Social media for a healthcare organisation
A hospital, a health system or a professional association runs social media as a programme rather than as a stream of posts. The programme overcomes what holds the organisation back, serves purposes the organisation already has, sets a policy that protects patient privacy, grows out of the organisation's existing practice, keeps pace with changing platforms and AI tools, plans its goals and content, measures and listens, holds many channels to one framework, tailors content to each platform, and is staffed and trained. Running it turns the writer or communicator inside the organisation into its manager.
What holds an organisation back
A hospital whose bottom line should be restoring health to patients is not the same thing as a profit-oriented corporation, but many of the problems and opportunities it meets in social media are the ones companies face.
Most hospitals were not early adopters, but the number of clinics using social media increased significantly. Many of the restraints holding them back are the same as in other institutions: ignorance of the tools, insecurity about how to use them, organisational barriers, insufficient resources, and the absence of a strategy or of guidelines on social media use. Once the first three are addressed and a clinic decides to start, the last two quickly come to the fore.
Social media should be integrated into the organisation's overarching communications strategy and directed at clearly defined goals, and its particular capacity for interacting with audiences has to be recognised and used. Some hospitals, like some companies, had not yet fully grasped the Web 2.0 shift and continued to push information at audiences instead of trying to have a conversation with them.
Having a conversation with the many people likely to engage with a hospital's presence is a great deal of work: the Mayo Clinic, arguably among the leaders in this, started with limited personnel and came to employ a full-time staff of nine to monitor and feed its channels.
To some administrators the whole activity can look like a huge drain on resources with no return, but used strategically it reaps significant benefits. Hospitals were getting back at least as much as they gave: money through fundraising, qualified staff through recruitment, and unfiltered information from listening to what people say about them. Social media offers a chance to improve policies and processes on the basis of patient and community feedback, and since there is always room to improve the patient experience, it can be an invaluable sounding board for what patients really think. A positive social media experience can allow hospitals to build and strengthen their own patient communities.
Purposes the channels serve
After a slow start, hospitals in the Western world were increasingly using social media to connect with different audiences. North American clinics had a head start on European ones in frequency of use, with good examples on both sides of the Atlantic, and beyond connecting with communities and receiving feedback on services, the channels can be used for brand and crisis management, patient and physician education, fundraising and recruitment. Hospitals and medical schools use social media to inform, influence and inspire, appealing to the heart as well as the mind, to engage key audiences outside the exam room or the classroom, whether patients, students, scientists or donors. Academic health centres use it across their other missions too, drawing attention to research, attracting enrollees to clinical trials, recruiting medical students and building new pathways to community engagement, and health organisations that are not on social media are missing out. Social media meets stakeholders where they already are and lets a health system be part of people's lives even when they are well, offering helpful tips, emotional support and news of the latest discoveries and clinical breakthroughs. Its communication also extends beyond local geographic boundaries, raising awareness and reputation more broadly.
Extending an existing reputation. The Mayo Clinic was among the world's first hospitals to use social media, and did it by learning as it went, dovetailing existing resources with the new tools and growing the platform incrementally. Its strategists saw social media as an extension of the word-of-mouth principle that had always contributed to the hospital's success. So the clinic stayed tightly focused on its core strategy, helping people with their health and well-being, trusting that satisfied patients and families would act as multipliers on the new channels too. The clinic expanded its brand into social media with more than 60,000 Facebook fans, 260,000 Twitter followers, its own YouTube channel and its own online community where people could reach health information and connect with one another on specific topics.
Explaining procedures and showing the people who perform them. Videocasts, on the organisation's own site or a YouTube channel, are a particularly effective medium for explaining complex medical procedures: University Hospitals Birmingham made an animated videocast explaining radiotherapy treatment to children with the Aardman animation studio. The same format humanises an organisation by giving visual access to the people behind the scenes and by storytelling, through specialist interviews on particular conditions and through patients describing how they experience and cope with illness. Blogs keep patients up to date: the Wellington Hospital in the UK curated an extensive blog searchable across subjects from breast care to urology. A German hospital used its existing patient magazine as the starting point for a campaign integrating print, video and social media, converting parts of the magazine into videocasts, having each platform promote the others, and letting readers order the print magazine through Facebook.
Fundraising. San Francisco Medical Center's "Challenge for the Children" competition pitted teams against each other to raise funds for a new children's hospital. One team used the gaming platform Farmville, where players bought seeds for peppermint sticks and received a teddy bear for their virtual farm, with the proceeds going to the fund; it raised more than $800,000 from 162,544 donors against a projected goal of $100,000. St Jude's Research Hospital, with almost half a million Facebook fans and almost 100,000 Twitter followers, used its platforms consistently to fund childhood cancer research.
Serving a defined local community. The South Coast Health System, a non-profit covering three regional hospitals, had no flashy presence and was instead geared to its own community's needs, developing an iPhone application called MyHealth to help patients and carers manage prescriptions, appointments and the rest of their healthcare. Twitter is a powerful tool for connecting with patients, and some experts held that healthcare was not yet using it to its full potential. NHS Nottingham City used it to alert patients to flu vaccination and point them to their nearest provider, Birmingham's Heartlands Hospital ran a two-week "Twitter-o-thon" educating patients about diabetes and obesity, and a Twitter session by a Mayo Clinic specialist led a patient to seek help for a condition she had been told was untreatable.
Communicating through an incident. The South Coast Health System also used Twitter during an environmental crisis: after a large chemical spill it kept up a continuous live stream on patient admissions and discharges, treatment progression, and what the media were reporting about the accident. Hospitals might do well to explore further uses of Twitter in emergency care, in triage or in managing emergency response teams. Internal tools serve too: Texas Health Resources, a 13-hospital system, used Yammer, an internal equivalent of Twitter, when one of its emergency departments was overcrowded with flu patients, and after the chief nursing officer posted about the problem another hospital offered to share its resources.
Professional education and recruitment. Johns Hopkins Medicine tweeted live during seminars, raising its re-tweet rate and its standing with followers; the University of Buffalo encouraged surgeons to tweet during surgery in the hope of accelerating the flow of information for training; and several US hospitals used Twitter during live surgery both to educate doctors and to inform patients and the public about specialised procedures. After difficulty recruiting gastroenterologists through medical journals and direct mail, Geisinger Health System launched a Facebook page with pictures, information about recruiting events and links to its own site, and found it substantially more successful at attracting candidates and filling posts than the conventional channels had been. Hospitals including the Children's Hospital of Philadelphia used videocasts describing what their staff do day to day, aimed at people considering a career such as nursing.
Hospitals and medical schools generate a large volume of high-quality health information, from fundamental, preclinical and clinical research to clinical studies and authoritative information about disease mechanisms, prevention and spread and about novel treatments. Clinicians and biomedical researchers are arguably the most reliable sources of medical information and have contributed greatly to health communication, and in an information ecosystem where reliability is key, hospitals and medical schools have the potential to become key players as the most trusted sources of health information. During the COVID-19 pandemic access to reliable health information was more vital than ever, and health institutions such as hospitals and medical schools could contribute uniquely to the fight against the coronavirus by providing accurate information, educating the public and engaging in policy discussions with other elements of society. With more than 2,000 American local newspapers gone out of business since 2004 and newsroom employment down by 50%, local hospitals and universities can provide critical health information that best serves their local communities, while interacting with the national media and the government to advocate for and represent those communities.
People get much of their health information from the internet, often from social media: research by GWI in 2016 found that 97% of adults aged 16 to 64 had logged into at least one social channel in the previous month. Some sources, such as health care organisations, provide resources that can support productive conversations with providers, and health material from the internet can improve the patient–provider relationship when the patient discusses it with the provider, which can lead to more engaged health decisions. Misinformation runs rampant on social media: during the COVID-19 pandemic Facebook began warning users that what they were reading could be incorrect, and users share without citing sources, fact-checking or even reading what they like and share. That is why health care organisations and professionals should be on social media, where sharing credible, high-quality information brings appropriate answers to the place patients and families are looking.
Organisational accounts are an important tool for combating misinformation, but hospital-owned channels do more. They support revenue-driven marketing campaigns, share stories that show the organisational culture in support of recruitment and retention, and serve customer service and responses to reviews and feedback. When a patient or employee posts a negative comment, a real-time conversation can sometimes prevent further damage to the hospital's reputation: the patient relations team at Nationwide Children's has stopped situations escalating after being alerted by a post; a parent tired of waiting, for example, can be de-escalated in the waiting room before further reputational harm occurs. Individual clinicians can also make an impact as organisational thought leaders: if their social media work is supported by education and training, they can help share accurate and relevant information. Twitter especially is a place to share research with peers, amplify speaking engagements and connect with referring physicians or consumers. In 2020 social media played a large role in attracting candidates who could not tour facilities in person, a trend one hospital's social media team expected to continue past the pandemic. Most importantly, by disseminating evidence-based information, health care organisations or individuals on social media are in a position to actively combat statements that are at best erroneous and at worst a hazard to public health.
Social media were changing the way EMWA communicated, interacted and did business with its members, sponsors and other stakeholders. They are instruments of two-way communication, not just sources of information but also ways of interacting, and EMWA used them to interact with its members daily, to promote discussions and to share information. For members, following the association's channels was a way of staying in contact with colleagues, following discussions and keeping up with its news.
Social media policy and patient privacy
Putting healthcare and social media together raises ethical questions about what is permissible in a hospital setting, and a hospital needs to address them and work out a binding social media policy covering everyone in the organisation, to avoid embarrassing gaffes or full-blown crises. In the so-called "Placenta Incident", for example, nursing students faced disciplinary measures after posting a picture of a placenta on Facebook following a training session.
The University of Maryland Medical Center and the Mayo Clinic were exemplary in implementing such guidelines and making them openly accessible, the Mayo Clinic's social media network making its guidelines and related documents available to peers globally.
Privacy, ethics, professionalism, and content monitoring and governance all require a healthcare organisation to proceed more cautiously than other business sectors might, and a health system building a social media strategy should establish guidelines and best practices for use. Handled poorly, social media can harm an organisation's image more than help it and can breach patient privacy. At UF Health, the University of Florida's academic health centre, the social media policies prohibit posting confidential or protected health information, including patient photographs without written consent; coordinators are trained to respond to self-disclosure of protected information and to escalate so that content can be removed; and employees' personal accounts must make clear that they speak as individuals.
Concerns about patient privacy, and particularly HIPAA, made some hospitals hesitate. The Mayo Clinic's earlier media relations work and a proper understanding of health care's regulatory environment were essential to its ability to venture onto the new platforms, and an analysis with its legal department showed the obstacle could be easily addressed. HIPAA prohibits covered entities such as hospitals from disclosing patients' protected health information without their consent, and the clinic's media relations team had long obtained exactly that consent for patient stories, so the same signed authorisation was required before the clinic published protected health information on its blogs and social platforms. Patients, however, are not covered entities: when they disclose information about themselves on public social media, even on a hospital-sponsored page, it is the patient who publishes it, not the hospital. So the privacy obstacles could be overcome either through a standard media release or through a proper understanding of who was actually initiating publication.
EMWA issued a short guide for members who use its official Facebook, LinkedIn and Twitter accounts, to make posting and reading online more pleasurable for everyone. Social media function like traditional ways of communicating, but their high speed, interactivity and global access to anything published bring particular considerations that must be taken into account. People posting on the association's channels are not members of a closed community: a throwaway comment can spark a frenzy of worried postings, and malicious posters, known as trolls, deliberately try to interrupt constructive debate. The best advice is to approach the online and the physical world in the same way, with sound judgement and common sense, and to try to understand netiquette, the set of social conventions for interacting in the digital age.
The guide makes nine suggestions for members to consider:
- Take time before responding, because the internet is permanent and never forgets.
- Do not pick a fight: a wide range of individuals will be encountered, and where someone is contentious and wants to pick a fight, be polite and minimise contact.
- Be the first to respond to your own mistakes: be up front about an error and correct it quickly, which can help restore trust, and where content posted earlier, such as a blog post, is modified, make clear that it has been.
- Adopt a warm, open and approachable tone.
- Use your best judgement, since what is published may have consequences: anything that causes even the slightest discomfort is probably best not published, or published only after seeking further advice.
- Be conscious about mixing personal and business lives: keep personal accounts separate from professional channels, and remember that only the association's PR officer is authorised to speak publicly in its name.
- Take account of the European and global audience, since statements deemed acceptable or even funny in one culture may be considered offensive in others.
- Share only publicly available information, unless there is a clear mandate to do otherwise.
- Be a scout for critical issues affecting the association, whose members are its most vital assets for monitoring the social media landscape: forward positive or negative remarks about it that seem important to its head office or to a member of its executive committee, so that legitimate concerns can be addressed as soon as possible.
Growing a programme out of existing practice
The Mayo Clinic created its Facebook page on the first day Facebook allowed organisations one, when few other hospitals were even considering social media, and marked its tenth anniversary on 7 November 2017. Health care is by nature a risk-averse industry: it expects its providers to use scientifically validated therapies and interventions, and when providers want to experiment with possible improvements, rigorous procedures protect human subjects from harm and secure informed consent. Alongside that process a global system for disseminating knowledge and best practice developed, from peer-reviewed journals at the formal end to medical society gatherings, visiting lecturers and faculty exchanges at the informal end, and the clinic's founders both took part in and helped shape this social networking among physicians. William J. and Charles H. Mayo learned surgery from their peers, which train travel made possible: by the late 1920s Will had studied surgery in every US and Canadian city of 100,000 people or more, crossed the Atlantic 30 times and observed surgeons in 25 countries. Between 1908 and 1918 nearly 3,400 physicians travelled to Rochester, then a town of about 5,000, as members of an informal Surgeons Club; they came to the Mayos for their own ailments and referred patients, who shared their experiences with family and friends. This analog social networking among professionals and patients was essential to the clinic's development and growth, and a century later patients came to it from every US state and more than 140 countries each year. In 2000 word of mouth, news stories and physician referrals were the most important sources for people choosing the clinic.
The programme grew out of media relations. In 2005 the media relations team gave the clinic's daily syndicated radio segment an RSS feed and listed it in Apple's month-old iTunes podcast directory, and three weeks on the directory's front page brought an 8,100% increase in audio downloads. That increase helped make the case for experimenting with YouTube, consumer-grade video cameras, Facebook, Twitter and blogs. The first uses were media relations done better, pitching stories with videos of physicians and patients rather than press releases or telephone calls. The next was reaching narrow audiences of patients interested in rare conditions where the clinic had leading expertise, and inviting them to share their own perspectives.
Colleagues from other hospitals asked how the clinic had resolved its concerns and asked for resources to drive their own organisations' adoption, and the clinic's leaders saw an opportunity to create a modern-day analog to the Surgeons Club for social media. In July 2010 they established the Mayo Clinic Center for Social Media and the Social Media Health Network, later combined as the Mayo Clinic Social Media Network, to accelerate adoption of social media strategies throughout the enterprise and to serve as a resource for peer organisations. Where the clinic's earlier efforts had focused on public relations and marketing, the network's goal was to encourage social media use in support of clinical practice, research and education. Its staff consulted internal stakeholders to help them conceive social media strategies and developed resources to support them, and it recruited external thought leaders and practitioners to an external advisory board. Beginning in 2011 it ran a day-long Social Media Residency for professionals building strategic plans, held annual conferences on the clinic's Minnesota, Arizona and Florida campuses and summits in Brisbane and Melbourne in 2015 and 2016, created with Hootsuite in 2015 the first CME-accredited online course in social media basics for health professionals, and set up Mayo Clinic Connect, a community of more than 80,000 patients and caregivers in more than 50 disease-specific groups. As social media in health care came of age, the network became a free platform for anyone interested to engage in discussions and connect with peers. Its core premium offer is a corporate membership that gives employees of member organisations unlimited access to the training resources the clinic provides to its own staff. Members of the Surgeons Club paid dues of $1 for their visits to Rochester, and the network's annual corporate dues are even lower, especially accounting for inflation, without the time and expense of travel. The clinic's social media leadership through the network is held to be a natural extension of the social networking instrumental in its founding and early development, and the network's continued existence and growing relevance to support the view that, had social media been seen as a harmful mutation, the organisation's immune system would have rejected it.
A changing landscape and AI tools
Social media's role as a real-time channel will continue to present new opportunities and new challenges for health care organisations, and a sensible strategy can help build reputation, increase transparency, and educate and empower consumers seeking information for their decisions. With a constant flow of new technologies, shifting user behaviours and global events, staying ahead of developments that may affect the effective use of social media is crucial for health and medical communicators, and they must be proactive in seeking out best practice. Using social media's interconnectivity and convergence of technologies brings both risks and rewards, and delivering informative and authentic campaigns requires a particular set of skills in digital health communication.
The rise of new platforms and the rebranding of old ones pose new challenges for medical communicators and the organisations they represent. TikTok's rise and Twitter's rebranding as X prompted rivals such as Bluesky, Mastodon and Meta's Threads, and short-form video spread to Facebook, Instagram and YouTube. Science and medical communication influencers gained ground on Instagram and TikTok, and to a lesser extent YouTube, LinkedIn kept growing as the professional platform, and slow uptake of the X replacements was a possible signal of user fatigue. Increasing digital noise is one of the many obstacles to connecting with audiences in the digital age of healthcare.
To cut through the digital noise, health communication has to strike the right balance between convenience, quality and trust. AI offers new approaches to content creation and audience insights. There is no shortage of third-party applications that generate social copy, edit or proofread it and create graphic materials. Communicators can use AI to brainstorm content ideas, write social copy from prompts or existing posts and suggest images or video, and major players in social media and content creation have built AI assistants into their software, such as Adobe's Firefly, Hootsuite's OwlyWriter AI and Canva's Magic Design. Being comfortable with what AI can do is a strength and should not deter communicators from streamlining social media workflows or redirecting human brainpower to the more abstract work of strategising. Audience interaction, content strategy, caption editing, keeping graphics within brand guidelines and monitoring brand safety and compliance risks should stay human. Working in a regulated sector such as healthcare requires external communication to be consistent, evidence-based, transparent and compliant across the product lifecycle, and navigating the changing terrain requires adherence to regulatory standards. Following the EMA or FDA guidance can help ensure that sensitive information is communicated practically, takes account of the audience's health literacy and follows the GDPR or HIPAA. Where compliance and authenticity are at stake, human hands on the keyboard help improve the chance that sensitive content resonates and is interpreted as trustworthy. The European Parliament's AI law would require AI-generated content to be labelled, and Meta was already moving to identify AI content on Facebook, Instagram and Threads. In the face of deepfakes and deceptive images, critical analysis and regulatory labelling will, it is hoped, protect audiences from deceit.
Digital health communication will need to adapt to the changing social media landscape to get key messages taken up and campaigns to succeed; adhering to branding guidelines, tailoring content and following a structured strategy are some of the pointers that set a communicator on a path forward.
Planning goals and content
A structured roadmap runs from clear goals or objectives through key performance indicators, a content strategy, executing it, monitoring and measuring performance, analysing and optimising, and iterating and scaling, to continued learning. The first step is to analyse goals, such as referrals, reputation and reviews, recruitment, or a little of all three. Setting goals helps determine which platforms suit and guides decisions on how much time and staff to dedicate and whether further online tools are needed. An organisation expanding its social media should ensure it has clearly defined goals and then match the medium to the message.
Content starts from its audience: health communication should connect with the audience's social identity and give actionable recommendations that fit existing cultural behaviour. Surveying existing platforms lets a communicator build an audience persona of age range, location, profession, seniority and interests, which helps target content and encode messaging. By investing in platforms, content and campaigns that attract and retain audiences, communicators can set their social media processes on the trajectory to success. Audiences want an organisation that is authentic and adheres to its stated causes and missions, and content relevant to them and to the platform. Communicators can routinely inspect the organisation's brand identity across platforms for consistency and adherence to its causes, the graphic identity should be complementary and relatively modern in appearance, and updating banners, profile images and bios helps keep profiles from going stale. Content strategies should be informed by predefined goals and the key performance indicators that will be measured, and creative materials crafted with these in mind. Communicators should consider what content will prompt the audience to engage with a post, repost it to their networks and take it home with them. Scheduling tools such as Buffer, Hootsuite or Later, or the platforms' native scheduling, can make execution simpler.
Measuring and listening
Communicators need to keep measuring social media metrics to stay ahead and deliver effective, impactful campaigns. Monitoring and measuring the performance of posts should be second nature to most of them. Extracting meaningful insight from the metrics can help guide future campaigns and strategies. Campaigns should be informed by overarching goals or objectives, and once these are defined, key performance indicators can be set out and measured. The commonest are impressions, the total times a post was seen in feeds; engagements, the likes, comments or shares per post; and clicks on any element of a post. Most platforms offer native or external reporting, such as Meta Business Suite or Twitter Ads, on each post, follower trends and ad campaigns. Analytics also show audience growth and which content appeals. A drop in engagement or followers may signal a negative return on investment on one platform, which a social media audit can confirm, and keeping abreast of new platforms and content trends can help guide creative energy, digital marketing investment, A/B testing, which compares two versions of content, and future strategies. The results of analytics may be used to refine current strategies or creative materials, and when the goals, objectives and key performance indicators are met, posts can be iterated and scaled up for broader impact. The process can be further informed by lessons from analytics, surveying competitors and new social marketing techniques.
Social listening services such as BrandMentions, Brandwatch or Meltwater gauge audience sentiment towards specific terms and opinions on current issues, and their real-time and historical data let communicators measure a brand's performance and reputation in online discussion. Changing privacy and data-access rules limit what they can report. Tracking trending hashtags and adjacent topics can help campaigns reach more users and tailor content to existing audiences. Ultimately the story behind the content decides success.
One framework across many channels
For a large health system, finding a common voice that builds a consistent brand while leaving room to customise content can be a challenge. UF Health, the University of Florida's $3.1 billion academic health centre, has more than 22,000 faculty and staff, six health-related colleges, nine major research centres and institutes, two affiliated hospital systems with six hospitals and more than 100 outpatient practices. Its social media team preempts problems with proper planning, standards, training and support, and with a framework of commonly shared values supporting unique voices that enhance the organisation while protecting patient privacy, maximising reach, maintaining and enhancing reputation, and listening and responding to the community.
More than 150 official UF Health channels support the system's clinical, research and educational missions, and managers of official accounts work with the UF Health Communications team on communications plans that meet business and communications goals. Wherever possible, content creators are encouraged to feed existing channels rather than start new ones, to take advantage of established audiences and limit splitting them into ever smaller niches. Each account links to central accounts that focus on patients' needs and perspectives and convey what UF Health calls empathy, meaning stories of care, quality and service to the community, and wisdom, meaning the educational mission and research breakthroughs. This focus celebrates the achievements of patients, their caregivers and the community. Content flows between the primary, patient-care and academic accounts, the organisation's websites and outside news and social media. The writing process builds social media in: communications staff drafting a story must supply Facebook and Twitter abstracts with it, which the social media coordinator reviews and edits against engagement practice. The process has encouraged writers to consider each piece across all platforms and helped them use each channel's tone and style.
Content can be cross-promoted among an organisation's accounts, but not all of it should be, and too many accounts can dilute the brand and add to governance responsibilities. Striking a balance can be hard: in a hospital, once one service line or lab has an account they may all want one, and it is important for the social media or communication department to have an account approval and governance process in place before getting started. To open an official UF Health account a coordinator must submit a detailed content strategy, covering audiences, tone and publication schedule, which a social media communications committee reviews, asking whether an existing channel would serve instead, before helping refine the plan. The presence thus expands carefully, nurturing existing channels with additional content streams and making sure new accounts have a solid, self-sustaining base before launch.
Tailoring content to each platform
Messages should be tailored to the platform as well as to the audience, and tailoring content to platform specifications and audience needs can help maximise engagement and reach. On Facebook, about 3 billion users, customise the action button to the audience's needs and invite comments or questions; on Instagram, about 2 billion, optimise visuals for posts, reels and stories and for mobile, and update the bio link to reflect a current campaign; on TikTok, about 1.6 billion, optimise video for mobile, keep copy concise and follow fast-changing trends; on LinkedIn, about 1 billion, write longer copy or short articles in a professional tone and use the article, document and poll functions; and on X, about 619 million, keep copy concise, choose hashtags strategically and use a light or humorous tone if brand guidelines allow.
On Facebook an organisation establishes its presence through a page rather than a profile, and a page differs from a profile in four ways. Anyone can view it, including people without an account, so search engines can index it; fans opt in without being confirmed; there is no cap on how many there can be; and an update can be sent to all of them at once. A page comes with applications for sharing and managing content: a notes application that is Facebook's blogging feature, for anyone considering blogging who does not want to commit to setting up a site; a video application for sharing videos or clips of live events with fans; and a discussion board where fans talk about the organisation's work, products and upcoming events. The Board of Editors in the Life Sciences, the Society of Critical Care Medicine and Kaiser Permanente were already using pages to connect with their audiences.
A page can drive traffic to the organisation's website, increase brand awareness and let it interact with people interested in its services. In October 2009 a study by an online advertising network, across 33 million unique users, compared the visitors arriving at content sites from major traffic sources with the number of times they returned. Facebook produced the highest number of repeat visitors, with 20% of the visitors it sent returning to the referred site at least four times a week.
Dancing doctors can share vaccine efficacy on TikTok, but there is no audience for that kind of performance on LinkedIn, and research studies have a place on Twitter but are less likely to get traction with a consumer audience on Facebook. At Nationwide Children's the main Facebook channel carries broad consumer messaging, Human Resources has one for job postings and culture, and the foundation one for fundraising events and patient stories. Some departments use Facebook for parent-focused messaging, sometimes through private groups where parents and providers interact around complex or chronic conditions. Instagram shows the hospital's mission through images of patient care, child-life initiatives and diverse staff. On Twitter several audience-specific accounts serve the main hospital, Human Resources, trainees, and particular departments and programmes. Among them a physician- and researcher-focused account shares research summaries, new publications and research videos and runs topic-specific Twitter chats, in which faculty use their personally maintained professional accounts and are amplified by the organisation's. LinkedIn serves recruitment, retention through awards and acknowledgements of staff, and long-form posts from administration on strategic initiatives. Pinterest suits wellness and prevention content with a visual element, such as a dietitian's recipe or a physical therapist's kettlebell exercises. TikTok, which hospitals may shy away from, can put evidence-based content in front of a new audience through doctors sharing prevention information or busting myths about everything from vaccines to food allergies.
Each audience, whether consumers, health care professionals, donors or staff, is typically found on four or five social media platforms, and blog posts, statistics and job postings each have three to five preferred platforms.
Each UF Health channel has its own job. Facebook is the primary channel, mixing research and news with the service lines, such as cancer, cardiovascular care and neuromedicine, and, apart from paid campaign posts, relying solely on free, organic reach. Continual A/B testing of wording and publishing times produced a triple-digit rise in engagement over a year, with some organic posts outreaching paid ones. A key lesson is to let the social media team schedule for the audience rather than the news cycle: releases go out in the working day, but social audiences may not be active until evening, and untethering social publishing from an all-at-once schedule raised engagement and sharing markedly. The team also monitors local community Facebook groups for praise and complaints and refers people to patient advocates when the need arises. A Pinterest channel promotes lifestyle and healthy preventive behaviours and shares words of affirmation and healing. With its strategy still being developed, it was seen as important for discussing health care with women, particularly female heads of household: an online poll reported that 85% of Pinterest users are women, and the US Department of Labor reports that women make about 80% of their families' healthcare decisions. Twitter carries the same stories and is monitored by keyword and location to gauge sentiment about the organisation, which shapes coming marketing campaigns and goes to senior leadership so they can identify trends in customer satisfaction and make changes to improve patient satisfaction. A consumer health blog launched in early 2016 lets the organisation take stories trending on social media and discuss them through its own experts and service lines rather than linking to outside news. The blog also shares general health tips and guidelines that make the organisation's resident experts more visible to the community and enhance its reputation.
UF Health's next steps were in newer formats. An Instagram channel giving a behind-the-scenes look at its units was to be run by rotating departmental takeovers, letting departments without a long-term plan take part through a short commitment and become familiar with the resources needed for a possible ongoing account in another channel. Facebook reported that 500 million people watched 100 million hours of video on the platform every day and spent three times as long on live video as on prerecorded video. Because of patient privacy, UF Health restricted live video to press and public events, where initial results were encouraging and showed markedly more engagement than packaged video, and live question-and-answer sessions, building on the participatory forums of Twitter and Reddit's Ask-Me-Anything, were the next step to explore. Recruiting to clinical trials through social media remained a particular challenge, especially around privacy and patient trust, and initial pilots indicated that different patient populations respond differently to various methods of online recruitment. The team was working with its institutional review board and clinical and translational science institute on a best-practices document.
Great content is only useful if people see it, and sharing it on targeted social channels helps ensure the target audience sees what has been produced. Nationwide Children's online magazine for researchers and physicians, Pediatrics Nationwide, can be found through search engines, but it is hard to tell there who is finding and reading it. Sharing it through the researcher- and physician-focused channels serves targeted content to the targeted audience and makes reading it likelier. In the other direction, a striking statistic buried in a report or feature article can reach more people when shared through the right channels. At Nationwide Children's, medical writing experts, social media experts, researchers and health care professionals working together developed a network of social channels that support and benefit from the content channels: blogs, podcasts, research articles and more. Other organisations would be served well by developing a similar network of experts. Understanding goals, identifying audiences and channels, and educating the organisation's social media users give them a place to start, without forgetting a health care organisation's responsibility on social media to dispel myths and provide high-quality health information.
Staffing and training
EMWA's social media team had one named person in charge of each platform. The manager of its LinkedIn discussion group stepped down after many years and a new team member took it over, with a separate person taking charge of its Twitter account and a third already responsible for its Facebook page. That page grew from 300 followers in early May 2013 to almost 600 that November.
A fourth channel, the LinkedIn company page, was assigned to a publication manager at a medical communications consultancy, whose remit was to work with the team to raise the association's online profile. The LinkedIn discussion group then had over 3,000 members, the Facebook account more than 600 followers and the Twitter account more than 800.
The association could always use more support for its channels, however small the offer, and offers went to its public relations officer.
Once goals are set, it is important to be educated in best practice: just as someone would not perform surgery without a proper education, they should not tweet without one either, because improper use is a reputational risk. Nationwide Children's trains its whole workforce in personal and professional social media use on four pillars: advocacy, professionalism, awareness and compliance.
UF Health's social media team gives the managers of its accounts ongoing support. An intranet group for social media managers shares upcoming campaigns and best practice and meets bimonthly for brown-bag lunches on trends and platforms, successful campaigns and lessons learned. Twice a year the team holds "microconferences" on developing a voice and on tracking and analytics, and it encourages managers to attend the monthly social media managers' meetings hosted by the University of Florida's social media team.
The writer's role
With communication platforms proliferating and change accelerating, the role of a writer or communicator in a clinical organisation is subtly shifting and broadening. The writer will not only have to stay abreast of developments online but will need to expand their qualifications to formats such as podcasts and videocasts, whose effective use still depends on the conceptualisation skills behind good writing but whose storytelling approach is different.
Alongside communicating with outside audiences directly, the writer will need to extend their role inside the organisation by identifying and recruiting individuals willing and able to engage with the tools, teaching staff how to use the platforms, and encouraging them to find their own writing voice. The writer is becoming what is termed a social media manager or community manager: a flexible enabler who gets messages across by intelligently fusing old and new communication tools.