It was a classic childhood scene, a mom pulled her young daughter in a cherry-red wagon. Both had smiles as broad as a their faces would allow. When they made the a turn to the left, a young lady stooped down to the daughter’s eye level and said something that put them both in a fit of laughter. There was something really special about how much fun they were having. It’s a simple thing really, but aren’t wagon rides kind of a childhood rite of passage? That wagon can be anything – a pony, a space ship, a semi truck or just a plane red wagon.

The young lady stood up, adjusted her scrubs and went back to the nursing station. Mom and daughter turned the corner for another lap down the hospital floor hallway.

Have you ever stayed in a hip, boutique hotel? You know that cool thing they do with glass walls and bright lights? Well, that’s pretty much exactly what I was not expecting when I stepped off the elevator at the University of Minnesota’s Amplatz Children’s hospital. My friend, J, was giving us a tour. He explained each floor has a story teller character, some animal who’s image is repeated as a design theme throughout the floor. The wall was bright orange and yellow glass. If there had been club music I would have assumed we were, in fact, in a W hotel.

“The whole place was designed with onstage and offstage spaces,” J explained. An onstage space is patient facing, it is their space where staff are expected to play the role of compassionate caregivers. Fred Lee, author of If Disney Ran Your Hospital, would be proud. Offstage spaces are where staff congregate, or push noisy carts – the kinds of things which wake patients up at night or remind you that you are in a hospital. The idea of onstage and offstage goes deeper than having a separate hallway for food service delivery. Being onstage reminds staff they are, in many ways, a guest in the space. Families, particularly in a children’s hospital, settle into their rooms and the surrounding environs. Being onstage means always playing the part of someone who loves children, and serves families, and provides care, and doesn’t mind getting a cup of shaved ice for the third time that hour. Need to huff and puff about it? Take it offstage.

“You know, it’s funny, everyone thinks I’ve gotten into IT… I haven’t, I’ve gotten into connecting people and making the experience for these kids a little less scary.” J played a considerable role in the design of the hospital. One of his many contributions is the design and implementation of a state of the art video conferencing system. The system, available in about half of the rooms, consists of a wall of video monitors, including a 42″ screen, and a motion tracking video camera. From a bedside touch panel, kids can dial up family members who may be hours or many miles away. Some kids have even been able to attend school using the video linkups. “It’s a way to maintain some sense of normalcy and connection, ” J told us. Amplatz is a regional draw, servicing a wide swath of the midwest. Video conferencing can enable the dad who can’t take off work to talk to his child several times a day. Doctors can plug in a computer on wheels and do a split screen between the patient, the parent and the medical record, effectively hosting a virtual care conference. How cool is that?

I’m with J, the people aspect is by far cooler than the enabling technology. And the technology is impressive to be sure. The design aesthetic is also – and I say this with no hyperbole – the best design I’ve ever seen in a care space of any kind. But what really stands out at Amplatz is the atmosphere, the total package. It’s not the iPod docks, rainbow walls, x-box enabled video conferencing onstage touch screen dohickies…. it’s the utter selflessness that working around sick kids demands. You simply cannot bring your own baggage onto a floor where a family is fighting for what could be their last hours or months together. Kids level the playing field. Check your ego at the door.

Why does it work so well at Amplatz? I’m not entirely sure. There is undoubtedly some combination of culture, training, design and technology which enables the care environment. There is attention to design, particularly around experience. Hospital committees met and drew the initial brush strokes. A parent’s council then came in and refined the ideas. The ultimate decisions, however, were made by a council of children patients. It’s pretty hard to get the typical non-patient-centric committee compromises when patients get the final review. Clearly, you also have to give staff room too. I don’t mean physical room, but rather latitude to be empathetic, personable and compassionate. I didn’t get to observe the culture long enough to understand how Amplatz enables culture, although it is clear they do something right for their staff.

Every healthcare provider has a responsibility to be as good as Ampltaz. Here are some of my key takeaways from our short visit:

• Patient centered design with patient input and review
• Onstage and offstage spaces
• Give staff permission to be empathetic (here’s an example, at Ampltaz, any patient care conference supersedes staff conferences. If staff are in the conference room for a meeting and a provider wants to discuss care with a family, the staff all leave and reschedule their meeting…wow!)
• Enable connections, relationships and remove fear – that will drive your IT choices rather than letting them drive you
• Don’t be afraid to have fun – the space was fun. There were games everywhere. Each room had an Xbox! Why do we paint hospitals in muted tones and use dim lighting? No one wants to convalesce in a depressing cave.

The University of Minnesota Amplatz Children’s Hospital is a joint venture between UMN and Fairview Health System.

You can follow Amplatz on twitter here.

Part 2 of a 34-part series
The next level of growth for healthcare social media, must come from within the organization and involve all employees in the effort.

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…

Part 1 of a 3 part series

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

So you have a hospital blog, now what? The more contributions you have to your social media effort, the more engaging you will be. No one is an island, and it would be nearly imposable for one person to represent an entire hospital or health system. Fortunately, the nature of social media is that everyone can join in the fun.

A model of which I am increasingly in favor is the “Pipeline” approach. The pipeline is where many contributors funnel in various media (video, written posts, photos, etc) into the effort. Those contributions can live on which ever site is most appropriate (IE video on youtube) and be aggregated and embedded on a centralized, branded “social media hub”. Sharing.mayoclinic.org is a great example of a social hub. They then become the fodder of tweets, facebook updates, etc.

As interest in social media grows and marketing funds disappear, service lines and departments are clamoring for support. We answer that demand by asking those interested to become contributors – part of the funnel of content, the pipeline. When an department or service line is identified, we share a guideline document with them. The guide highlights the social media program and establishes expectations for time commitments and content.

The example below is not fancy or even complete (what about policies and a review process?) but it may help serve as a launching point for those creating their own pipeline of social media contributors. This is a de-identified and simplified version of the document we use internally, please forgive the generic name and branding. It can  be downloaded and used under the creative commons guidelines.

Social Sharing guidelines by Nick Dawson is licensed under a Creative Commons Attribution-Share Alike 3.0 United States License.
Based on a work at www.nickdawson.net.

Ask any kid who they would list as heroes and role models and my guess is that pilots are on that list. I bet doctors are too. Ask any adult what they think about traveling or going to see a healthcare provider and their reaction may not be as awe inspiring.

If you had asked me two weeks ago if I was excited for vacation, I probably would have given a reluctant “yes”. That reluctance would have had nothing to do with how the week turned out (knee injury). The stress in my voice would have everything to do with the travel. I will admit it, six years of crisscrossing the company consulting for hospitals left me a little discontented with the airline industry. Here is the kicker, there are a lot of similarities between the airline industry and healthcare and its not because of the fares.

I am convinced, but hopefully not jaded, that airlines will always drop the ball in some regard. It may be lost luggage, a botched seat request, delayed flight, or more than likely ornery crew. Seats are littered with trash and crumbs from the previous flight. Ever walked up to a gate agent who is too busy typing to look up? Its become a cliche! What about flight attendants who roll their eyes at passengers trying to lift bags into the bins? In short, it is not an industry where many people expect world class service. A lot of the issues are surrounding the belief that airfare is the number one determining factor in how passengers pick an airline. To race to the bottom means cutting a lot of employee benefits. The Gallup organization will attest, that employee satisfaction is the key driver in providing good service.

The airline industry has had a lot of pressures that have resulted in over stressed and overworked employees. Fuel costs, decreased volumes (following 9/11) and telecommuting technology mean less people are traveling. To cut costs, some airlines have merged, filed bankruptcy and restructured. Restructuring often allows them to work employees longer hours and on less wages; not the kind of thing that makes anyone happy to serve customers. As an example, some airlines have dropped contracts with cleaning crews in favor of having flight attendants clean the cabins- all the while doing so on wage cuts. I do not offer that as an excuse for poor service, but only to shed some light on the surly attitude of the front line staff.

Ask any kid who they would list as heroes and role models and my guess is that pilots are on that list. I bet doctors are too.

What does that have to do with healthcare?
If doctors really are still our healthcare heroes, what does that make the rest of the the professionals in the healthcare industry? We have reservations, thats the scheduling department. We also have ticketing agents, we call them Patient Access. From there, it may be a little more nebulous but I suspect readers can find appropriate analogies for flight attendants, luggage handlers, mechanics and executives.

Most patients interact with the front line staff – patient access, nurses, etc- far more than they see the doctor. Frequently the interaction we get with the ‘hero’ is not much different than the overhead announcement and the casual goodbye while you deplane. That means that our front line teams hold the entire experience in their hands. Botch the reservation or roll your eyes at check-in and you have ruined the patients entire ‘flight’.

Healthcare has very similar stresses. While it may not be fuel costs, providers are struggling with lower reimbursement. In many markets Medicare pays less than the cost of procedures. The industry has built a business around group health plans making up that difference, a hidden tax on employers and patients. Other markets are facing the threat of unions who’s contracts limit what someone can and cannot do as part of their job. Ask a union nurse to take away the tray of food and you may be surprised to hear that he cannot, he has to call dietary services. Of course dietary services cannot clean up the mess, that is the role of house keeping. Not exactly a seamless service experience but probably something that sounds very familiar to unionized airlines.

How do we change course?

Barack Obama has set the tone for this generation – a time of change. His campaign may have been one of the greatest grass roots efforts in our democratic history. One of President Obama’s clearly stated goals has been healthcare reform. While I personally believe that the administration’s focus is on the payor side of the industry it does not recuse providers from examining their owe practices. (It is also worth noting that during the election Obama was the number 1 twitter user, with the most followers.)

If providers do not own their image and cultivate a service culture, then they will find themselves in the same position as the airlines. Patients may come through the doors, but they only praise they will be singing are about the ‘heroes’, the physicians. The only way to change that future is to take the reigns and effect change in how the organization presents itself. It starts with employees who want to come to work and represent you on the front line. Ask them what they need to in oder to do that for the organization.

James Gillmore and Joseph Pine, in their work The Experience Economy assert that good service is tantamount to success. Experience Economy spells out the importance that front line staff plays in giving the customer a seamlessly wonderful encounter. Like the Ritz-Carlton’s goal, providers should strive to fulfill every customers desires, spoken or unspoken. When we see someone who looks lost, stop and offer to help. Do not be the flight attendant that watches the elderly man who cannot lift his bag. If you are a physician do not be late. When passengers hear ‘weather delay’ and see blue skies, it does not matter what the true cause is; they are not getting where they want to be. This is the time, as has been discussed here before, to start connecting with all of the healthcare constituents outside of your physical walls. The tools are free, all it takes is the willingness to use them. Lets ask ourselves how we would want to be cared for, then do that!