Must Waiting Be Inherent To Medical Care?

“By the time you see the doctor, you’re either dead or you’re better,” my mother-in-law told me. She had to have multiple tests, all with long waits to get the appointments and the results, before her health insurer would allow her to make an appointment with a specialist.

“Waiting is the bane of the medical system,” a former student, an R.N., concurred. Advances in medicine and technology have improved medical outcomes, but have often resulted in more waiting at a time when every other aspect of life is speeding up. Waiting is a systemic problem exacerbated by advances in medicine and by health care reform.

Some of the ways we wait:

1. Wait to see if the symptoms go away or get worse. We all struggle with these decisions: do we need to be seen about the fever, back pain, or rash? Sometimes we wait because of denial or hopelessness; sometimes because of the cost or availability of medical care. I make decisions about when I need to see the doctor by asking myself if, under the same circumstances, I would take one of my children to the doctor.
2. Wait to get an appointment scheduled. I’ve made appointments for a sick child by channeling an old friend who could be relentless: “That is not acceptable. I need an appointment today.” Obnoxious but it sometimes worked. The rest of the time, though, the period between making and having an appointment can feel very long.
3. Wait to get to the appointment. Doctors and hospitals are more abundant in Greater Boston, where I live, than in other places, although traffic and parking can be problematic. Melody Smith Jones described a man’s six hour commute to see a doctor.
4. Wait to be seen by the doctor. It isn’t called the waiting room for nothing. Dr. Atul Gawande wrote in The Checklist Manifesto about people in the waiting room getting irate when he was running two hours behind on a hectic day. Being irate – or anxious or bored – is unlikely to increase the quality of physician-patient communication.
5. Wait in the examining room. At least in a waiting room you are dressed. If it is cold and you are wearing a paper or cloth johnny, distractions don’t work as well and examining rooms have fewer than waiting rooms.
6. See the doctor. Nowadays, as my mother-in-law recounted, you have to wait for the doctor to review your records before even looking at you. I find it surprising that physician rating systems give equal weight to wait times as they do to “communicates” and “listens”, when the latter are so much more important.
7. Wait in the lab. The selection of magazines is skimpier. You may be reviewing what you were told not to eat or drink: will that cup of black coffee skew the results?
8. Wait for lab results. If there are any non-routine reasons for testing, this can be interminable. I leave a lab asking when results will be ready and then I call. A former student told me about using Harvard Vanguard’s MyHealth Online. She said, “I love getting the lab results immediately online but I can see how those without clinical training could be overwhelmed or confused by the data and how to interpret them.”
9. Wait for the doctor’s interpretation of lab results. Lab results can be hard to decipher without clinical training, as my student said above. Even when I know results are available and the doctor has seen them, it can take many phone calls to obtain the doctor’s message via the secretary. Asking the doctor follow-up questions takes even longer. These are waits with a cell phone never turned off so you don’t miss the call.
10. Loop. You think you’re done but you may need to see a specialist, get a second opinion, or have more tests. As my mother-in-law pointed out, this process can be controlled more by insurance companies than by doctors’ availability. Another type of waiting also takes place now: waiting to get better. A friend bemoaned how she “couldn’t wait” for her black eye resulting from a fall to clear up because she was tired of people staring at her.

Waiting Reduction

We all have to wait. Waiting is an inherent part of being ill. But here are some ways to reduce wait time or lessen the impact:

1. Schedule tests and doctor’s appointments together. My exercise teacher told me about her husband’s hospital visit that started with a CT scan and ended with a doctor’s appointment to discuss the results. With no problems detected and a year until they next visit, they both said what a relief it was to get it over with quickly. Scheduling appointments together reduced both waiting time and anxiety, although not all tests results can be interpreted this quickly. Personally I find it is much easier to deal with a diagnosis than fear of what a symptom could mean.
2. Avoid unnecessary appointments through email or phone. A Dutch friend, whose sister and aunt are doctors, recounted instances when she was able to get quick answers by email or phone to questions, be reassured, and save a lot of time and effort. One instance: “Once I was on holiday in Greece and sent my sister a picture when my eye was infected. She told me to buy drops and that it would go away.” Since most people do not have convenient relatives with medical degrees to talk to, being able to easily reach a doctor or nurse by email could provide a way to get a quick answer. Dr. Danny Sands has long been a proponent of physician-patient email, but most practices do not support it. I can easily see the benefits because email forces you to describe a situation concisely and images can be attached as appropriate.
3. Meet Dr. Skype. Melody Smith Jones posed the question, “Can telehealth be used to end this man’s 6 hour commute by providing him access to the specialists he requires? What barriers and challenges still lay before us to make this a reality?” Dr. Joseph Kvedar answers this, saying “We have to move beyond the antiquated notion that you must visit a physical space and talk real-time with your health care provider to fulfill the process of care.  Seamless communication between you the patient and the system (including your provider but also your health information) will allow us to cut through what is a falsely complex and inefficient system to achieve more efficiency, less waiting and less anxiety.”
4. Ask the expert. Self-proclaimed experts and community-verified experts provide advice in many sites like Yahoo! Answers. Recently there has been a proliferation of sites supporting health Q&A. A new entry, HealthTap, promotes that it has “Answers from 5,000 U.S. licensed physicians. No waiting room.” I tried it and questioned why I needed to answer so many personal questions during the registration process. Once registered, I started to ask a question but was stumped by how much context to provide. In general one of the things I like about Ask the Expert is the ability to browse other people’s questions – sometimes you learn more from questions you never would have thought to ask – and answers.
5. Use clinics for non-urgent care. I had a friend who believed that it was important to see the same doctor because he or she could notice changes that might not otherwise be detected. While I agree, the Minute Clinic (note the name) model can potentially reduce some of the use of doctors for non-urgent care.
6. Enhance health literacy skills. With 80% of US internet users looking online for health information, better health literacy skills are needed to guide the strategies used to seek, select, and use online health information. This is rarely taught in schools or by doctors, and is increasingly necessary because of the lower barriers with social media: it is easier than ever to promote herbal supplements and bad advice.
7. Make waiting fun – or at least less stressful. Deirdre Walsh, a health coach and a former student, said, “The pain and frustration of endless waiting seems needlessly cruel. But it’s often the emotional toll of fear and uncertainty that does the most damage from the negative effects of stress chemicals on energy, sleep and mood.  If waiting is inevitable, there are self-awareness exercises that restore calm, power, and the sense of control. ” Games and gamification have potential as well: a version of “Wait, wait… don’t tell me!” for the waiting room?
8. Is there an app for that? Not that I know of, but social media is being used by public health departments to post flu clinic waits and by emergency rooms to post wait times. What about for doctor’s visits? Dr. Richard Besser said, “You shouldn’t have to wait more than 15 minutes unless there’s an emergency.  Social media might be a great place for people to share waiting times.” Along those lines, I read about, but have not tried, WaitChecker, a web-based service to alert patients to appointment delays.
9. Set expectations. The metaphor Trisha Torrey uses is “when you arrive at a busy restaurant on a Friday night, what’s your question to the host?  How long is the wait?  It’s only fair that providers manage our expectations about wait times, too.” It is easier to be patient with expectations set, not just for the length of a wait but the course of a disease.
10. Use waiting time on task. A student once told me that she had a rash when pregnant and assumed it was unrelated to her pregnancy. She searched for information on her iPhone while in the waiting room, decided it might be related after all, and asked her doctor, who treated it. She saved another doctor’s appointment. What if all waiting rooms provided mobile devices? Or promoted prevention with education, exercises, and healthy snacks. Talk about captive audiences.

Quality of Health Care Is Paramount

It is important to maintain perspective: quality of health care is paramount. Everyone wants the best care possible and sometimes waiting is unavoidable. With no health advantages to waiting, put , as Dr. Ted Eytan said, “the patients’ cost of care, which includes the time they spend waiting, into the equation. Everything follows from that.” There is no reason to accept that it’s part of our health system, but, instead to work to reduce waiting, and to reduce the impact of waiting.

Social Media Metrics for Healthcare

Metrics show which approaches are successful and justify the expenditure. Social media metrics are tricky because obvious ones, such as numbers of fans and followers, may not be the measures indicating success at achieving goals.

Jennifer Schmidt, in Social Media and Health, did a class project on Social Media Metrics for Healthcare in which she identified the four most effective metrics to measure, brand mentions/sentiment; activity ratio; engagement duration; and loyalty. Learn what these are and how to measure them in her paper, Social Media Metrics for HealthCare and slides, which close with the apt and powerful message: 

Develop a message, create an audience, analyze, adjust, and engage.

The Art of Running a Twitter Chat: Lessons from Dr. Richard Besser and ABC News

I learned that Dr. Besser runs a weekly Twitter chat on Twitter, of course: @drrichardbesser: Reminder: Twitter chat today #abcDrBchat 1PM ET Are you prepared for a disaster? Let’s talk about it. @ABC

For the uninitiated, this translates to: Dr. Richard Besser, chief health and medical editor of ABC News and former acting director of the CDC, is running a Twitter chat about disaster preparation.

I participated in the chat because disaster preparedness was on my mind after being interviewed earlier in the day about how social media is being used in Japan and because I follow Dr. Besser and wanted to see how he conducted his chat. I participate in the weekly #hcsm chat when I can and lurk in others, so it’s fascinating to compare moderation techniques. The chat, by the way, was lively, informative, and well-attended. My personal highlight was when Dr. Besser retweeted me and then @ABC retweeted him!

I was in my office at Tufts School of Medicine and the door was open, so colleagues came by and enjoyed looking over my shoulder (they fell in the uninitiated category and were uniformly impressed that Dr. Besser wasn’t). After the chat ended, I contacted Dan Childs, aka DanChildsABC, who heads the Health section of ABCNews.com, to ask how Dr. Besser’s weekly chat started, how it is conducted, and what happens after the hour is over.

Lisa: Who had the idea to start the weekly chat with Dr. Besser? 
Dan: This was actually an idea that was hatched during a discussion between a few of us on the Health team and Niketa Patel, the Social Media Producer for ABCNews.com. We had wanted to do something special that would allow Dr. Besser to connect more directly to his audience through social media, and Niketa offered up this idea. This is the first such effort for a correspondent here at ABC News, so we’re the trailblazers in a way. Or the guinea pigs, depending on how you look at it. Trailblazing guinea pigs.
 
Lisa: Did he like the idea? 
Dan: Dr. Besser loved the idea. 
 
Lisa: This was my first chat with Dr. Besser but I see there is another next week. When did they start? 
Dan: Today was our fourth Twitter chat so far. We started about a month ago.
 
Lisa: How are topics selected?
Dan: Generally, the chat crew will share ideas either in a meeting or online. As with the chat today about disaster preparedness, we try to pick topics that are in the news and, therefore, within the public consciousness. Last week, Dr. Besser tweeted from Africa on issues of global health in the developing countries there. We try to pick something that is relevant, but also gives participants a feeling of going beyond the headlines to explore how these current issues are relevant to them.
 
Lisa: I was very impressed that Dr. Besser was supported by @LaraSalaABCNews, @BigCityRig, @CarrieHalperin, and @DanChildsABC. What actually happens during the chat?
Dan: Several members of the chat crew set up laptops in Dr. Besser’s office, while others of us participate from our offices and desks. Certain members of the chat crew will be responsible for certain aspects of the chat; one may be tasked with presenting questions during the chat, while another will be in charge of scouring ABCNews.com for articles that are relevant to the discussion at hand and posting those links. It is also usually helpful to have one or two people navigating various external sources on the web to ensure that all tweets we put out are based on the most current and reliable information available.
 
Lisa: What happens after the chat to review how it went? Who is there and what is the discussion? Are there noticeable changes the following week?
Dan: This is generally a discussion that takes place in the course of our Health team morning meetings, and then more informally throughout the day as we think of the things we learned from the previous chat session. What is great about this whole process is that the product has evolved pretty much constantly since its inception – every time we do this, we do at least one or two things a little bit differently. Sometimes these adjustments are small ones, probably barely noticeable to our audiences. But then there are larger changes that really seem to have an impact. In our most recent session, for example, we were able to coordinate with ABCNews.com to have the tweets appear in real-time in a text box on the Home Page and the Health page of the website. So when something like that happens, where the rest of the eyes in the network can see what you’re doing and how you’re interacting with the audience, that’s pretty exciting.

How and Why Massachusetts General Hospital (MGH) Uses Twitter to Reach Patients

Mike Morrison tweets for Massachusetts General Hospital as @MassGeneralNews and for Massachusetts General Hospital for Children as @MGHfC. I met Mike when I tweeted about the Benson-Henry Institute for Mind-Body Medicine including @MassGeneralNews in my tweet and Mike immediately followed me. I contacted him to find out what his strategy is for Twitter use and what the benefits have been:

Lisa: Let’s start with the name: Locally we say MGH or Mass General and even the website uses all variations of the hospital name. How did you decide what to use for Twitter to be recognizable and searchable to locals and everyone else?

Mike: The name was a tough decision. MGH was definitely an option but outside of Massachusetts it doesn’t resonate. Beyond that it was a matter of pragmatism. Twitter limited the number of characters for our name and we definitely wanted “News” in the title so after that is was pretty much a foregone conclusion.

Lisa: Do you know anything about which MGH employees – or patients – are on Twitter?

Mike: We usually find out about patients, doctors, and staff on Twitter by seeing their tweets. Each time we’re followed by an account I like to take a good look at the profile to see if they are in one of those categories because I want to continue building that sense of community. We also occasionally remind our own staff about our presence through our internal weekly newsletter.

Lisa: Tell me about your background: what did you do before this and how did you learn to use social media?

Mike: After graduating from the University of Maine in 2005, I completed a post-college PR/Marketing internship at North Shore Medical Center in Salem, MA, close to my hometown. After 3 months I was hired at the Museum of Science (MOS) in Boston as a Publicist in the Media Relations department. I worked at the MOS for more than 3.5 years and loved every minute. Though I had originally joined Facebook in college, it was at MOS that I began to see its full potential as a professional communications tool. Along with my colleagues, I worked to launch both a Facebook “fan” page, as they called it before the most recent “like” change, as well a personal page for Cliff, the Museum’s triceratops fossil. I also helped to launch both the YouTube channel and the @MuseumOfScience Twitter page. The jump to social media communication, though conceptual at first, became a reality for us when the media industry began to severely cut staff. Many of those cuts came from Arts and Entertainment writers and reporters who helped us garner much of our publicity. It became quite clear to us that utilizing social media was an important practice.

Lisa: Explain more about why it was important and also how social media for a museum compares to a hospital?

Mike: Social media is important because it allowed us to connect with passionate Museum fans and communicate our news that, while perhaps not ‘big” enough for traditional press to cover, was important to them. We were also able to have a lot of fun. We ran contests for our Facebook fans and Twitter followers. The staff at MOS continue to come up with even better ideas for engaging fans. In terms of a comparison, both hospitals and museums need to listen and interact. At the hospital we have to ensure that we apply our high standards of patient privacy to our social media practice. Though I didn’t realize it before I arrived, MGH’s world-class research programs ensure that science is very much part of what we do. Some of the most covered MGH stories come from our ground breaking research.

Lisa: How long have you been at MGH, what are your roles, and how did you get this position?

Mike: I arrived in October of 2009. I received an email from a friend letting me know they had noticed the MGH position and thought I should take a look. At its most basic level, my job entails the traditional proactive and reactive media relations (pitching stories/pairing our experts with media). I also oversee social media for the Public Affairs department and do general writing assignments like web stories or annual report stories. Two examples are http://www.massgeneral.org/about/newsarticle.aspx?id=2462 and http://www.massgeneral.org/about/newsarticle.aspx?id=2377.

Lisa: What do you do specifically in this role?

Mike: While at MOS, I would say 80% of my job was proactive and 20% reactive, whereas as now that number is reversed. We respond to hundreds of media calls each year and also operate a live television studio to accommodate national and international broadcast requests. We in Public Affairs work on a beat system with staffers covering different areas of the hospital. Mine include Global Health, Neurology, Neurosurgery, Imaging, and Orthopedics. The other part of what I do – and a major reason why I was hired – was to help launch and integrate social media communications. Luckily my superiors saw the importance of social media before I got here and when the opportunity came to fill a position they made social media a priority. So to that end, I launched @MassGeneralNews on Twitter last February and hope to hit 1,000 followers by the end of this year. I also launched our YouTube channel (www.YouTube.com/massgeneralhospital).

Lisa: Does MGH have a Facebook presence as well?

Mike: Yes, our colleagues in the development office do a great job: http://www.facebook.com/#!/massgeneral , we have a really nice collaboration. Recently, some colleagues and I did launch a profile page in order to communicate bicentennial (we turn 200 in 2011) and history info from the hospital. The profile belongs to Padihershef, a literal mummy who resides in the Ether Dome: http://www.facebook.com/#!/MGHPadi

Lisa: How much time do you spend on the average day?

Mike: Assuming my day isn’t a crazy media day with a major event, I generally work 8:30-5:00 with 60-70% of that time being spent on media calls and the vast majority of the remaining time spent on social media (practice, monitoring, and self-education).

Lisa: What happens with Twitter when you are off duty – do you ever check nights or weekends? Mike: When it comes to Twitter I’m never off duty. While it’s not required for me to check on weekends, I absolutely do. While that probably comes more from a personal desire to grow the presence and not an expressed mandate, I also know the conversation never stops and I like to keep up on it. Occasionally I “unplug.”

Lisa: What oversight is there?

Mike: I’m fortunate to work with superiors and colleagues who “get it.” Though our social media presence is monitored by the leaders of our department, we have a decent amount of leeway.

Lisa: Do you get physicians and other staff at MGH involved, for instance feeding information to you to tweet?

Mike: Often we are approached by different groups in the hospital about the use of social media to promote their efforts. We do in fact work with doctors and administrators from various departments to add their content to our platforms whenever possible and ask that they send us current interesting content.  For example we were approached by an extremely talented group of researchers from our Emergency Department who created a great free app for the iPhone, which lets users find the closest emergency room to their location anywhere in the United States. Our strategy here was to create this YouTube video and then pitch to bloggers encouraging them to use our embed code for their stories. We got great a great response on this as it was posted to Boston.com and Wired.com’s Geek Dad Blog. Although it’s tough to get publicity among a sea of apps, our video allowed us to provide more content for bloggers and increased our chances of getting attention. Even if we didn’t have the pitching success we did, we were able to tweet the video and the link to download, as well as post to our Facebook page. It was a great combination of traditional pitching, content creation, and social media.

Lisa: Does MGH have a social media policy?

Mike: MGH does have a social media policy which helps to provide clarity for our employees and audiences for social media interaction with MGH, or on behalf of MGH.

Lisa: What is the ROI – is MGH doing this because everyone else is or because they see this as essential to their mission, and how do you know you’ve been successful:

Mike: For us, it was easier to think of social media as an important tool we can use to accomplish the goals we already have. We are more of a news/PR office and not marketing so I’m more concerned with communicating and sharing stories or useful information and less about bottom line. Although that’s probably a little shortsighted of me, it’s easier to get started when you already have the goals and the content, and think of social media as a vehicle for both. While I think ROI is important, I’m a true believer that if your reputation is solid you’re going to get the business anyway. To MGH, social media is essential to our mission. Our mission (although I’m not quoting) is to help people. If we know people are looking for help through social media channels, we should be there. For me, it’s like us not having a website or telephone: how can we help if we’re not using the same technology as our patients?

Lisa: How much monitoring do you do of MGH’s online presence and how (obviously you saw my tweet!)?

Mike: I monitor Twitter constantly. I have searches set up via tweetdeck for our Twitter handle, hospital name, and several of its variations. While I don’t log any of the info in any kind of official report, I do respond to and inform folks we work with about any tweets or communications that could indicate a wide-spread issue that warrants a response. Also, if time allows, I do some simple Google searches (blogs, news, etc.) just to see what’s out there.

Lisa: What are specific strategies you use to follow, get followed, tweet, and get retweeted?

Mike: First off, the tweet is king. I try to always offer interesting content, or at least content that is a bit more humanizing and takes away the mystique of a huge faceless organization. Beyond that I try to slowly follow people who are tweeting about us or healthcare in general. I find using hash tags to file my tweets by medical topic often results in followers because people searching that tag are usually the most passionate. Also doing simple things like adding social media icons to my email (as long as outlook is behaving) and putting information about our Twitter handle in the weekly employee newsletter helps. Most importantly, I build followers by engaging. For me it would be easy to view Twitter as a one-way source, but MGH needs to be retweeting and asking questions to develop a truly valuable follower base.  Also, our breaking scientific research news is probably our most retweeted.

Lisa: Do you compare what you are doing to other hospitals or any other organizations?

Mike: I definitely like to see what other hospitals are doing with social media. Any great organization keeps up on industry trends and I think lots of hospitals across Boston and the country are being really creative. It’s also a great benefit to attend conferences with folks at other hospitals because we trade ideas and tips. I think that’s what I like most about social media: the community spirit.

Lisa: For someone starting out in a similar role or wanting to improve a hospital’s online presence, what are your 5 pieces of advice?

Mike:

1. Content. If you don’t have good content, you have nothing. Obviously this isn’t my idea but I believe it’s the gold standard of online communications. Not offering good content would be like opening a YouTube page to host your TV commercials…snooze……
2. Commit. Never use social media “cause everyone else is doing it.” Once you have an idea of your content, make sure you commit the time or allow your employees to commit to learning and practicing it. Even if it only takes a minute to tweet something, you need to be looking at Twitter constantly. At any other job, searching YouTube channels may be grounds for a conversation with your manager, for me it’s a matter of researching best practices and keeping up on trends.
3. Culture. In order to become involved in social media, you have to understand the culture. If you ever friended your parents on Facebook, you get my point. When starting out, just listen. This is especially true with Twitter. For example, someone who doesn’t understand the Twitter culture might find it odd for MGH to retweet a “competing” hospital who just won an award for a service we offer. But the Twitter audience is completely comfortable with this. At the end of the day it’s about standing on your own work, your own reputation.
4. Put yourself in your audience’s shoes. For us, it’s patients. When I think about good content, I try to think about a person who has just learned that they or a family member has been diagnosed with an illness. What they want is to get the critical information quickly. What they don’t want are slick commercials, pop up ads, or a link to a phone number with no information.
5. Be human. How many times do we hear about robo customer service? Or how some large organization seems like a monolith that doesn’t listen? Social media puts the power back in the consumer’s hands and it’s important to engage in two-way conversation. When people feel connected to your organization they’ll work with you. Even if they have a negative experience, they’ll return as long as they’ve been heard.

Sukar Ala Sukar- A Website Design for Diabetes Education and Support for Saudi Arabian and Middle Eastern Children

Sukar Ala Sukar is a website for 4th and 5th grade Saudi Arabian and Middle Eastern children to learn about diabetes. Nada Farhat, MD, designed this in my fall course, Online Consumer Health, and she and I revised her project to submit to the 2010 DiabetesMine™ Design Challenge, a competition “to encourage creative new tools for improving life with diabetes”, in the hopes that we would get funding to implement and evaluate the site.

Here is our description: We designed a website to meet the education and support needs of children with diabetes, at risk, or with diabetic family members who live in Saudi Arabia and other Middle Eastern countries or whose families are from these countries. Culture and language (English and Arabic) are embedded in the website design which includes separate areas for girls and boys in keeping with societal norms. The website goals are to increase awareness of diabetes and debunk myths children might have, which are carried out though text, video, games, recipes, and activities. Social media further reinforces education and provides peer support. Our goal is to develop and evaluate the effectiveness of the website with Saudi children in the US and in Saudi Arabia.

To me, this project is fascinating in three ways: the impact of culture on effective design; design of a bilingual site when one language is read left-to-right and the other right-to-left; and how health website design for children is different than for adults. Nada’s final paper for the course addresses many of these through her competitive analysis and research. Our initial answers to the culture question are in the entry. For instance, one way to address cultural norms is to separate the site by gender. Another is to use drawings of people since photographs of girls violate cultural norms. We know that bilingual design can be challenging for languages that are more similar than English and Arabic, such as English and Spanish, especially when one language uses more characters than the other to express the same thing. We also know the importance of localization. And for children’s design we want to be consistent with best practices yet be fresh.

We welcome your feedback.

Social Media at Sarasota Memorial Health Care System

Shawn Halls tweets for Sarasota Memorial Health Care System (SMH). He has been Market Research Manager at SMH for 12 years. Through him I met his manager, Peter Taylor, the Director of Marketing (pictured to the left). Peter essentially runs an internal ad agency for SMH responsible for both internal and external communication. I interviewed them on February 18, 2010 about SMH’s Web strategy and their use of social media.

Lisa: Start by describing SMH’s Web presence.

Peter Taylor, Director of Marketing, SMH

Peter: Early on we identified that a digital customer engagement platform was fundamental to the future success of all forms of marketing and communications at SMH. The components of this are our website, Twitter, Facebook, MySpace, Delicious, YouTube, Flickr, an external blog focused on a new bed tower construction project, and an internal blog/vlog written by our CEO.

Lisa: Why did you decide to use multiple social media technologies?

Peter: We decided to cast a wide net to increase the likelihood of reaching all of our target audience.  There are clear demographic differences; for example, MySpace turned out to be a great place to reach young mothers. Also, we use them differently; Twitter by definition requires quick, concise, newsworthy messaging whereas Facebook is more leisurely and facilitates more of an intimate relationship.

Lisa: What did you see as your opportunity when you introduced social media?

Peter: We wanted to focus on preventative healthcare and saw an opportunity to engage with our audience of patients and get involved in their daily lives in environments where they feel more comfortable (i.e., without being invasive). The advantage to patients beyond education was that if they need to use our services (hospital or outpatient), everything is more familiar and less alienating. They aren’t meeting us for the first time while in a gown being stuck with needles.

Lisa: How do you know what’s effective?

Peter: We use qualitative and quantitative plus anecdotal metrics. We use Google analytics, not just to see how many visitors we have to our website, but to see where they come from and how they navigate through our site. Our website gets 80,000 visits a month (excluding internal traffic), most of whom find it through our url or a search engine. More and more are coming directly from our social media sites. For example we get almost 5,000 visits a month from our Facebook page.  We use focus groups on and offline to track our presence and improve our content, navigation, etc. We also continually elicit feedback from our social media sites which has been invaluable.

Lisa: Who actually manages and uses social media for SMH?

Peter: Each person in our marketing department is the CEO of one social media site. This way they each develop an expertise and can dedicate the time needed to stay active.

Lisa: Can you give me any time estimates?

Peter: Shawn, for instance, uses twitter. Probably on average 30 – 45 minutes a day but it varies.

Shawn: I registered @smhcs in November of 2008 but didn’t start actively tweeting until March 2009.  My vision was to try out social media.  In keeping with our goal of connecting to and engaging with our community before they need us, social media is ideal.  I love Twitter because it allows us to respond to customer service issues in near real-time.  Since I am the only person currently tweeting at SMH, the policies that guide my tweets are mostly between my ears.  We are in the process of opening Twitter up to the rest of the Sarasota Memorial staff, though, so we’re working on a more formal approach that will be shared in the coming weeks. Right now I don’t have a separate Twitter account for just personal use.  I don’t use our Twitter account to just promote our hospital, certainly I do that too, but I’ve tried to interject professional and personal tweets in the Sarasota Memorial account to add a little personality to it.  Therefore, I’ve never really felt a need to have a separate Shawn Halls account.  What you see in @smhcs…is Shawn Halls.

Lisa: Do you also use social media internally?

Peter: Internally there is limited access to social media right now. We are taking baby steps. As Shawn said, we just granted internal access to Twitter 60 days ago. We recently developed social media guidelines for our 4,000 employees which are still in the process of being implemented.

Lisa: What are the internal concerns?

Peter: HIPAA violations, privacy, and somebody posting/saying something stupid they would regret later.

Lisa: Are there any concerns about disgruntled employees or whistleblowers?

Peter: Yes, these are valid concerns but we would treat them like any other situation where this may arise, independent of technology.

Lisa: What about externally – have there been any concerns raised?

Peter: Nothing yet but we will continue to monitor it very closely.

Lisa: What is your biggest success to date?

Peter: Traditionally marketing has been a top-down exercise but that is reversed in social media. As a result our biggest success has been the way we have reconfigured our entire marketing activity to start with the consumer and not the product. This consumer-centric philosophy has improved our overall marketing and communications. We truly now have an consumer engagement platform.

Lisa: What has been your most serious problem?

Peter: Getting employees on board when they can’t access all social media sites from work at this point. We are very fortunate to have a visionary CEO who has embraced our digital strategy and let us “get our hands dirty” before we had all the answers and who has given us permission to fail if necessary.

How Celebrity Doctors Use their Online Presence to Communicate with Healthcare Consumers

Erin Dubich, a graduate student at Tufts, and I are doing a study about “celebrity” doctors who use their online presence to communicate with healthcare consumers.

Please help us by telling us which celebrity doctors you believe have an effective online presence and why: Dr. Gupta, Dr. Oz, Dr. Phil, Dr. Richard Besser, or another? We are interested in those who have Web sites, blogs, etc., unlike, say, Dr. Ruth, a celebrity doctor whose presence is not online.

The characteristics we are looking at are:

Basis of reputation (credentials, job, books, TV, etc.)
Website(s) featured on
Where seen besides website (TV, radio, books, syndicated column, etc.)
Topic(s) of advice/articles (general health, sexual health, etc.)
Type(s) of advice (ask the expert, interviews, etc.)
Why is the doctor an effective health communicator (timeliness, credibility, topics, reach to common concerns or fears, etc.)

If you have examples of celebrity doctors who you believe are not effective or exploit their fame or their position, we would like to hear that too.

Please post a comment or email me. We appreciate your help and will post our compiled results and conclusions.

Finding Useful H1N1 Information Online

I was interviewed for Healthcare IT News about how H1N1 information is disseminated to the public. While the news media was providing constant updates about outbreaks, my interest was in how healthcare consumers get useful information. I sent the author, Molly Merrill, a quick analysis of some of the sources of information I had used.

The CDC is known and established as the most respected source of information in this country and comes up as one of the first results in most searches on “swine flu” or “H1N1”. Their site is well-branded and is clearly marked with the last updates. However the site itself is busy with sidebars and lots of related information, while arguably the most important information for most healthcare consumers is in a box near the bottom, “What You Can Do to Stay Healthy”. What is likely to be prevalent on most people’s minds doesn’t appear at all here. If you click on “H1N1 Flu & You” near the bottom, a Q&A format addresses the questions people are likely to have, such as “What are the signs and symptoms of this virus in people?” In addition, the CDC has done a great job of using social media, such as twitter, for updates.
 
While I applaud the Massachusetts Department of Public Healthfor providing material in 14 languages, the page itself is basically a collection of links to PDFs. The documents I read are are well-written but some are not even what the links say; for instance, under “Resources if You Are Sick or Think You Are Sick”, the Flu Symptoms Checklist was designed for a parent to determine if a child should be kept home from school or brought to the doctor.
 
WebMD’s Swine Flu Centerdoes a better job of providing immediately visible and useful information through clearly labeled links to answer common questions such as “Swine Flu and Travel”. Due to poor health literacy skills and the fears that have been played upon by the media frenzy, health Web sites should provide very specific information that addresses the concerns uppermost on a healthcare consumer’s mind and it should take minimal scrolling to find it, as is the case here. 
 
Finally, my town, Lexington, MA, has done a great job of addressing parental concerns through emails. The school department Web site provides a parent resource with guidelines about how to talk to your child, a huge problem when children hear a lot on the media and from their friends and need to hear factual age-appropriate information from their parents. And, when one of my sons was out sick for a few days, I received a phone call from the school nurse!

Ten Things You Can Do in Ten Minutes To Be a More Connected Health Professional

You need a break and, instead of heading to the coffee pot, take 10 minutes to follow one of these 10 suggestions to be more connected and better at communicating health messages:

1. Become a social networker: Take your pick, LinkedIn, Facebook, Plaxo, … Create a profile, including a picture, and invite some colleagues. If you search, you’ll find many of them already there. (You can connect to me!)
2. Try twitter: Join twitter and try out micro-blogging. Invite some colleagues or find some who are already there. Try following me (I am a sporadic user but I post health links occasionally) or try BBC Health.
3. Read a blog: Health blogs range from very professional and constantly updated to navel-gazing ones that were last posted in over a year ago. I recommend you start with Well, Tara Parker-Pope’s health blog at the New York Times, The Wall Street Journal’s Health Blog, Consumer Report’s Health Blog, or Health 2.0. For contrast, try Leroy Sievers’ NPR blog or one of WebMD’s blogs. Not feeling overwhelmed yet? Do a search on “health blogs” or even “health blog directories” and I guarantee you will be suffering from information overload. Now comment on a blog. Not only do bloggers like to know you read a post, but you undoubtedly have something to contribute. After all, if you wrote a blog post, wouldn’t you like to know what your readers think? Be a producer, not just a consumer!
4. Create a blog: You knew this was coming! But only do it if you can commit to posting regularly. If you think you can only post sporadically, start one with a few colleagues. I recommend wordpress but there are many other blogging tools.
5. Create a community: try ning and set up an online community about your health specialty. First search to see what else is there. If you find some, check to see how many members they have and the date of the latest site activity.
   
6. Do a search on a health topic: Select a topic of interest to you professionally and do a search. Look at the number of results first. Next look to see if there are sponsored links. Finally, look at the first 10 results and see if you think they represent your topic well. If your work isn’t there, come up with a plan for greater visibility. (If you don’t know what SEO stands for, then at least become conversant with it.)
7. Learn how information spreads: Post an article you like (or wrote) to digg, mixx, StumbleUpon, or reddit. Or post a picture to Flickr or a video to YouTube. If you aren’t ready to post, then participate by commenting on or voting on it.
8. Use Wikipedia: Have you read Wikipedia’s entry on your health specialty? Read it and enhance it. If there isn’t one there, create it. There are other wikis out there too – for instance, you might want to add your name to the list of Health 2.0 people – and see who else is on it.
9. Connect with a person: Email a colleague about something you read or are thinking about. Or pick up the phone. Or even invite someone you’ve been meaning to talk to out for coffee. (See, you get your coffee break after all.)
10. Just for fun: What would it take for you to be the first health specialist on TechCult’s Top 100 Web Celebrities list – besides a blog (see #4) and funky hair?

Finally, think of your own idea for a 10 minute activity that can improve your health communication skills and post it as a comment below so others can benefit.

Thanks to the students in Emerson College’s Summer Institute for Social Marketing and Health Communication who inspired this post following my lecture on New Technologies for Health Communication.

How Social Networking Dilutes the Definition of Friendship

It’s my birthday today and, for the first time, I received more birthday wishes from businesses and associates than I did from friends. Bette Midler sang, “You got to have friends,” and I have many friends who kindly remembered my birthday. But when site registration includes a date of birth, birthday messages with15% off coupons can result. (If I receive a 25% off coupon, does that mean we have a stronger relationship?)

MCI’s widely advertised Friends & Family calling program in the early 90’s introduced me to the commodification of friendship. This loyalty program provided “a lower rate for calls made to customers that they had included in their calling circle,” and, furthermore, increased switching cost since a departing customer’s former calling circle had to pay more for calls to that person. This program ended when a flat-rate plan was introduced, allowing people to call their friends without having to designate people as members of their circle.

Marilyn Monroe sang, “Diamonds are a girl’s best friend,” and obviously friendship has varied meanings. Social networking is stretching the definition of friendship even further as sites use different terminology to describe the people one is connected to. LinkedIn asks me to “Add friends or colleagues to your network?” “Friend” appears 29 times on my Facebook profile – and some of my Facebook “friends” are not people I even know well. In contrast, I really like it that twitter calls the people I follow “people”!

I believe that this overuse of “friend” can dilute the word’s meaning. Dionne Warwick’s “That’s what friends are for” is the title of a RevolutionHealth post about how “Good friends hold you together when you are falling apart, even if it’s over the silliest, most minute things.” A friend is “a person attached to another by feelings of affection or personal regard,” while social networking contacts are acquaintances or – perhaps a better word – associates: “a person united with another or others in an act, enterprise, or business; a partner or colleague“.

“Studies show that people with close confidants have healthier immune systems, stronger hearts, and less depression and anxiety — not to mention more fun.” While people certainly form tight bonds in online health communities with others who are in a similar situation, I imagine these studies more likely refer to friends in the traditional sense. A study by Dr. Will Reader at Sheffield Hallam University found that most people “have, on average, five really close friends,” whether or not they use social networking sites. (I wonder how many people think that their stature is increased by the number of connections they have in a social networking site.)

It is not surprising that I was happier with the phone calls and cards from my friends, rather than those from businesses and my social networking associates. And what about that e-card from my dentist’s office – it’s hard to get a warm, fuzzy feeling. I can certainly think of more perfect ways to celebrate – in fact, already have! – than “A perfect way to celebrate: 25% off the regular price of…” And, if you are my friend, please come join us!

Tech Populism and Discotheque Populism: Parallel Revolutions

Tech populism, a term coined by Forrester Research, refers to people bringing the technology they use in their personal lives into the workplace where traditionally tools have been provided to them and their use prescribed. Employees may, for example, have access to online courses they are supposed to take, but they may prefer to search for and use information available on the web instead of utilizing these courses. Another example is when there is a corporate knowledge management initiative but employees find and contact each other through LinkedIn or other social networking services.

Tech populism is revolutionary in that the traditional tight controls on workplace behavior are violated – often to everyone’s benefit. And a revolt can occur when employers attempt to suppress tech populism.

“Bona fide revolutions—whether political, cultural, or spiritual —occur infrequently in history” and one is certainly taking place in the workplace today. This revolution parallels what was arguably the biggest revolution in music, dancing, and nightlife: the discotheque.

The American Heritage Magazine article goes on to say that “the discotheque originated as a den of resistance in Nazi-occupied France” and, from the 1960s to the 1980s, impacted all aspects of culture in the US and other countries. “Discotheque dancing followed the 1960s pattern in which teenagers invented pop-culture trends and discarded them soon afterward, at which point they were taken up by adults,” just like Facebook today!

“Saturday Night Fever propelled disco fever to epidemic proportions: By 1978, 40 percent of all the music on Billboard’s Hot 100 was disco. Meanwhile the discofication of America proceeded: There were disco lunch boxes, disco “Snoopy” bed sheets and pillows, disco belt buckles, disco records by old-timers like Frank Sinatra and Ethel Merman, an estimated two hundred all-disco radio stations, disco dance courses, disco proms, books about the proper makeup to wear to discos—and an estimated twenty thousand discotheques nationwide.”

I coined discotheque populism to refer to how this “discofication” still lives in the music, lighting, and dance moves found in any club. Even the clothes, makeup, and hairstyles periodically return to popularity. Tech populism is no different – the Facebook of yesterday is the Twitter of today. Tomorrow will bring new applications that will be adopted (and even created) by teenagers first, become mainstream, and then be abandoned by the original adopters just when managers are developing policies for their use.

Seven Habits of Highly Connected People by Stephen Downes, Guest Contributor

Stephen Downes was kind enough to allow me to publish this here. I was especially interested in it because FranklinCovey was one of my clients when I worked at EDS. Watch for a version of this to appear in eLearn Magazine later this month!

With apologies – and all due credit – to Stephen Covey.

1. Be Reactive

There’s a lot of talk about user-generated content on the web. That’s great. But if publishing your own stuff comes at the expense of reading, and commenting on, other people’s stuff, that’s not so great.

The first thing any connected person should be is receptive. Whether on a discussion forum, mailing list, or in a blogging community or gaming site, it is important to spend some time listening and getting the lay of the land.

Then, your forays into creating content should be as reactions to other people’s points of view. This will ensure, first of all, that they read your comment, and second, that your post is relevant to the discussion at hand.

Posting, after all, isn’t about airing your own views. It’s about connecting, and the best way to connect is to clearly draw the link between their content, and yours.

2. Go With The Flow

We all know those people in our online community who are out to Prove Something, to Get Things Done, or to Market Themselves.

These are people we tend to avoid. Because no matter what the topic of discussion, they’ll weigh in with their pet project, peeve or talking point.

When connecting online, it is more important to find the places you can add value rather than to pursue a particular goal or objective. The web is a fast-changing medium, and you need to adapt to fit the needs of the moment, rather than to be driving it forward along a specific agenda.

This doesn’t mean you shouldn’t have any goals or principles for yourself. You should; that’s what will inform your participation. It’s just a reminder that your goals are not the same as other people’s goals, and therefore that your online participation needs to respect that fact.

3. Connection Comes First

People talk about not having time for email, of not having time for blogs. Sometimes they even talk about working without an internet connection.

It’s good to take a break and go out camping, or to the club, or whatever. But the idea of replacing your online connecting with busy-work is mistaken.

In almost all fields, connecting with others online is the work. The papers you write, the memos your read and toss – all these have to do with connecting with people. Even if you work with your hands, making cabinets or rebuilding engines, all your contacts with customers and suppliers are about connecting with people.

If you don’t have enough time for reading email, writing blog posts, or posting discussion lists, ask yourself what other activities you are doing that are cutting in to your time. These are the things that are often less efficient uses of your time.

If you are spending time in meetings, spending time traveling or commuting to work, spending time reading books and magazines, spending time telephoning people (or worse, on hold, or playing phone tag) then you are wasting time that you could be spending connecting to people online.

If you make connecting a priority, you can take that walk in the forest of vacation in Cadiz without feeling you are not caught up.

4. Share

We’re all heard the advice to “think win-win”. Forget that advice. If you follow that advice, you will always be looking at things and saying, “what’s in it for me?” That’s exactly the wrong attitude to have in a connected world.

The way to function in a connected world is to share without thinking about what you will get in return. It is to share without worrying about so-called “free-riders” or people taking advantage of your work.

In a connected world, you want to be needed and wanted. This will, over time, cause resources to be sent to you, not as a reward for some piece of work, but because people will want to send you stuff to help you to be even more valuable to them.

When you share, people are more willing to share with you. In a networked world, this gives you access to more than you could ever produce or buy by yourself. By sharing, you increase your own capacity, which increases your marketability.

5. RTFM

RTFM stands for ‘Read The Fine Manual’ (or some variant thereof) and is one of the primary rules of conduct on the internet.

What it means, basically, is that people should make the effort to learn for themselves before seeking instruction from others.

Almost everything a person could need to know has been recorded somewhere online (by people who are sharing their knowledge freely). Taking the time and effort to look at this work is not merely respectful, it demonstrates a certain degree of competence and self-reliance.

For example, if your software fails to install, instead of calling customer service or posting a note on a bulletin board, copy the error message into the Google search field and look for answers. Almost every software error has been encountered (and documented) by someone before you.

Finally, when you do ask for help, you can state what you’ve read and tried, and why it didn’t work. This saves people from giving you advice you don’t need, and helps them focus on what’s unique about your problem.

6. Cooperate

Offline people collaborate. They join teams, share goals, and work together. Everybody works in the same place, thy use the same tools, and have the same underlying vision of the project or organization.

Online, people cooperate. They network. Each has his or her own goals and objectives, but what joins the whole is a web of protocols and communications. People contribute their own parts, created (as they say in open source programming) to ‘satisfy their own itch’.

This is probably the consequence of distance. Online, it is not possible to enforce your will or (beyond a limited extend) to get your way by shouting and intimidation. This means that online communications are much more voluntary than offline communications. And successful online connectors recognize this.

To cooperate, it is necessary to know the protocols. These are not rules – anybody can break them. But they establish the basis for communication. Protocols exist in all facets of online communications, from the technologies that connect software (like TCP/IP and HTML) to the ways people talk with each other (like netiquette and emoticons).

7. Be Yourself

What makes online communication work is the realization that, at the other end of that lifeless terminal, is a living and breathing human being.

The only way to enable people to understand you is to allow them to sympathize with you, to get to know you, to feel empathy for you. Comprehension has as much to do with feeling as it does with cognition.

People who use online communications ‘only for business’ – or worse, feel that other people shouldn’t be posting cat photos or playing Scrabble on Facebook – are employing only a small part of the communications capacity of the internet.

Learning and communicating are not merely acts of sending content over a wire. They are about engaging in (what Wittgenstein called) a ‘Way of Life’. Having a cat is as important for a physicist as having an advanced research lab. These common everyday things form the mental structure on which we hang the highly theoretical structure.

The idea behind ‘being yourself’ is not that you have some sort of offline life (though you may). Rather, it’s a recognition that your online life encompasses the many different facets of your life, and that it is important that these facets all be represented and work together.

Using MySpace for Health Information: Where is the Empathy?

MySpace has over 300 million accounts as of 2/3/08 and was the #1 website in the US at least one week in 2006. If someone is a regular user of MySpace and has a health question, it is easy to turn to one’s community for help. MySpace Forums have a Health and Fitness section with exercise, general, and nutrition forums. The most active discussion under Nutrition is a thread on diets started 6/9/05 and it includes a post from someone who offer 59 ways to eat less of which many are potentially extremely dangerous. The 1300 replies range from serious posts about anorexia to advertisements. The other forums are similar, with a mix of serious, frivolous, and seemingly harmful discussions about bodybuilding, natural remedies, steroids, etc. There is a broader mix of comments than in most health forums and the amount that are off topic or what I perceive as far from helpful is far greater than in other forums I have looked at. Most other health forums tend toward highly supportive comments or advice. Are there different social norms in MySpace that lead to less empathic behavior?

Who Am I Today? The Problem of Multiple Online Identities

At a course I taught on Online Health Communities, one of my students described how he investigated and tracked down a person who had a dozen personas in the community he managed. MIT Technology Review reported how a social networking site, Moli, allows (and encourages) users to develop multiple profiles and control access to them. The issue here is that everyone has multiple facets and it is difficult to portray and maintain multiple personas online, whether for honest or fraudulent purposes. I may not want the readers of eLearn Magazine to know that my passion in life is swing dancing (oops!) or to package my consulting skills to fit a profile form. LinkedIn, for instance, only allows you to select one industry. I selected “e-learning”, but could have accurately chosen “higher education” or “health, wellness, and fitness”. “Dance” isn’t even listed.

Using a Blog to Aid Reflection (or Would Thomas Jefferson Write a Blog?)

Thomas Jefferson said, “One travels more usefully when alone, because he reflects more.” Robert Davison, in Learning through Blogging: Graduate Student Experiences, finds that blogs help his students at City University of Hong Kong reflect on what they are learning and on the applicability of it to their jobs. He has them blog both in class and on their own. I think the very prolific Thomas Jefferson would have been an active blogger (although not Twitter or other social networking tools), and, like Robert’s students and me, would have found it aided reflection.

The New Technology Spectrum: From Embarrassment to Pride

According to CNET News, many people are embarrassed to admit that they use dating sites, even though the numbers indicate heavy use. Many people use Wikipedia too, but a well-known researcher sheepishly admitted in an email to me that he uses it all the time for “basic science stuff”. And many people read the Dummies book series, but don’t boast about it, as I discovered in an email confession, “I hate to admit my secret: WordPress for Dummies.”

If the embarrassment end of the spectrum is the use of certain types of web sites and sources of information, then at the pride end are thin devices (yes, people still proudly display their phones and cameras), successful social networking (lots of connections and recommendations), and being invited to tape a Comedy Central segment after posting YouTube videos. Personally, I am proud to have authored a Wikipedia entry (but that might be different than using Wikipedia as a reference) and to carry a thin phone.

e-learning, Diet Coke, and the Super Bowl

The Super Bowl is all you hear about these days in Boston, where our sports teams are doing great (how ’bout those Red Sox!) I’m not a huge football fan, but I read reports of how Tom Brady practiced yesterday and his right ankle was not taped, swollen or discolored. And I stock up on Diet Coke at Super Bowl sales.

Technology is playing a greater role every year in sporting events. Social networking is being used by Nielsen to rate Super Bowl ads. “Nielsen Online also will provide real-time analysis of messages and opinions from 70 million blogs, message boards, online communities, video-sharing sites and sports enthusiast sites.” Their site, Hey! Nielsen, is “a way for you to influence the TV and movies you watch, the music you listen to, and more… all while making a name for yourself.” Clearly someone at Nielsen saw that Time Magazine’s Person of the Year for 2006 was You. I’d like to learn more about the technology they use for text analysis and drawing meaningful conclusions from these millions of messages.

But what does this have to do with e-learning? I kept hearing on the radio “blah blah University of Phoenix Stadium blah blah” before it hit me – the 2008 Super Bowl is being held at University of Phoenix Stadium! The University of Phoenix’ home page doesn’t mention this, but it can’t hurt enrollment. Does this mean e-learning has reached a tipping point?

My biggest take-away from all this has nothing to do with sports (although I might look for an online course to finally understand football). What I learned was linguistic. Today’s Boston Globe reported that “Plaxico Burress went Joe Namath on us Tuesday and got a lot of headlines.” Joe Namath? I’m going to use that 3 times in a sentence today.