2.0 Is the Wrong Number in Healthcare 2.0

A patient having his blood pressure taken by a...

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Is healthcare important. Is it one of the most critical industries? If it is, why is it so behind the project referred to as ‘Web 2.0’? Why should healthcare be so exceptional an industry as to be stuck in another century?

I think we’ll have to abandon the numeric system when referring to new versions of the Web, especially when formulating applications within the healthcare industry. There’s really no ‘Healthcare 1.0’ (whatever it was, it was a dissappointment). So why bother with a 2.0? Why not just settle with Healthcare?

The goal of healthcare is healthcare, not social media. The current system in the United States is so horribly deranged that we we need enormous investments to heal it. Internet technologies and social networking applications for patients and professinals certainly will help in the area of management. But it won’t travel too far in revamping infrastructure.

I’d love to see more healthcare facilities provide more intelligent and usable online interfaces with their communities. Right now, that’s the kind of servicing Web 2.0 can offer, such as:

  • A process for updating the community (via blogs)
  • A process for giving voice to the community
  • Updated information on patient care (e.g. online discharge instructions)
  • A portal for building support groups for patients and family members

The list can go on. HIPAA certainly gets in the way and will need to be repealed or revamped in a more intelligent way. Dignity shouldn’t be a pretext for industrial secrecy. Web 2.0 won’t change that. Good old fashioned political rage can.

Web 2.0 won’t get to healthcare. A whole new iteration needs to be integrated. Unfortunately, Healthcare 1.0 is going to be here for longer than it should. Sadly, we might even see Healthcare 0.5 coming our way. Or -2.0 if we keep screwing things up.

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Elements of Hospital Blogging…Some of the

Intensive care bed after a trauma intervention, showing the highly technical equipment of modern hospitals.

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My post on Blog ROI generated some excellent questions about how to face the specific challenges of hospital blogging. There’s a lot of unchartered territory, and I doubt that any one person or group has all the answers. But I’ll pound out some on-the-fly thoughts.

A Little Internal Trackbacking
Before offering thoughts on how to address the specific problems of hospital blogging, it should be noted that whether or not a blog itself is ultimately worth burning the candle, there can be merit to the process of blogging.

There’s something about the discipline of blogging that confers benefits worth considering.

Just as the process of writing and reading can help you become a better communicator, thinker, problem-solver or just a more awakened animal, blogging can polish the lens through which you see things. The pliancy of the blogging process offers the ability to zoom-in on details you might otherwise miss or zoom-out to view the larger forest. It also connects you with other people and those people in turn connect you with new ideas or novel mutations of older ideas. And although it can be a solitary discipline, it opens you up to the world around you (if you’re paying attention). (Uh oh, I just caught myself meta-blogging. Shoot!)

Web 2.0 Shmeb 2.0…But: It’s Still Useful
For all the ridicule of Web 2.0’s hype, its tools permit a connection to the rest of the world that is unprecedented. That’s not a small thing. In fact it’s so big that it’s probably going to overwhelm us.

Still, the tools have utility in the right hands. For example, RSS feeds help you to stay on top of what an oncology nurse is thinking. And in conjunction with Twitter and Yahoo Pipes, RSS can help medical students Follow (spy on?) doctors. And I’m sure that there are ways to use FriendFeed similarly, if not even more powerfully.

(Incidentally, if you’re experiencing comment-fragmentation due to FriendFeed, here’s a WordPress plugin that’ll make your day.)

It’s usually blogging around that gets you hooked into these tools. So far, most of the social tools are being used to fuel untreated addictions. But that’s OK: boredom will eventually set in and the tools will evolve refinements that get us back to being more productive with them. For now, it’s a good time to adopt, play around, and figure out what works for you. Just don’t take all it too seriously.

That’s my argument for why hospitals might want to consider blogging. Not necessarily to throw a blog up (especially without seriously thrashing the project about up-front). But the benefits that the blogging process confers might justify its work-up. In the process, your employees might learn things they never knew were possible.


Basics…Start with Them
My primary suggestion for hospital blogging is to keep the focus pretty limited at first. I don’t think being comprehensive all at once is a safe approach. Rather a narrow focus on a topic that has a low risk of causing controversy and legal entanglements is a smart start.

Fear is not a strategy. It’s a paralytic.

Mindfulness is the Antidote.

For example, a CEO’s or CNO’s posts about her plans for her facility could be low risk with a better return than posts about controversial matters. Starting small also gives more wiggle room for the mistakes inevitably needed for learning.

Involving the right people is another important step. Scout for hospital employees who (responsibly) blog on their own time. There are some pretty web-savvy doctors and nurses out there who might just love the opportunity to contribute. Give them permission to be champions!

Ah, Them Lawyers and PR Wizards
Yeah, they blog…some of them do. And they’re smart and helpful…many of them are. Consulting with these resources is another important component of taking the first steps toward a hospital blog. Public relations may have a bad reputation (some of it earned, some of it not) but it’s an important tool in ensuring that the right kinds of messages are sent out.

“The right means in the wrong hands lead to the wrong results.”

That’s what good PR agents help you to avoid: costly and unnecessary wars. So consult with them and solicit their feedback.

In fact, PR and Legal might be able to spot bad operational decisions before they’re implemented since they may have a fresh perspective on a project that even the most capable operational managers can miss. So get them involved in the pre-launch thrashing. Don’t dismiss them. The up-front expenses of remarkable PR are probably lesser than their back-end replacements.

[[Link Update: Seth Godin indirectly invokes to the spirit of what I’m talking about with respect to PR and lawyers.]]

Involve IT, but Don’t Let ‘Em Bone You Out with “Can’t Do”
Strange as it is, the (important) IT component of blogging isn’t the biggest challenge. Blogs can be fairly straightforward, technologically. It depends on what you want. Find out how you might want to grow the blog. Consider the sorts of things should you build in at the beginning in case you want to expand your blog.

Establish strict security protocols. And make sure that the users of the blog can just blog and not have to worry too much about technical tweaks in a shaky system.

Custom-built bogs are one way to go. For smaller entities WordPress.org or Blogger might work. But WordPress, for all of it’s remarkable features, can be quirky and troubling. A simple and stable solution might be TypePad. Sure it’s not as sexy, but sex isn’t what you’re going for here I suspect.

Your Patients (aka Citizens)
Safety First. Always.

Don’t look for home runs or gushing bursts in your revenue streams. Instead, simply enable your community to interface with your facility’s human beings. Give time to sew the seeds and grow as it were. There’s no rush to assault Mount Remarkable. Don’t set high or unrealistic goals. Keep things simple.

Set strict privacy policies for your blogging. There shouldn’t be any reason for a hospital to mention the names of patients in a blog. And in fact, cases probably should not be discussed…at least until your blogging routine becomes well established. Start with fictive cases if that’s an interest.

Develop a Terms of Service policy. On one hand, you want to make it easy for participants to enter your blog; on the other, you need to establish their informed consent. And blog monitoring should ensure that participants do not reveal the names of other patients.

Complaints (legitimate) on a blog are perhaps the single most valuable commodity on a hospital blog. Why? Becuase they’re information. They’re (free) consulting data. Use what’s being given to you. Follow up immediately, whether or not it’s appropriate to do so on your blog. Give your citizens simple and easy choices on how to complain. Invite your complainers to a personal meeting. Ask them for more. And: thank them.

(You know what the Return in ROI really is? It’s “thank you”. Just a thought for all you John von Neumanns of financial ratio fetishes out there.)


This is just a small outline of a larger plan for implementing a blogging strategy for a healthcare facility. These are just open-ended intuition pumps, to be taken more for early project-thrashing than as Gnostic Gospels with precise schematics to blindly follow.

It’s easy to get lost or burned blogging about your hospital activities. But it’s even easier to get burned providing the very services you provide daily. Examples of the risks/costs hospitals face/incur almost every day:

  • Medication Errors
  • Surgical blunders
  • Patient Identification FAIL
  • Protocol Breaches

These are the risks already inherently built into the fundamental operations of a hospital.

Blogging, for all its pitfalls and potentials for blunder, probably won’t harm people as much as the items above. Put things into perspective. If anything, the practice of blogging might:

  • Enable a more efficient dialogue about the risks listed above
  • Provide your facility with the opportunity to explain the challenges of running a hospital that you strive successfully to meet (people love the honesty of competent minds)
  • Offer an information-based incentive for your staff to provide the remarkable services for which you hired (and pay) them

Creatively capitalize on your investments. (And don’t stare at sunk costs. You’ll fall into a black (red?) hole.)

With a successful blog, you just might shine your sincere concern and commitment to safety and efficacy of care. That’s an assurance that’s good for patients. And your tush-line.

So, here are some of my off-the-cuff, very informal and un-researched suggestions for hospital blogging:

  1. Start small…but don’t be afraid to think big
  2. Keep the focus narrow, to one topic perhaps (e.g. fundraising events)
  3. Recruit passionate bloggers internally (or externally)
  4. Establish good blogging hygiene
  5. Monitor comments and vanguard privacy
  6. Promote locally first
  7. Don’t promote too heavily (at least in the beginning)
  8. Involve Legal and PR ahead of time (thrashing)
  9. Don’t get discouraged by setbacks
  10. Invite guest bloggers for consultation and/or posting
  11. Reach out to the community of “Social Media” folks…(but use your common sense and skepticism!)

Don’t blog until you really understand the hard work needed for easy use. The intangible costs of blogging are heavier than the tangible ones (yes, a paradox of physical laws, but that’s blogging). When in doubt bail out and get back in when you’re vision is clearer.

Blogging s an open affair, whose floorboards are set down on the fluid air. But so is life, which is what healthcare is all about serving. What I mean is: you have to acquire the talent and skill to be able to think and respond swiftly but responsibly even if the aren’t established templates or recipes for doing so.

The purpose of a blog (at least this one) is to spread ideas, have them filtered through other brains and watch them grow. My hope is that I encourage free (not hate) speech with critical commenting.

The process is the principle.

For more about integrating emerging technologies into your enterprise, check out Health Is Social here.

The Efficient MD


These aren’t “hospital blogs” but they do illustrate what some smart folks are doing with these tools.

Please…comment: it’s free and useful.

Blog ROI: It’s About Value, Stupid!

Simple question: why would a hospital have a blog? Or use Twitter? Or maybe even FriendFeed? Simple answer: value.

A hospital aught to be one of the most valued kinds of facilities in our communities. Every effort aught to be encouraged for such organizations to optimally utilize those resources which can improve the delivery of care, expand an organization’s presence, and even generate positive returns from the investments in those resources.

But not every organization blogs. Not every one needs to. Why? Because the theme of returns and cost efficiency have been propounded so heavily into our heads that we overlook the obvious. We need to kick ourselves and say: It’s about value, stupid.

Hats off to ROI Harper and Generally Accepted Accounting Principles (GAAP)

Before addressing the specifics of hosptial blogging we aught to dip into some accouting theory, finance and arithmetic.

Organizations benefit greatly anytime they can create interactive means for people to find, experience and share value. A company’s Return on Invesment (ROI) is a simple quantitative method to express the expected gain from a deployed asset. But often, analysts focus so much on the number that they forget the value that drives it from the start.

Investing in social media is an investment in an intangible asset. Intangible assets generate both tangible and intangible losses and/or returns. Tangible assets include hospital beds, ventilators, infusion pumps, buildings, operating rooms, etc. Accounting theory offers ingenious methods for quantifying these assets in order to provide valuable information to investors and other stakeholders to make the soundest decisions about their resources.

Intangible assets include competent nursing care, physician experience, goodwill, communication styles, etc. They also include blogs and other social media that are currently evolving. Accounting theory has yet to work out how to measure a blog’s asset valuation (it could use a market costing methodology perhaps).

But the Financial Accounting Standards Board (FASB) hasn’t yet seemed to issue a promulgation on the matter. If you’re a CEO, CFO, CIO or CAO of a publicly traded company maybe you can get a conversation going with the SEC or FASB (who knows, you might be able to get some tax deduction rules going: hint, hint).

Until someone establishes a standard measure of Blog ROI, I think it’s helpful to focus our lens on a fundamental question:

What information is needed to decide whether a blog is worth its cost?

There’s probably a complicated anwer to that question, one which depends on the economics of your particular organization. In its place, I’d like to offer up three simple intution pumps:

  1. Value drives ROI
  2. Price is a function of Value
  3. Value-Multiplied is replacing Value-Added

Value Drives ROI

ROI is just a noun. A number. A goal. It’s important.

Value is a verb. A movement. An infection. It’s essential.

If you want to generate positive ROI, you will have to create the setting through which customers (who these days aught to be called citizens) feel the value they seek (consciously or unconsciously). You will not only have to be the creator of value, you will also have to provide the means through which citizens can express their passion for the value they perceive.

So if you’re not able to derive an equation that gets you to ROI, you’re still not in the dark. If you’re trying to decide about developing a blog for your organization, you can just follow one word: value. What value would your blog offer to the people who read or join? Could you list out the (hypothetical) values? I think you could: around a conference table or in your armchair.

Price is a Function of Value
If your service isn’t valued there is no price strategy that will keep your going concern, well, going on. Price is simply a numerical expression of value. It’s either determined by monopolistic Short Snouts, oligopolies, government regulation, or the Long Tail of perfectly competitive market forces.

Be the Genhis Kahn of social value.

Mongol Lego-Archer

Photo: Dunchaser’s Photostream

Your strike-price is a derivative of the value people perceive. So strike value right into the hearts of your target. Be the Genghis Kahn of social value. I say Genghis Kahn because his small horde of lithe soldiers wearing silk shirts conquered more land mass while ridding on tiny horses than any other force in history. His enemies wore thick, heavy, metallic armor and everything they did was big. Why did his strategy and tactics work? Because in silk, there’s value. (Lesson: you’re going to get wounded, so make it easy to pull out the arrows.)

Value-Multiplied is Replacing Value-Added
It’s no longer good enough to “add value”. You’re sinking down the Long Tail. You might be in denial about this, but it’s true. Technology will own you (sorry, we’ve passed the singularity). The value you create and which your customers/citizens perceive has to be multiplied, not simply “added”.

And that’s where intelligent applications of social media come into play. Can you think of a better way to multiply the shared values of your going concern? Word-of-Mouth (WOM) was always king. But know the kingdom of WOM has come. Know thy king. He’s a little different this time around. He’s wearing new clothing: a crown of truth, a cape of respect and a staff of democracy. In fact: he’s you!

You cannot lie in the New Kingdom of WOM without being cast out. This is good news: you can now multiply your value with nobility. You can now impress your citizens with your infectious passion.

Value-Multiplication. That’s the new math you need to learn. And learn well.

Family Values are Social Values

There is an endless list of things people value in general. Here are some activities that I think most people value greatly:

  1. Kvetching
  2. Praising
  3. Sharing
  4. Bragging
  5. Linking
  6. Being flattered
  7. Being Right
  8. Never Being Wrong or Hurt (unless it’s a Dominatrix service)
  9. Loving
  10. Being Loved
  11. Inputing
  12. Suggesting
  13. Being Listened to
  14. Commenting
  15. Creating
  16. Meeting Others
  17. Learning
  18. Getting Great Free Stuff
  19. Taking Action
  20. Being Offered Simple, Easy Choices
  21. Hearing “Thank You” (even when they mess up)

These are all ingredients to successful blogging. Successful relationships. Successful business. Succesfful Successful anything, really. You don’t need Excel for the formulaic recipe. But you can cook. Be creative, use your senses, surprise yourself and become a remarkable presence in the kitchen of your marketplace.

Remarkable Opportunity Ingenuity (ROI)

Let’s redefine ROI. Let’s give ourselves permission to take a few steps back from the professorial whiteboard, put down the calculators and take a look at where we are along the Long Tail. If you don’t know where you are or what value your blog will create, how will you ever hope to properly calculate the returns on your investment? Would it even matter?

“There are some things that count that can’t be counted. And some things that can be counted that don’t count.”

John C. Bogle’s paraphrase of an old proverb

You’ve read Seth’s blog (I hope!). So you already know what to do. You know the answer: be remarkable (don’t just feign it). Be remarkable in your decision about whether to blog or not. It’s not as easy as it looks. It’s hard. It’s costly. Which means it can be numerical and maybe calculable. But do the calculations AFTER you do the valuations. If you lay down the tracks for your customers’ value-train then ROI will come chugging along.

Some Rationales/Reasons for Hospital Blogging

Let’s return to hospital blogging, since it seems to be one of the most challenging. There are considerations in the healthcare industry that may not exist in others, including but not limited to:

  1. Patient Privacy
  2. Empolyee Privacy
  3. Safety
  4. Efficacy
  5. The Provision of Authoritative Content

There are of course other considerations. But they are manageble Dips. They’re not dead-ends (although I think many hosptial cultures automatically conclude that these are the dead-ends that deceptively justify the easy choice: not to blog at all).

So what are some of the rationales for crafting a remarkable hospital blog? Here are some suggestions (I use the word citizen in place of patient, family member and general public because it’s the only word that makes sense in a remarkable democracy):

  1. Citizen Complaints (These Should be Prominent!!!)
  2. Citizen feedback and praise
  3. Services updates (a new Operating Room or Surgical Procedure)
  4. Introduction of New Staff
  5. Nursing Notes (I Know a Bit Nightingalish)
  6. Up-to-Date Content on Disease Processes and Management
  7. Community News
  8. Pledge Drive Announcements
  9. Guest Posts from Prominent Doctors, Nurses & Other Healthcare Professionals
  10. Staff Recruitment (Show Off What a Remarkable Facility You Have – Be The Zappos of Healthcare!)

The same could be (partially) true for services like Twitter or FriendFeed. Here are some values to be shared through those media:

  1. Tweeting facilities about emergent crises
  2. Using Twitter for staffing needs
  3. Using FriendFeed to keep a stream of blog posts and other information about your facility for the whole world to see (also: if Google purchases FriendFeed, wouldn’t you want to be listed on their prime SERPs?)
  4. Using Twitter or FriendFeed as an educational tool for nursing and medical students (let them follow the best in the business)

Conclusion: Value Multiplied by Infectious Interaction Equals Gross Blog ROI

If all of this is new and bewildering to you, perhaps you aught to focus your investing efforts on a blog. For one, blogging develops the kinds of skills needed for effective social media marketing. Also, it offers a simple interface with your citizens.

Being passionate about your hospital and the services it provides is important. But: that passion must always be subordinated to something even more important. Be passionate about infusing your citizens with the infectious vectors of value that they can spread through the community.

A blog is one component of the passion-pump. Additional social media tools offer more options, which I will talk about soon (Twitter & FriendFeed). For now, you can follow me on Twitter or subscribe to my feed and we can continue the discussion. And feel free to (respectfully) obliterate my arguments here. Quality of life is at hand here.

Whatever your background, a blog is a good start to a healthier hospital. Then again, you could just let someone else do all the talking for you while you keep handing cash over to lawyers and PR wizards instead of your nurses and doctors and capital equipment. Who knows, with all of the ultra-portable devices around these days, you could just let your organization become a featured superstar on Youtube. Just what are you waiting for?


For remarkable resources on blogging and social media, follow these links:

Darren Rowse Problogger (No Nonsense Mate from Down Under)

Chris Brogan (Knows his stuff and knows how to communicate it!)

Guy Kawasaki’s Alltop Blogging (A Great Collection for Beginners & Pros)

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