Social Media: One Piece of the Patient-provider Communication Puzzle

Consumers have increasingly used social media networks to share news and maintain personal relationships, but healthcare has been slow to establish its presence in this virtual landscape. As more patients turn to the internet for healthcare needs, healthcare professionals are presented with a powerful tool to help bridge a gap in patient-provider communications.

All about access

“We want to hear complaints, so we know where to improve,” says Lauren Brendel, coordinator of corporate communications for Adventist Health, the 19-hospital system based in Roseville, Calif.

A visit to a provider leaves too many patients feeling slighted. Whether dealing with an inadequate response to an appointment request or a long wait on a customer service hotline, patients are taking to social media platforms to voice their complaints. Providers should view these instances as opportunities to recognize communication failures and engage patients having negative healthcare experiences.

One May evening, an injured patient wrote on Kaiser Permanente's Thrive Facebook page, “I am very disappointed with Kaiser’s handling of my appointment.” Less than 45 minutes later, a Kaiser employee posted a response: “I’m chagrined to hear this. Please email me and I’ll bring this to someone’s attention.” Two days later, a satisfied patient had changed her tune: “I have been extremely impressed with Kaiser’s handling of my situation!”

Fear of negative feedback may prevent some providers from joining social media. Giving patients a haven where they can express dissatisfaction is important. Lauren Bailey, MPA, acting director of online communications for the Department of Veterans Affairs, worried that social media platforms would serve as “complaint central.” That hasn’t been her experience generally, but “sometimes it is and that’s fine because patients just want a place where they can come and talk to somebody.”

Accessibility is why the Veteran’s Health Administration (VHA) expanded its social media efforts. VHA employees realized several years ago that military veterans were rapidly building an online community, primarily active on Facebook, according to Bailey. They recognized an opportunity to engage these patients where they are congregating and the goal of “getting the right information to the right veteran at the right time” has driven the nation’s largest health system’s social media activity ever since.

The VHA first established a social media presence in 2008 with a single Facebook page. It has since expanded to include a Facebook page for each of its 152 medical centers, 64 Twitter feeds, a YouTube channel, a Flickr page and frequent contributions to the VA’s VAntage Point blog. Multiple communication channels mean the VHA can connect with more patients the way they want to. For instance, separate Facebook pages for each of its facilities allows the VHA to tailor messages to individual communities, whether it’s to warn of a coming storm in Muskogee, Okla., or to announce free screening services in Anchorage, Alaska.

“We go to where the veterans want us to be,” Bailey says. “It’s not so much about what’s convenient for us as it is about where the veterans are and where they want to engage with us. It’s customer driven.”

While many providers perceive risks with a social media presence, ignoring the trend may be riskier. Facebook has more than 1 billion users and Twitter has more than 140 million active users globally. As healthcare moves toward a patient-centered delivery model, it will need to meet patients in the spaces they occupy. “If you look at what patients want, they’re flocking to the internet,” says Ted Eytan, MD, MPH, medical director for the Oakland, Calif.-based Permanente Federation, which represents the interests of Kaiser Permanente. “Check how accessible you are to the people you serve.”

Empower and trust employees

“Participating in social networking and other similar internet opportunities can support physicians’ personal expression” and “enable individual physicians to have a professional presence online,” according to the American Medical Association’s policy on professionalism in the use of social media. Both Kaiser and the VHA encourage their employees to take advantage of this opportunity for personal expression.  

Believing local providers and healthcare employees know best what their communities want and need, the VHA gives individual facilities the latitude to control their own social media accounts. “We think of our employees as advocates, never liabilities,” Bailey says. “We want our employees to be empowered to reach out to veterans to give them the information they need. We think of them as subject matter experts, and they are.”

This concept is apparent in the VHA’s social media policy. Before building its virtual presence, some within the agency wanted to move quickly to adopt social media and others were reticent. VHA leadership wanted providers to feel they had a stake in social media activities and not that these were unnecessary workflow interruptions being forced upon them, according to Bailey. Now that the VHA has achieved widespread internal support, Bailey is inundated by employee suggestions to make it better or try something new.

“Physicians have a good sense of what it means to serve a patient well,” says Eytan. Kaiser trusts its providers to develop relationships with their patients. Social media represents a mode of communication they can use to cultivate these relationships and their social media presence is an extension of a broader communications strategy to engage patients. 

Eytan doesn’t give a concrete list of instructions when asked for help with social media platforms, which are designed for widespread adoption and usability. Learning the technology is not a social media novice’s most difficult task, but establishing a persona might be. Be yourself and be personable, Eytan advises. “I’m not telling them how to use the tool, just asking them about the physician they want to be.”

Growing pains

If state public health departments’ social media activity is any indication of a more general trend, then healthcare has not optimized its use of social media. Only 1.5 percent of state health department tweets represented a response to a follower’s tweet and 86 percent of their Facebook status updates received no comments, according to a study published March in BMC Public Health.

“Most of what you see is one-way communication,” says the study’s lead author Rosemary Thackeray, PhD, MPH, an associate professor in the department of health science at Brigham Young University in Provo, Utah. “It’s not capturing the social part of social.”

Thackeray blames the lack of strategic social media plans and points to state health departments’ positioning in the social media landscape as evidence of their absence. Of the 60 percent of state health departments using social media, 87 percent are active on Twitter and only 56 percent are active on Facebook, even though Facebook has a larger user group.

“Social media can be such a powerful tool if it’s used appropriately,” she says. “Public health has started to use it, but we need to use it more strategically. If we can identify our audience and learn how to use social media more interactively to engage people, then we can really tap into the power of social media.”

The importance of a social media presence is growing for healthcare organizations and it may be tempting for them to dive right in, but it is important to have a plan. Even though there are low barriers to entry, maintaining an effective social media presence can be difficult.

“Facebook is a great starting point, but just like with anything else, it takes time,” Brendel says. “And the most time-consuming part of social media is content curation—finding that content and making sure it’s relevant to your audiences or tailoring it to your audiences.” 

A communication tool

“Social media is communication,” Eytan says. There is growing demand not only for patient-provider communication via social media, but for increased patient-provider communication in general. A social media presence does not excuse healthcare organizations from abandoning or failing to adopt other methods of communications.

Both the VHA and Kaiser Permanente aggressively use all forms of communication available, including secure email and online patient portals, to engage patients and make health information available. The numbers suggest patients appreciate these options. Kaiser’s approximately 9 million patients sent more than 12 million emails to their providers in 2011. And, since Kaiser launched a smartphone application for patients to access their health information earlier this year, nearly 268,000 have downloaded it.

As a component of a larger effort to engage patients using online communication tools, social media can play a crucial role. But it is not a substitute for other forms of access to providers. “It’s one more tool that you can master and integrate into communication with patients,” Eytan says. “Use it to be there for your patients. Don’t use it to be far from your patients.”

Live-Tweeting Brain Surgery at Memorial Hermann Texas Medical Center
More than 14 million people followed online as the Houston-based hospital’s social media team provided live coverage of brain surgery using social media sites, including Twitter, YouTube and Pinterest. It was an opportunity to “educate the general public about brain tumors and take them into the operating room to see what happens during a brain surgery,” neurosurgeon Dong H. Kim, MD, said.
— Natalie Camarata, Digital Marketing Manager, Memorial Hermann, Houston

Disaster Response at Southcoast Health System
This New Bedford, Mass.-based, three-hospital healthcare organization took to social media when a chemical spill at a local waste treatment facility led to 120 hospitalizations. Southcoast’s public affairs professionals tweeted hourly updates that included information on risks posed by the spill and the number of patients being admitted to the hospital due to the spill.  The outreach let the community know the situation was under control.
— Jim Rattray, Vice President of Marketing and Public Affairs

Fundraising at University of California San Francisco (UCSF) Medical Center
With a new children’s hospital slated to open in 2015, the UCSF marketing team proposed a social media campaign to raise $100,000 from 1,000 donors in eight weeks.  They worked with Facebook “Causes” and earned support from Zynga, a social gaming company, which sold virtual items in the game Farmville. The result was a fundraising project that outperformed original goals ten-fold, raising $1 million from 164,000 donors.
— Karin Rush-Monroe, Interim Deputy Director of Public Affairs

Tips for Crafting a Healthcare Social Media Policy
David Harlow, JD, MPH, principal of the Harlow Group in Boston and author of Healthblawg, offers the following suggestions for your social media policy:

• Know Yourself: It may be tempting to look at a social media policy posted by a healthcare provider already active online, change the names and run with it. One key reason not to do that is that every provider is at a different level of social media “maturity.” If your senior management has just authorized dipping a toe into the social media waters for the first time, then the Mayo Clinic policies are not going to be right for you. In the early days, it makes sense to revisit policies and procedures every six months.
• Know Your Goals: Why are you making the foray into social media? Is it to connect with referral sources? To connect with patients directly? The specific goals you have will inform your choice of tools and tactics, and may affect the content of your policies as well. For example, if you want to encourage real-time communications with team members, perhaps you should not lock all social media sites on the office network.
• Inclusive Processes Will Yield the Strongest Policy: A social media policy should be developed not only by senior management or compliance professionals, but by a team including them and also younger employees who use social media tools on a daily basis for personal and/or professional purposes. All of these perspectives may be harnessed in the development of policies and in disseminating them formally throughout your organization.

Looking Ahead: Secure Messaging

A lot of providers have rolled out secure messaging for Stage 2 Meaningful Use requirements. Those who were not using secure messaging asked many questions about how to deal with the flood of inappropriate messages that will not be reimbursed and those who had deployed the technology raved about the convenience compared with phone calls. More and more secure messaging with patients will be linked to a connected application, and not just the patient portal.
— Farzad Mostashari, MD, ScM, National Coordinator for Health IT, speaking at the CMIO Leadership Forum: Transforming Healthcare through Evidence-Based Medicine