I love this image. I use it in talks all the time. Vail Honeywagon Trash Service - satisfaction guaranteed or your trash back. I’ve always kind of thought of it as a pithy way of saying what computer programmers call “garbage in, garbage out.” Vail Honeywagon is confident you’ll be pleased with the quality of their work. Or you can have your trash back. This week I read an interesting post on why most companies won’t succeed at social media from Rich Meyer (thanks @FranklinTweets for tweeting the link). In healthcare, when we talk about results or success, we often use the word outcomes. If quality and outcomes mater to our employees, patients and physicians, they must also matter in our social efforts. Outcomes are the result of a treatment, therapy or protocol. Your symptom is a headache. Your treatment is an aspirin. A successful outcome is pain relief. I'm not medically trained, I'll stop there; you get the idea.

A few weeks ago, I wrote about the meaningful use of social media. Here's a recap. The government says simply having an electronic medical record is not enough, its how you meaningfully use it to drive outcomes which matters. Provider use of social media is not any different. Simply having a Facebook page is not enough. What are we as provider organizations doing to actually affect our friends and followers in a meaningful way?

In this post, I want to explore the rest of the equation. The tool + meaningful use = outcomes. In this case the tool is social media and we are solving for outcomes. It is important at this point in the conversation to bring up that most taboo of topics: ROI. This is a post entirely about ROI. Does a return have to be financial? Of course not. In fact, wouldn't any physician say a patient who leaves healthier than when they walked in is a valid return on the investment of the physician's time?

Outcomes as return

Most texts on collaboration and teamwork offer some common guidelines for a successful project. (Can you tell what I'm studying this semester?) One of ground rules for a successful project is to start by establishing a common goal. What do we want to get out of this? Did you ask that question about starting your Facebook page? Many of us did not. Many of use even gave others the Nike speech - just do it! That was ok. We needed to gain a critical mass. It does not, however, excuse us from asking the question now and evaluating our go-forward strategy. What is our goal with social media? What do we want the outcomes of our social therapies, protocols and treatments to be?

Many healthcare organizations have chosen to answer the question by grounding social media in traditional marketing and PR efforts. The appeal of using social media for marketing's sake is easy to understand. Consumer brands have been increasingly embracing the trend over the last few years. It is also easy to measure. If I tweet a seminar, and someone comes to my seminar as a result, I've got a successful conversion from social media.While I do not want to admonish the outcomes they have identified, I will brazenly suggest some alternatives.


Drumroll for Nick's brazenly offered suggestions for the outcomes of social media in healthcare:


  • Supporting Employee Culture - Why do we start things like this externally at all? Does this exchange feel familiar:

Patient: "You guys are the best on Twitter, if you hadn't reached out, I wouldn't have come in today!"

Nurse: "We're on twitter? Is that like what people had for breakfast?"

It is, in fact, a little antithetical to the whole nature of social media to exclude our employee base, but that is what so many organizations are still doing. Instead, think about impacts on employee culture such as morale improvement, easier communication, professional collaboration (including collaborating on care protocols!) access to leaders, closing geographic disparities between facilities… the list is seemingly endless. A successful healthcare social media strategy simply must include, and should perhaps start with, outcomes aimed at supporting internal culture. It has been shown time and time again, providers who feel well taken care of are in a better position to care for others. Improved clinical outcomes will follow.

How to measure the outcome: employee satisfaction, employee happiness, employee use of internal social platforms, operational efficiency (read up on knowledge workers and how inefficient email is in supporting them)

  • Improving Patient Experience - People want to be taken care of. I paraphrase Dr. Bridget Duffy almost daily: "Most people cannot evaluate the quality of their medical care, but everyone has the ability to gauge their experience." Chalk it up to consumer choice increasing as a trend in healthcare if you are feeling pragmatic. The bottom line (pardon me while i step up onto my soapbox) is experience matters. We've all been in a meeting or discussion where someone references Malcolm Gladwell's vignette on physicians and time - spending one extra minute with a patient reduces the chance of a law suit by 60%. If the numbers don't appeal to you, how about the heart? Yesterday, Dr. Atul Gawande tweet this:

How to measure the outcome: HCAHPS scores, patient survey results, share of voice reports, customer loyalty, customer comments, number of hugs given

  • Clinical Quality - What would a conversations about outcomes be without talking about clinical outcomes? For the sake of clarity, I'm going to refer to clinical outcomes by its kindred synonym, quality. If I'm being altruistic about internal culture and passionate about patient experience then let me be explicate about clinical quality. One of the most important outcomes of the use of social media in a healthcare setting is to support improvements in clinical quality. Social media has already been demonstrated to improve access to care and improve adherence to treatment plans.As the race towards Accountable Care continues, or at least makes a pit stop at pay-for-performance models, what can social media tools do to help improve population health? I've written before about the idea of culling lifestyle behavior, for example gym checkins on foursquare, to monitor and reward healthy behavior. Does the time argument go away when sick visits become a financial liability rather than a source of profit?

How to measure the outcomes: impact on behaviors, increase in preventative wellness visits, decrease in sick visits, decreases in readmissions, cost savings, population health advancements, the list is nearly endless...

The argument for clinical quality as an outcome of successful, meaningful social media use is worthy of a post on its own (coming soon). So, I'll leave with these thoughts from two social savvy practitioners.


Dr. Howard Luks wrote on his blog about his use of social media and its value to his practice:


…my presence online is to support the spread of meaningful, trustworthy, evidence based (when available), actionable information and guidance to patients and consumers from around the world.  I am personally not looking at my engagement  from an ROI perspective… I continue to feel that physicians have a moral obligation to fill Google’s servers with quality content to drown out the commercialized nonsense that exists online today … but for those of you in search of bringing patients in your door

Dr. Luks goes on to make the point that having a meaningful presence has helped drive patients through is door and has resulted in a financial gain. Yet, he has clearly found his why in providing information and access while allowing the financial upside to simply happen on its own. Simon Sinek would be proud!

How's this for a why:  Dr. Wendy Sue Swanson often speaks of the responsibility physicians have to use social media. She expresses her passion as follows:

"I believe doctors have an ethical obligation to share opinions online. I write about my experiences at home and at work caring for children. I translate science and share the journey of motherhood, illness and wellness."