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.

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

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.

On being productive

I thought I'd start 2013 reading around the topic of productivity at work.  I was looking for new ideas and testing my own assumptions. After a fair amount of reading, this is where I ended up.




General principles

• Productivity means different things to different people
• Learning styles matter; so there's no point in promoting one method as the best - it needs to fit the style of the person, and their workplace. People who shout about a specific system are those who discovered something so perfect that works for them - this doesn't mean it will work for everyone else
• A home office and freelance lifestyle is not the same as a 9-5 office job

What I do already, that works for me, that I will continue

• When I am with a client I do only that client's business; I stay present (and this means being organised, not doing email etc)
• Don't do work email after 5pm on a Friday and before 7am on a Monday. I've learnt that even if I've been away for a week, I can get through it all in a couple of hours on Monday morning
• Don't accept paid work on a Monday. This means I don't travel on a Sunday (which is important to me). It also means I have Monday to get sorted, do admin, meet my Mum for lunch, go to the Post Office, read a book, research papers etc.
• When I'm in my home office I try to do one task before turning on the computer (filing, reading a paper, tidying up), then one task before opening my email (designing an agenda, writing ppt or paper).
• Use lists. I have a "lab book" which usually has all my lists in it but I have been using the Allen Getitdone app which syncs my lists across PC, iPad, smartphone. I'm not entirely certain I like it but will keep trying it for another 3 months. I do like the way you can send emails to it, then schedule working with them.
• Work with my energy. I'm a morning person. I know I do very little between 11:30 and 2:30 pm so I don't bother any more. I go for a walk or lie on the sofa and read a book.
• I don't try to work while I travel. The results are never good. So I sleep, relax and read. This does mean I need to put preparation time into my diary. I've always felt that preparing while travelling is not giving the work my proper attention.
• Finally, my favourite productivity technique is the Pomodoro method. You work (set timer) for 25 mins, then take a 5 minute break - and repeat. Do one thing in the 25mins (like this blog post). After a few repeats, take a 15 minute break.  I divide my productive time into these 25 minute blocks. And have 3 of them during the day for doign my email.  You can download a Chrome Pomodoro extension to be the timekeeper.

What new ideas I got from my reading

• not so much new as a reminder - exercise is good for me. So I shall put in the diary.
• turn off the Twitter alerts!!

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 

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: 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.

Paper: Framework for analysing collective action events on Twitter

This freely available paper (PDF) is one for the nerdy person like me who wants a bit of theory and a framework to figure out what goes on when Twitter is used for collective action.

It's a shortish, easy to read and I think valuable addition to our thinking and understanding of the use oif Twitter for large scale change.

Using Twitter for Rumour Management

Twitter can be used in a zillion ways. I 've been doing some research to help my understanding how it can be used to manage rumours and/or bad news.

When it comes to rumour management, the first step is to pick up the rumours.  Use Google Alerts or similar programs to collect on a daily or weekly basis, comments that are being said about you or your organisation, or product. Use Twitter search to check if you are trending - for the worse... It's no good relying on traditional paper cutting services - the Interest is a hotbed of gossip, much of which never makes it into the printed papers.

The best form of rumour management is prevention.  Make sure there is lots of positive content about yo, your product or your organisation on the Web.  Use facts and details to enhance your credibility. Use Twitter to post content and to link to content. Retweet content which relates positively to you.

When something crops up, contact people directly and engage them in discussion (either on or off the web). Ignore them at your peril.  "Nipping in the bud" is the name of the rumour management game.  Ask your advocates to speak up for you using their social media methods. Remember Twitter is one way you can provide good answers to questions and allow others to see these answers.

If it gets really big, then call in a Crisis Management expert.It's unlikely that in-house communications departments will have the experience and expertise to manage an Internet based communications mess.

Here are some case studies:

• Guardian newspaper article referring to the 2011 London Riots and how Twitter was used to knock-down rumours
• Guardian resources provide various info graphics to show how rumours spread on Twitter - fascinating

How not to use Twitter

There are no hard and fast rule for using, or abusing, Twitter. But here are some of my "cautions".

1. Following everyone and anyone; indiscriminate following, in the hope you get followed, is a short term action with long term consequences. Before I follow someone, I often look at who they are following. That way I can get a feel about their interests.
2. Not having a profile photo or putting up a picture of your dog. I want to follow a human ad I want to know who they are. Anonymity doesn't allow for constructive tweeting.
3. Random discussion.  A bit of chat is fine, but when my Twitter stream is filled with a discussion on the merits of gooseberry jam versus Seville marmalade for the morning toast - then I'm going to do some unfollowing.
4. Too much personal information: I really don't need to know about your dandruff, your toenail fungus or what you got up to last night.  Perhaps you could save that for private discussions amongst close friends.
5. Using Twitter to sales pitch using automated Tweets: Endless automated tweets, or even ones done by hand which continually sales pitch your own stuff can feel a bit mob-handed and lead to unfollowing.

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.

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.

Most popular posts on the Spread Good Practice blog

Here is the list of the most popular posts on this blog for the last 6 months.  If I'd had to guess I'd not have guessed these - nothing like a good bit of measurement to separate fact from opinion!

Model 2: data, information, knowledge, wisdom 22 Dec 2010, 1 comment 640 Pageviews

The quickest way to spread scale up change 21 Jul 2010 484 Pageviews

Model 1: data, information, knowledge, wisdom 20 Dec 2010 339 Pageviews

Using Twitter in the Classroom or Organisation 2 Sep 2010 320 Pageviews

Productivity 1: Operational Efficiencies are not e... 24 Oct 2010, 1 comment 284 Pageviews

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/)

How Twitter can help engage staff by increasing transparency & trust

If you're playing Buzz Word Bingo in the healthcare at the moment then you will know that "Engagement" is a hot word. Nothing new there you say, it's been a consistent buzz word for the last 10 years at least.

Well, there's something new on the horizon. It's a bit scary, you may not like it and it seems to be one way to practically engage some staff. More than that it moves from a passive engagement to an interactive process, which through its transparency leads to increased trust.

Let me explain using a very current example. It is 22nd March 2010 and British Airways is on day 3 of a strike, with another series of strike days looming. It's a mess really, for all involved. As with many crises it's interesting to learn from how companies and individuals manage them to best effect.

I've been following @British_Airways on Twitter. The updates are immediate and a complement to the less frequent and more formal announcements on their website. When I start seeing a string of complaints - or compliments - on Twitter I get a sense of what is going on. I have no idea how many people they have handling the Twitter stream (probably only 1 - if so they need a prize for multitasking while keeping their head about them..). More important than the pattern on Twitter is the manner in which cries of despair, shrieks of delight, moans and queries are being handled. All in public and all is transparent for us all to see. When it gets to personal details they request a DM (direct message). As long as the nice BA person at the end of the Twitter Stream keeps calm I will keep calm. And I'm starting to trust they really will get me to my next destination.

Some hints and tips for using Twitter to engage with staff and customers, especially in a crisis
1) Ensure your Twitter stream is managed by a human and not a computer. Endless feeds of your website will not engage me and will most likely reduce my trust in you.

2) The 3 R's of Regret, Reason and Remedy go down very well. A 140 character Regret is enough of an apology. A quick Reason helps me understand the issue and I then know you also understand what I mean. Then a masterful 140 character or less Remedy will make my day. I don't need 3 page letters within which we all lose the point.

3) Be open. Speaking up in front of the crowd means you need to stick with your tone of voice and content of your speeches. If I know most fo the talk is going on where I can hear it then I will be more trusting. An advantage of the Twitter feed is I can scroll back quite a few days ago to see how the conversation has been going.

4) Allow me to discover people like me. Although the official stuff is importnat, I also like to engage with people like myself. I need to be able to do this without you controlling the place, person and pace./ On Twitter I can see who else is having a problem like me and can contact them to see if they, for example, discovered any easy solution.

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: http://www.youtube.com/watch?v=ddO9idmax0o

Context
With Twitter http://www.twitter.com/ 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).

Results
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 http://www.twittercounter.com/ to measure progress. My ranking worldwide is 79,492 and within England it is 79th http://www.twitterholic.com/

Learnings:

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...

Follow me on Twitter: http://www.twitter.com/sarahfraser

Using Twitter as a social movement strategy

It was Stephen Fry, on Twitter http://www.twitter.com/stephenfry, who, in response to a criticism that eReaders would be the death of books, that said:
"I collect books. Have done for years. I will no more throw out "real" books cos I have a Kindle than I'll jettison pens cos I have a Mac" (11.03.09 8:55)
[responses]
"This is the point. One technology doesn't replace another, it complements. Books are no more threatened by Kindle than stairs by elevators" (11.03.09 9:07)
[responses]
"I've thousands of books and will continue buying them till I die. Smell and feel, yes. Maybe. But that was true of horses" (11.03.09 9:10)

As Stephen Fry so eloquently pointed out, there is room for a both / and when it comes to integrating new technology with older methods and habits. This post covers only Twitter and my own view. I know there are other methods for enabling social movements.

Much of what we know about social movements is from evaluations and post-hoc descriptive research. This is a good way to find analyse and identify some of the key features of a social movement, with the intent thereafter of trying to replicate some of these so as to accelerate the implementation of organisation and system change. For me the jury is out as to how much a social movement can be engineered, though this doesn't detract from some very important components which seem to work well when implemented.

So where does Twitter fit in to the concept of a social movement?
I feel it is a complementary communication method and perhaps one which can accelerate the process. However, it will probably never take away from the more traditional methods of face-to-face (F2F) influencing. It is a both / and.

1. Tweetups: Twitter can be used to facilitate the gatehring of people both virtually and F2F; called a tweetup! For an example of how viral Twitter can be in organising action then go to http://uk.techcrunch.com/2009/01/25/twitter-meetup-spawns-global-charity-event
for an example. The charity event, Twestival, took only 24 hours to get 40 cities involved and after that a further 60 joined up.

2. Getting the word out; hierarchical, planned and controlled media (if that's not an oxymoron...) tends to attract the attention of a "target" audience. Twitter works through its transparency, openness and democracy where anyone can follow anyone. There are no rules about who gets what information. Of course, the Twitter system uses its group wisdom to weed out individuals and organisations who behave badly - they get "unfollowed" and "blocked" and then wither on the digital vine. You know your message is hitting the right note when it starts to be retweeted (others copy and send to their own networks). This is energy for a social movement.

3. Jumping networks; targetted communication campaigns are limited in their effectiveness usually because they are just that - targetted. Twitter enables the jumping of an idea from one person's network to another which may seem unrelated though could potentially be the breakthrough in attracting the attention of peopel who really care about the topic. The jump can be from one group of people to another or from one techology to another, for instance when a tweet gets posted onto Facebook http://www.facebook.com/

4. Social movement becomes social and has movement; Twitter is informal, casual and to the unitiated often chaotic. When an idea takes off, it flows rapidly through the system. Getting it to this point is difficult, however, and requires patience and practice. In true social movement style, you cannnot make a message viral. It becomes viral when followers deem it of value. They drive it, not you who wishes it to spread. A point to remember is that the enegry comes from the social interaction combined with the power of the idea.

Twitter is one part of what is becoming known as mobile social movement enablers. One of the difficulties of assessing its value is it is developing fast, changing over time in terms of both technology and use, that it is difficult to evaluate. This reminds me of what a social movement is like. Namely something we can analyse after it has happened but durign the process it is all a bit messy, unclear, possibly exciting and almost impossible to evaluate.

http://www.twitter.com/sarahfraser follow me there
If you're interested in patient safety then follow http://www.twitter.com/patientsafety
or if large scale change is your thing then http://www.twitter.com/largescale

Lessons in how online communities work

A few months ago I set up a Facilitating Change Forum using the social networking system Ning http://facilitating.ning.com/ This was in part to provide people who may be a bit afraid of social networking with a sandpit where they can test and play. Then it was also as a means for connecting those with an interest in Facilitating Change.

Separate to this I have been building my online presence using Twitter http://www.twitter.com.

What have I learnt so far:

1. The adage of giving stuff away to get something back is true virtually as well generally in life. The more I post "useful" stuff on Twitter, the more the followers grow. And the more I get back. I needed a solution to a problem, posed the question on Twitter and someone (who I didn't know) replied in minutes with a fabulous answer.
2. Letting go, going with the flow - or whatever aphorism works for you - really is necessary. I have just spent 20 minutes actual time and 8 hours elapsed time signing up to a NHS system where I now have to ask permission to join a community. I've lost the will to communicate by now. Access needs to be easy and without significant restriction. I feel for communities to work online they need to be fresh, flexible and open rather than hindden behind walls and barriers.
3. There is not only widsom in the crowd but also leadership. Having neglected the Forum for a few weeks I feel proud to see a number of people (some of whom I have no idea who they are - and this really doesn't matter) take a leadership role in welcoming new joiners and in stimulating discussion. Wow, this is truly distributed leadership in action.
4. Like all natural systems, getting started is like pushing a snowball uphill. Then all of sudden it takes off. With Twitter I nearly gave up, persisted another week, and hey presto I reached a criticial mass of usefulness. Same goes for a number of virtual ways of working like using team spaces. It is so easy to have a go, hit a huddle and then drop out the race.

What have these online communities got to do with the spread of good practice and large scale change? They are a great way of sharing messages, asking questions, discovering new ideas, keeping up to date, reducing isolation etc.

Follow me on Twitter http://www.twitter.com/sarahfraser

Check out Patient Safety Twitter Feed http://www.twitter.com/patientafety

Join the Facilitating Change Forum at http://facilitating.ning.com/