“In Canada in health care we’re at a point where most hospitals accept the role of social media for branding and communication, but only the lead adopters are using it for patient engagement and for clinical use.” – Ann Fuller, public relations director,   Children’s Hospital of Eastern Ontario (CHEO)

Call up the website home page for any large Canadian hospital and you’ll likely spot the familiar icons that link to the institution’s facebook, Twitter and YouTube accounts.

Hospitals are inherently conservative institutions and, as such, have been relative latecomers to adopt social media, which are broadly defined as digital channels that can facilitate timely, collaborative and interactive communication.

As they enter the social media fray, hospitals face a host of challenges and decisions. These range from basic upkeep—nothing is more frustrating to a potential user than a neglected or stale-dated facebook or Twitter account—to deciding how interactive to be with patients, and what staff should be trained and involved in social media use.

From marketing to improved care

Not all hospitals haven entered the fray—for example, smaller hospitals may not be able to afford the expertise and time involved in establishing a social media presence—and among those that have, how they use social media varies significantly.

Many still use the channels for marketing and old-style public relations communication—for example posting news releases—while some larger hospitals are more active, have thousands of followers, and can track and address patient concerns.

But the potential of using social media to improve patient care and patient experience is only beginning to be realized, according to health care digital communication leaders.

That’s not surprising because it’s only been a few years since hospitals began to take social media seriously; the Ontario Hospital Association hosted its fourth Social Media in Health Care conference just last month; the first was Jan 21, 2010.

Social media policies can allay concerns about risk

The issue of privacy and risk dominated discussions about social media several years ago, but that concern has begun to be addressed as hospitals formulate and adopt social media policies (see CHEO policy, for example) that spell out ground rules for use.

An emerging debate contrasts the approach of hospitals that use a single channel “firehose” social media approach—institutions that have just one facebook and one Twitter account for all communication—and those that have multiple social media channels.

To Ed Bennett, who manages web operations at the University of Maryland Medical System, the progression from hosting single to multiple speciality channels—from addressing patient concerns at a broad level, to also addressing narrower concerns of specific patient groups—is a natural evolution.

Social media: this is where the public is talking about you

Part of his job is to monitor all online mentions of his medical centre and decide which ones are appropriate to respond to, and who should respond. “This is where conversations are moving, where they’re [the public] is talking about you, and if you don’t participate, you are cut off from the discussion.”

A lot of concerns are about services such as parking, or long waits in the ER, or how to get test results, he notes. “If you are able to resolve these, or just respond in a polite way, you can turn a negative into a positive.”

Craig Thompson, director of digital communications at Women’s College Hospital in Toronto, says  the  “low hanging fruit”  that  social media can address involves better communication about issues that frequently frustrate patients, such as hospital access and how to prepare for procedures.  Beyond that, opportunities to use social media to improve patient experience “present themselves at different times, every organization has to find its own solutions.”

Social media such as facebook also present the opportunity to create “extensions of real life face-to-face patient support groups,” says Bennett. The Maryland University Medical System sponsors four or five of such groups, including for transplant and for trauma patients; participants have to be invited to join (the groups are closed) and the groups are moderated by a health care professional.

“Still, we explain that nothing on the Internet is 100% closed and warn people not to put out any information that wouldn’t be comfortable with the world seeing,” he says.

The multiple channel approach

Michelle Hamilton-Page is the manager of social media at CAMH (the Centre for Addiction and Mental Health in Toronto), which has a multiple channel model approach to social media (see, for example, its foundation-associated endstigma facebook page).

Hamilton-Page’s position is based in education, rather than communications, and she spends much of her time helping groups within CAMH think through whether social media can help them meet their objectives and, if so, how to go about it.

A similar approach is taken at St. Michael’s Hospital in Toronto, notes digital media manager Anthony Lucic. “People think of social media as mass communication, but it can be really focused and targeted. Sometimes, it’s about just wanting to talk with a core group of peers. Our approach is very grassroots, we sit down with people to find out who they want to engage, and what networks they could use.”

Children’s Hospitals have been early adopters of social media

Children’s Hospitals, like CHEO in Ottawa and the SickKids (the Hospital for Sick Children) in Toronto, are among the most advanced in terms of using social media. That’s partly because the patients, and their parents, are younger—and members of age cohorts that are relatively more comfortable using social media.

“Our patients, and their parents, have different expectations” compared to adult hospitals, says Ann Fuller, public relations director at CHEO. “New generations are used to sharing more and have different expectations of privacy than my mother did.”

And Fuller notes some doctors are saying it is time to relook at the idea that that physicians should not interact through social media with patients, point to “niche applications” where, for example, a clinician could be on facebook with a group of young patients with diabetes.

A recent research study at CHEO into patients’ use of facebook underscored its importance to teenagers with long-term and chronic illnesses and noted that only a few disclosed any personal health information on their facebook pages.

It concluded that that the need for social-network-based communication between patients and healthcare providers—now forbidden by some institutions—will increase and that “age-appropriate privacy-awareness education” should be strengthened.

Calls for more education, literacy

Better education about social media is something that Sivan Keren Young, manager of digital communications at Sunnybrook Health Sciences Centre, thinks is essential. “Everyone is using social media, but no one gets any social media literacy training, there’s nothing in schools, and that can cause mistakes, people can unintentionally do the wrong thing.”

Interestingly, it was disappointment about the level of public uptake for H1N1 vaccination was the inspiration for the first major Canadian examination of how health care institutions could use social media to understand and improve the patient experience.

“For us, the light bulb went on” when the Toronto-based Health Strategy Innovation Cell went online to find out what was being said in patient websites and chat rooms about the H1N1 vaccine, says Cathy Fooks, president of The Change Foundation , which co-authored a report on using social media to improve health care and worked with two health care organizations to explore the potential of social media.

What the investigators discovered was a whole series of anti-vaccination conversations about concerns about the vaccine—concerns that were inhibiting people from getting vaccination. “Public Health had no idea—none of that concern had turned up in their formal communication channels,” Fooks noted.

The foundation went on to co-author with the Innovation Cell a seminal report on using social media to improve health care and a report based on work with two health care organizations exploring the potential of using social media.

According to Bennett, those who are still sceptical about social media should stop thinking of it as brand new and different: “It’s still people talking to each other.”