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.

Thought Leadership 2.0

Graphic from Indiangroup.com

I came across the 2.0 version of thought leadership from the article by Maria Tabaka in Inc.  She has posited that social media has opened the way for a new form of thought leadership where

“[…] the Internet allows ordinary people with extraordinary ideas to lead and make a difference. Do you have what it takes?”

I've been saying for some years that the Roger's Diffusion of Innovations version of an opinion leader is well out of date (the book was first published in 1984). Many peer reviewed papers continue to reference this outmoded version of opinion leadership, without considering how social media and other technology based platforms has changed the opinion and thought leadership landscape.

Maria's advice on being a 2.0 thought leader is straightforward; you have to work at it.

“Begin by becoming a true expert in your arena. Do your research, and then do more research. Learn to speak about your ideas with passion; become a story-teller. Your passionate disposition will recruit followers and other leaders who respect and appreciate your insight. These folks will spread the word!

Step onto the stage, speak to live audiences, upload videos that teach and inspire, write, write, and write some more. Guest blog, invite others to blog as your guest. Author that book that has been burning to get out. Promote yourself to podcasters and broadcasters who speak to the same or a similar audience.

I like the way Maria focuses on the need to keep doing research. This is a theme from many of the publications about being a thought leader. To be out there, you need to be out there with something, some new content. You need something to be passionate about. Thought leadership is about going to depth, about sticking with a concept or idea and bringing it to life.  It’s not about spouting forth on the latest craze you’ve read about.

Thought Leadership 2.0 is about using social media to best effect.  It’s more than hanging on Twitter. Here’s a checklist of some activities a TL 2.) may be involved in. How many can you tick off.

• Active on Twitter; engage in conversation, retweet others (without making them your own), share useful information and links
• Participate in LinkedIn groups; specifically those groups within your thought leadership domain
• Host a Facebook Page, or two
• Maintain a personal blog and update it on a regular basis
• Guest blog for other influential sites / people / organisations
• Host your own podcast / video series
• Guest on others’ podcasts or video
• Use other social media sites such as Foursquare, Google+ etc

Yes, it’s hard work, but TL 2.0 is about extending your reach and cementing your passion in the reality of virtual relationships.

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
4. Medical Thought Leadership

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.

How can patients use social media? 7 thought provoking references

There's a buzz at The 24th National Forum run by the Institute for Healthcare Improvement; and it's not just because the weather is warm in Florida and thousands of gallons of coffee is being consumed.  It's taken a while (I did the first social media presentation there about 5 years ago) but social media is hit the top of the agenda.

One of the questions being discussed is how patients and their families are using social media.
I've done a run round the Internet and collated some references to help this discussion. There are some condition specific references, most notably diabetes - however, I'e stuck with the more generic links.

• 4 ways social media can improve your medical practice AMEDNews; useful tips with some examples
• Using Twitter for e-patient communication  A comprehensive PDF guide
•  NHS reaction to online patient feedback is changing Guardian Newspaper article 2011
• Patient satisfaction in the age of social media  Excellent blogpost by MD suggesting some disruption necessary
• Can Twitter be used for doctor-patient communication from same blog as above
• Unleashing the Power of Social Media for Patient Experience  Has some useful links to examples
• How the NHS uses Twitter  Guardian Newspaper 2011 

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.

Social Media and Emergency Planning: What is your policy and procedure?

There's a good blog post by Ben Proctor on how Emergency Planning can/might/does work as part of Emergency Planning strategies. There are some good references in it to more academic reviews and publications. Lots for the NHS to learn about, I think.

Book Review: The Wisdom of Crowds by James Surowiecki

It's quite annoying to find out that groups make better decisions than you can as an individual - but a very powerful thought. However, the groups need to be diverse, independent and decentralised (so that may exclude a few crowds I can think of...)

We are essentially cooperative beings and meld our behaviour around that of others. One of the examples in the book is how crowds flow in shopping centres, how we move on staircases etc. We do all this even when there are no explicit rules. Mind you, as someone who regularly travels to the US from the UK I know what it is like to accidently move against this flow when I forget to walk on the "right". So maybe there are more socialised rules and logic than the author makes explicit.

One theme in the book which did appeal to me was the notion of the difference making a difference. While it seems inefficient, having a diversity of ideas seems to allow meaningful differences of ideas, especially at the early stages of decision making - and this is important. Groups also need to be able to distinguish good ideas from bad ideas and having more to choose from helps.

There is some helpful work about distinguishing the difference between situations which are easily defined by a single answer, such as the weight of an ox, and those which are more co-ordination problems, such as traffic manageemnt. Co-ordination problems come when all individuals want to go their own way. Here the wisdom of the crowd sound a lot like complexity science and simple rules and I wasn't totally convinced of all of his arguments. However, they were interesting.

A thought provoking book which much more to say that the few bits I have mentioned here.

The book's website is here http://www.randomhouse.com/features/wisdomofcrowds/ where there is a lot of detail and audio to download.

Book Review: New Age of Innovation; Prahalad & Krishnan

If you're interested in large scale change and innovation then you'll find this book fascinating. On the one hand it felt like there was nothing startlingly new to me yet on the other it was neatly put together in a readable way that made sense.

A key premise is the current trend of personalisation and how value is based on the unique experience we all want. The authors refer to this as N=1. Current technology drives this, social networking, web 2.0 etc. How can we co-create value with our users and consumers? What are the challenges with managing who owns the knowledge? All good questions. They also suggest we need to make the most of collaborative networks, electronic and face-to-face, be flexible and ensure scalability. I liked the section on scalability and in my mind there is more in here than what they covered. This is a key element and is also linked to their second premise.

The 2nd key premise is the one that resources need to be global and they use another little formaula: R=G. Here they suggest the issue is that access to resources is more importnat than providing products; namely it is the solutions that matter rather than the kit or pieces. I think I agree with this. Again, scalability comes up.

They mention social movements and how they figure in the process as well as organisational transformation. There was nothing much new in the organisational process other than the context of the infomrational technology infrastructure - well, that is rather new and for some people rather perplexing.

If you've not yet engaged with Web 2.0 and new technology then this is definitely worth a read.

Book Review: Groundswell by Charlene Li & Josh Bernoff

The authors define a groundswell as “…a social trend in which people use technologies to get the things they need from each other, rather than from traditional institutions”. mmm that sounds like an important thing to know about if you think you're a traditional institution, or if you think you're breaking new ground, or if you're a consumer wondering why you're starting to feel left out the loop.

What I liked about the book was the examples and case studies. Usually I skip these, however, I foudn these ones riveting reading. Who needs thriller novels when the business world presents us with such chaotic and roller coaster events. Fabulous.

I also found the way the book was constructed and organised to be very helpful, especially when faced with a disconcerting topic. Far from being disorganised, the underlying structure helped get the message through.

Read this book and it will move you on from thinking about "all we need to do is have the odd blog and a fancy web 2.0 website" and get you into strategising about your social media presence. I have always been convinced that social media is not just for the youngesters and this book has all the examples and conceptuals models to help you create some of your own thinking for your business to prove it is for everyone.

The book has, as you would expect, a great website. http://www.forrester.com/Groundswell/index.html It is good to see them practising what they preach. They have a blog and there is also a social media profiling tool you can download and use.

I'm not one for giving 5 stars to a book, but this one deserves it. I might just read it a second time.

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.

A Primer for Bloggers

Chris Brogan has blogged a brief list of things for newbie Bloggers to think through when starting up and maintaining a blog. Good hints and tips in here for healthcare and NHS bloggers.

I like #18 "Inspiration is both a verb and a muscle."

Digital Engagement: From participation to partnership PDF Report

Life moves on. Things change, well, mostly.  What seems not to be changing is the methods of involving, engaging and interacting with the public.  Some public sector groups are starting to grapple with how best to use technology to best effect. For instance, I learnt recently that after 6 weeks on no replies to email and 30 minutes waiting time on phone calls, that the best way to get a response from our local Council Waste and Recycling department, was to tweet. Instant response. Instant relief. Problem solved fairly quickly.

So what is healthcare doing? There's a proliferation of Twitter accounts being set up but these are mostly used as another channel for advertising with little listening going on.

Public and patient engagement is mandatory for the NHS, especially for the new CCGs (Clinical commissioning groups).  Digital engagement is more than setting up Twitter and Facebook accounts, or sending out emails asking for responses to documents.

This report from Future Digital, published in June 2012 has some excellent strategic and tactical ideas on how to get with the times and to design interventions that are appropriate for our 21st Century.

How to use Twitter to effect Social Change (Video)

"It takes many streams to create a river" - great quote from this video. I found this 3 minute video covers all the basics of Twitter good practice, especially for those who are hoping to influence social change through their use of the technology.  It was a bit quick and I had to rerun it to make sure I had all the info.

Using Twitter for Customer Service

My own experience of using Twitter for customer service has generally been far better than trying to contact the brand by phone or email. British Airways were excellent during the ashcloud, and Menzies Airports responded quicker by Twitter than the receptionist when I had a problem at an airport.

My tips include:

1. Respond! There's nothing worse than contacting a brand via Twitter to find they only use their Twitter feed for pushing out automated tweets.
2. Be open. One way a customer can be supported is by reading your replies to tweets. This was useful in the Ashcloud incident.
3. Manage privacy. In contrast to the above, don't ask a customer for their personal details to be tweeted, or start conducting business transactions publicly on Twitter. Use the Direct Message facility.
4. Solve the Problem - Now. Don't pass the tweeter onto a phone line...
5. Tweet ahead. If you know there is likely to be an issue, start providing solution options in advance

In healthcare, the privacy issue is a tough one to manage. If a patient tweets an NHS organisation asking for a problem to be solved, then the conversation will still need to be managed carefully, to make sure privacy is not compromised. Check they want to continue the conversation via Twitter and give an alternative means of instant access communication.

Implementing social media is more than dabbing in a few fun technologies

Technology is really exciting - for those who get excited about it. But technology is useless unless it connects with those who use it. There's the obvious stuff about it needing to be easy to use. But there's also the need to any technology that puts "social" in its marketing blurb - to be just that - social.  And then there's the need for the organisations that want to jump onto the social media bandwagon to make sure they are doing so with thought and concern rather than a random set of activities they can tell everyone they are "into social media".

Here are five sets of questions to ask yourself if you're wanting to involve social media in your business:

1. Why social media and not any other strategy or technique we and our customers are used to?
2. What do we expect to happen? What is our intention? 
3. How will we, and our customers, keep moving with the times as new technologies become available? 
4. To what extend are we building on what works? Does this matter?
5. What policies and legal concerns do we need to take into account?

Oh, and I'll add one more, just in case:

(i) How do we define social media?

Social Media Policy: The simplest way forward

So many public sector organisations are still banning the use of social media. This seems a bit like being unwilling to give up your horse when the cars are all whizzing past you.  Anyway, the root of this short-sighted vision is often fear. Apart from fear of the unknown (when senior managers have no idea about social media they are more prone to ban it or poo-poo it) there is also the fear of lack of control. In the public sector we're good at writing rules and regulations so when management does get to grips with social media it tends to be via a tortuous and complicated social media policy.

I particularly liked Mike Brown's take on social media policies. He recommends the following (please go to his blogpost to read the whole article:

“Will what you’re about to share online offend, surprise, or shock your

• Spouse
• Mother
• Employer (current or future)
• Clients (current or future)
• Business partners (current or future)
• Coworkers
• Children

in a way which critically jeopardizes your relationship? If you answer even one “Yes” for this short list of people, think long and hard before publishing your content.”

Literature review for the use of Web 2.0 tools in Education

Whilst education is different from both healthcare and private organisations, there is a lot in this literature review to get you thinking.  I was wowed by the comprehensive coverage of the technologies and the analysis of what might best be used when and where and by whom.  I started reading from the back - with the Appendices!



Introduction
Methodology
Changing
 technologies
The 
emergence 
of
 Web
2.0 
tools
A 
typology 
of 
Web
2.0 
tools
Changing
 learning 
and 
learners
Theories
 of 
learning
New 
forms 
of 
learning
Patterns
 of
 technology 
use
and 
the
 characteristics
 o f
learners
The
 changing
 role
 of
 teaching 
and 
teachers
Strategies 
for 
supporting 
the
 use 
of 
technologies
Barriers
 to 
uptake 
and 
lack 
of 
impact
Digital,
 networked
 and
 multi­literacies
Success
 factors 
and 
strategies 
for 
change
Contextual 
examples
Blogs,
 wikis 
and
 social
 tagging
Twitter.
Social 
networking.
Immersive 
environments 
and
 virtual
 worlds.
Summing
 up.
Conclusions
Appendices

Using Twitter in the Classroom or Organisation

Twitter feels like one of those applications that has been searching for its use. Within healthcare, specifically the NHS in England, its use has been limited. Many organisations see it only as another media channel through which they advertise their services. A few, however, have grasped its potential to spread the word  in a personal way and are using Twitter as a means of engaging with patients and staff. A good example is @OBMH (Oxfordshire and Buckinghamshire Mental Health).

While healthcare is prevaricating and the organisations that preach and teach innovation are being slow to catch onto what is now practically a mainstream communication method, education has been stealing a march. An excellent blog post about using Twitter in the classroom includes a framework which made huge sense to me and helped me think through how best to use twitter in a training event as well as for the duration of a healthcare improvement project.

Not only does it help communication for the project it also adds in the "spread" and "Scale up" component that it so often missing.   If you are worried about the word student, then substitute patient or staff member. What I particularly like about this framework is it is a way for organisations using Twitter to self assess their use of it.

(Picture from Prof Hacker http://chronicle.com/blogPost/A-Framework-for-Teaching-with/26223/)

Spending Challenge - HM Government using crowdsourcing

The UK government is using a simple online webpage to gather ideas on how to save money. It is called the Spending Challenge. You can input your idea, some words about how it can be implemented, add a tag or two and then post it. You can read through others' ideas, add tags and ratings. The system allows you to search by tag, new ideas, most commented or highest rated.

This is crowdsourcing at its most pragmatic. I doubt they spent more than £1000 setting up the system. The addition of a rating system gives it power and meaning. Especially as anyone can rate any idea - not just those in power.

In the same month this is launched I've worked with a variety of public sector teams who range from denying the existence of technology, denying they have permission to use anything remotely interfacing the public (or their staff) unless there are controls, or want to create their own thing. Probably worse, some are still working at the level of theory and concept for social movements, mobilisation and networking, running workshops and developing programmes to spread the word of change. By the time they've spent a fortune on their programme, a huge part of the UK population will have been mobilised using simple techniques such as this Spending Challenge one.

I feel that so often we get lost in the theory and concepts, and the need to develop eloquent (and controllable) solutions, that we overlook the most simple mechanisms, complemented with speed and pragmatism.

Well done HM Treasury for getting the Spending Challenge social movement underway.

Using Facebook Pages: A Guide for Governmental Organisations

The Learning Pool is one of my favourite resources for the use of social media in governmental organisations. Their guides are excellent.  I suggest you can download a copy of their latest guide which covers how to use Facebook pages to best effect.

The guide covers the basics like "what is a Facebook page", though to how to get the best use out of one as well as a step by step process to setting one up and marketing it. Huh, wish I'd written this guide myself!