Social media is for more than marketing
The quality possibilities are only just beginning to be known
Sure, your facility has a Facebook page. And a Twitter feed. Maybe you even get a copy of a tweet now and again if someone says something about his or her stay that is related to quality. But for the most part, that stuff is for marketing, right?
Not so fast. More and more hospitals and other healthcare organizations are figuring out ways to harness social media into a quality and safety tool, and if you haven’t put your mind to the matter yet, you might want to. It’s a powerhouse that’s here to stay and is increasingly the mode of communication that your clientele want to use to talk to you and about you.
In Springfield, MA, Baystate Medical Center patients were invited to suggest ways to improve care on the hospital Facebook page last spring. Tara Lagu, MD, MPH, a research scientist at the Center for Quality of Care Research working on the project, says she had seen stories about patients in the United Kingdom using the physician review website to comment and provide feedback about their healthcare, not just their doctor. "The United States doesn’t have a similar national website like the UK’s National Health Service, but Facebook is used by an estimated 128 million U.S. adults, which might make it an appropriate medium for patients to provide feedback to healthcare providers," she says. "Because of this, it seemed like that might be a good place for soliciting patient feedback in order to learn how to improve the quality of care that we provide."
The project is ongoing, but she anticipates that the feedback will be good fodder for the hospital to improve care. They are planning a paper to describe the comments they got.
Using the Facebook page is just one way Lagu sees of using social media for quality purposes. "It could provide an opportunity for patients and providers to interact in real time," she says. "There are still barriers that have to be overcome for this to happen, though — like privacy rules." Until that happens, such a use might be difficult for hospitals or providers and their patients. However, some work-around will undoubtedly take place, perhaps through private messaging options.
She says that teaming up with the marketing department — or human resources, or whomever is currently making the most of social media in your facility — to brainstorm about uses related to patient safety and experience, quality of care, and other overarching themes that go beyond branding should be one of the outright goals. "At first, it might just be about learning what various departments do around social media," she says, "but over time, there may be opportunities to conduct experiments similar to what we did on Facebook, which can allow examination of the potential of social media to help improve care quality."
Felix Greaves, MD, PhD, currently a fellow at Harvard School of Public Health, studied the use of social media in the UK’s health system before hopping across the pond. Two of his studies are well known in the field — one looking at social media comments to find out about poor quality of care,1 and one looking at tweets about hospital quality.2
He says that we are still "at the experimenting stage" with the marriage between QI and social media. "But there is a lot of promise. It’s already good for service recovery and flu outbreaks. But we have to learn how to use it for quality and safety. We have to figure out what information is out there, and most hospitals still view it as something that is a cultural norm for young people. They don’t see it as particularly useful for them."
In the Twitter study, Greaves and his colleagues collected all the tweets sent to the UK’s National Health Service hospitals over the course of a year. There were about 200,000, about 10% of which mentioned quality or safety issues or errors.
"It’s a signal to noise problem," he says. "There is a lot of stuff out there, and you have to dig through it to get at what you want."
What is said is largely positive. There is a lot of talk about staff and their interactions with patients, the personal relationships they develop during a patient stay. But they also mention things like, "I’ve been waiting two hours for this test and I’m bored," or "this nurse was rude." They can be of significant value.
"They are different from surveys because these patients are self-selecting, and you can’t compare measures between hospitals," he says. "But if you want to use Twitter to find examples of good and bad care, it’s got great potential."
It sounds like a lot of work, and perhaps right now it is — although there are certainly tools out there to help you search tweets to narrow your investigation, and that will likely increase and improve over time. But Greaves says regardless, "you don’t want to have your head in the sand about this. This is happening now and increasing, whether you are on board or not."
Most hospitals aren’t getting more than a half dozen tweets about them per month. But you have to have an eye out for those. And if you have communications staff handling quality and safety issues, it will ring false with your constituency. So like Lagu, he recommends getting together with the people who are now handling Facebook, Twitter, Instagram and whatever other social media interests your facility is aligned with.
"This doesn’t have to be some onerous task," he says. "Take the time to learn about what’s going on. Think of this as another potential tool in your kit. It won’t replace surveys, but it will give you another sense of patient experience."
In Las Vegas, Dignity Health is already using social media to improve patient feedback, says Maggie Rafferty, RN, MHA, MBA, DHA, chief experience officer for the system. She wrote a paper on the use of social media as an adjunct to patient satisfaction surveys that appeared in Nurse Leader in June.3
The quantity of tweets, blog posts, and other feedback from these less than traditional areas is increasing but is still relatively small, she says. Some of her peers don’t even have it on their radar. "But we are undoubtedly at the beginning of something," she says. Indeed, this isn’t even the first study she’s done on the topic in this calendar year. "Earlier this year, I worked on a study looking at medical tourism and online narratives of people who travelled overseas and did an analysis of the feedback on quality and service they gave through those mechanisms."
She shares the burden of collecting, collating, and evaluating the data that comes through social media with the marketing team. "They monitor the blog and Facebook, and we track and trend the data," she explains.
Soon, there will be some ability to get real-time data — through an in-room keyboard that will give patients triggers to comment at particular times of day, Rafferty says. The rationale was to provide a way to give staff recognition — through awards for nurses and for non-nursing staff. But other information, such as how the room is, if it’s too warm or too cold, if the meal is good or bad or late or cold — can also be triggered by a timely question or two.
That information will go automatically to the nurse manager through a pager system so that any problems can be dealt with promptly, she says.
"There isn’t going to be a choice but to use social media," she says. "Our customers are using it to make buying decisions for products like refrigerators and cars. And they are already reading about us on Yelp and Angie’s List. This is here to stay. And this isn’t telling your family at a barbeque about your experience, but your 500 closest virtual friends. This isn’t a private Facebook message, but something on a public page for anyone to see."
When a comment comes in, the response is as near instant as sleep and weekends off allow. Problems are addressed, thanks for kind words are effusive. And Rafferty says patients should be made to feel what they are doing isn’t just welcome but a good thing. They have a way to instantly make a difference, not just in their own care, but potentially in the care of other people who come after them. "We don’t have to wait weeks or months for a survey to come back to see a comment," she says, "and they don’t have to wait to see us fix a problem."
And one more thing that social media provides: a great list of potential candidates to be involved in other initiatives that demand patient and family input. As patient and family involvement becomes de rigeur, it becomes more important to identify people in the community with an interest in making sure the care people receive is of the best quality. The ones who send a tweet? They care. The ones who comment? They are those candidates, she says.
Occasionally, Rafferty says, they will get a story through social media that is really amazing or touching, and they will contact that patient or family member and bring that person in to record the story so that it can be shared with the staff and board. "Those things are impactful for us. For us, social media information means we can be much more responsive, and the patients and the staff both have the opportunity to see that."
Sit down with your marketing folks and ask for a quick tutorial in Twitter if you don’t know about it already. Get a Facebook and Instagram lesson. Then educate your team. It’s possible one or more of them already knows the ins and outs. Use that talent.
Figure out what platform works for you — there are many that allow you to sort tweets, says Rafferty. Some platforms will grab all the tweets and drop them into an email box. Other will troll through all social media — Yelp, Facebook, etc., and look for mentions. She explains again that marketing people are a great first stop for information on what you are currently using to monitor chatter and what might be good for the quality department to use as a tool to manage any information that comes up related to safety and quality.
Treat what comes through as if it were any other kind of praise or complaint. Write them up exactly the same way, and treat them with the same degree of gravitas. Just because it comes through on the ether and is spelled in textese doesn’t mean you don’t take it seriously, Rafferty says.
"We really are in the infancy of all this, and there is a lot more work to do," she says. "As consumers are increasingly using social media, we will have to be, too."
For more information on this topic, contact:
• Tara Lagu, MD, MPH, Research Scientist, Center for Quality of Care Research, Baystate Medical Center, Assistant Professor, Tufts University School of Medicine, Springfield, MA. Telephone: (413) 794-7688.
• Felix Greaves, MD, Ph.D., Fellow, Harvard School of Public Health, Cambridge, MA. Email: email@example.com.
• Maggie Rafferty, RN, MHA, MBA, DHA, Chief Experience Officer, Dignity Health Nevada, Las Vegas, NV. Email: Kamilah.Word@DignityHealth.org.
- Greaves F, Ramirez-Cano D, Millett C et al. Harnessing the cloud of patient experience: using social media to detect poor quality healthcare. BMJ Qual Saf 2013;22:251-255 doi:10.1136/bmjqs-2012-001527
- Greaves F, Laverty AA, Ramirez-Cano D et al. Tweets about hospital quality: a mixed methods study. BMJ Qual Saf 2014;0:19. doi:10.1136/bmjqs-2014-002875.
- Rafferty MO, Gray K. Beyond patient experience surveys: leveraging social media to glean patient feedback. Nurse Leader 2014;3:31-35. DOI: 10.1016/j.mnl.2014.03.010.
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