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  • What can hospitals learn from Mr Rogers?

    Posted on April 6th, 2009 admin Comments

    Won’t you be my neighbor?  (Part 1)

    Mr. Rogers got it. Here was a man that kicked off every show by asking the audience to be his neighbor. He was literally genuflect when asking us all to be his friends (he was also clearly a fan of comfortable footwear). Fred Rogers may have understood social media and the importance of relationships in brand building long before any of us. And he also clearly understood that being humble and earning the friendship he asked for paid much greater dividends than telling his audience what to think. So why are healthcare organizations and physicians not doing the same thing?

    In Social Pulse, I suggested that healthcare organizations might actually ask their patients, staff and physicians to be their friend. It sounds easy and perhaps even a tad juvenile (medicine is far too serious work for such pedestrian language). But without that invitation healthcare organizations will never gain the traction with social media that thought leaders are touting today.

    Jumping into the world of social media is often a splash of cold water to the corporate face. Just because you build it does not mean they will come. As Steven Barley, head of internet services for Riverside Health System in Norfolk Virginia, states frankly: The reality is not everyone in your market is on FaceBook and even fewer still are on Twitter. So how can healthcare organizations encourage the conversation to take place online when only a fraction of their markets are online? Borrow a page from Mr. Rogers – and ask very simply “will you be our friend?”

    Imagine a campaign that asks that very question, “Will you be our friend?” on billboards around town, on flyers in staff break rooms and in an email to physicians. Maybe its nebulas, “join the discussion at GenericHospital.com/friends” which directs your new amis to the CEO’s blog and the hospital’s twitter account. It could also be more overt – “Generic Hospital is on FaceBook, look us up and tell us how we are doing”. Does it mean taking off the jacket in favor of the cardigan (proverbially speaking)? Yeah, it does, it also means speaking to people they way conversations occur, not in the vernacular of a press release. It requires healthcare organizations to humble themselves; indeed the first step is admitting that you may not be as important in your constituents’ lives as you think. But if your organization believes that you truly serve your community (including employees and physicians) then why not ask on bended knee – “will you be our friend?”

    Fortunately it may not take getting your entire market online to be a success. A critical mass may be as little as 2-5% of a market (1,600-4,000 patients for an average 80,000 vist/year hospital). Malcom Gladwell, the author with a genius for making commonsense sound extraordinary, has written about the power of influencers in The Tipping Point. Gladwell tells us what marketers have known since the dawn of time: nothing beats word of mouth.  Most social media early adopters fit the mold for what Gladwell calls “connectors” and “mavens”. The former are people who have a natural ability and pride in facilitating relationships. We all know them. They are the ones who answer anything with “oh, you should talk to my friend So-and-so about that, I’ll arrange a lunch.” The later, mavens, are our friends who always seem to know about the best meal in town, or which computer has the best bang for the buck. If you have spent any time ‘crowd sourcing’ on Twitter, then you have seen both personalities in action. If a healthcare organization reaches 2-5% of its market through social media, and that 2-5% are mostly connectors and mavens, then imagine the conversations they may have on your behalf. All of the sudden you have an army of powerful influencers in your community who are ready to help you own the perception.

    Healthcare organizations (and I’m counting physician practices in that group), starting thinking “What would Mr. Rogers do?”. Invite your communities and constituents to join you in a conversation. As patients, and we are all potential patients, see out ways to engage with your care providers. If your provider is not interested in a two way dialogue consider what that says about them as an organization. A neighborhood is, by definition, a community and a community cares about one another.

    I hope you will be my neighbor – twitter.com/nickdawson

  • Its not the airfares – in healthcare or travel its all about the experience

    Posted on April 6th, 2009 admin Comments

    Ask any kid who they would list as heroes and role models and my guess is that pilots are on that list. I bet doctors are too. Ask any adult what they think about traveling or going to see a healthcare provider and their reaction may not be as awe inspiring.


    If you had asked me two weeks ago if I was excited for vacation, I probably would have given a reluctant “yes”. That reluctance would have had nothing to do with how the week turned out (knee injury). The stress in my voice would have everything to do with the travel. I will admit it, six years of crisscrossing the company consulting for hospitals left me a little discontented with the airline industry. Here is the kicker, there are a lot of similarities between the airline industry and healthcare and its not because of the fares.

    I am convinced, but hopefully not jaded, that airlines will always drop the ball in some regard. It may be lost luggage, a botched seat request, delayed flight, or more than likely ornery crew. Seats are littered with trash and crumbs from the previous flight. Ever walked up to a gate agent who is too busy typing to look up? Its become a cliche! What about flight attendants who roll their eyes at passengers trying to lift bags into the bins? In short, it is not an industry where many people expect world class service. A lot of the issues are surrounding the belief that airfare is the number one determining factor in how passengers pick an airline. To race to the bottom means cutting a lot of employee benefits. The Gallup organization will attest, that employee satisfaction is the key driver in providing good service.

    The airline industry has had a lot of pressures that have resulted in over stressed and overworked employees. Fuel costs, decreased volumes (following 9/11) and telecommuting technology mean less people are traveling. To cut costs, some airlines have merged, filed bankruptcy and restructured. Restructuring often allows them to work employees longer hours and on less wages; not the kind of thing that makes anyone happy to serve customers. As an example, some airlines have dropped contracts with cleaning crews in favor of having flight attendants clean the cabins- all the while doing so on wage cuts. I do not offer that as an excuse for poor service, but only to shed some light on the surly attitude of the front line staff.

    Ask any kid who they would list as heroes and role models and my guess is that pilots are on that list. I bet doctors are too.

    What does that have to do with healthcare?
    If doctors really are still our healthcare heroes, what does that make the rest of the the professionals in the healthcare industry? We have reservations, thats the scheduling department. We also have ticketing agents, we call them Patient Access. From there, it may be a little more nebulous but I suspect readers can find appropriate analogies for flight attendants, luggage handlers, mechanics and executives.

    Most patients interact with the front line staff – patient access, nurses, etc- far more than they see the doctor. Frequently the interaction we get with the ‘hero’ is not much different than the overhead announcement and the casual goodbye while you deplane. That means that our front line teams hold the entire experience in their hands. Botch the reservation or roll your eyes at check-in and you have ruined the patients entire ‘flight’.

    Healthcare has very similar stresses. While it may not be fuel costs, providers are struggling with lower reimbursement. In many markets Medicare pays less than the cost of procedures. The industry has built a business around group health plans making up that difference, a hidden tax on employers and patients. Other markets are facing the threat of unions who’s contracts limit what someone can and cannot do as part of their job. Ask a union nurse to take away the tray of food and you may be surprised to hear that he cannot, he has to call dietary services. Of course dietary services cannot clean up the mess, that is the role of house keeping. Not exactly a seamless service experience but probably something that sounds very familiar to unionized airlines.

    How do we change course?

    Barack Obama has set the tone for this generation – a time of change. His campaign may have been one of the greatest grass roots efforts in our democratic history. One of President Obama’s clearly stated goals has been healthcare reform. While I personally believe that the administration’s focus is on the payor side of the industry it does not recuse providers from examining their owe practices. (It is also worth noting that during the election Obama was the number 1 twitter user, with the most followers.)

    If providers do not own their image and cultivate a service culture, then they will find themselves in the same position as the airlines. Patients may come through the doors, but they only praise they will be singing are about the ‘heroes’, the physicians. The only way to change that future is to take the reigns and effect change in how the organization presents itself. It starts with employees who want to come to work and represent you on the front line. Ask them what they need to in oder to do that for the organization.

    James Gillmore and Joseph Pine, in their work The Experience Economy assert that good service is tantamount to success. Experience Economy spells out the importance that front line staff plays in giving the customer a seamlessly wonderful encounter. Like the Ritz-Carlton’s goal, providers should strive to fulfill every customers desires, spoken or unspoken. When we see someone who looks lost, stop and offer to help. Do not be the flight attendant that watches the elderly man who cannot lift his bag. If you are a physician do not be late. When passengers hear ‘weather delay’ and see blue skies, it does not matter what the true cause is; they are not getting where they want to be. This is the time, as has been discussed here before, to start connecting with all of the healthcare constituents outside of your physical walls. The tools are free, all it takes is the willingness to use them. Lets ask ourselves how we would want to be cared for, then do that!


  • The Patient Patient – why being cared for & about wins every time

    Posted on April 6th, 2009 admin Comments

    I had intended to write a different post this week; when I speak to healthcare groups I often use what I have dubbed as my ‘airline analogy’. However from where I am seated it just does not feel appropriate. For starters I am at 35,000 feet somewhere over the midwest. That in itself is not unremarkable- I am no stranger to travel. However, this is the first time that I have flown with crutches and an immobilizing leg brace.


    The last week was supposed to be our annual ski trip. Let me avoid mincing words by saying that its the week I most look forward to in the year; I work towards the trip all year. Unfortunately this year my professional and personal life were more woven together than I would have cared for.

    On the first day our our trip I took a fall that was substantial enough to sever the Anterior Cruciate Ligament (ACL) and damage the meniscus of my left knee in two places. In short, a total blowout. Endorphins and poorly placed ego got me off the mountain under my own power, but the next day things where pretty banged up. My knee was well over twice the size that it should have been and my range of motion was almost zero.

    I spent most of Monday in the Steadman-Hawkins Orthopedic Clinic in the Vail Valley

    Medical Center. The name Steadman-Hawkins may not be familiar, but the roster of patients would make any sports fan’s head swim. The corridor from the elevator to the clinic door (ironically long for a place that specializes in busted joints) is covered with

    jerseys, posters, notes and pictures. Chances are that if a pro athlete has suffered an orthopedic injury in the last 10 years, they were probably treated at Steadman-Hawkins.

    MRI 2

    You are probably asking yourself how an amateur skier got in the door. More on that later.

    Every Sunday night there is a group of healthcare and marketing professionals and enthusiasts who use Twitter as a chat-room. Using the ‘hashtag’ #healthcomm we spend an hour discussing ideas surrounding social media and healthcare. It’s fast paced and intense and I always come out thinking about some topic differently. Recently the discussion was about how patients find their care – physicians, hospitals, etc – and what makes a difference.

    Many of us who work in hospitals believe strongly in rankings, awards and recognitions. I’ve written before about the Healthcare Highway in Richmond. Billboards flaunt “Top 100 cardiac care” and “best place to have a baby”. But at the end of the day what do those lines really mean? Who said you are a top 100 cardio hospital? Are they objective, are they national and most importantly does a patient really care?

    A few facts: in most hospitals, 80% of patients come in through the ER. Those that have non-urgent surgery or deliver babies are usually directed to a hospital by their physician. In other words, most patients do not pick their hospital. When it comes to physicians the story is pretty similar. People are influenced by word of mouth for their primary physician but how do people find a specialist? According to the American College of Surgeons more than one-third of Americans do no research at all. Those who do research their surgeon spend less than one hour doing so (compared to four hours planning a vacation).

    I consider myself fortunate and not just in the sense that I will make a full recovery. Though personal and professional connections I was able to get a same-day appointment at Steadman-Hawkins. Most people would go to the ER and while I am confident that they would still receive excellent care, I am doubtful that it would have been as personal as my visit was. After the consult I had a choice: surgery with a world-renound physician or travel home where I could recuperate in more comfortable surroundings. There is a lot to be said for having surgery at home, from followup care to sleeping in your own bed. The challenge was finding an orthopedic surgeon in Richmond that I would have the same level of confidence in. This is where working for a health system has its advantages. Not only am in the less than one-third who does research their care, I have the professional skill set to wade through the nonsense and the acquired confidence to push through the red tape. I know the difference between an orthopedic fellowship in one place and a residency at another. I have no problem insisting to speak to doctor’s nurse rather than waiting for a call-back that may never come. And when push comes to shove, I know first hand the financial ramifications for me, the physician and insurance. At the end of the day, what made the difference was speaking to a doctor in Richmond. This particular surgeon, either through coaching or personal gift, made a real and genuine connection. Here was someone that I knew could care for me and who had made a point to care about me. That is a winner every time.

    There is no profound take-away here, just a recognition of a few things. Saying that you are number one may not mean as much as we think. There is no doubt that it strengthens employee engagement, and that is a great thing. But for most patients, the billboards have very little impact. I have discussed on this site the relevance of The Cluetrain Manifesto. That work suggests that a personal connection goes further than anything else in impacting markets. Furthermore, as social networks level the playing field across the powder-distance index, it makes it eve easier for patients to build that relationship. Post a comment on a forums about a bad physician and there will be an impact, even if the doc is unaware. Say something great and patients will beat a path to their door (look at Steadman-Hawkins). When the physicians take the time to reenforce those positive statements by making a personal connections it will always be a success. Providers need to participate in that relationship by making sure the image they cultivate is one that makes sense to patients and employees, not just industry insiders.

    As patients, we have to realize that the power is already in our hands. The ACS suggests that If you were going to spend $1,000 on vacation you would take the time to make an informed decision. Shouldn’t we do at least that much when it comes to our health? Being cared for and about has two components- clinical quality and real human caring. If you cannot get the information or response, demand it. Not sure what the federal quality measures on the hospital’s site means? Ask until you get an answer you are satisfied with. If you sense physician or the hospital does not care about you personally, go some place else. What does it say about a doctor who discourages patients from discussing their care? Do your homework and make sure you are being cared for and cared about.


  • Service Included – what can health care learn from a four star resturant?

    Posted on April 6th, 2009 admin Comments

    On this week’s Splendid Table Podcast (and radio show) Lynn interviewed Phoebe Damrosch, author of Service Included: Four-Star Secrets of an Eavesdropping Waiter (New York Times Notable Books) “>. Phoebe worked her way from a waiter to captain at Thomas Keller’s Per Se restaurant. I recently posted our menus from a meal at Per Se in December and remarked that the service made the experience.

    I have not read Service Included yet, but my copy is on order. Listening to Damrosh speak about the training and execution of world class service was inspiring. It has made me wonder – what can we learn from that level of service?

    In healthcare, my other passion, we often talk about having a compassionate presence. But if you have ever spent any time in a busy ER, either as a patient, family member or part of a care-giving team, you can relate to how challenging that environment often is. While it would be inappropriate to suggest that the work of a world class restaurant is on par with that of an emergency room, there are some important similarities. Both center around a busy, highly skilled core with support staff working both the ‘front’ and ‘back’ of the ‘room’. It is a dance that when executed perfectly looks like a Viennese waltz (something Damrosch says was part of their training, how they learn to move around a room).

    I am the first to admit that in a clinically demanding situation, I get out of the way ASAP. But during those other times – the elderly person walking in the door, the family member with a lost look wondering the halls, the young child being admitted – how can we in healthcare learn from waiters at Per Se? How can we become at once disarmingly personal and staunchly professional?

    I am looking forward to reading Service Included as soon as it arrives. Will I share my thoughts here? It would be my pleasure!

  • Social Pulse – new version and permanent home

    Posted on April 6th, 2009 admin Comments

    A few weeks ago I posted a very rough draft of a “white paper” called Social Pulse. Shortly after, I shared my thoughts on how the 1999 book The Cluetrain Manifesto is still a wake-up call to healthcare organizations today.

    I have been refining those thoughts, as well as correcting some typos and am excited to say that Social Pulse is nearing version 1.0 status. To make it easier to find, there there is now a dedicated page on this site that will always link to the latest version. You’ll find it at www.nickdawson.net/socialpulse

  • CNN (and me) on Twitter in healthcare

    Posted on April 6th, 2009 admin Comments

    UPDATED to add some context

    One of life’s more altruistic points is that actions really do speak louder than words. Talk is cheap. And, as I wrote  recently, traditional marketing talk is especially cheap.

    Savvy hospitals are already coming around to the idea that its about forming a relationship with their constituents. At the core of that relationship is a real give and take, earnest interaction. Last week the Henry Ford Health System made a splash by “live tweeting” a real surgery. A physician sat in front of a computer giving the play by play while a skilled team (led by a different physician) manipulated a Di Vinci robot inside of a patient’s abdomen.

    Being witness to a surgical event is nothing new. Cable TV stations picked up on what teaching hospitals have done since the inception of medicine. What is ground breaking about the live tweeting model is how it spread, maintaining its interactivity the whole time. Followers of the HFHS account saw the initial tweets. Many re-tweeted news of the event to their own followers. Soon there was an entire flash mob community following the removal of a tumor on the kidney of a patient in Michigan. Throughout the procedure that physician at the twitter console was fielding questions as they came pouring in (how did I know it was a Di Vinci robot? I asked).

    CNN also took notice of the event. The real credit goes to the web team at HFHS. They engaged their leadership, sold them on the idea and pioneered what will undoubtedly become a trend.

    That said, I’m proud to make my own contribution to the CNN report…Look for yours truly around 0:45 seconds – hey, its a cameo role…

    I am really impressed with the web team and leadership at Henry Ford Health System for putting this together.

    Link to the story here and the video here

    Embedded video from <a href=”http://www.cnn.com/video” mce_href=”http://www.cnn.com/video”>CNN Video</a>

  • The Cluetrain – time for Healthcare to get onboard

    Posted on April 6th, 2009 admin Comments

    Over the weekend I read an inspiring book: The Cluetrain Manifesto
    by Rick Levine, Christopher Locke, Doc Searls, and David Weinberger.

    The Manifesto consists of four discussions surrounding 95 theses; the crux of which is that “markets are conversations”. In a world were the internet gives everyone a voice, its time for organizations to listen to and participate in those conversations or be left behind. The authors argue that the internet has tipped the scales in favor of the consumer. Connectivity has given a everyone a chance to shout as loudly as they can how wonderful, or how poor a product is. They challenge institutions to learn the parlance of the new market place and become an active, and most importantly, genuine participant. The penalty for non-compliance is simple, they get left behind and become afterthoughts or lessons of failure.

    The book was written in 1999.

    1999, that is 4 years before MySpace, 5 years before FaceBook and 6 years before Twitter. The Cluetrain authors already knew what most businesses are still coming to grips with. “Markets are conversations.”

    A few weeks ago I posted my own white paper on the use of social media in healthcare. The terms and tools are newer, but the ideas are rooted in the work of Levine, Locke, Searls, and Weinberger (though I did not know about the Manifesto when I drafted Social Pulse).

    Here in Richmond, VA we have a stretch of interstate that I have dubbed “Healthcare Highway“. There are five hospital billboards in less than one mile. “We are the best carido program on the East coast…”, “We treat you faster in our ER…”, or “Best place to have a baby…” there is nothing wrong with that type of marketing. A friend describes it as being a good neighbor, reminding the community that you are there. But it serves little purpose past that.

    This is the time to stop littering the skyline with superlatives and start having conversations. As healthcare providers we need to ask our employees, patients and physicians how we can best help them. What do you want out of a relationship with your local hospital? How can we serve you better, and when we don’t live up to your expectations, how can we make it right?

    The good news is that its not too late. Unlike what we are seeing with the automotive and credit industries, the unique nature of healthcare has afforded us a chance to slip under the radar. But it will not last long. Look at the scrutiny and criticisms leveled at the for-profit insurance industry. Sure there will always be services where we have a captive audience: OB, the ER, etc. But as modern medicine makes traveling with an health issue easier and recovery time faster will we start seeing people leave our markets and travel for their care? And when that happens, patients will not beat down your door because of your billboard on 64-W, they will come because you cultivated a real and meaningful relationship.

    The Cluetrain Manifesto
    can be found on Amazon, the authors has also made the entire book available online for free here.

  • SocialPulse – using social networking in Healthcare

    Posted on April 6th, 2009 admin Comments

    UPDATE: – all links have been changed to http://www.nickdawson.net/socialpulse/ where you will always find the most current version of the paper

    This is a very early DRAFT version of my white paper on the use of tools such as twitter and facebook in a healthcare setting.

    Download the PDF here healthcare-socialnetworking-draft-20080205