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 Lucks. 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

Thanks to all those who participated:

• Dr. Jeff Livingston aka @macobgyn
• Christine Kraft  aka @christinekraft
• Dr. Val Jones aka @drval
  
• Jon Richman  aka @jonmrich
• Nick Dawson  aka @nickdawson
• Liza Sisler  aka @lizasisler
• Greg Matthews aka @chimoose

And a special thanks to the producers of the event:

• Meredith Gould aka @meredithgould
• Tom Stitt aka @tstitt

Finally, and to reiterate what I said at the top of my segment in the audio cast, thank you to the #HCSM community. In the last year we have laid the ground work that is changing the face of healthcare. Every day this group comes up with new ways to improve the patient experience. After all, we are all patients.

As an experiment, what is the first thing that comes to mind when you see this image?

How long does it take to register “STOP” in your mind? Probably longer even than it takes to put your foot on the brake. Call it Pavlovian, but the truth is that our brains are wired to process visual stimulus very quickly. The “decompression” of the meaning of a red octagon is highly efficient.It takes very little effort for us to decode the message behind the sign.

Now examine a sonnet from Shakespeare:

There are two challenges to texts as ethereally magical as those from Shakespeare. The first is the creation of the written words. To take a simple phrase – ‘I cannot figure out if it’s my heart or eyes that love you more’ and transform it into:

Mine eye and heart are at a mortal war
How to divide the conquest of thy sight

requires a substantial amount of intellect. The effort required to “compress” the emotional sentiment associated with the text is staggering. It is probably our appreciation for that effort that causes us to always conjure mental images of poets gazing into the distance, quill in hand, always thinking more than writing. It is not just poets that have the challenge. Writing is simply hard work. Ask any good editor . To take an idea and translate it into text that, hopefully, the majority of your audience can understand is not a simple thing. Your audience, in turn, has the job of decompressing what you have written and recompiling it into a cohesive thought. Its a lot more complicated that drawing a stop sign to write about something as complex as love.

Video has emerged as pretty comfortable middle ground in the compression/decompression challenge. From a decompression standpoint, videos require fairly low “processing power”. That explains why so many of us are glued to the TV every night. The entertainment value is high compared to the effort we have to put into it decoding it. Practically speaking, the “how two” video has a lot of advantages over a text book. Julia Child understood this very well. Showing someone how to truss a chicken is easier on both parties than writing about about it. To truss a chicken you first tuck the wing tips into and under the wings themselves. Then you have a complicated procedure of wrapping one long string around the bird in a way that both closes it up and forms the perfect roasting shape. On second though, let the folks at HowCast show you how…

Video, as it turns out, is pretty efficient in both compression and decompression as a means of interacting with media. It is worth noting that audio, as in the spoken word, also fits nicely into this niche. Both require less effort than text to create and less effort for an audience to decode.

In a healthcare setting, one of the biggest challenges to the adoption of social media is time. It is fairly easy to convince people they have something worthwhile to talk about. It is another thing to get them to take the time to do it. Doctors, executives, department heads, etc all have the same excuse “who has time to blog or tweet?” I wonder if what they mean is ‘I don’t want to have to write a term paper every week!’. But what about 30 second audio blip, or 2 minute video? How hard is it to stop a doctor in a hallway, stick a camera in their face and ask for three health tips? OK, maybe it feels funny to do it, but the effort required to capture that moment is pretty low. From an audience standpoint, no one has to read a bombastic (ahh humm, you are still right this, right?) post about health tips; you get the “how to” video and nothing else.

With that in mind, I present a Phil Baumann styled list of 10 things you can try for easily compressed and decompressed social media posts (in no particular order)

1. Sign up for AudioBoo - AudioBoo is a site that allows you to record (via computer or smartphone) an audio clip and instantly post to many social media sites.
2. “Three Words” campaign – every day, stop someone in the hall and record them giving their name, job and 3 words that, to them, represent the organization. Do themes, like heart month, and nursing week… Use audiboo, an iphone, a flip camera…
3. Doc on the spot – stop a doctor, record a 30 second health tip. Make sure the doctor mentions their specialty and how to follow up for more info. “Hi, I’m Doctor Jones with a quick tip for sleeping better…. want to know more, tweet us your questions…”
4. Roving reporters – Distribute inexpensive flip video cameras everywhere. They are inexpensive. Send them around the hospital and ask people to be “roving reporters” – every week, send out a theme or question and ask for people to interview co-workers. Compile the videos and post online
5. Physician updates – Imagine a family member in surgery. Have the doctor record updates as audio clips that can be shared with family members who are not in the waiting room.
6. CEO minute – a daily update from the CEO on the most important things on his desk that day. It is a glimpse into his world (and ultimately what is important for the organization). It does not take the CEO more than a minute to record, and the staff more than a minute to view. He or she can even produce it from his phone on the way to work.
7. Show the way – record a time-compressed video of how to drive from major intersections to medical practices.
8. Share the health – allow interested patients to record doctor advice during appointments including advantages and disadvantages of treatment options. Remember that your patients have a network too, help them help their friends (and it doesn’t hurt your image either)
9. Employee recognitions – record spontaneous employee recognitions. Have someone to recognize? Take a video camera, bundle of balloons and their boss along to that person’s work area. Record the recognition and share it – tag them on appropriate networks so their friends and family see how important they are to their employer.
10. Photo of the day – ask employees and fans/friends to contribute to a flickr pool. Re-broadcast one photo a day. Again, remember themes and important weeks.

Have some more suggestions? Post them in the comments!