a note to your friends.

The game part comes into play in two ways. First, if you check into a place multiple times you may become its “Mayor”. Savvy restaurants and businesses are rewarding mayors. In early 2010, Starbucks began offering Mayors a $1 discount off Frappuchinos. The second part of the game are the badges. You get badges for anything from checking in after 3:00AM (School Night) to checking in near the water (On a Boat). Think of them like Girl or Boy Scout merit badges, only, well, internetier.

Back to our medical example

Patient care is not a game and to create a social site that does not trivialize it takes tact. However, there is nothing wrong with a little healthy competition. The Federal Government’s CMS website offers good data on how one hospital stacks up against another; and it is fairly easy to read….if you work in healthcare and spend your time digesting these kinds of things. I am not convinced that the average consumer wants to suss out the percentage difference between two providers (although the site does a nice job of using plain language).

What I am suggesting – no – begging someone to build is a site that is relevant to both clinicians and the public. Think: Foursquare for doctors. Write a script for a generic med three times, get a badge. Have a better than average outcome, get a badge. Become the mayor of wherever you attend CME courses. Doctors could follow each other and would see what their peers are up to. When Dr. Jones writes a generic script three times, Dr. Smith might ask him which med it was, what the differences are, why Dr. Jones prefers it, etc. The professional interaction does not have to happen on the site. The site is simply a way for docs to encourage each other to improve care. Patients can follow along too. You could visit your doctor’s page and see what badges they have. Looking for the best surgeon? Find the one with the “10 complication free surgeries” badge.

I’m not much of a coder and don’t have an ability to produce great design (although I did the fancy syringe badge for this post, pretty good huh?). So please… someone build this!

Now, if you are asking why I was picked, you are not alone. I’m still in awe of that myself. Setting aside that certainly unanswerable question, it was without doubt one of the most honorable and proud experiences I have had.

Some detail:

The Civil Summit, the second of these to occur, was conceived as a way to identify socially beneficial solutions to human rights concerns in parallel to the US/Russian presidential summits. To accomplish the goal, key areas were identified – education, anti-conspiracy, healthcare, and others – as working groups. Each working group consisted of three to four US and an equal number of Russian delegates. Those delegates spent the first day identifying challenges in their respective areas and brainstorming solutions; typically involving private industry. On the second day the various groups came together in the plenary session to present their challenges and solutions.

The audience of the plenary session included most of the delegates. In addition representatives from President Obama’s cabinet, including Hilary Clinton, Russian ministers, US AID, various NGOs and industry innovators were present to form a group of about 200 large.

In search of solutions:

When I opened this post with “amazing experience”, it is not the company I kept that led to that statement but rather the intense intellectual discourse that left me inspired. In particular, the ideas around healthcare challenges and solutions were quite impressive.

Both Russian and US delegates identified the following as challenges:

• Lack of healthy behaviors
• Pediatric health
• Infant mortality
• the health of the elderly
• lack of MDs and RNs
• substance abuse
• disaster preparedness
• communication challenges between clinicians and communities they serve

To my fellow HCSM (healthcare communications and social media) compatriots those issues will undoubtedly sound familiar. Many are the same concerns we have been discussing in online chats and conferences for two years.

What may also come as no surprise are some of the proposed solutions (may of which are in fact tools to reach solutions):

• Web platforms
• Mobile applications
• Anonymous feedback mechanisms
• System to verify product authenticity (eg: pharma products)
• Online health professional groups and forums
• Health based online games
• Internet communities to combat isolated groups
• Applications for chronic disease management and wellness promotion

Some stand out points of the conversation came when we were able to dig deep into the real cause of an issue. One pediatric physician discussed the importance of using data to drive outcomes. His example was focused on using APGAR scores to better understand the performance of labor and delivery teams at various times of day. Another physician keyed into a conversation about the Foursquare social networking site and suggested a twist – doctors getting badges for reducing costs or improving outcomes. Imagine the positive peer pressure from docs “one upping” peers by getting the “no unnecessary tests” badge.

As the conversation progressed, three main challenges emerged:

• Who would provide the health information  -  it may be relatively easy to build a web, or SMS platform to deliver wellness information. However, finding an authoritative source to produce that content may be difficult.
• How to keep people engaged – just because you build it does not mean they will come
• How to increase interactivity and social proliferation – how do I get my friends to sign up too?

Power to the people:

In the end, one of the most solidifying concepts proved to be “the wisdom of crowds” (a phrase I contributed, although in consideration of the book of the same name, may have misused). We rallied around the importance for communities to help drive the content, the engagement and the feedback. Health providers can take the role of curators who help cultivate the expertise that comes from actual patients. It was a powerful breakthrough and something that resonated with the plenary group.

I’m still processing the the event, the thoughts and their impact. The proceeding “brain dump” represents only a faction of the big ideas and valuable relationships that came out of the 2010 Civil Society Summit. It is something that, as I continue to reflect, will provide much fodder for pontification… and of course more blog posts.

This inspiring video came to my attention by way of Dr. Howard Luks. Every time I watch it – I have done so several times – I become more inspired. Dr. Bridget Duffy, the Chief Patient Experience Officer for the Cleveland Clinic (how great is that title!) presented this talk at the Gel Conference. Dr. Duffy makes the case for elevating the patient experience to the same level of importance as clinical outcomes.

There are two concepts in particular that resonate with me from this talk. The first occurs around 21:45 when Dr. Duffy talks about “Code Lavender”. In her words, TV medical dramas have made us all familiar with a Code Blue, a patient in cardiac and/or respiratory arrest. A Code Lavender is when someone is emotional arrest – a patient, visitor, doctor, nurse, anyone in the hospital. Calling a code Lavender means that “everyone in the hospital stops and sends healing intention or prayer…” It is a powerful concept.

The second point that I find especially apt is an overall theme of the talk: creating a meaningful, positive, healing patient experience is the most important strategic goal a provider can have. “If you focus on that, [hand washing, clinical outcomes, quality, performance improvement] will come.”

At the end of her talk, Dr. Duffy slips in a key part of this plan, “listening to their needs.” I recently had cause to say to someone “I’m working with a patient to resolve a concern they have, this is the best part of my job, social media is just a way to get there.” Using these real time tools to connect with patients and improve their experience is truly what #HCSM is about to me. I am fortunate to work for an organization that has made experience a strategic goal. I get to see every day the impact it has.

Bridget Duffy at Gel Health 2009 from Gel Conference on Vimeo.

The previous post in this series reviewed the first year of healthcare social media and noted the correlation between engaged employees and customer service. I’ve predicted that in the coming year we’ll see progressive organizations extending the use of social tools to their employees; thereby creating a culture of information exchange and online service. Achieving a socially connected employee base at a healthcare provider is not without challenges, although it may be easier than some would suggest.

Action conquers fear

We have no reluctance about hiring someone to register a patient or letting nurses tend to patients. Healthcare providers, as Lee Aase of the Mayo Clinic has quipped, are accustomed to embracing cutting edge advances in medicine but ironically slow to adopt new business practices. And so, it should come as no surprise that many hospital systems balk at the idea of allowing a nurse or registrar represent their brand online. Many concerns can be easily relieved by exposure to social media tools and education about their use.

Compliance and regulatory issues usually top the list of concerns and rightfully so. A well-intentioned caregiver posting a patient’s picture could unwittingly generate serious legal problems for a provider. Similarly, I would not suggest completely dismissing issues relative to branding. Again, a well-intentioned employee could post offensive or misleading information.

But there are also concerns that rest on a much less solid foundation. Here, I’m referring to the red herrings of productivity, viruses (or other technological malfeasance), and inflammatory discourse. I suggest these concerns can be allayed by  what psychologists call exposure therapy.

The tools that organizations are scared to give their employees  can, in fact, be the way to overcome fears – real and imagined. It is time to begin using social media internally, within provider organizations. Doing so will help assuage naysayers and allow organizations to cultivate online ambassadors.

Connecting the dots by connecting employees

Out-of-the-gate it may not make sense to extend Twitter to 5,000 employees. However, a simple forum site, accessible only internally, may be a gentle introduction for both the organization and its employees. Consider augmenting the intranet site with a forum. Make the rules clear and accessible — no foul language, no insults, and no patient information. This is not a unique idea.

Paul Levy, the widely-read CEO blogger from Beth Israel Deaconess Medical Center in Boston set up forums when facing a difficult financial position last year. He explained that layoffs seemed inevitable, but offered an online, intranet for employees to discuss other options. It worked. Employees collaborated openly and created ways to reduce costs and save jobs. Concerns about inflammatory language proved unfounded, the conversation was civil and professional. Levy is a seasoned leader who knows criticism is often a suggestion in disguise; he’s fearless about letting employees speak freely.

If forums are the first steps, a more feature-rich social platform may follow. Multi-user content management systems like open source Word Press MU or commercial Microsoft SharePoint can be used to build powerful internal social networks. As a colleague puts it: “I can log into Facebook and see what everyone I know is up to in broad strokes, and it only takes minutes a day. Why can’t we do that across our organization?”

Imagine logging into an intranet and discovering what’s going on in finance, surgical services, registration, administration, and infection control,– all from short status updates. Wouldn’t knowing where the company as a team was headed be useful?

These kinds of controlled, internal social efforts also help employees better understand what leadership looks like. Leaders,  coached by those who understand social networks and organizational development, can model leadership by their participation in online communities. Most companies already have online training tools, so including Social Media Communications 101 is an easy drop-in that will lead to an internally connected and engaged workforce.

Next time, a deeper look at the the tools to build an internal social network…

The next level of growth In healthcare’s use of social media, must come from    the within the organization by involving all employees in the effort.

Preface

For many healthcare provider organizations, social media has become an extension of external marketing efforts.  And while  big external wins, like viral videos or news coverage of tweets can help create internal momentum, too often these actions are little more than glorified sales pitches. To truly be successful in the use of social media, providers need to begin thinking about engaging their employees in the social conversation and. creating a team of online ambassadors who serve each other and their customers more effectively. In the case of healthcare, it means engaging the  entire staff of caregivers in the conversation about bettering the patient experience.

The story so far
If seven human years equal a dog year, how would we calculate an internet year?

Only twelve to sixteen months have passed since early adopters got serious about social media in the healthcare industry. A lot has happened during that short period of time. Just recently the #HCSM twitter chat celebrated its first birthday. According to Ed Bennett’s Found in Cache, over 500 hospitals now have some kind of social web presence.  We’ve seen surgeries tweeted, the Pink Glove Dance go viral, doctors tweeting, and iPhone applications for hospitals. So what does the coming year look like for healthcare social media?

Most, if not all,  healthcare providers  share the collective goal of improving patient experience. Sometimes, this is expressed as clinical excellence; sometimes as increased efficiency. Regardless of wording, having an entire organization discussing this type of improvement can strengthen a provider’s ability to deliver care. Just as there is a correlation between engaged employees and good service, so too is there a connection between connected employees and empowerment.

During the past two years at the hospital where I am employed, we have seen how increased employee engagement has  improved everything from patient satisfaction to clinical outcomes.

Well cared for, happy employees serve customers with an exuberance that comes from a sense of pride that cannot be induced by coaching alone. The exuberance and best in class service I have observed  across multiple service industries is a result of establishing and sustaining a company’ culture of serving customers with pride, anticipating patient needs, and caring about positive outcomes. This type of culture is rooted in engaged employees who believe in the organization’s mission. And just as service emerges from a culture of engaged employees, social media must emerge from engaged participants.

Prediction
This next year for healthcare social media will be an opportunity for progressive providers to grow in amazing ways. I say this is the year that organizations that truly embrace openness and transparency will move to the forefront. Social tools have a role inside of organizations. When they’re used to help flatten the org chart and promote discourse, the entire enterprise benefits and convey an important ethic that branding alone cannot match. The path has been paved in this last year. The very social tools that we have been using externally have an immense power when they are applied internally. More on that thought soon…

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This post is shared with much gratitude to Meredith Gould for her editorial guidance

Of the topics discussed, one that really resonates with me are some of the complications surrounding the reimbursement challenges of our third party payor system. For those of us who work in that part of the industry it can be easy to be lulled into forgetting how complicated the system is. Ask any patient who has been denied after seeing a doctor and they can remind you about the challenges.

The Interval crew also delved into a question posted on Health Leaders Media: “If You Could Tell the CEO One Thing About Marketing, What Would it Be?” My comment on that post was, “marketing is dead”. As ambiguous and inflammatory as that comment sounds, the Interval team did a great job of interpreting my meaning. One of my favorite concepts is the idea of the “experience economy”. The term comes right from the title of a book by Pine and  Glilmore. The essence is that we live in a time when ubiquitous connectivity and real time communication (IE social media) enable consumer to discuss products and experiences in real time. To put that in context, I do not need to see a billboard about a hospital in town, I can see what people are saying about that hospital right now online. Those experiences will have a much greater impact that marketing.

Chris makes an eloquent counter point about marketing. When applied as the “art and science  of [retaining and growing a customer base]” it is not far afield from the experience economy. I would argue that under that definition the onus (and effort) moves off of traditional marketing and is placed on operations, customer service and clinical outcomes. In that sense, the need for billboards and print ads becomes superfluous – marketing, at least in that sense, is dead.

I have had the recent pleasure of some deep conversations with a friend who knows a lot more about these concepts than I do. Without a doubt those who “get it” understand that the future of healthcare marketing is not about a bigger watermelon truck. Business development has to be strategic and tied to the proverbial bottom line. When service and the patient experience are approached with the same attention, the results are surprisingly affirmative in advancing that bottom line number.

Enough of my drivel, have a listen to Chris and the Interval team here on their site, or subscribe via iTunes