I had the privilege recently of being asked to write a short reflection on the use of social media in healthcare. I suggested many of us are moving from our freshman year – getting familiar with campus, determining which is the cooler spot to hang out at, facebook or twitter… you get the idea – towards our sophomore and junior years. For many providers, this year is about figuring out what to do next. What will actually bring value and make using social media in healthcare, well, meaningful. What are the meaningful use guidelines for #HCSM?

In late 2010, the federal government released a much anticipated set of guidelines around how healthcare providers should use electronic medical records. The guidelines, know as Meaningful Use, specifically spell out what features an EMR must contain and how doctors must use those features in order to qualify for federal stimulus dollars. For instance, the guidelines suggest providers council every smoker on smoking cessation. The software must be able to prompt doctors when someone has identified as a smoker and it must be able to capture that the physician has spoken to them about quitting.

Meaningful Use says it is not enough to simply have an electronic record. Meaningful Use says the EMR’s feature set and how it is put into practice determine the impact it has on care. Today, we can say the same thing about social media in healthcare. With heartfelt thanks to the pioneers who fought the HIPAA and ROI battles, it is no longer enough to simply have a facebook page or twitter account. There are expectations around engagement, user experience, quality and value which users have come to expect through interactions with other individuals and organizations.

The good news is that there is no single correct way to use social media and digital communications as a provider. There are, however, a few basic ideas which I boldly offer as guidelines for using social media as a healthcare provider:

• Be available – Phil Baumann said it well. You do not need to be famous online, you just need to be available. In fact, the rest breaks down if when this guideline is not followed. It has been said many times by many people, social media is less about pushing and more about pulling. If you are not open to conversations with the public, patients, other providers, etc then social media may not be for you.  As guidelines go, this one may be the most significant for meaningfully using social media. Being available is more than just replying to tweets. Availability means knowing who within the organization can answer the question authoritatively; It means having a team of on call experts. I know at least one healthcare thought leader who envisions call centers giving way to tweeting centers. Have the capacity and expertese to follow up with your tweets, comments and facebook wall.
• Bring Value – There is an easy litmus test for this one. Think: “why would I follow or fan a company?” Most people get enough spam email and junk mail. Can you honestly say you would want to get the message you are pushing out if you didn’t work for the provider pushing it out? If not, then it is probably spam. So what kinds of things bring value? Think about curation, sharing expertise, answering questions, helping someone find what they are looking for. Here is a simple way to bring value: go to search.twitter.com and select advanced search. For the search string, enter something like “doctor” and then put your zip code in the location field. Chances are someone in your area is looking for a good doctor. Reply and offer to set them up with a same day appointment. Now that’s value! Another example includes hosting diagnosis specific communities and wikis with clinician participation. Imagine an online community of folks who have been and are about to go through an orthopedic joint replacement. What kind of value would they get from connecting with each other and sharing experiences in a forum moderated by a clinical expert?
• Liberate your expertise – Most physicians go through at least 4 years of medical school and post graduate education. Many pursue fellowships and residencies. There is a significant amount of intellect and scholarship trapped in those brains of theirs. Here is the problem, until there is something wrong with me, I have no way of tapping into that knowledge. We often mistake holding onto our ideas and knowledge as power. The reality is the opposite. Those who are willing to share their expertise often find the rewards to be considerable. If you are a physician, you are a trusted expert in your field (the same can be said of provider organizations). Your use of social media must consist of sharing that expertise. Provide your opinion on the health news of the day. People would much rather get that expertise from someone local and trusted than an etherial disembodied name on the byline of a major news paper. Here are two great examples: Dr. Howard Luks and Piedmont’s HealthWatchMD site.
• Be collaborative – engage publicly with other physicians and experts (and can’t patients be experts in their own conditions?). If you are an expert individually, and there is indeed benefit to liberating that expertise, imagine what happens when you team up with other experts? In medicine there is the concept of grand rounds – opportunities for physicians to present complex cases as learning experiences to other providers. Today’s social tools are perfect platforms for grand rounds. The more providers are willing to interact and share, the more we all benefit. This collective knowledge becomes searchable, accessible by anyone – patient or provider – who wants to learn more about a condition or treatment. Dr. Gayle Smith does a fantastic job of collaborating with patients and colleagues.
• Be Innovative - Innovations come in many forms; not everyone has to be the next iPod. Think about how social and digital tools are being used outside of healthcare. What applications might they have in improving health and patient experience? Over 500 million people are using facebook. According to their statistics, 250 million access the site from a mobile platform and mobile users access the site at least two times a day. What does that tell us about the role mobile platforms play in what has become the most significant communication tool of our age? Do you have a way to interact with patients via a mobile device? What about text messaging? There is an innovation which is easy to adopt. Solve problems, don’t get hung up on them.

There you have it. How is that for a start? As we start to go beyond simply being online it is time to think about how to have an impact in what we are doing. What other guidelines would you propose? What about from a patient’s perspective, what makes social media meaningful?

So, let me get this out in the open. I’m not a social media advocate. I’m not a social media guru, expert, thought leader, or zealot. I am not pro-twitter. I’m not really that into Facebook (please don’t unfriend me!). You might be surprised to read that I’m not always looking down at my phone. Maybe I am. But still.

I am an advocate for care. I am an aspiring healthcare guru, a wanna be expert, a hopeful thought leader and unabashed zealot for improving the patient experience. I am a pro human. I am really into making someone’s care experience a holistic one. You might be surprised to read that I like to spend part of my day greeting people at the door of our ER.

When did social media become about, well, social media? When we we decide that talking about what we are talking on was more important than what we should really be talking about? I’m not an angry blogger, I promise. And I’m not singling out anyone or any post either. In fact, there have been some important online discussions recently about the validity of social media in healthcare.

But, isn’t it really about healthcare, about care. I mean, if its not, why are we interested? I’m guilty of getting wrapped up in frenzy; and suspect we all are. This is my call to action, my reminder to myself and my sincere wish – lets keep it about advancing how we care for others. We do that in many unique ways. Doctors do it differently from nurses, who do it differently from patient advocates, who do it differently from mental health professionals who do it differently from us admin types, who …. well, you get it. Still, we are all focused on improving the experiences and outcomes of those we care for. When we start talking about the 1s and 0s that our bully pulpit is made of, we’ve lost some of our effectiveness.

Be health champions first. Let’s be champions of care first. Let’s focus on using early adopter, expert, and guru status to champion what it is we are really doing – elevating the art of healthcare.

epilogue: Now, I know what you are thinking. Wasn’t my last post on this blog a hubristic, aggrandizing, self-promotional link to an article where I was quoted as being some kind form of thought leader? I see where you are going with that though and I agree. I’m talking to myself in this post. In fact, when I forget about this altruistic nonsense, I expect you (my two readers, hi mom!) to call me out. I’ll also add that those kinds of articles and posts are important. They are ammo in our arsenal to promote the use of social media – we just need to remember why we are so keen to promote it in the first place.

The November issue of the Catholic Health Association’s Health Progress Magazine includes an article on social media and healthcare. Social Media: New tools boost marketing, education, community, by William Sweetland and Susan Thomson is available on the CHA website as a pdf.

I had the privilege of being interviewed for the piece. I find being asked certain questions prompts me to think about my own work in a different way. That was abolutely the experience I had when Bill Sweetland asked me about the intersection of Catholic healthcare and social media. I am not catholic and have only worked in catholic healthcare for a little over 3 years. When I made my transition from the consulting world back to the provider side, joining a not-for-profit with an emphasis on customer experience and community health was a no-brainer. When we formed our social media program, the same tenants that govern our mission and values went into guiding our social media program. It was a fun exercise to see just how much overlap there is between social media and mission-driven, community focused healthcare.

At Bon Secours Richmond Health System in Richmond, Va., Nick Dawson, administrative director for community engagement, has so far figured out that his goals for social media include “improving the patient’s experience” and “giving away” the hospital’s “vast scientific medical knowledge to promote holistic healing and wellness.”

Wait, give away core expertise? Isn’t that counter-intuitive?

“Isn’t there a saying that tells us that if you give away your riches, your core competence, it will come back to you many times over? It’s a funda- mental truth when you think about it,” Dawson said. “And social media can help us do that” — educate patients and the public, in other words — “in a big way.”

Remember when rock bands would storm the radio station, taking over the morning zoo? They had totally free run of the place. “Dogs and cats, living together, mass hysteria.” Well, at least that’s how it seemed to me circa 1993. In the end, it was just one of many marketing and promotional tools used by bands to tout new records. However, there is a kernel of validity in handing over the controls from time to time. When the same idea is applied to healthcare social media programs, the result are fresh voices and perspectives, deeper explorations of topics and a group of employees who are more capable of representing the organization online.

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.

“Most patients want the high tech and a great quality outcome, but they can’t judge the quality of the [treatment] they can judge the quality of the experience…” – Bridget Duffy, MD

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.

After a twenty year stint in the U.S. Air Force as a medical records expert, Bob Ross was destined for a life in healthcare social media. Somewhere he got sidetracked.  By some accounts it was when the Air Force stationed him at Eilson and he first saw snow-capped mountains. Destiny being the fickle force that it is took Bob’s life in another direction. Today very few of us think of Ross as an Health Information Management (HIM) guru. Instead we remember him as the the afro guy who had the painting show on PBS. But, I think, were he still with us today, Bob would confirm my suspicion that he was really just preparing us for the social web.

The Bob Ross Theory of Social Content Management is simple: Let your content live where it naturally wants to live and embed it in your own happy place.

Or, as I call it at work, the argument for having our own blog site. Social networks are by definition communities; and communities are all different. It is what makes life interesting. It is also what makes the initial entree into social networking a challenge for many healthcare organizations. Is it Facebook or Twitter? What about YouTube? Should we really be giving all that traffic away (does traffic really matter anymore)? The answer is more simple that it sounds. Let the content live where it wants to live and embed it on your blog.

Having a blog-type site is more than just having a place for long from posts. They are the blank canvas for our own social media oil painting. One of the biggest advantages of a content management system like WordPress is the ability to aggregate all of your social web efforts. With a blog site, or “social hub” as we have started calling our site, content like videos can live on sites like YouTube. The advantage is that you can present them on a site you own and control. It also lets you showcase them alongside your other social content like photos from Flickr, audio from AudioBoo, presentations from SlideShare, etc.

There is another distinct advantage to The Bob Ross Theory. As hospital web content expert Ed Bennett often points out, YouTube is the third most visited site online, making it the second biggest search engine (after its parent, Google). Ed is also quick to share the tip that the more information you populate about your video, the more likely it is to come back as a search result. Where else would a happy little video want to live? Once uploaded, you embed that video on your blog site and share your own link via twitter or facebook, but the video still lives on YouTube. It is the best of both worlds.

The Bob Ross Theory is not limited to videos. Flickr is the 34th most visited site and second largest photo site after Facebook. Lets put a happy little photo right there. Now add some tags, a description and presto, it becomes a search result on Yahoo!. When you want to share that photo or slide show, you embed it as a blog post and share that link.

Pretty soon your blog site is not such a blank canvas, it is full of happy content. When prompted with: ‘Bob, everything in your world seems to be happy.’ Ross replied: “That’s for sure. That’s why I paint. It’s because I can create the kind of world that I want, and I can make this world as happy as I want it.” 1

For more information on getting started with a blog site, take a look at Lee Aase’s SMUG site.

1 Wikipedia http://en.wikipedia.org/wiki/Bob_Ross

On Sunday, January 17th, as a group we celebrated the one year birthday of #HCSM (pronounced “HIC-sum” by those in the know). The event was a special 2 hour chat that included a first ever live audio component. Lee Aase, Director of Syndication (and social media) for the Mayo Clinic and Dana Lewis moderated. Seven participants, I was proud to be one, spoke with Lee and Dana on the state of and future of social media in healthcare. You can listen to the event via the player below or download it as a podcast into 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.

What happens when you need to get a message out to a lot of people quickly? You turn to your friends and fans.

What takes longer, teaching a doctor to tweet or sticking a microphone in their face and asking a question? I have been thinking a lot about efficiency in the way we interact with media. Techy types often have the same thoughts about data storage – compression and decompression. What is the most efficient way to record a file to a disk and then read it back? It is not a stretch to think about our relationship with media in the same way.

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!

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.