Thursday, 2 April 2009

Pull vs Push; Twitter Case Study - 90 day project

One of the mantras of working out how to implement good practice more widely is "pull don't push". This refers to the need for potential adopters of a good idea to "pull" the information to themselves and then to act on it. This is a very different dynamic from the "push" of sending out case studies, instructions or clinical guidelines and then expecting others to implement the recommendations. (I wrote a paper on this topic with Paul Plsek in 2003; S. W. Fraser & P. Plsek, "Translating evidence into practice: can it be done through the process of spread?" Education in Primary Care, May 2003)

Theory is often interesting and sometimes useful. Practice is usually difficult and never quite what you expect. Thinking about "push" vs "Pull" I decided to run my own 90 day project to see what I could learn about enabling "pull".

This blog is both about Twitter as well as about a 90 day project process. If you don't know what Twitter is then check out this video:

With Twitter you share information, 140 characters at a time, with those who follow you. You also get to "listen" to those who you follow, and if you like, you can forward on their messages to your own followers (called retweeting). It is easy to follow someone; do a search for names or keywords you're interested in and then click on the "follow" button. You may also see a message someone has put up and then decide to follow them.

But how do you attract followers? How do you get a pull? This was my project question.

90 Day Project Aim
To get my profile in the top 100 of England and top 100,000 of all Twitterers (of a population 2 million and growing). I chose a ranking rather than a number of followers as I felt this is more aligned with my intention and context. A bit like choosing to reduce hospital costs by having no infections, rather than counting the number of infections. One of the complications of measuring ranking is you have to keep up your position in an ever increasing pool (the denominator is increasing rapidly).

On 27th December 2008 I had 7 Followers. On 2nd April I had 347 followers. Average growth per day was 8 and the current trend predicts 536 followers within 30 days. I have used to measure progress. My ranking worldwide is 79,492 and within England it is 79th

  1. It really does work to learn from where other have gone before. I was 45 days into my 90 day project before I realised I hadn't practised what I preached, namely discover the existing good practice. Only then did I search for other's experiencing of generating a pull and adopt some of their ideas. This helped, though it was not enough.
  2. It is possible to get started (on Twitter and I believe anything else) without knowing exactly how you're going to do it. For me, the act of the 90 day project meant I had to learn how the technology and system worked. It focused my attention.
  3. Measurement is crucial. I check on a regular, sometimes daily basis to see whether my actions where having an impact. Ok, so this is easy when there are systems in place to do the measurement, though I would find it hard to know what was a successful strategy without this. After a while I began to see pattern in the data which matched my Twitter behaviour. Quite amazing really...
  4. A "pull" is about adding value. No-one is going to follow unless they have a reason to do so. Equally, they can unfollow at any time (and I had one wobble when the graph slipped back due to unfollows - largely due I think to me unfollowing a lot of people - we sort fo went into a negative slide). So I have started to learn how to create a pull through a virtual medium communicating only 140 characters at a time. So if this was a non-Twitter project I would still think about what value am I adding for others and how succinctly can I communicate with them in a way that works for them
  5. The social process of retweeting is important. I am valuing others' messages and sharing - then they do the same. As humans we are inherently social. Encouraging trust, openness, enabling and allowing connections and networking seems to be fundamental. Why should I expect anyone to follow me if I don't share, put others' messages forward (always attributed) etc?
  6. I put my Twitter link on my email signature, added a button to my website, integrated it with my three blogs. What I am seeing is the links between these online activities and how they feed one another. Using a variety of tracking software I can see which ones are triggering followership. Maybe for other 90-day change projects it is important to think widely and outside the direct scope of a project in order to influence change.
  7. One of the scary things about a pull vs a push is you're not in control. Yes, I can see who follows me and I can then choose also to follow them or not, I can also block people. However, by letting go I have discovered some new contacts, new people that I would not have encountered before. Yes, I have also encountered some fairly random followers who I see no reason why they should follow me. But who am I to judge? And that is the point.
  8. When it came to updates I tried to be regular and consistent (something every day or two), aimed not to overwhelm at any stage and to tread lightly.

What will I be doing in the future

I will continue with Twitter as I find it useful. I've now set a different goal which is about quality rather than quantity. I want to test the next stage of "pull" - where something gets acted on as a result of a "pulled" tweet. This won't be easy to measure. I was fascinated by the recent example of this type of "pull-action" from Stephen Fry and Twitter. At the time he had around 352,000 followers (he is in the worldwide top 20). One day he tweeted a link to an Open University website / game. This OU page / game then got 52,000 hits in a single day. Around 15% of his followers acted instantly on a tiny fragment of a message. And the numbers were big.

If 15% of clinicians, professionals and managers in healthcare acted almost instantly on a message they had pulled, I wonder what might be the impact? Scary, huh...

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