Healthcare Uses of Social Media

Last week I presented at the Social Media Plus Summit and discussed the importance of understanding the nature of emerging media before just jumping into the latest craze.

Healthcare adoption of emerging technologies (not just new media) needs to be done with a robust understanding of them in accordance with strategic visions. Privacy isn’t the only consideration in healthcare: dignity, content, information and excellence in communication and community-building are just a few of the others.

I wanted to go beyond that typical social media hype and give a deep view of what’s needed in healthcare communications. Included are some slides on how Information and Content related with each other in order to provide true empowerment for patients.

You can view my presentation below or over here (there’s also another copy here).

Too often, organizations and industries attempt to integrate new technologies without delving deeper into their ramifications, possibilities and limits. As a result, they often run into trouble and then back away, leaving internal champions frustrated. Understanding is the first step toward doing. Paradoxically, though, with emerging technologies you need to do a bit of both at the same time.

If you would like to see me speak to your organization or help conduct personalized workshops and bring some perspective and orientation on process design, email or call me: info@CareVocate.com – 484-372-0451.

8 Stages of Social Media Psychosis

Even though it’s 2010, the talk and hype orbiting around social media cintinues. In fact, it seems to be getting louder. So I put together a Prezi: 8 Stages of Social Media Psychosis (some language may be harsh).

For those of us who’ve been at this for a long time (my experience with social networking goes back to 1978 – that’s a whole other story), it’s startling to witness the level of web literacy in many imprtant, well-financed organizations.

So, unfortunately, due to this web illiteracy I’m sad to say that the talk will go on for some time.

That’s dismaying because there so much more that we can talk about.

Favorited by Pixels and Pills List of Pharma Tweeters

I’m not a particularly big fan of lists of “thought leaders” and such, but occasionally a smart group of people compile some useful observations about folks who are passionate about a topic or field. The good folks over at Pixels & Pills listed my Twitter stream along with several of my other friends’ as active voices in Pharmaceutical adoption of novel media technologies.

I do a lot of work in helping to advance our understanding of the Web, how it impacts our culture and the health care ramifications of the media which it continues to evolve. I do wish, however, that the leading voices in this discussion were the executives and (smart) agencies working in the industry were on lists like these. But perhaps their absence simply reflects a pattern with revolutions: the view from inside the status quo is simply too murky, and thus outsiders’ perspectives are needed to spark things.

At any rate, I’ll take a pat on the back once in a while. You can read their full post here and follow them on Twitter.

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Will Checkins Be The New Inbound Links?

iPhone home screen updated: new theme & added ...
Image by waynesutton12 via Flickr

After having had some fun half-mocking health care uses of location-based media such Foursquare, BrightKite and Gowalla, I do think these services represent a small part of larger set of trends. Although these services have thus far emerged as stand-alone media, their essential functions can be thought of as modules which eventually will be mashed up and integrated and subsumed into bigger bits. And now I wonder if geolocation-based media may usher forth a new kind of attention-currency.

Just as links to a website play an important role in how we find businesses in Google, I can see how checkins could be part of an emerging trend to bring hyperlinks to “real” places. Services like Foursquare provide information about business in several ways, two of which are by number of checkins and the tips/reviews patrons tap into their mobile devices. Additionally, other meta-data (such as the number of tweets or blog posts referring to a particular venue on Foursquare) conceivably add attention-weight to businesses.

What’s interesting about these technologies, is how (and that) people use them. We now know – for good or ill – that there are people who willingly share personal information which only years ago they would have concealed within an intimate context. The revealing nature of technology becomes clearer as novel technologies beget novel re-purposing, which in turn reveal things about ourselves.

And so, anytime we consider these media, we have to not only consider their effect on human beings but also on their effect on the evolution of technology itself. The Web is giving rise to metadata-based media. Which is to say if the medium is the message, then the message of the future Web is metadata. Just something to consider as social-streams become a staple of human interaction.

Anyway, I can envision the emergence of other services which wish to capitalize on this new kind of IRL hyperlinking. What do you think? Will we see the emergence of a new kind of attention economy, where metadata like geolocation and tagging become valuable commodities?

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Instant Is Not Real-time

Facebook, Inc.
Image via Wikipedia

Should Enterprise software be like Facebook? That’s a question Salesforce CEO Mark Benioff recently raised. While reading Dennis Howlett’s analysis, Dennis makes a very simple but easy-to-overlook point about the difference between instant media and real-time media. It’s an important point, one I believe gets lost in the noise and hype about social media.

INSTANT CONFUSION

One of my main focuses is health care adoption and employment of software for improving collaboration and communication among patients and doctors and nurses. It’s important, therefore, to understand the property differences between media and the different contexts, conditions and processes needed for successful deployment. What works for consumers (Facebook) doesn’t necessarily work for business.

One of the properties of media like Twitter and Facebook has to do with time. Twitter and Facebook statuses are instant (at least when there are not server errors). Instant is exactly that: immediate, without regard to relevance. Real-time, however, has to do with relevance. In an enterprise, what matters are information flows – and without context and relevance, information is just data.

Real-time is more than just anytime (which is what instant is) – I need the right information delivered at the right time within the right context throughout the right process.

This distinction between instant and real-time is critical because any software developed must take into account the purposes and needs and contexts in order to ensure proper user experience and appropriate results.

So no: I don’t believe Enterprise software should be designed like Facebook. It follows then, that any software designed for patients and hospitals and doctors and nurses must not confuse themselves with consumer applications.

BUILD IT RIGHT AND SPEAK CLEARLY

Therefore, any healthcare enterprise analogues of media like Twitter, must take into account the difference between instant and real-time. The applications must take into account the sociological and informational needs of clinical processes. Otherwise, disaster is certainly built-in.

Software lock-in is a huge problem in technology. I fear that philosophical lock-in of social media philosophy may be one our time’s greatest threats. (As an illustration of what I mean, the Privacy Is Dead mantra is, I fear, just one self-fulfilling instance of social media fallacy – it’s one of the most dangerous myths propounded and accepted by superficial thinking these days – it’s a dangerous mind-virus.)

We need a clear language when discussing technology – especially media technologies. Confusing instant with real-time is sloppy thinking. In a health care context, it’s downright dangerous.

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The Winkler Nurses Case on #RNchat

When I started #RNchat last year (@RNchat on Twitter), my hope was to assemble a simple and supple forum for nurses and the public to discuss important issues from the perspective of a diverse group of people.

Here’s a re-post of the transcript for Friday, February 12, 2010’s RNchat, with my commentary on the Winkler County, Texas Nurses case:

Below is a SlideShare of #RNchat for Friday February 12, 2010, organized in chronological order (from beginning of chat to sometime just after). The chat was moderated by Ellen Richter (@EllenRichter on Twitter).

The #WinklerRNs case was the topic of conversation. In Winkler County, Texas, nurses who went through the torment of being charged for leaking private medical information. One of the nurses went to trial and was acquitted within one hour. Now the nurses are responding

This is an important case, one which – among many other things – highlights the need for swift and bold and sturdy nursing organizations. This case isn’t just about defending nurses: it’s ultimately about the safety of patients, the ethical fiber of nurses and doctors and administrators and government officials. Had Anne Mitchel been found guilty, the ramifications could well have been ominous for the integrity of our entire health care landscape.

Friday’s RNchat, discussed topical features of this case: the best practices for whistle-blowing and how to get more organizations behind nurses and the public. Feel free to share the presentation below.

Let’s hope that nurses don’t become scapegoated victims. Do nurses make technical mistakes? Sure they do – we all do. But it’s critical that nurses never feel afraid of expressing their sincere perceptions, their intuition nor their ethical belief system. People can die under those circumstances.

Nurses are the last Jedi Nights of our faltering Republic. A cheesy metaphor? Yes. But it’s true. Anne Mitchell and the other nurses involved in this case are Jedi Knights who fought through a derangement of how ethics and law and responsibility should work.

Anne Mitchell has gone through a Kafka-like hell. Let’s hope she receives comfort and equity and sanity.

NOTE: We also are preparing for a special even in conjunction with the Robert Wood Johnson Foundation. Details upcoming soon!

As always, thank you to those who joined today. If you’re new to #RNchat, just follow @RNchat on Twitter and we’ll provide updates and links on how to make the best use of this nursing chat. You can also send inquires to info [at] RNchat [dot] org.

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The ROI of the Tweet

Money
Image by TW Collins via Flickr

Is Twitter a sales tool? Can it “drive” sales? If so, what’s the return on investment of a tweet? Most executive teams today still view the world through the lens of the assembly-line. They like metrics and clearly defined goals and well-thought decision trees. They prefer straight lines over curves with cloudy distances. They are largely justified in their lines of reasoning.

But the Web has opened up a decidedly non-linear fabric of novel media. Consequently, many organizations have been slow to adopt emerging media and technologies because they simply don’t see the return on investment. Often, they’re not even sure what the investment is. Or what the return might be. Or what the goals or purposes or opportunities of subsuming the Web into their going concerns could be for them.

So this post aims to provide a clearer, if alternate, view of what’s at stake. We’ll look at metrics. We’ll also examine how organizations can better understand the nature and essences of media – all media, old and new and media not even around yet.

If you work in an organization which has been struggling with keeping up-to-date, I offer this to you so you can go into C-Suite and answer the tough questions without looking like an unprepared stooge. You owe it to yourself to understand the media you sell to your executive team – and you owe it to yourself to ensure they understand how to properly enframe media in the 21st Century.

NOTE: This is a long post. My aim here is not to prove that Twitter is not valuable to business. Quite the contrary: I don’t believe enframing Twitter as a generator of financial ROI is the proper way to view the service. But I do believe that evangelists must be able to say to executive management something like this: We have crunched pro forma numbers and in our opinion Twitter is not really a direct (or even indirect) driver of ROI; we do believe, however, that Twitter can be a linchpin within a web of comprehensive web strategies. You can get this post as a document here.

BRUTE FORCE APPROACH TO TWITTER

In order to provide some insight into the difference between Twitter-as-sales-tool and Twitter-as-public-utility, I believe pro forma metrics may help to reveal some important properties of a medium like Twitter. Too often claims are made about Twitter’s business values – and usually the issue of metrics is explained away with vague optimism.

But why not take a crack at metrics, if only to reveal a basic truth of Twitter? After all, Twitter’s simplicity makes it a utility with varied uses. By seeing that Twitter’s effectiveness in driving revenues (even indirectly), allows conversations to focus on a more robust enframming of the service.

I’ll call the strict Financial ROI enframing of Twitter the brute force method. The brute force method makes several assumptions and follows an algorithmic, assembly-line logic. So here are the assumptions:

  • Number of followers are true fans – not just the count of followers according to Twitter – not bots,  or miscellaneous people who aren’t invested in a brand.
  • Followers are people who are likely to buy a product and who are actively paying attention to the Twitter stream of the business/product account.
  • The tweets include links to actionable web real-estate where conversion is possible.
  • Customers make at most one purchase per month.
  • Clickthrough and conversion rates are comparable with traditional web metrics.
  • The effect of retweets is actually minimal on tweets about products (at least in this case) and has been left out of the model.

So let’s look at a hypothetical. Let’s tackle a difficult industry: Pharmaceuticals. For this example, we will leave FDA regulations and other constraints on the industry out of the equation. We’ll say that the company runs a Twitter account for a particular drug and tweets links about an OTC medication (again, we’re assuming these are “FDA-compliant” tweets – yes: laugh – conversations around Twitter can be that ridiculous).

We’re going to assume that the labor time for running the Twitter account is based on $50 per hour. Furthermore, we’ll assume that only one hour a day of labor time is needed (for Twitter accounts with a very high volume of tweets, management will probably need many more hours of labor time in practice). But we’ll be conservative.

Here are a few scenarios (pulled the pro forma spreadsheet which you can view here):

1,000 Followers x 5% Clickthrough x 5% Conversion x $5 Margin x 12 Months – $12,500 Labor = ($12,350)

128,000 Followers x 5% x 5% x $5 Margin x 12 Months – $12,500 Labor = $6,700

1,024,000 Followers x 5% x5 % x $5 Margin x 12 Months – $12,500 Labor = $141,100

8,192,000 Followers X 5% x 5% x $5 Margin x 12 Months – $12,500 Labor = $1,216,300

In order to achieve over a million dollars in revenues, tweets would need to yield a ROI of 9,630%! Use your common sense: it’s utterly delusional to think that ten tweets per day over a year would provide that kind of return. Even to achieve over $1 Million, this pharmaceutical company would have to have over 8 Million followers! And each of those followers would have to be devoted true fans. Think of the investment required to generate a tribe of 8 Million followers – the time, the electrifying tweeting style, the power to be loved.

You can tweak any of the variables and crunch new figures. You can input a higher margin, for instance – but you may need to re-think clickthrough and conversion rates and follower counts. Go work up a brute force model for you business or client and see what you get. Just be realistic and understand the properties of Twitter (or whatever other medium you’re working with). That’s one of the problems I think (some) marketers have: they don’t really understand the media out of which they’re seeking to extract value.

I won’t say that you can’t generate these kinds of numbers – but there are weaknesses and paradoxes in this approach which I’ll reveal in a moment. And yes, I’m fully aware of the general effect of positive WOM but that’s not the point of this story. I’ll touch on brand awareness in a bit – wait for it. 🙂

As you can see, given these assumptions, this brute-force approach to Twitter doesn’t release a lot of financial return (not for larger enterprises with capitalizations greater than $1 Billion). Sure if you run a relatively small enterprise and can cultivate a massive and committed fan-base in the long-run, there’s a chance Twitter may provide substantial gains in line with your revenue stream. Of course, your margins may be larger (but as margins grow, you may encounter diminishing actual conversions). Most importantly: building a tribe of true fans is hard work – very very hard work.

Yes, Dell has claimed it earned $3 Million from Twitter, but Twitter was simply an ancillary service to their wider web presence – and Dell indeed has over a million followers (and a larger margin than in my pro forma).

None of this means, of course, that Twitter has no business value. In fact, I would argue that Twitter can be an essential linchpin for overall web presences: Twitter enables a pliant means to connect various media and web real estate together. It’s also real-time which means you can literally stream your presence and respond swiftly to shifting currents.

But there are paradoxes hidden within the brute-force approach. Let’s take a look at them.

THE PARADOXES OF BRUTE FORCING TWITTER’S WINGS

There’s a sort of Uncertainty Principle underlying Twitter: the more directly you mechanize a given strategy, the more dilute the attention of followers becomes.

For any Twitter strategy to “work”, the tweeting must be remarkable, attention-enlivening, creative. Tweets need to be interesting day-to-day, week-to-week, year-to-year. Annoyance and boredom are easily un-followed. Value and connection and humor are followed more sustainably. Thus, the only way a business can hope to achieve long-term attention via Twitter is to relentlessly be creative and captivating and social and valuable. Tweeting coupons and links to products alone doesn’t work all by itself.

There’s another paradox on Twitter: Promotion of Other is a greater promotional tool than promotion of Self. This is one of the hardest concepts most organizations have to understand.

Retweet your competition.

If you can’t retweet your competition, you probably don’t have the confidence and faith in your enterprise to stand out. If you’re not standing out, just what are you doing with your marketing dollars?

Marketing not only has to be effective but it also has to be respectable. For an industry like Pharmaceuticals, anything less than respectable is unprofessional.

RELATIONAL APPROACH TO TWITTER

I hope I’ve made it pretty clear that achieving a robust Financial ROI of Twitter directly is not a realistic proposition in most cases. If that’s your only enframing, I would suggest you forget Twitter.

I would suggest, however, that Twitter’s pliancy and immediacy and connectivity provide means to many other ends. It’s basically just a telephone for our century. The most valuable enframing of Twitter is in a Relational context.

Building and sustaining relationships are bricks and mortar for all successful businesses. Smart businesses understand the paradox of the un-sales approach to relationships: the more sincere and mature the relationships, the better the conditions for business development.

Sure, we can talk about buzz-concepts like brand awareness. (Of course, you could also stick a finger down your throat and achieve a similar effect.) But I actually think that’s a sub-set of the brute-force approach to Twitter. Once you make that your purpose on Twitter, you lose your followers’ attention. Brand awareness, at best, must be a pleasant side-effect of much more remarkable ways to employ Twitter.

Yes, it’s a cliche but social media is social. If you have poor social skills, you better develop them now. Since relationships operate in non-linear geometries, you’re going to have to learn to think beyond rigid lines. The Web can be an unforgiving creature and will eventually break you if you don’t have the pliancy to turn on a dime.

THE OPPORTUNITY COST OF STRICT FINANCIAL ROI ENFRAMMING

By hoping to achieve financial gain via an inhuman algorithmic enframing of Twitter, you forgo several important and valuable business opportunities. If I were a Public Relations guy, I’d look at Twitter and say: Wow! We finally have a way to re-humanize our communications and how we connect – We can finally go back and re-work those arcane methods we developed when we had only broadcasting media.

The fundamental truth of the Web is that organizations composed of cogs – people with little incentive to shine their talents – simply don’t have the supple musculature demanded of a public sphere laden with real-time technologies.

Organizations must cultivate cultures of creative, ambitious, informed and swift-thinking human beings. If you’re going to invest in Twitter, you better have remarkable people working for you – do it yourself if you have to.

A narrow focus on Financial ROI will enframe a human context within a technological one. In other words, it’s putting the right shoe in the wrong box.

The opportunity cost of enframming the business value of Twitter within fincancial ROI is the larger frame of possibilities which Twitter offers. The most important of these are the re-humanization of corporate communications and the connecting of disparate elements of an active online and offline presence.

THE ROI OF THE TWEET IS…

The ROI of the tweet is elusive.

The ROI of the tweet is what you make it.

The ROI of the tweet is the expression of your daily artistic creativity.

The ROI of the tweet can be mechanized – but at enormous expense and opportunity cost and risk.

The ROI of the tweet is relational.

The ROI of the tweet is conditional.

The ROI of the tweet is contextual.

The ROI of the tweet is human.

How you enframe tools influences what you get out of them. Sales people enframe sales uses around media. Marketing people enframe marketing uses around media. Public relations people enframe public relations uses around media.

The fact, however, is that the Web is Mother of All Media. It not only spawns new media with differing properties, the media it spawns all inter-relate among each other in novel ways. We don’t have a Grand Unified Theory of the Web, but we can at least understand the fundamental properties of individual media. When I get asked how to “use such and such a tool”, what people are asking is: What’s the theory here. But there isn’t any tested theory: at best we have intuition and reason and experience and imagination. Of course, if your lack these then a theory probably won’t help you.

My recommendation to anyone interested in new media’s role in business is to go back to fundamentals. Language like “old media is being replace by new media” can lead you down misguided paths. Marketing is more than messaging, of course, but it’s important for marketers and communicators and public relators to understand Media. Here are some questions to ask yourself and your team about media:

  • What is this medium? What’s is its essence?
  • What are the properties of this particular medium?
  • What are the possibilities of this medium?
  • What category(ies) does this medium fill: social, impersonal, synchronous, asynchronous, unilateral, bilateral?
  • What does this medium enhance?
  • What does this medium obsolesce?
  • What does this medium retrieve?
  • What does this medium reverse? What happens when this medium is pushed to its limits?
  • What happens when a person encounters this medium?
  • How does this medium relate to other media?
  • How might this medium change the world?
  • How should this medium be enframed?

These are simple but difficult questions (I will expand on them in future posts). When was the last time you asked any of these questions? What have you done to acquire an orientation about new media? That’s the purpose of the above questions: to get you to pan back from your accustomed views and assumptions and experiences and re-frame things in clearer contexts.

It’s also important to understand the different kinds of connections between media and people and things. Social isn’t the only connection. People have connections with products and services – but those connections aren’t social. For example, the connection between a customer and a brand isn’t social. It’s something else – knowing what kind of connection binds medium to medium or people to products helps you determine what media you choose.

For instance, by understanding what a medium enhances, obsolesces, retrieves and reverses, you can better compare novel media with familiar media. You can develop insights into what features of traditional approaches can and can’t be ported into new media. If you’re unfamiliar with McLuhan’s Tetrads, you can learn more here.

If you work in an agency – PR or Marketing – you need to answer these questions so that you can equip yourself with the resources to properly view emerging media. It’s no longer enough to “get” Twitter or Facebook or Blogging: you must have a fresh philosophy about media in general because the Web is evolving. You need to hone an intuition about emerging media and these questions offer a good practice for you.

THE LESSON OF THE TWEET

The lesson here is that there is return on the tweet. But before you get to return you must get to re-frame. This is going to be a turbulent century. It’s easy to get tossed about and disoriented. Assumptions and methods which were once effective may no longer give lift. Orienting is itself a skill to be treasured.

Focusing on one narrow objective like financial ROI before fully understanding an asset is not all too wise. Not when your competition has figured out things you haven’t even considered.

I have tried to address the legitimate concerns of “old-school” executives who rightly question the expected returns of social media. I believe they are entitled to an honest accounting about the limits of media. The smart ones will see the folly of attempts to port assembly-line thinking into territories in which it makes no sense to do. The smart ones will also then be able to see things aright and perhaps your organization or client will understand the proper context and enframming needed to be remarkable.

You can go the brute-force method and miss a much larger party. Or you can be something far more interesting and ultimately financially rewarding. My advice on Twitter is to be a Lovable Peacock: someone with the goods worth showing off but with a warm heart for the flock. Many executives won’t like that metaphor. But then, not many businesses here today will be around in 2020.

So, what’s your take? Is my brute-force analysis flawed? Does it help to demonstrate and to admit up-front that Financial ROI isn’t a wise enframing of Twitter? Does it advance the conversation?

Will you re-enframe everything you think you know? Will your Corporate Philosophy take to wing…or fold?

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