Can Twitter Help Save Lives? A Health Care Social Media Case Study, Part II


This case study is the second of a two part series. The information below reflects the events of April 25, 2011 from a tactical standpoint, with critical regard to process and strategic considerations. Part I details the story of April 25, 2011 from a human standpoint.

Background

The dialogue that took place on Twitter between Emory Healthcare and Matthew Browning on April 25, 2011 was a powerful one. Without time to spare, Matthew turned to Twitter in a time of crisis to help get his wife Phoebe’s grandmother transported to a hospital with capacity and capabilities to help treat her ruptured aorta. We were able to assist Matthew and his family in an emergency situation, leading to Phoebe’s grandmother being airlifted within 16 minutes of receiving contact information, a truly amazing feat. Despite this, there are countless lessons learned from the experience. While Part I of this case study explored the story and events of April 25, 2011, this portion focuses on the meaning behind and implications of that story. The whole goal here is to help people; and if that’s truly your goal with social media crisis resolution, there are steps you can take to make that a reality, knowing that there will always be scenarios and circumstances that can’t be resolved with a cookie cutter process.

What’s Covered in Part II

  • What we knew before our interaction with Matthew and how that produced the outcome that was achieved on April 25, 2011
  • Tactics and qualities we employed as part of our social media strategy
  • Steps your organization can take to define its process and strategy
  • Things we learned from our interaction with Matthew
  • Questions that remain unanswered

Health Care Social Media – What We [Thought We] Knew Then

Prior to our interaction with Matthew on April 25, 2011, we had what I would deem to be a thorough and solid process for mitigating risk and resolving issues over social media. Our process and general process recommendations are outlined below.

Social Media Process Tactics

The tactics used at each organization will differ substantially based on organizational structure. Larger, more siloed organizations will have to work harder to bring together disparate contacts in the time of crisis. Aligning these groups and stakeholders in advance is highly recommended. Below is a listing of core components of our social media strategy at Emory Healthcare prior to our engagement with Matthew Browning.

Evaluate Need for Response

When receiving feedback via social media, before jumping into any process, you must first evaluate whether there is a need for response at all. Many may already deem this item to be common sense, but in fact, it’s not. Not every contact via social media warrants a response, especially not when you’re getting hundreds of them a day. Ask yourself first:

  • Does it require a response at all?
  • Does it need an immediate response?
  • Is it likely that our network will respond on our behalf?

Collaborate

No work in health care or any business is done in a vacuum. Collaboration is key both within the walls of a hospital or clinic, and outside of them. At Emory Healthcare, social media is another realm in which this collaboration continues. We collaborate with direct contacts in several departments who know we rely on them to solve problems over social media. If we get a billing complaint, there’s a contact for that. If someone voices concern over an insurance issue, there is a contact for that. If at any point, we can’t get an answer from one of these contacts, we still take action by letting the individual know we are working on getting them an answer. As soon as we do, we always circle back and follow up.

Continue the Dialogue Offline

When the dialogue gets heavy or privacy becomes a concern, we try to steer the conversation to a more private location. When on Twitter, we will often Direct Message (DM) contact information for the appropriate department so the individual can work directly with them to continue the resolution process. Social media is not an end. It is a means to the end, which is an appropriate source for resolution. It is our job to make the transition from Twitter to telephone, or hospital, or clinic as seamless as possible for every individual.

Identify Common Complaints

You know your health care system better than anyone else. If your most common source of complaint relates to long wait times, or slow billing, you should have on-call contacts to help when those concerns come up. But furthermore, you should communicate those trends in feedback to departments that can directly impact their improvement. Again, Twitter is not an end; it is a piece of a very large and cyclical accountable health care puzzle.

Just like our doctors, nurses, and staff have been trained and are equipped to handle the most severe and/or high-pressure medical cases, so too have our team members behind the scenes who facilitate Emory Healthcare’s internal operational and communications processes. This means that before an emergency ever arises, we have processes in place to guide groups in a decentralized organization to a commonly understood and supported outcome.

Questions to Help Guide You in Defining Your Process

When looking to define your own process, contacts, logistics, process, stakeholders, and response times are just a few of the things to consider and outline before developing a process for handling social media feedback. Based on our experience in the past and the events of April 25, here are some questions you should consider and ask:

  • Are you listening constantly and able to act immediately?
  • Do you have contacts for every standard issue? I.e. Is there a person you can reach immediately in every department that may be required to assist you with resolution?
  • Do you keep key contact information in your line of vision and reach?
  • Have you considered every possible one-off emergency that could come your way?
  • If every necessary contact in your process disappeared, do you have a back-up plan?
  • Do you have a way to communicate to teams in your health care facilities (if decentralized) to keep them in-the-loop?
  • Do you have a method to reach other health care facilities in the region if you are unable to help?
  • Could you remove spatial barriers to appropriate teams? Are your teams strategically located to aid in social media efficiency?
  • Is there a feedback loop in place to allow you to proactively stay informed once a hand-off has been made?

Social Media Process Qualities

Every brand and every brand’s social media manager(s) deals with negative feedback. No company, product, or service is perfect, so none are immune from this. And as discussed above, in health care, the services we provide can oftentimes be life altering ones. Whether or not we’re aware of it, health care social media managers are often leaders of support groups and patient advocacy. As such, providing patients, families and community members with options for effective help and resolution via social media is key.

There are four key qualities consistent amongst every successful health care social media feedback strategy, including ours at Emory Healthcare:

1. Immediacy
2. Empathy
3. Authenticity
4. Empowerment

Immediacy

Feedback can come at any time. It is important that the person(s) managing health care social media presence have a constant finger on the pulse of their stream. Personally, when not in-office, I use my mobile phone to remain constantly in tune with and updated on the feedback our Emory Healthcare social media accounts receive. Without a constant listener, there can not exist the constant ability to act. And when there is a crisis or complaint, the response should be immediate.

At Emory Healthcare, when we receive negative feedback, if we don’t have an immediate solution or next step for an individual, we contact them to let them know we’re working on it. If you don’t respond immediately, you miss an opportunity to serve and demonstrate your commitment to your community. On April 25, a lack of urgency would have almost certainly resulted in an immediate loss of life.

Empathy & Authenticity

Every dialogue and situation is unique. Empathy, or at least the ability to acknowledge we don’t know each person’s unique story is so important from a health care social media standpoint. When the situation allows, we must take the time to educate ourselves on the person reaching out, and learn as much as we can about their circumstances. What makes them tick, what have they gone through recently, have they reached out before? When it doesn’t, we must be aware that unique or unexpected circumstances may exist and avoid jumping to conclusions.

When Matthew Browning reached out to us on April 25, there wasn’t time for extensive research. Because I monitor our Twitter and Facebook presence as well as the general health care social media space as close to 24/7 as a human can, I knew of Matthew and his role in the space. I did not know the details of this situation. In fact, when he reached out about who we later learned was his wife’s grandmother, we didn’t know if he was helping his own family member or the grandmother of a friend, but it didn’t matter. What did matter, was the fact that he and his loved ones were in desperate need of help.

The impact of empathy and authenticity on your strategy and process should be pervasive. Empathy and authenticity should exist from start to finish, because if in fact an authentic dialogue, focus on quality of care, and true concern for humanity exist, these qualities are innate parts of your process. Every touch point, whether via social media, in a health care facility, over the phone, or otherwise, should reflect this. If the people involved in your process cannot buy in to this, I suggest you find new people.

Empowerment

Assuming you have the right processes and people in place, EMPOWER THEM! Without being empowered to help people and do the right thing via social media, I and the Emory Healthcare team would have been unable to execute the processes and tactics outlined for above. The more rungs of the hierarchical ladder the person on the front lines much climb, the slower your response and the less effective it will be.

The Opportunity Cost of Fear

Operating in the health care social media space requires the right kind of process, being employed by the right kind of people, with the right kind of attitude, not to mention a lot of effort. So what justifies these things? The risks of not participating in social media far exceed those encountered via participation. From solely a reputation management perspective, health care organizations must consider that at least 59% of internet users use social media to “vent” about a customer-care experience1.

Consider a person taking a flight out of state and receiving the run around from an airline after delays and being rerouted. If this person uses social media technologies such as Twitter, chances are, their following is going to hear about the experience. Flight hassles, however, don’t usually have a lasting impact on one’s life.

Those in health care must always be cognizant of the fact that the work we do has direct and potentially lasting implications for a person’s being. Going through airline security is not as frightening as going under anesthesia before an operation. Being hassled with flight rerouting is trivial when compared to trying to juggle resources to get your loved one seen for emergency surgery. Let’s face it– health care can be scary. It’s our job to remove those fears with action. As humans, we’re much more likely to tell others about a negative experience than a positive one. Whether or not you’re listening, it’s being said, and to a lot more people than you think.

Health Care Social Media – What We Know Now

As much as we’d like to think that formal processes create solutions for every one-off scenario, they don’t. When a person’s life is on the line there isn’t time for following a flowchart or researching his/her history.

When a crisis does arise, it is mission-critical that outlined processes are well understood and can be executed seamlessly, because when in an emergency, as Matthew told us, “You can’t think. You gotta just move.” And he’s right. When a crisis presents itself, we take our training, knowledge, and contacts, and couple those with common sense and urgency, and move. No barriers. No flowcharts. No waiting. What’s most important is acting quickly and effectively in a chaotic time of need; if that means cutting out steps, that’s what has to happen.

However, from our experience on April 25, we have determined that a sub-set of our processes and list of additional phone numbers must be created for such urgent situations. As an example, when Matthew mentioned in his tweet that his grandmother needed a emergency airlift, we did not have an immediate phone number to reference for such a request.

Thankfully, the way we are structured puts us in the same organizational department and physical area as our call center staffed by Registered Nurses. When his tweet was sent, it was a literal 30 second walk down the hall to get contact information and confirm that in order to be airlifted, the transfer service phone number must be called first. (This is why when we contacted Matthew, he was given a phone number for this service rather than directly to our airlift service). This situation proved that careful consideration to  things such as departmental organization and spatial closeness can save precious and potentially life saving minutes in an emergency.

We also know with certainty that without Twitter on April 25, 2011, a family would have felt more hopeless and helpless than they already did. They would have had one less avenue through which to gain answers and options. They would have been forced to use alternate streams to get these answers; streams from which getting an answer could have taken much longer than Twitter did. All risks that I personally, and I believe Matthew Browning will agree, we can’t be willing to take. When it comes to saving lives, the motto has to be “by whatever means necessary.”

Health Care Social Media – What We Still Don’t Know

What does all of this mean for health care and social media? This story could mean that Twitter becomes a means to a life-saving end, and it could not. I and the rest of us at Emory Healthcare are not going to pretend to be the authority on the industry. Despite the success of the process, qualities, and methods we use here at Emory Healthcare, when evaluating our interaction with Matthew Browning on April 25 in hindsight, there exists much that can be improved and much that we still don’t know. Below are several unanswered questions that we hope generate a dialogue that lead to our community sculpting its own answers, rules, and ideas for what the future of health care and social media will look like.

Does Network Size & Influence Matter?

It turns, as was touched on in Part I of this case study, that Matthew Browning is well-connected in the health care and technology spaces. So much so in fact, that even prior to the events of April 25, 2011, we were already following him on Twitter from our Emory Healthcare account. His level of influence is an important consideration when evaluating this case. Matthew’s necessity for a regionally based facility for his wife’s grandmother is also an important one. Matthew resides in the Northeast, and his connections are by and large from the same area. As Matthew told me on Tuesday “I was out of my turf, but I have a great network.”

Questions we must consider regarding Matthew’s background include:

  • Did his level of influence and large network of industry peers impact his ability to get help via Twitter?
  • If so, how would those without such a network achieve similar volumes of quality and actionable assistance in the time of a health care crisis?
  • To what extent did Twitter allow Matthew to dissolve geographic and time consuming barriers to help?
  • What role did Matthew’s intrinsic knowledge gained from his background in health care play in his ability to break barriers & get help?

What does it All Mean?

As mentioned above, we are not going to pretend to be the industry authority on the future of how social media will be used in health care. While on a personal level, this story means more to me than any number of words can express, from an industry perspective, the final outcome may prove to have nothing to do with social media.

Our interaction with Matthew Browning has many potential future implications for health care’s use or lack of use of social media. Maybe it means we need to open doors that make immediate assistance a more reasonable thing to achieve. Maybe it means a discussion around privacy as it relates to saving lives emerges. Maybe it means there needs to be a long and hard look taken at improving access to regional emergency care. Maybe it means the 9-1-1 system needs an upgrade. To be honest, we don’t know what it means.

The Inherent What-Ifs

The overwhelming majority of people working in health care social media will tell you themselves, the space is filled with a lot of “what ifs”:

  • What if someone exposes their personal information to us in a public arena such as Twitter?
  • What if we aren’t careful and diligent in our response, could we further compromise that person’s privacy?
  • What if we can’t help?
  • What if we don’t respond? But most importantly, what if we do?

1http://sncr.org/

Author: Morgan Griffith, Interactive Marketing Manager, Emory Healthcare

 

Related Links:

Can Twitter Help Save Lives? A Health Care Social Media Case Study, Part I

Twitter Emory Healthcare on Twitter
Twitter Matthew Browning on Twitter

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7 Responses to “Can Twitter Help Save Lives? A Health Care Social Media Case Study, Part II”

  1. Chris Fenoglio says:

    Morgan,

    Thanks for the posts about the amazing events with Matthew Browning’s family. I hold a similar position as yours with LifePoint Hospitals. Many of our hospitals are in rural communities so these events and your responses are very helpful in growing our social media programs.

    Will you answer some “nuts and bolts” questions? How did you or your staff exactly detect/receive the incoming Tweets? Did you have your Twitter web page open? Did it arrive by email or text to your phone? Do you use a monitoring service (HootSuite, etc.)?

    Monitoring social media activity can take hundreds of man-hours, even for large medical centers like yours and especially small hospitals like ours. Thanks in advance for your assistance.

    Chris

    P.S. I believe this would be a great case study / presentation at SHSMD and the Healthcare Internet Conference in Vegas. Hope to see you there.

    • Morgan Griffith says:

      Hey Chris,

      Thank YOU! And thank you for your feedback! I’m happy to answer your specific questions, and have done so below:

      How did you or your staff exactly detect/receive the incoming Tweets? Did you have your Twitter web page open?
      Yes. I had both Twitter itself and several Twitter applications open at my desk and I saw Matthew’s tweet from one of those applications that allows us to monitor our mentions separately from the general stream.

      Did it arrive by email or text to your phone?
      While having our Twitter related tools open on my computer, the tweet also came to my phone. I saw it on my monitor before my phone, however.

      Do you use a monitoring service (HootSuite, etc.)?
      Yes. Several tools are in use, ranging from the basics (Twitter’s web interface) to much more complex and flexible tools, such as Radian6. Mobile tools are in use as well for times during which I’m not by a computer (see below).

      I agree that monitoring social media certainly takes dedication, hours, and effort. I use more than one tool on my phone, for example, just in case there is a lag in receiving updates from any one of them at any time.

      Thanks again for reaching out, and I agree that it would make a great case study presentation. Lots of questions still remain unanswered and lots of good dialogue (and hopefully change/action) can come from this. I certainly hope it does.

      Thanks again Chris,
      Morgan

  2. Anne Marie Cunningham says:

    Hello
    Thank you for sharing this story. Communications departments seem to be moving into uncharted territory with healthcare social media. They don’t seem to consider that situations like this may arise. Despite deciding to inhabit these spaces they don’t develop clear social media policies which would guide their behaviour and that of patients/clients/consumers. If they have developed these policies then often they don’t link to them from their twitter accounts.

    What does your story tell us? I’m in the UK so I’m not an expert on US healthcare and I’m a generalist so I’m not an expert on the management of ruptured aorta. But it sounds as if the communications team decided to intervene in patient care in response to contact from a concerned and distressed relative. Does this seem appropriate in any way? Is this a precedent that you want to set?

    As a Web Communications & Social Media Specialist you may think that “When a person’s life is on the line there isn’t time for following a flowchart or researching his/her history.” But ask any clinician and they will tell you that this is not true. The decision to transfer a patient with a ruptured aorta must surely be up to those who will care for the patient not to the communications team. And those health care professionals should be researching the history of the patient before they decide to accept the transfer. And perhaps they might be following a flowchart as well as part of an evidence-based pathway.

    I’d like to know the perspectives of the professionals caring for this patient as well. Do they think this scenario was well managed? How would they like you to inform distressed relatives in the future?

    You are not the only communications team to run into difficulties like this. In the UK, the team from St. George’s have blogged about their experiences of monitoring the tweets of patients before they established a social media policy. http://nhssm.posterous.com/2nd-case-study-st-georges-healthcare-nhs-trus

    It’s not impossible to find good examples of social media policies. Dr. keely Kolmes has made hers public. http://www.drkkolmes.com/docs/socmed.pdf

    You have been honest in stating that you don’t know what the meaning of this story is. Hopefully we can work it out together through respectful and open discussion.

    Anne Marie

    • Morgan Griffith says:

      Hey Anne Marie, thanks for your comment. You’re right, it’s important that we remain honest in acknowledging we don’t fully know what our interaction with Matthew will mean for the future of health care social media. You bring up some good points that Matthew and I have collaborated on to address below:

      Here at Emory Healthcare, we have several formal social media guidelines and also a posting/comment/contribution policy. The former will be updated even further to account for the events of April 25. The latter is a very finite document in scope that gives our users a clear set of expectations. You can find our user posting policy on our blog using the “Posting Policy” link at the top of each page.

      You asked, “What does your story tell us? I’m in the UK so I’m not an expert on US healthcare and I’m a generalist so I’m not an expert on the management of ruptured aorta. But it sounds as if the communications team decided to intervene in patient care in response to contact from a concerned and distressed relative. Does this seem appropriate in any way? Is this a precedent that you want to set?”

      We are not necessarily trying to set any precedent, other than the precedent of an open dialogue around the inefficiencies associated in garnering emergency medical care during times like the one Matthew and his family found themselves in. To say we “decided to intervene” is a bit off base. We decided to HELP after being contacted directly. We reached a hand out to help someone who seemed to have no other options or outlets and was in desperate need of immediate help. The most important piece here is the urgency of the situation. There wasn’t time for hold-ups, and with Matthew’s network being as large as it was, he was able to reach out to over 4,000 people in a matter of one minute. I’m not sure the same could be accomplished with phone calls. Again, this does not make social media a substitute for any traditional communication tactic. But it does show that something needs to be done to open up access to emergency care.

      You also said, “As a Web Communications & Social Media Specialist you may think that “When a person’s life is on the line there isn’t time for following a flowchart or researching his/her history.” But ask any clinician and they will tell you that this is not true. The decision to transfer a patient with a ruptured aorta must surely be up to those who will care for the patient not to the communications team. And those health care professionals should be researching the history of the patient before they decide to accept the transfer. And perhaps they might be following a flowchart as well as part of an evidence-based pathway.”

      You’re right. And the decision was not up to us. In this particular situation, because Matthew reached out via Twitter, a realm that is managed by our Web & Marketing teams, we were tasked with facilitating this dialogue and hand-off in an emergency situation. Once he was given that phone number, it was up to our operational and care teams to determine if we had capacity and the ability to care for his grandmother. So when you say, “The decision to transfer a patient with a ruptured aorta must surely be up to those who will care for the patient not to the communications team,” that was exactly the case in this situation. The role we served was to speed up the process of getting the right information to Matthew, which is a communications function. Our care and operational teams have their own processes to guide them in making determinations on capacity and ability, all we did was assist in making that transfer happen as quickly as possible. Though, I would imagine that a clinician, when confronted with the same choice (saving a life or slowing down that process), would inevitably choose to save the life, while, as we mentioned in Part II, paying mind to the process and following it as closely as the situation allows for. In response to your tweets about “dismissing” flowcharts, we are not suggesting that this be the case either. As we mentioned in part II of the study, we have processes we follow, and we did follow these processes. This case has demonstrated a need for consolidated steps and processes we must follow in even more urgent situations. But to be clear, we are certainly not advocating the removal of process. Strategic process is key in all areas of health care.

      We’re also not implying that social media be the solution for these scenarios. In fact in many regards, it’s unfortunate that in this case it was. But it does go to show that there are steps that must be taken to improve access in the most desperate of circumstances. This time, Twitter helped break down a barrier to access, but that doesn’t mean this will be the way things *should* be handled in the future.

      Thank you for your feedback, and I hope this clears some things up for you.

      -Morgan (w/ input from Matthew)

  3. Anne Marie Cunningham says:

    Thank you very much. That does help a lot. So it seems that the main benefit of twitter was getting the phone number of the transfer team to Matthew who could then give it to the hospital. You are correct that this does show a failure of the system. It would have been much better if the first hospital had the phone number of all the surrounding hospitals. Relying on social media to get that kind of information certainly does show deficits. It would also be good if he could have obtained this kind of information through search- although I guess it wouldn’t be a common search and might fall foul of google’s algorithims!

    What concerned me was Matthew’s tweet to you asking you to tell the transfer team to look out for the request and to accept it. That was the part which seemed to me to be interrupting usual care pathways. But reading back over it is clear that you do not say that the twitter discussion with Matthew did change outcomes in any way apart from getting the number to him.

    At the end of the day you were placed in the same situation as the hospital switchboard might have faced if they had been contacted and asked the same question. They might already have had the contact details to hand, and might have been able to respond even faster. It seems that they would be good people to talk to about how to handle urgent requests from the public.

    Thank you very much for the response.

  4. Dave says:

    Morgan:

    What have you done to safeguard this content exchange with the end-user? Are you going to ingest and hold this twitter conversation under your records management environment for potential legal implications or are you going to rely on Twitter holding that information forever? If you could describe the disposition and governance you are using after the incident, it would be appreciated.

    • Morgan Griffith says:

      Hey Dave,

      You certainly raise an interesting question. In this particular case, we’re fortunate to have LOTS of documentation around the exchange, as it has been covered across the web. Typically, we use several tools that allow us to export past interaction data & details from exchanges such as this. We also adhere to standards such as requiring media release forms be signed by any one whose personal information may become public, among others.

      For the future, this is one area in which we’ll want to further consult with our legal and risk teams to more specifically determine requirements for proper documentation and how we can be sure to always satisfy them.

      Thanks for your question!