Developing social media guidelines for education, training and change management in health care settings


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Presentation given to the e-Health 2012: Innovations in Health e-Care conference in Vancouver, BC.

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  • These technologies are distributing the power of publication and authority to the masses, and it is letting people talk to one another, instead of engaging solely through an intermediary information provider, whether that is a mass media outlet or even a health professional.We hear this expressed in other ways as well, as a desire for empowerment, engagement. We’re looking and talking online about our health more and more – and in Monday’s plenary, it was perhaps said best, that our health professionals are acting more now as information stewards, not as information providers.A big part of this is generational and you see it across the board in social movements in the United States and Canada. Different generations have different learning and leadership styles that they prefer, I heard yesterday from Accenture who has been looking at how different generations want to interact with the health system. And Millenials, those born in the 80s and 90s, as well as their Gen X counterparts, tend to prefer more collaborative leadership styles and more horizontal structures in their interactions around their health. There are not only a lot of younger people seeking collaboration around their health care, but there is also a wide range of information on the internet now that is being spread through these technologies – much of it good, and much of it bad. Having health professionals active in these spaces help to provide a needed balance to what otherwise tends to allow pseudoscientific voices, and we can all think up our favorite celebrity vaccine deniers here as an example of this, to ring out clear.
  • Some of the ways that social media are changing the information structures in health care include very briefly, information discovery and curation: finding information has never been easier, and for those of us who can use critical appraisal skills, we can help to spread the good stuff and critique the badSharing of best practices: it allows professionals and also patients to connect with one another in ways that just simply weren’t possible before now. If you’re interested in learning from other people, the time has never been better for that.Research dissemination and knowledge translation: There are folks in Montreal today talking about bridging the gap between research findings and the bedside. And this is a huge problem right now where we see evidence for certain things, but it takes years to get them incorporated into our care practices. Social media is helping shorten that lag time by allowing quicker spread of research, more open peer review especially post-publication, as well as the dissemination and discussion around those findings which is what I mean by knowledge translation
  • If we accept the claim that social media really is this transformative for health care practice and research, then we should also acknowledge the fact that with that power comes the danger of its abuse. So there is such a thing as being too open about the work that we do, especially in health, and I don’t think I need to dwell long on the myriad ways we can violate patient privacy using the web especially to the crowd in this room. But one of the things I’ve appreciated from many of the speakers at this conference is that privacy is a true concern, but we shouldn’t let that stop us from making progress. In many ways this isn’t a new problem – I took the photo on this slide in the elevator at Vancouver General Hospital. There are different implications maybe for online privacy violations than those made in the elevator, but the idea that are now facing something completely terrifying regarding privacy on these things isn’t completely new.
  • One increasingly common way of dealing with these things is by the creation of a social media policy or guidelines. Often these things go hand in hand, especially in a business setting. Many of you who work for vendors or corporations probably already have these in place at your organization. Those of you who work in health settings or universities may not.Policies tend to be more directive (thou shalt), to protect an organization if someone ends up “going rogue.” Guidelines tend to be less prescriptive and broader in scope. Policies tend to be set in place by organizations like corporations and hospitals, with large staff sizes; guidelines tend more often to be laid out by professional associations such as the CMA and further contextualized by local jurisdictions.Both are in place to explain and contextualize social media use for health professionals
  • So now I want to get into talking about how people are starting to deal with the problems around feeling like they have some sort of “control” around social media use. The solution I’m ultimately going to suggest here is a set of guidelines like we’ve seen come out from groups like the CMA, the AMA, other professional orgs. But before we get there, it’s interesting to me, that something that at one time was actually used as a critique of the necessity of social media guidelines and has now curiously snuck into the actual language of them. That is the adage of to just use common sense.It’s intuitive for people to say, hey, you don’t talk about your patients in the elevator, so don’t talk about them online either, right? But you can see the people listening in the elevator. Online you can’t “see” anyone. Facebook “feels” private to us. It’s not, far from it, but sometimes it feels like we are talking with a very closely defined group of people. Facebook also owns the data that you enter into it. And so our expectations and impressions about what these online spaces represent and the reality of the situation is often very different.As a result, we don’t have common sense about social media right away. It’s not common until you use them for a while.
  • Like I mentioned before, I work for a research office in the Faculty of Medicine called the eHealth Strategy Office….We work on projects that most often are connected to doing research on the social aspects of the adoption and implementation of technology in health care practice and education. These projects are across the board when it comes to audience, we work with students, faculty, the ministry of health and community organizations on various different projects – all of which have this thread of exploring how new technologies have an impact on health practices.
  • So right now we are undergoing a change management from research practices that are in many ways traditional in nature and into one that incorporates a more modern and social take on the work that we do. But this is difficult, because again it inverts a lot of the old values of the research model (this is my project, not yours), and it turns those things inside out – what’s mine is now yours and we want you to build on it. We want to partner, we want to share. But that’s just the theory of how the new model works. In practice, we’re up against some cultural factors that work against that, and even though we examine how people use technology, we don’t always stop to examine the ways in which we ourselves incorporate technology into our practice.The idea that I came to when preparing for this presentation (and if anyone’s here from my group, I wonder if you agree with this or not) is that the problem is one of “common sense.“To our researchers, “common sense” is to not talk about the research until it’s published.To somestaff, it’s “common sense” that their day-to-day work isn’t interesting enough to share.To some staff, common sense is that they’re “too old” to use social media.
  • So the out of the consultation process, what I’ve been hearing about what people need is something like this:Policy statement is to keep the social media activities of our office aware as much as possible – we have many projects on the go at once, but it’s good for at least one person to be aware of everything that’s happening. So for us the policy is less about protecting the organization from liability, though in its final form it will address that. But more it’s about establishing a governance model for social media projects, that without one, tend to crop up and die off.When I am made aware of new projects, I’ll start by referring people then to the guideline documents that try to address some of the most common issues that I hear – those of time and of privacy. The guidelines are there, along with myself, to act as training and a resource for the implementation. It’s up to the project managers, however, to do the day-to-day management or delegation of the social media efforts themselves.But inevitably there are tools that people are curious about and would just like to experiment with, and I’d like to encourage that behaviour as well. Not everything has to be perfect. But I can’t always guide people one on one through learning new tools, so I’m going to start developing some links to places where folks can get some training.
  • The final product is also started to be built on a wiki. UBC has a wiki that is hosted locally and the idea of doing it here is not only to exemplify the use of one of these technologies, but eventually the hope is that they can be collaboratively contributed to as more staff become involved in the process.They are also publically available. I drew on a lot of public sources for the development and drafting and thinking around how to get this right, and it’s only fair that our guidelines can be shared and discussed in the same way.
  • So I’d just like to close by talking a little bit about the frameworks behind my thinking on implementing this sort of thing in an organization. And we’re all familiar with this chart of the technology adoption lifecycle. You start with innovators who try something out, they make a buzz about it, a few more people get on board, it either dies from their weight (falls into that chasm), or you hit critical mass and things work for you and more people join until eventually everyone’s using it.The only thing I don’t like about the way this presents things, is it doesn’t give you an actionable framework for how to move through these cycles. Its not enough to see the chasm for what it is. How do we get through it? How do we even get our first innovators to notice what we’re doing?
  • So another frame that helps us with this sort of thing is that of organizational change management. And this particular graph is from a paper in the 80s, though this isn’t the original, it’s an interpretation of it I found. I’m less concerned with the particulars of the graph and more so with the stages. We move through these things in a way that I think is more helpful in interpreting the psychological state of different users – and I think you can see in some of these things that technology adoption curve being reflected in the points on this curve.
  • To even further contextualize this graph, I’ve plotted some of the plan points onto this graph here to show you where I think these things lie. We’re starting out by raising awareness and doing some surveying to gauge the understanding. We’ll build understanding through the reporting of those survey results. We’ll gather feedback and my hope is that by incorporating staff feedback into the guidelines that the positive perception of social media and the value will become stronger. Adoption comes next, and really institutionalization is the last step, but that seems kind of hollow to me.Instead, where I see us going, is to a place of shared expertise. I don’t want to wear this “expert” hat. What I want to see is the people I work with coming to me with ideas I haven’t thought of yet, with solutions to one another’s problems. And that the next draft of the social media guidelines (since these things are constantly changing) will actually be produced by people who are interested and have the skills to guide where they think these things should be going.
  • Developing social media guidelines for education, training and change management in health care settings

    1. 1. eHealth Strategy Office
    2. 2. Developing social media guidelines foreducation, training and changemanagement in health care settingsDaniel Hooker, Liz Heathcote, Kendall HoeHealth Strategy OfficeUBC Faculty of Medicine eHealth Strategy Office
    3. 3. Outline• Social media’s growing influence on modern health care contexts• What’s different about social media?• The problem of “common sense”• Social media guidelines and the eHealth Strategy Office case example eHealth Strategy Office
    4. 4. Social MediaSocial media are web- andmobile-based technologiesused to turn communicationinto interactive dialogue.-- Wikipedia eHealth Strategy Office
    5. 5. Social Media• Transparency, openness, collaboration, “user-generated content”• Monday’s plenary: physicians are increasingly information stewards, not information providers eHealth Strategy Office
    6. 6. Social media in health• Social media are changing health care practices and information structures• Information discovery and curation• Sharing of best practices• Research dissemination and knowledge translation eHealth Strategy Office
    7. 7. Pitfalls• With great power comes great responsibility• It is possible to be too open• Don’t let the privacy “smokescreen” halt change eHealth Strategy Office
    8. 8. Social media guidelines• Policies and guidelines are being put in place to protect patients, providers, organiza tions• Offer solutions and guidance to shepherd health professionals though balancing personal/professional online spaces eHealth Strategy Office
    9. 9. The problem of common sense• Many people appeal to health professionals’ “common sense” around using social media• But new contexts require new social norms eHealth Strategy Office
    10. 10. Case Example• Led by Dr. Kendall Ho, the eHealth Strategy Office is a 25-person research office in the UBC Faculty of Medicine• Research projects are focused on social aspects of the adoption and implementation of technology into health care practice and education eHealth Strategy Office
    11. 11. Case Example• We are incorporating social technology into our research practices in the same way as everyone else• Again, we have a problem of “common sense” eHealth Strategy Office
    12. 12. Case ExampleGuideline implementation plan:• Staff consultation, survey (needs assessment)• Guideline drafting• Feedback cycles• Evaluation eHealth Strategy Office
    13. 13. Case ExampleWhat our social mediaguidelines look like:• Policy statement• Guideline document• Training resources eHealth Strategy Office
    14. 14. eHealth Strategy Office
    15. 15. Frameworks: Technology Adoptionsource: Wikimedia Commons eHealth Strategy Office
    16. 16. Frameworks: Change Managementsource: eHealth Strategy Office
    17. 17. Frameworks: Change Management shared expertise increase in activity feedback survey consultationsource: eHealth Strategy Office
    18. 18. Thank you!Daniel eHealth Strategy Office