Designing social media impact; a challenge for healthcare improvers

Social media is the in thing in healthcare organisations - Twitter, Facebook, LinkedIn etc. These systems have been around for 5 years or more but are now catching on in healthcare as they are seen as a method for sharing messages quickly and a way to bring diverse and segregated communities together. And this works well.

The challenge is to integrate the use of social media into the mindset of the quality improver.  The Improvement Model asks three questions - all of which are relevant for social media use:

1. What are we trying to accomplish?
2. How will we know its an improvement?
3. What changes can we make that will result in an improvement?

If you're starting out using, say Twitter, and you're in a healthcare quality improvement role the have a think about:

• What do you want to achieve? What is your purpose in using Twitter? Do you want to discover new info from others, link to others, use the media as a broadcast system, raise awareness, raise your own profile... etc? You need to have a purpose.
• How will you know it's an improvement? In the Twitter case, how will you know whether you are reaching your purpose / objectives and in a way that's better than what you do now? It really helps to think about this.  How will you measure your progress? How will you learn? Will you be using an analytics system to learn about what works (classic PDSA processes work very well for understanding how Twitter can work for you).
• Linked to the measures above, how will you maintain your learning and continue to get better and better at using Twitter?

In my experience it's best to thing through purpose and practice as part of starting on the social media road. An online social media account where nothing happens tends not to be a good strategy.

Knowledge Worker 2.0

I continue to fret that the dominant model for understanding healthcare organisations and in defining methods to improve them, comes from an old fashioned industrial process methodology (Lean). I think this continues to hold the stage because it is easy to understand a process and to make charts that count things. It makes us feel better.

But healthcare is not only a service industry it is one based on relationships. The workers are predominantly knowledge workers.  And the role, the use of and the ways in which knowledge workers connect is changing rapidly.

If the whole concept of the knowledge work is an unfamiliar one then have a look at the presentation below. And if you role is one of making improvements in a system then think about how you might go about such changes when you conceive of staff - and patients - as knowledge workers.

Knowledge Worker 2.0 - Power to the people from Stephen Collins

When an app becomes a care plan and a pathway co-ordinator; Asthma AWA

This is a guest blog post from Howard Last. He contacted me after my spate of reviews about healthcare apps. He's provided more information about the asthma web app AWA.  If you'd also like to guest blog then please contact me.

Putting the ‘technology horse’ before the cart was our aim in developing the asthma ‘web app’ (AWA). It is, regrettably, so often the other way round. I work as a GP in an inner city area and was acutely aware of the needs of patients with asthma and the shortcomings in provision of asthma care. I also have an interest in I.T. so it wasn’t long before I wondered how we could use I.T. to address these clinical needs. Making use of Web 2.0 we developed an ‘app’ which tackles the major issues contributing to poor asthma control: inhaler technique, patient education and provision of a care plan.

The provision of a care plan in particular is one area which needs improvement. The AWA control plan is the key component in the application. Patients without a care plan are four times more likely to need an acute admission with poorly controlled asthma. Yet, only one third of asthmatics have a plan. The AWA makes it much easier for a GP or asthma nurse to provide a personalised plan for a patient during a consultation. Subsequently, patients have access to a web-based version of their care plan either through PC or mobile devices. But it goes one step further. The AWA care plan, unlike a paper-based version, adapts dependent on the patients asthma control, prompting an increase in treatment with poor control or allowing a ‘step-down’ with good control. In other words it promotes self-care.

The AWA also provides an alternative healthcare pathway to the traditional model where patient care takes place in GP surgeries or hospitals. The AWA allows the healthcare professional and patients to interact remotely. This is particularly valuable for the ‘difficult to engage’ patient. In asthma care this translates into teenagers. This is a group who are always resistant to invitations to asthma clinics but for who the use of a mobile phone or tablet is second nature.

I think the success of an ‘app’ depends on two simple principles based on need and data handling. First, there has to be a clear clinical need for an ‘app’. Secondly, collecting data is not in itself sufficient.  Doing something useful with the data for the benefit of patients is the crucial step. I believe the AWA passes these tests. Whether it is innovative, I will leave you to decide.

Howard is happy to be contacted if anyone would like more information about the AWA.

What if managers held end of day briefings like nurses do?

Nurses do briefings at the end of their shifts. I was reminded of this by @nurchat on Twitter as it s one of the topics for their weekly #nurchat tweetup. The reminder tweet made me think - why don't healthcare managers have a similar end-of-day briefing?

The briefings can be managers with their teams, or groups of managers - I like the idea of the Executive team holding an end-of-day briefing session.There are both advantages and disadvantages to holding one, though the only disadvantages I can see are ones about timing.

Benefits

• Reflection on the day's operational activities
• Reflection on personal contribution to the day's operational activities
• Highlight priority issues
• Ensure priority issues don't fall between the management gaps
• Improved communication skills
• Improved meeting skills

Disadvantages

• when is the end of the day for managers (though a briefing can be held at 4:45 for 15 mins)
• perception that the briefing gets in the way of other meetings
• poor briefing skills means it turns into a long meeting

It seems that much of the imperative for improvement and innovations pushes nurses to learning from managers - maybe now is the time for manager to be looking at what nurses do very well, and learn new skills of their own.

January 2013 Thought Leader of the month: Paul Levy

Throughout 2013 I will be posting my thought leader of the month. It will be a personal view, of course, and I aim to recognise those I follow and whose thoughts I appreciate.

My January 2013 Thought Leader of the Month is Paul Levy.

·       Paul hosts the blog “Not running a hospital;” and he is also active on Twitter.  He’s a former CEO of a large Boston hospital and he has things to say – and he says so eloquently and with authenticity. I follow his thought leadership, even though it is USA centric and I am UK based, because he’s not afraid of speaking up when necessary, of praising when deserved and criticising constructively when required. He shares a variety of thoughts, from science, statistics, service redesign, stories and personal stuff too. This means it's easier to understand his perspective. He’s rounded and it’s easier to trust him because you get to understand his perspective. He messed up once at work, at he made an apology public on his blog - that's the authenticity that attracts me as a follower.

There are five articles in my thought leadership series:

1. What or who is a thought leader
2. Being a thought leader
3. Organisations as thought leaders; some healthcare examples
4. Medical Thought Leadership
5. Thought Leadership 2.0

You can vote / suggest February's Thought Leader by tweeting #hcthtldr

Medical Thought leadership

I’m unconvinced whether there is “A Medical Thought Leader” role. Rather, I think there are a number of thought leadership roles for clinical professionals.

·    Clinical area thought leader; this is a professional who is thinking ahead, sharing their views, perhaps innovating in their clinical speciality.  They will be accessing and reviewing both the peer-reviewed and the greyer literature. They balance their thinking with a decent amount of talking about their hopes, dreams, fears and ideas for their speciality.

·    Techie clinical professional thought leader; this is a growing role where professionals are inhabiting the space which used to be reserved for IT geeks. They are writing apps, participating in Hackathon days, and developing idea and strategies for revolutionising healthcare.  They are mostly very active on many social media platforms.

·     Healthcare services clinical profession thought leader; that’s a bit of a mouthful but it means what it says. These are professionals whose interest lies in reconceiving the delivery of healthcare services. Some of these sit on the committees and Boards of their local services so they can use their influence. Others stay on the outside, shouting at or encouraging others.

Previous articles in this series include:

1. What or who is a thought leader
2. Being a thought leader
3. Organisations as thought leaders; some healthcare examples

Is #wenurses THE NHS social movement?

I’m late to the party - #wenurses  has been around for a while; but then. I’m not a nurse. I discovered #wenurses by accident and lurked in the background of a few of their weekly tweetups.  What a joy.  Usually my Twitter feed “nhs” search column has an ever-increasing stream of negativity and attacks on the NHS.  #wenurses is different.

#wenurses is a way for nurses of all disciplines and interests to connect using social media. They can get training in using Twitter, have blogs, resources and are active with tweetups, workshops and blogs.

#wenurses tweetups are Thursday evenings at 8pm. The first tweetup of 2013 was a delight in the endless positive comments about the successes of 2012 and filled with ideas on what to do in 2013. I loved the way someone suggested it would be good to get a CEO to join them. Someone replied mentioning the twitter names of those who may be good to ask. By the end of the tweetup a number of those CEO’s were joining in the chat. That is digital democracy at it’s best.

These are nurses who don’t talk about what’s wrong, or complain about the reforms. They are asking questions about how they can be better at what they do, how they can get help in understanding changes, such as commissioning.  

Is it a social movement? I think it is because:

• There is no organisational or policy imperative that they come together and do something
• There is a simple website around which they can organise themselves on social media; it#s #wenurses website and isn't a subset of another organisation. The branding and identity is clear.
• There are no apparent rules, other than a very good statement of appropriate behaviour for nurses using social media
• It’s self-organising around topics
• It’s driven by the passion of individuals
• The purpose is clear; to use social media to connect the community of NHS nurses, to share knowledge and to provide support.

The friends and family test comes into use in the NHS in a few weeks. This is where patients will be asked if they would like a member of their family or a close friend cared for on this ward, in this hospital, by this doctor etc.  When I’m a patient, I’m going to be looking out for the small #wenurse badge. If I see a #wenurse mug on the desk then I’ll know already that this is a good placed to be.

Consistency of leadership matters

No matter what "evidence" you seek, leadership is always in the top ten of factors necessary for change and transformation of systems of care - or any system for that matter. There are books, papers and reviews all trying to qualify the type of leadership that works well.

I've been asking myself whether length of time in a leadership role makes a difference. When I look about me at the organisations who are held up as role models for good organisational processes, good collaborative working and good results - most often the leadership team has been in place for many years. Not just one leader, but at least 2 or 3 of the team.

Perhaps it important just to be there to hold the history and to maintain some form of continuity. Doing this while everything changes around you means the good leaders are naturally those who learn to adapt themselves  and their organisation, to the changing context.  I suspect they don't have great charismatic abilities, not do they espouse clever theories - they just get on with the job - year by year.

I applaud that level of commitment.

Hospitals as prisons

To compare a hospital to a prison is challenging. Maj Rom, leader in Sweden for the project to improve the experience of life for the Elderly, used this comparison to wake us up, to make us think, to challenge our perceptions.

I found this a shattering concept, but the more I considered it, the more I realised we can learn from the challenge. Where else, toher than in a hospital and a prison do we:
• Have rules regarding who may enter, who may visit and the times of this visit (and even what they may bring in with them)
• Segregation for those with problems (like infections)
• Rows of beds, organised like cells, with a co-ordinating point for the “guards”
• A hierarchy that determines behaviour and where the inmate/patient is the recipient and often seen as the lowest of the low – to be done to be organised, to have rules explained
I could go on, but you know how the list continues. You may even discover that some of the aspects of prison are better than hospital – privacy, own TV, better food etc.) Try it out at your next meeting.  Or better still, walk around your nearest hospital with the eyes of an alien comparing it with a prison.

The challenge is not to make the comparisons, but to figure but what this means to us.  It’s not about criticising hospitals but it is about engaging with what we have created and finding the strength to change what we don’t like.

Rain, risk and redesign

It’s come as a shock to me to discover that teenage cousins in California have a “rain schedule” at school. Basically when it rains, children are kept indoors in their classrooms.  If this were the case in England our children would probably never see daylight!  Rain is seen as bad, something to be avoided – wrong even. Apart from my concern that they are disconnected from the realities and needs of life on earth, I was provoked into thinking about risk and perception.

One of the reasons for the corralling indoors is to reduce the risk of colds and flu (though this is a fallacious one), that they don’t have the clothes for wet weather (really?) and they might slip and injure themselves. We have the health and safety elves in England too, so overly risk averse behaviour is one we know well. However, all learning involves some risk.

In healthcare, I wonder what we are perceiving as so risky that we reduce the ability for anyone to learn. Health services are by their nature risky and much of the safety discipline is about reuing that risk. But is there something else we’re doing that we don’t recognise as limiting learning?

The only thing I can think of at the moment is the way we redesign (improve, change) services. The predominance of the Improvement Model and the attending PDSA cycles are a way in which we reduce risk, and I think, may actually reduce learning rather than enhance it.  I’m open to other thoughts and perceptions about this – please leave a comment on this blog if you feel differently.

How do we tell our Emperors and Empresses that we know they are naked?

Image from: www.emperorerswithoutclothes.com

The fable about the Emperor who had no clothes is well known. He believed he was wearing sumptuous velvet adorned with jewels, but in truth he was naked. His minions played along with him, "dressing" him every day and complimenting him on his attire.  Then one day, someone decided to tell the truth...      

How to diagnose whether you are an emperor or empress

1. Do you have strong beliefs about something?  What people or processes do you have in place to ensure you are not believing your own beliefs? For example, a mentor or critical friend who has the strength to point out when you are dashing about naked.
2. Do you have "minions" around you who are constantly agreeing with you, forwarding your tweets, nodding their heads in meetings and running about in the shadow behind you.  Can you remember the last time someone really disagreed with your point of view? Does it happen often? Do you ever disagree and have a constructive debate with someone?
3. Do you talk about your "clothes", are you constantly changing them, adding jewels etc.  The endless focus on the clothes, and the changing thereof, can make it difficult for "minions" to comment.
4. Do you marginalise the person who disagrees with you. This may happen without any conscious thought. You could be picking up a signal and then ignoring them out of fear they may point out what you already know.

A number of CEO's have mentioned to me that one of their greatest fears on appointment to their role, is that staff no longer tell them the truth about what it happening and instead tell them what they think they want to know. They then set up ways to counter this problem.

If you are an improvement leader in healthcare  do you have a way to check the extent to which your clothes belong to an emperor or empress?

        

Redisorganisation in healthcare: the theory and the practice

A good friend, Bill Russell, tweeted a link to "A surrealistic mega-analysis of redisorganization theories" published in the Journal of the Royal Society of Medicine, December 2005.  Yes, it's a Christmas edition spoof, however, there is some unnerving truth underlying the splendidly irreverent - and creative - paper.  I share it nervously, as I wouldn't be surprised to find it turned into a PowerPoint and a half day course being run to teach people the theories.

The paper got me thinking about the tendency of Healthcare Improvement Leaders to grasp at the latest theory that comes their way, further confusing the people they are expected to serve with their "leadership".  Recently I have encountered an exhortation about the need for consistency and a single model for change in the NHS; countered by the push of new ideas and theories, which dilute this message.  As well as new concepts being presented as though they are the next best way to make an improvement / support change; the concept is a concept - it has not been fully tested.

The frivolousness and scattergun approach for supporting healthcare staff and their organisations is unlikely to be a useful one.  My concern is the endless search for the quick fix is confusing people. In addition, when one theory ends up not working in practice, then I'm not seeing the evaluations, reviews and sharing of lessons (as in role modelling learning and improvement). Therefore each new concept is being built on an ever-weakening foundation.

The value of of those who lead improvement and change in healthcare  I believe, should be based on the depth and pervasiveness of change they support, rather than on the number of new concepts of pilot projects they put into the system.

Review of NHS iPhone apps

A number of NHS “innovators” are up there with their iPhone apps. I say “innovators” loosely as most of the apps are no more than websites in an app – useful but hardly innovative.  What’s more interesting is the lack of apps, even the most basic ones, from one of the world’s largest systems.

The NHS brand is one of the most well known in the UK, and using it and looking after it is important. There is now even a Brand Manager (c.£90k post) on the National Commissioning Board. From my days as the advertising manager in Esso, I know how important it is to make sure logos and accreditations are used properly.  My review of apps discovered many people using the NHS brand when they are not the NHS, and others in the NHS are not using their brand at all.

I chose the apps that appeared under a search for “NHS” on iTunes AND where there was NHS in the logo or title of the app.,The apps listed are all free.  

  

NHS Direct’ health & symptom checker

One of my favourite NHS apps and one I have used. It feels like the whole of NHS Direct is in my pocket. The feature of finding, for example, a pharmacy nearest to where I am standing is very useful. Comprehensive, easy to use and a flag bearer for app quality.

NHS Drinks Tracker

Not entirely clear but I think this is from NHS Choices (they could use their branding on the app logo perhaps?). Interesting to play with but it looks like it lacks flexibility to suit a wide range of users – as verified in the comments for the app.  Maybe an update is required? There’s also a Dept of Health Change for Life Drinks Tracker (do we need duplication?).

NHS Quit Smoking

Branded in the app as NHS Choices. I like the way it counts the amount of money saved according to the number of days you go without smoking.

NHS BMI healthy weight calculator and tracker

Another NHS Choices app. Clear and easy to use. Like the other apps in the series, it looks from the comments, like it could do with an upgrade.  There is stuff competition in app-world for BMI calculators and food intake / exercise trackers, so there needs to be a good reason for someone to use this one.

NHS Give Blood

From the NHS Blood and Transplant service, though confusingly the app logo doesn’t use the NHS branding. It’s a map function of where to give blood locally. I can see this being very useful in a crisis.

NHS 24 MSK help

Hmmmm, pink logo and very strange branding. Developer is NHS 24. Looks like an exercise app. Didn’t inspire me to download it and try it.

UK Clinical Trials Gateway (NHS Institute for Health Research)

Nice – I like it when the name of the app says what it is about and who it is from. As they say in their blurb, it’s for everyone, patients included, and covers the portfolio of clinical trials registered in the UK. I expect I can also get this off a website somewhere, so the innovation here is packaging it all up – a but like NHS Direct.  There is evidence of the app being updated which also enhances its credibility with me.

NHS Moodometer

This one took some detective work to understand. It’s an app to measure your moods. Useful if you’re in the process of understanding your own moods. It has the NHS logo on it. It comes from 2together NHS Foundation Trust – which I found out is in Gloucestershire – not obvious at all who they are and what they do from their name!  If they are using this app with staff then we need to know about this innovative use of it…

NHS Bristol and NHS Yorks & Humber

This is a well-designed organisational app that looks like it can be a standard one for many NHS areas. It’s more than a replication of their website and it is wonderfully designed for us.  It covers ICE (in case of emergency), your personal reminders and notes, where to find which service and cleverly uses the clour coding of the campaign to reduce A&E attendances (the thermometer). This app has a purpose which goes beyond advertising services.   Will need an update after all the structural changes.

My visit to Guys’s and St Thomas’ NHS Foundation Trust

Excellent. Designed for the patient, this app covers appointments, hospital information and maps.  I like the fact the name of the app says what it is for, and the integration with GPS on the phone is useful.

NHS Tameside and Glossop

Not certain about the logo use but the app is one that has broken away from the regular brochure / map / information approach.  Instead it is disease based giving information about conditions and pathways. I am not sure who is the intended audience? The name of the app left me thinking this was about the organisation but the contents are something different.

Welcome to St George’s Hospital

Another one with an app name that is useful. This is another information type app. I found some of the colouring a bit difficult to read and the design is rather poor. There’s a nice facility for providing feedback to the Trust – though I haven’t tested this.

NHS ActiveME

An app from the Royal Hospital for Rheumatic Diseases NHS Foundation Trust allowing the monitoring of daily activity levels.  Nice. Nice. Nice!  Beautiful design, easy to use and I love the graphic reports.

NHSCovWarks

Hmmmm apart from the rather short hand title, I’d not know this was an NHS app. The app logo is coloured stripes – which become obvious when you look at the app – it’s another one of the “ where do I go for what” apps”. 

Northumbria Healthcare’s GP Clinical Information Exchange

OK, so this is something different. Also has CiiX on the app logo. Says it gives real-time infomration about services, clinics and consultants  Not sure what it means by real-time, but what I like is it moves beyond being an directory to adding in some information about what to do if certain thing happen – and that’s good. I’m just not sure we need to add another acronym to the business.

NHSSC Health & Safety Awareness

Logo alert here, if only for adding SC to the NHS. It’s South Central (will need to update (or delete) app when the structural shifts happen). Seem to be aimed at staff though not entirely clear. I like the content but the title, logo and framing is poor.

Reframing patient empowerment

It's good to talk - and following a chat with friend and colleague Bill Russell. I've been thinking about why it is "patient empowerment" doesn't seem to work in practice.

Firstly, it is an irony (check here for a definition and more info on what irony is). There is a dissonance between its implied meaning and what it literally means. Just thinking of the term assumes that someone other than the patient has power - and by creating a program or concept called "patient empowerment" comes across as them with the power trying to give them without the power, some of their power - ultimately the ones with the power are still power-full.  Hence the irony.

Secondly, who thought you in healthcare had the power anyway?  As a patient I am the only person who has power of my health  I may need help from health professionals, the gym instructor, my mother, advice from the bookclub ladies, thoughts from the parish priest etc.  The issue is that I may be seeking a way that health providers do not take away the power I have when I access them.

Thirdly, maybe thinking it is all about power is the problem.  Power itself has no use unless it is applied, employed, or used. This process is called influencing. Some people, with little obvious power can get a lot done through effective influencing - and vice versa. So I wonder what would be different if we thought about the relationship/s and the influencing flows between patients and healthcare providers?

Please add a comment if you have any reframing propositions for "patient empowerment"

Digital Engagement: DoH, NHS, England

The Dept of Health is getting up to speed with digital engagement. There's an intro available on the website, along with links to other policies and hints etc.

Worth a look if you're in the NHS and new to all this social media and digital stuff.

Book Review: Overtreated by Shannon Brownlee

The subtiutle of this book is "Why too much medicine is making us sicker and poorer". This book was quite shocking. I know there is a lot of what goes on in healthcare that is unnecessary yet to find a huge amount of detail and information in one place really put the issue into perspective. It is focused mainly on the USA though there are many parallels with other health systems.

Throughout the book, the author provides stories and examples to illustrate the data and statistics that without the stories would appear cold and less shocking.

As I read through the book, particularly in the early chapters I found myself going "I know him/her"! Shannon Brownlee hooks a fair amount of the debate onto the actions of some of the current health leaders in the USA (you might like to read the book to see if you are mentioned...!) There is an excellent chapter on the VA Healthcare systems, how it has improved and in many cases how it is an example of how healthcare in the USA could look and feel.

Chapters include:

• Too much medicine: complelling arguments as to why population based healthcare would be a real improvement
• The most dangerous place: beware the hospital and what might happen
• Your local hospital: how uncoordinated care and overtreatment results in poor outcomes
• Broken hearts: how the latest fad takes root, based on economics
• The desperate cure: an argument for evidence based care if there ever was one
• The limits of seeing: an expose on the limits to radiology tests
• The persuaders: mmm who is influencing whom, and why?
• Money, drugs and lies: why not to believe everything published in journals
• The doctor isn't in: all about managed care
• When less is more: some ideas to cope with over-capacity and overtreatment in the USA

This book is a must for every health care improver who believes their own project is making a difference... The strategic and tactical issues raised in it really provide a new perspective.

Book Review: Sustaining lean healthcare programme; a practical survival guide - Eaton & Phillip

Different book styles appeal differently, to different people. This one appealed to me because it is relatively short (94 pages plus appendices), well organised, uses bullet points and lists, checklists, diagrams and has some short examples to illustrate points.

Contents include:

1. Where are you on your journey
2. Why do only 24% succeed?
3. Going Lean
4. The top ten signs of a failing programme
5. Creating a lean healthcare organisation
6. Four key checklists
7. The next eight things to do...

So do only 25% succeed? The authors suggest there are 8 critical success categories Communications. resources, involvement, training, implementation, compass, achievement and leadership (yes, these do spell "critical"). If you like wordplay then read the book and discover PRISM, CAD, VSE, RIE, RPE, FIT, FMEA etc. Not as bad as it looks in a list here. I found them a good description, and sometimes reminder, of basic principles.

The chapter on the top 10 signs of a failing program is easily read. For each reason there is an explanation of what you may experience, why it happens and then what you can do about it.

The four checklists you need? One each on people, success, tools and culture. Nothing really new to me, just nicely organised.

I particularly liked the Appendices which included key lean phrases and concepts (worth the price of the book for its organisation and simplicity), audit form, guide to common saying (fabulous!), and then a number of "how to" guides.

I know Mark Eaton has actually implemented lean in healthcare. This book is a demonstration that when written by someone who has got their hands dirty it turns into valuable desktop reference.

Paper: Judgement Sampling; a healthcare perspective

A new paper from the healthcare statistical gurus Perla & Provost needs to be read by all leaders and improvement project leaders.

The premise is that we can't apply regular statistical approaches that rely on specific sampling techniques - if we're not using those sampling techniques. And in healthcare projects we seldom use scientific sampling methods, instead using a non-probability, judgement sampling method. In their paper they describe the method and  explain the impact for healthcare settings.

The paper is in a subscription only journal. (Bah-humbug...) So if you're not able to access this journal, you can learn more about judgement sampling at these places:

• FULL ACCESS PAPER: Sampling for qualitative research, by Martin Marshall
• List of definitions of various sampling methods
• What is judgement sampling?
• When to use and setback of judgement sampling
• Advantages & disadvantages of judgement sampling

The Perla & Provost paper can be found here:
Qual Manag Health Care. 2012 Jul;21(3):169-75.
Judgment sampling: a health care improvement perspective.

7 Twitter Resources for Healthcare Professionals, NHS

If you're just getting started on Twitter, here are some resources you may be interested in:

1. 140 uses for twitter by healthcare - a blog post and one of my favourites. A bit old but still up there with challenges for you
2. Using Twitter in the classroom or organisation - nice framework
3. Canadian booklet on Twitter for Healthcare Professionals; short, sweet and to the point. Recommended.
4. How using twitter can help increase staff transparency and trust - one of my blog posts from a while back
5. Twitter for Doctors - by a doctor, with his experience
6. Pull vs Push; a twitter case study - this is my personal 90 day project from when I first started using Twitter. The lessons then are relevant to anyone starting up now.
7. Using Twitter as a social movements strategy; one of my blog posts from March 2009. Some actions to consider.

Do middle managers matter in healthcare improvement?

There are libraries full of research and case studies on how doctors (and increasingly other health professionals) as well as executives, influence the implementation of healthcare improvement and innovation.  Middle managers, the cream in the éclair (often squeezed out) have not been in the headlines. But there is a new paper out which looks at their role and its importance. More research is needed.



Implement Sci. 2012 Apr 3;7(1):28.
Uncovering middle managers' role in healthcare innovation implementation.
Birken SA, Lee SY, Weiner BJ.