Dr. Mark Novotny likes to tweak the healthcare status quo, asking questions about how care is delivered — and how it should be delivered. And he’s doing it publicly.
Take one of his recent blog posts, for example, which challenged the whole idea of doctors’ orders. “Most physicians don’t think of feedback or questions about an order as important dialogue to ensure the best care,” he wrote. “Often such questions are treated as annoyances.”
On the other hand, he continued, “in highly functioning teams, orders are written after or during multidisciplinary rounds where a comprehensive care plan is developed together, in front of the patient,” with input from nurses, pharmacists, care managers, and the patient himself.
But don’t expect Novotny’s employer, Cooley Dickinson Hospital, to be annoyed at his candor. After all, the blog is featured on the hospital’s website.
“I did this at my last job,” said Novotny, a hospitalist and CDH’s chief medical officer. “When I came here, I talked to the communications people and my boss. They started it here because of the need to connect with different types of folks in the organization.”
He cited research, reported extensively over the past several years, regarding the way people from different generations interact in the workplace, and how Gen-Xers and Millennials communicate differently than their predecessors.
“I thought, in this position in an organization with more than 1,000 employees, is there another way to connect with people, rather than walking through different departments and striking up conversations? I was aware that Millennials prefer these types of communications, and while they might not talk to me, they might blog with me.”
He found that to be true; each post tends to draw several responses — mostly from hospital staff, although the blog is accessible to the public — which Novotny often responds to in turn.
“It gives people an opportunity to communicate asynchronously,” he said, noting that he might post something at night that gets read and commented on the next morning, allowing back-and-forth dialogue to develop over time.
Welcome to the brave new world of social media in medicine, the ramifications of which hospitals and health systems of all sizes are dealing with. For the most part, they recognize the benefits of online communication with the public while grappling with what channels and types of messaging are best.
“We use all avenues — Facebook, Twitter, YouTube, Pinterest,” said Nancy Coley, public relations manager at Holyoke Medical Center. “I think that social media has really changed the whole landscape of healthcare communication.”
It’s a natural evolution, she said, or perhaps a response by healthcare providers to a climate in which the public is clamoring for information online.
“Think about the high-tech advances that have occurred in the past 10 years,” she told HCN. “People go online for a diagnosis. We now have mechanisms for grading physicians. Hospitals are developing patient portals where patients can access their medical records from home. It’s crazy.”
That revolution has presented both benefits and challenges to providers, she noted. “The pros are obvious, but there are cons to people having that much information at their fingertips. Physicians are always cautioning their patients against self-diagnosis or making changes without consulting a doctor.”
In other words, the Internet shouldn’t take the place of face-to-face interaction, and patients need to be careful about determining the accuracy of what they read online. Still, medical leaders are starting to accept the ubiquitousness of the Internet and view online communications as a new kind of partnership between doctors and patients. That’s where social media comes in.
“I find it’s helpful to let people know what their leaders are thinking and where the organization is going,” Novotny said, adding that he wants to counter the “doom and gloom” that springs from uncertainty about the direction of healthcare. “I’m painting a very literal picture of what I believe healthcare will look like in a couple of years, and why that’s exciting and a good thing, and how patients and providers will be better off.”
This month, HCN connects with several local leaders in hospital communications to discuss the potential — and the pitfalls — of the ever-evolving world of social media.
Likes and Shares
Baystate Health — a network of services encompassing four hospitals and dozens of other practices — maintains a multifaceted social-media presence, with separate Facebook pages for its hospitals and the health system itself, one all-encompassing Twitter feed, and a YouTube channel.
“We made our first tweet in February 2010, and we’ve been on Facebook for roughly the same time frame,” said Ben Craft, interim director of Public Affairs and Community Relations. “What we’re always looking at is, what is the next big thing? We’re looking at Pinterest; we’re looking at Instagram. It’s just finding the balance between not being so fragmented over so many channels, but at the same time reaching as much space as possible.”
He said each social-media channel meets a different need.
“For instance, we look at Twitter as ‘real time,’” he noted. “We keep it very informational — tips, events going on at Baystate. Where we found Twitter really useful — and Facebook as well, to some extent — is as a news ticker during emergency situations or weather situations. In a couple of bad snowstorms, the power was out and newspaper delivery was challenging, and when people couldn’t get information from TV or radio, we found they used Twitter to communicate.”
It has been a longer process to nail down what people are looking for on Facebook, said Craft, so Baystate Health recently surveyed its 3,756 Facebook adherents. “We got a range of responses, from information about very specific health conditions to more general information about nutrition, heart health, and diabetes. There was a strong outpouring of interest in actionable medical information. We know there’s a demand for that.”
It’s also a way, he said, to counter the often-unchecked information available on the Internet at large. “We talk to our doctors about this — how are patient appointments different now? Are patients more informed as a result of the Internet? Are they more inclined to diagnose themselves with things that may not be the correct diagnosis?”
Craft said Baystate not only posts its own content, but “curates” content from other sites — typically vetted, well-trusted sources like the Centers for Disease Control and the National Institutes of Health that are widely recognized as having a “stamp of authenticity.”
But beyond hard information, Baystate’s Facebook ‘friends’ have also responded with great enthusiasm to photos paired with a personal story. For instance, on one recent Friday, Baystate posted a photo of a husband and wife in the hospital shortly after she donated a kidney.
“I went home and watched it absolutely explode on Facebook,” Craft said. “Within 24 hours, it got 1,250 likes, 132 shares, and 110 comments.” Crunching the analytics of that activity, he said about 30,000 people wound up seeing that photo in the first day it was up. “People are looking for that emotional connection, that shared experience, and Facebook is great for that.”
Basically, he continued, people often don’t see the human side of healthcare unless they’re being served by the system. “It’s harder to get that empathetic connection, but social media is helping us to do that more.”
Coley said Holyoke Medical Center also presents a well-rounded mix of information on Facebook. “We try to post a variety of topics to appeal to all ages, from health-information topics to educational programs at the hospital to news pieces some of our staff might be involved with.”
But she was pleasantly surprised to find another area in which Twitter and Facebook could be valuable tools: crisis management.
HMC recently participated in a medical-crisis drill with the city of Holyoke, and “we were able to strategically use different avenues of social media to communicate with all involved,” Coley explained. “It gives you the ability to have real-time crisis communication with each other and simultaneously be able to post news and update the outside world.”
The exercise was beneficial, she added, not only in what it demonstrated about the benefits of social media, “but it also gave us information as a hospital to identify areas we might need to improve and fine-tune.”
Look Who’s Talking
Christina Trinchero, Marketing Communications director at Cooley Dickinson, called social media “another tool in the communicator’s toolbox.” And Novotny’s blog — the topics of which run the gamut from national shifts in healthcare delivery to personal wellness — has been an effective part of CDH’s social-media strategy, typically garnering between 300 and 1,000 views per weekly posting. “It’s typically among the most-read sections of our website.”
Although Cooley Dickinson is trying to emphasize a more open culture, Novotny said, employees are still sometimes reluctant to challenge the status quo. After his post about doctors’ orders, a nurse posted a comment anonymously, but she was encouraged to resubmit it under her name. That, in turn, got a real-life conversation going between doctors and nurses that might not have happened without the blog.
“Providers are people pleasers; they don’t like conflict, and they don’t usually see the value of conflict,” Novotny said. “Some of these conversations are things that people are thinking but not talking about. I can get five or 10 conversations going … that’s healthy, and that helps me be a better leader.”
Trinchero said the blog is one way the hospital stays connected to employees, physicians, and the community in a positive way, allowing an opportunity for two-way communication that sometimes turn into face-to-face discussion.
For example, “when Mark was the interim CEO at Southwestern Vermont Medical Center as his organization was going through changes, downsizing, he established a handful of relationships with people he would not have known otherwise. These people who read his blog then said things to him they would not have otherwise said to his face, and through the communication that was facilitated by the blog, they developed relationships.
“Mark was seen as available and approachable,” she continued. “This is very different from getting a printed newsletter about organizational changes. Traditional models of communication have often struggled with the two-way nature of communication. Typically, it’s been a one-way street. Social media has shaken everything up.”
For the general public, “I think it gives them an insider’s view of what goes on,” said Novotny, who emphasized that he thoroughly enjoys this aspect of his job. “I do it on the weekend. It’s challenging to find time to do it, but my wife encourages me, even though it takes away from our personal time, because she sees how much I enjoy it. Of all the things I do in my work that take me away from her, this is something she encourages.”
Craft is encouraged in other ways by social media — for example, how Baystate’s forays into the online world have improved communications between departments. “Social media is giving us the opportunity to integrate some work processes that may have been independent of each other,” he explained. “Sharing content across internal lines is giving us a chance to help each other, which is really nice.”
Craft said there was some trepidation early on about diving into the social-media realm, if only because many online forums are notorious for angry comments. “But we haven’t had a lot of negative feedback. We’ve probably been doing more listening than talking on social media, but our interactions have been overwhelmingly positive.”
He recalled a moment last year when he was presenting information about Baystate’s social-media activities to other hospital leaders. He had Facebook open, and during the meeting, a message popped up from a young mother in Colorado who had moved there from Chicopee some months before.
As it turned out, she had given birth early at Baystate, and her baby had spent some time in the neonatal intensive-care unit. “She went out of her way to write on Facebook, ‘my son is about to turn 1, and we think of you every day; we’re so grateful for the care you provided, and we want to say thank you.’”
As a result of that message, Craft said, the hospital set up a Skype connection between the woman and the NICU staff on the child’s birthday. “All this happened because of the Facebook connection. It wouldn’t have happened had social media not been available.
“That was just really, really rewarding,” he added. “And that’s one of the things social media does — it makes us more connected, in a good way.”