Develop a social media policy. This is true for all institutions no matter their size—even a small mom-and-pop clinical practice with one provider needs to have a social media policy. Remember, your employees will be on social media, and unless you have policy for behavior, you can't define how they are going to engage, says Mayo Clinic's Farris K. Timimi, MD. The AMA offers a set of guidelines.
Be clear that the thoughts and views expressed are yours and not the hospital's or group practice's.
Stay professional. A good rule to follow is that the same conversations you can have in a public elevator or Starbucks, you can have online. Something that you would not do in public—such as using unflattering language or discussing personal patient information—shouldn't be done online either.
Determine what level of personal information you want to share. Dana Lewis's advice for doctors is if they state on their physician profile that they enjoy skiing and hiking with their family, it is fine to post a picture of them hiking or talking about that. That type of information can make doctors more approachable, says Lewis, interactive marketing specialist for Swedish Medical Center. But it's up to physicians to figure out what they are comfortable with.
Start small. Physicians who are interested in social media should start with Twitter, suggests Timimi. "There is utility in claiming your Twitter username—names are not recycled—and it should be suitable across multiple platforms, so I'd use the same name across LinkedIn and Facebook, and then decide whom you want to engage with and engage."
All content doesn't have to be created and posted on the same day. A lot of content is still relevant months later, so bring it back up, says Lewis. "If you do anything like live stream videos, definitely package your efforts and show them off because they are still great resources after they happen."
Be cautious of how you use Facebook. "A practice or department can have a Facebook page, but if a physician has one, they should be cautious about friending patients," says Timimi, explaining that there are always tags that occur that extend beyond the physicians themselves.
Putting a "like me on Facebook" or "follow me on Twitter" icon on a Web page is not social media, Timimi says. "If your goal is truly engaging consumers to improve healthcare and achieve brand recognition for your institution, there has to be more conversation than that."
Many physicians are still hesitant about using social media in their professional lives. Concerns range from time commitment, liability, patient privacy, and unfamiliarity with the technology, to the appropriateness of social media interactions in a professional setting.
According to a study by QuantiaMD, 87% of physicians use at least one social media site for personal use, but only 67% use at least one social media site professionally. Of those physicians who use social media professionally, the plurality (28%) are participating in physician communities.
When it comes to sites that encourage patient-physician interaction, the percentage of physicians on those sites drops significantly. For example, only 15% of physicians are on Facebook professionally, 8% use YouTube, 8% read blogs, 3% use Twitter, and 3% are involved in patient communities.
But physicians should know that social media sites are not just a healthcare marketing or recruitment tool. They can also help educate and engage patients—and physicians play a vital role in those conversations.
Time commitment is one of the most cited reasons that physicians give as to why they don't use social media professionally. "I don't have time for extra work" is a common complaint. However, social media should not be viewed as extra work, argues Farris K. Timimi, MD, a cardiologist and the medical director for the Mayo Clinic Center for Social Media.
"If you study Internet use, people spend one in five minutes a day on social media platforms," says Timimi. "This is truly where our patients are, so our obligation is to make sure [patients] have accurate content available to help them make appropriate healthcare decisions. … Our obligation is also making sure we are part of those conversations. We have value to add to that conversation."
Another concern is risk. But when it comes to social media, physicians can't be so risk-averse that they don't engage.
"It's really important that physicians understand that if they don't take part in that conversation, that someone else's comments on Yelp or Angie's Listbecomes the new reality of how they are viewed online," says Timimi.
Dana Lewis, interactive marketing specialist at Swedish Medical Center, says another misperception is that physicians feel like they have to participate in all types of social media or that they should know everything. "One social media site doesn't work for everybody—some physicians like Facebook, others hate it. Some like to blog or make videos, but they feel like they have to do it all," she says.
Part of Lewis' job is to show physicians different ways to be involved in social media, whether it's a video, blog post, or finding content that Swedish can use. It's intimidating for physicians to get started if they think they have to be a super doc Tweeter or blogger like KevinMD, says Lewis.
Both Seattle-based Swedish Medical Center and Rochester-based Mayo Clinic have social media resources for physicians on their websites, and the organizations help train docs on using the technology.
Mayo Clinic has a blog page on its website, which also links to its Facebook, Twitter, and YouTube channels. In addition, it has a Center for Social Media microsite that includes information about its six social media summits, which are day-and-half-long intensive boot camps that shows providers and administrators how to use these tools effectively in clinical practice.
Swedish Hospital also has a blog , and it educates its physician groups through boot camps, and Lewis holds "lunch and learns" on a regular basis where staff can ask her questions. In addition, Swedish has created a one-page guide on "10 things to keep in mind when you visit social media sites" that it distributes to staff members on a regular basis.
Swedish's social media strategy is "not relying on people to come to us, but being where they are—whether that is Facebook, Twitter, or YouTube," says Lewis. "Because of that strategy, it makes sense to tap into the amazing experts of our system—the doctors, nurses, and researchers—and thinking how can we get content from them and get it online."
Lewis also educates physicians on how patients are using these platforms to find information.
Even if physicians don't get on social media themselves, they should be willing to recommend social media sites and information to patients, she says. Physicians should be providing a starting point online for patients, because the first things that come up in a Web search may not be that helpful or accurate.
Lewis says physicians should direct patients to a couple of websites, social sites, message boards, and factual sites. "It would take a little time up front for physicians, but would pay off manyfold for all of their patients in those disease areas," she says.
Making social media easy to use
Swedish has developed user-friendly processes to help its physicians get involved with social media, says Lewis. Currently, the health system has hundreds of physicians on social media—in part thanks to its huge video series. But it also has physicians producing podcasts and contributing content on Facebook and Twitter, and a couple of dozen docs who blogged this past year.
One of the nice features of Swedish's blog is that it's still on the main website and is tied to the physician profile system, says Lewis. The benefit of that structure, Lewis explains, is if a physician wants to blog 80 times, they can, but for the doctor who wants to blog once, that is fine too because there is not one person holding up the blog.
"It takes off a lot of pressure, because they can blog once and it can go on their profile and then we can put it on the main blog and get attention that way and it shows well in search," she says, adding that it's also important to show physicians that a blog post can be as simple as one to two paragraphs and a link or a video recorded from a smartphone.
Figuring out what physicians' interests are, what they are trying to achieve, and whether they have specific goals or are just exploring the platforms is essential to helping them use social media effectively, says Lewis. "Some [physicians] are very interested in the mechanics of social media—they want to know how to create a Twitter account and Tweet. Then other ones may just want to do a blog post, but even then there is a range—do they just want to email me a Word doc or upload it themselves?"
Reaping the benefits
In general, being on social media has helped Swedish improve its brand awareness and community engagement, says Lewis. "We also have examples of bringing patients to the door through live stream and blogging."
Timimi says that the recognition that can occur from a one-hour Twitter chat can create downstream referrals and recognition as well. But to secure physician involvement, you have to answer the question, "How is it going to help me?"
Lewis says you can show doctors examples of how another physician who has been blogging answered a question and now has a new patient paying for an out-of-pocket surgery. Or take a screenshot of their search results (from a neutral computer) before they start blogging and then after they blog so they can see how the search results improved.
In addition, repetitive clinical practices that have value to consumers can really be leveraged online, says Timimi. If you are a pediatrician, you probably talk with a lot of patients about picking a bike helmet for a toddler. It's a common conversation, he says.
But rather than spending eight minutes talking with each patient, you could create and direct patients to a YouTube video that summarizes the helmet selection process online. "It is not just you and that family in the exam room, it can now be accessed by anyone," Timimi explains.
Aside from patients, social media can also increase physician referrals, says Lewis. Just like patients who see a physician blogging online and decide to seek them out, physicians may choose to send patients to a specialist they see responding to patients and sharing information online through social media.
The great thing about social media is it has a short half-life, so organizations and physicians can try things and see what works, Lewis says. That short half-life also means, however, that if you do something great, it will go by really quickly unless you package your efforts.
"If you do a really great campaign or have really great videos, don't let them die a slow death on your YouTube channel. Bring them back out on a regular basis on a blog, Facebook page, or show them on the monitors at your hospital," says Lewis.
For the most part, the first group of providers to qualify for Stage 1 of the meaningful use regulations in 2011—and deposit incentive checks in the bank—were early adopters of electronic health records such as Old Hook Medical Associates, LLC in Emerson, NJ, a multispecialty practice that implemented its EHR in 2007.
OHMA has one location and 20 providers, including full- and part-time positions and nurse practitioners. It began using a commercial EHR solution in 2007. "That was essentially our first real EHR," says Edward Gold, MD,president of OHMA, as well as an oncologist and hematologist. "We had been using a medical manager product and were using some of the EMR capabilities that it had, which were limited. But we really weren't fully electronic until 2007."
OHMA began its 90-day meaningful use attestation period on January 1, 2011. It submitted its data on April 19, 2011, qualified for everything it submitted, and received a $180,000 incentive payment in May 2011.
The practice submitted data for 10 physicians. OHMA has some part-time physicians who didn't qualify because they only work a couple of days per week and OHMA isn't their primary practice, Gold explained.
He offers the following advice to practices considering MU attestation:
1. Don't accept pushback.
Gold says OHMA made a corporate decision to switch from paper to EHRs and didn't accept opposition from its physicians. As such, the physicians didn't get to choose whether to use the technology.
"We said, 'Okay, if you want the chart, it will be in the medical records room but it won't be delivered to your desk anymore," he explains. "We made it inconvenient to use the paper chart, and pretty quickly the physicians found it easy to use the electronic medical record."
2. Adopt the system, whichever you choose, wholeheartedly. OHMA uses every capability its EHR system offers, including the health maintenance portion, says Gold. "We went into it with both feet," he says. "The software is designed to be used as a whole unit. While you can pick and choose what you want to use with some of these programs, if you want to get the most out of it, you have to use the full functionality of the product—and that goes for any EHR product."
Gold says the one suggestion he gives to physicians in his community—many of whom know OHMA received its incentive payment—is not to adopt an EHR in bits and pieces. "If you try to piecemeal your way around because you like one thing and not another, or because you've done it this way for 30 years, ultimately you will have problems," he says. "If you adapt it wholeheartedly, you'll qualify."
3. If also pursuing PCMH designation, combine efforts. About one and a half years before pursuing meaningful use, OHMA made the decision to become a patient-centered medical home. OHMA was seeking a level-three PCMH qualification, and through that process, fulfilled many of the criteria for meaningful use—such as coordinating care, setting up a patient portal, and using e-prescriptions, says Gold.
In addition, the practice was already using the health management aspect of its HER, which provides recommendations, such as tests or screenings, for patients based on age or disease, as part of its effort to achieve the PCMH designation. OHMA was using practice analytics to identify diabetic patients with high blood sugar levels, for example, and it had processes in place for a nurse to follow up with those patients.
Because OHMA had these processes and the capability to collect data, "it became fairly easy to meet the level one meaningful use criteria," Gold says.
"The thing that we had the most difficulty with was giving patients the summary description of their visit," he notes. OHMA didn't previously offer patients a synopsis of their visit, so it had to change its work flow to meet that element of meaningful use.
Generating the summary description is an extra step in the process, and you need multiple levels of backup to make sure that it gets done, says Gold. "Establishing it to be done on a consistent basis was the hardest part."
To ensure that patients received the summary description, physicians were trained to generate the summary, nurses were trained to follow up with physicians, and receptionists were trained to check that the summary was done and offer it to the patients.
"Now we give it to patients as they leave the reception desk," Gold says. Ironically, he estimates that 95% of patients don't even want the summary, and "the 5% who do want it are happy to go on to the patient portal and get it."
OHMA launched its patient portal roughly one year ago and already has about 2,000 people signed up. Gold notes that the meaningful use regulations were unclear about whether offering patients an electronic visit summary via the patient portal is sufficient, or whether practices must offer a hard-copy summary as well. "We do both at this point because we want to cover our bases," he says.
4. Double the estimated training time.
Like any software product, whether it's an EHR or Microsoft Excel, the more familiar you are with the ins and outs of the software, the easier it is to get things done, says Gold. The problem is that physicians are very busy and don't have a lot of patience, he says. "[Physicians] don't want to spend the time necessary to learn the product properly so that they can get the results that they want. They are used to telling an office manager to do this and it gets done," Gold says.
However, the meaningful use criteria require physician participation. "If the physicians are not going to have the time, patience, or wherewithal to participate in [meaningful use], don't expect to be able to qualify for it," he says.
When it implemented its EHR, OHMA asked for additional training above and beyond what came with the product, says Gold. The practice had trainers on-site when the EHR went live. It also had a train-the-trainer program, where a number of people in the practice were trained first and became very familiar with the product so they could answer questions after the vendor's trainers left.
Physician practices need to spend time on implementation. Without a robust training plan, you can't succeed, says Gold. The challenge today is that "it is such a busy field right now with people buying products that the [vendor] companies are stressed to get [providers] implemented and get the training done," he says.
"Some [vendors] will say, 'We'll have you trained in a day and half—up and running—and you'll be good.' That is not true…whatever they tell you you need in training, double it."
In order to build relationships and truly connect with members of your community through social media sites, such as Facebook, Twitter, and YouTube, hospitals are learning that it takes more than simply pushing out a weekly bit of health advice.
Social media can be a great tool for patient education and brand messaging. But to really build loyalty—and possibly even grow market share—hospitals need to engage consumers in two-way conversations. Photographs, contests, and links to interesting stories can be a great way to get those conversations started.
St. Peter's Hospital in Helena, MT, is a relative newcomer to social media, having just launched its Facebook page in April 2011. "At first, we were using the page mainly to promote community events. We added monthly health tips and usual hospital news, but struggled to obtain friends," says Peggy Stebbins,director of public relations and marketing. After roughly nine months, the 123-bed hospital had only about 80 friends—many of whom were employees.
"The only increase in activity we saw was when we posted photos of a special women's event we held featuring Patty Duke," says Stebbins. So St. Peter's decided to join the growing number of hospitals conducting cute baby contests online.
The nonprofit hospital launched its own contest with media coverage of the first baby of the new year. And just like that, St. Peter's number of Facebook friends increased to 1,153—it gained more than 1,000 friends from the contest.
"Because of the success of the baby contest, we decided to continue with contests to increase activity," says Stebbins. "Our hospital holds numerous successful community events, and Go Red for Women was the next one scheduled. With our sponsorship partner, we devised the best red outfit photo contest."
St. Peter's wanted not only to attract more friends but also to give more women a reason to attend the event, says Stebbins. While the red outfit contest only generated about 10 new friends, St. Peter's did receive 18 photo submissions, and 96 people voted for their favorite red outfit. The number of attendees remained in line with the "Go Red for Women" event held in the previous year.
Michelle Kustra,marketing coordinator at Sherman Health, a 255-bed hospital in Elgin, IL, admits that, like St. Peter's, her organization started out simply posting information on social media sites as well. However, for the past few years, Sherman Health's social media goal has been to start discussions with the community.
Kustra says that the Illinois hospital uses all the tools at its disposal—including Facebook, Twitter, blogs, YouTube, and e-blasts. "We are no longer talking to the community, but talking with them and connecting to them and helping [the community] to connect with us on a personal level," Kustra says. Sherman Health has focused on photo submissions to help promote this interaction. It is also looking into sharing patient stories.
Healthcare organizations whose strategy is to simply post healthcare information are missing out on the true essence of what social media is all about—having "two-way communication and getting people to connect with you interactively," says Kustra.
1. Incorporate humor
Many healthcare issues are life- or-death topics that have a very serious tone or message. When it comes to social media, however, organizations should splice in some health-related topics that focus on the lighter side of healthcare. Otherwise, people may stop reading your posts.
When Sherman Health started using humor, its numbers began to climb, says Kustra. "We are up to 5,000 Twitter followers and a couple of thousand Facebook fans."
It's important to have your social media presence mimic the ups and downs of your patients' lives— meaning you should cover both serious events and fun events, says Charles Falls,president and owner of DC Interactive Group, the agency Sherman Health has partnered with for social media. "We don't want to cross lines, so we try to keep fun events that everyone would find fun and interesting. We are not looking for controversy," he says.
One of Sherman Health's successful forays in using humor to disseminate health information was its Movember mustache contest that took place in November 2011. "It was men's health month, so we were trying to think of creative ways to engage the community and remind them that there are a lot of men's health issues out there, and the big one is prostate cancer," says Kustra.
Sherman Health's marketing team meets with DC Interactive Group on a monthly basis to develop a social media plan for the next one to two months. During its brainstorming session, the idea of tying a men's health campaign to Movember, a global initiative to raise awareness and funds for men's health issues, was formed.
In addition to asking people to send in mustache photos, the hospital had blog posts on famous mustaches over the years, ranging from celebrities all the way to Ned Flanders from the television series The Simpsons. "We had to talk about what we were doing, but also had to talk about the things that were interesting to people to draw them in and connect them back to the contest," explains Falls. The blog posts also included information on the importance of having prostate screenings and eating healthy.
The mustache contest far exceeded Sherman Health's goals of 15 photo submissions and 1,500 unique page views. The hospital received more than 40 submissions and had more than 2,500 unique views for its Movember-related posts. In addition, the mustache contest also engaged employees at Sherman Health, many of whom were telling their family and friends about it, says Kustra. "It was a really fun experience all around."
2. Integrate your social media channels
For any contest or marketing campaign using social media, organizations should include as many channels as possible, says Falls. For Movember, Sherman Health used Facebook applications to run the contest, but its blog helped connect all of the social media channels. For example, its Twitter posts would drive people back to the blog where they could connect to Facebook and look at photos, he explains.
The blog allowed people to read about the contest without having to get onto Facebook and like the page. "While we like having ‘likes,' we are trying to build up our e-lists by having people sign up for e-mail communication so we can directly communicate with people," Falls says.
3. Keep the budget low
Sherman Health had a $500 budget for its Movember contest, and it plans to stick to that same budget for future contests, says Kustra. "Since we already have a lot of [blog] pages built and e-blasts in place, we spent that money mostly on prizes." For Movember, the grand prize was Blackhawks hockey tickets that were donated, the second- place prize was a Kindle Fire, and the third-place prize was a Norelco™ razor system.
Stebbins agrees these types of contests don't need large marketing budgets. The most St. Peter's has paid for a social media campaign is $350 for a Facebook ad for its women's health event featuring Patty Duke. The prize for St. Peter's baby photo contest was an overnight hotel stay, lunch, and dinner, a total value of about $200.
Based on her experience with that contest, Stebbins cautions hospitals about offering too big a prize. "People were amazingly competitive," she says. "One of the mothers had a relative who specialized in social media and sent the contest to one million friends. Obviously, this baby won with over 3,000 votes, the next nearest being about 200 votes."
Unfortunately, this activity resulted in people writing negative comments accusing the contest of being rigged—and some people wrote mean comments about the other babies, Stebbins explains. "We never anticipated this activity, and our webmaster spent nearly two days monitoring and deleting the nasty comments. We met our goal of increasing friends, but I'm not sure we'll keep them."
Still, Stebbins would do another baby photo contest, but with a more modest prize, she says, adding that she would probably use third-party software to administer the contest and offer a prize tailored to a more mature audience, such as a dinner with wine (which would require entrants to be at least 21 years old).
4. Tie Social Media to Service Lines
Ideally you want to connect social media campaigns to something that you are trying to promote, says Falls. "That ties [the campaign] into the business purpose for doing it and makes it easier for the C-suite to understand that there is a goal here, that you can identify it and see if you are meeting it."
Kustra says that based on the success of Movember, the hospital is trying to come up with an event each month that relates to a healthcare topic. For example, for February, it is doing a "What Do You Heart?" contest—where people can submit a photo of what they love, such as spending time with family, reading a book, or a favorite activity.
At presstime, it had a good mix of community members and employees submitting photos, Kustra says, adding that within five minutes of posting the contest, it had three submissions.
Stebbins says the "Go Red for Women" event and Facebook contest were part of St. Peter's overall strategy to promote its cardiologists, cardiology clinic, and services. "We also created a Helena HeartBeat publication with health and wellness education featuring our providers and a personal health tracker," she says. St. Peter's will probably do about six contests during the year, all of which will align with its community events, Stebbins says. "Most of our future endeavors will be targeted at women ages 25 plus, those who make the healthcare decisions for their families," she adds.
Falls advises healthcare organizations that are new to social media or looking to improve their consumer engagement to pay attention to what other people are doing. "Don't be afraid of putting together a contest and not having it be all you'd hope it would be," he says. "The important thing is to be out there."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of David S. Fox, CEO Advocate Good Samaritan Hospital.
This profile was published in the December, 2011 issue of HealthLeaders magazine.
"We focused on culture, created standards of behavior, decided to hire people who are a cultural fit, and hold ourselves accountable to how we behave."—David S. Fox
In 2004, Advocate Good Samaritan Hospital in Downers Grove, IL, determined it wouldn't thrive in the future if it kept to the status quo, says David S. Fox, president. "Our physician satisfaction was mixed. Our quality was perceived as being good, but not distinguishable. Our nursing care was viewed as uneven by physicians; for example, great on unit X but not so good on unit Y.
And our patient satisfaction was mediocre to poor," he says. Good Samaritan also had technology and facilities that were increasingly being perceived by consumers as slipping behind, staff satisfaction that was OK but not exceptional, and a physician hospital organization that was paying physicians 15% less than Medicare rates, Fox says.
So Good Samaritan, under Fox's leadership, launched an initiative called Moving From Good to Great. "The strategic intention was to become the best place for physicians to practice, associates to work, and patients to receive care," says Fox.
At the time, Fox, who comes from family of physicians and grew up working in hospital settings during his summer vacations in Chicago, had no idea that the initiative would help Good Samaritan earn the 2010 Malcolm Baldrige National Quality Award.
When the good-to-great initiative began in 2004, Good Samaritan did not even know what its physician satisfaction level was, Fox says, because a survey had not been conducted in years. In 2006, physician satisfaction was in the 65th percentile and for the past two years physician satisfaction has been in the 97th percentile.
Good Samaritan has a medical staff of about 950 physicians and —other than specialty areas like the ED and anesthesia, all are on staff at other hospitals. "While some people looked at that as a challenge, we looked at it as an opportunity," he says. The thinking was, by becoming the best place for physicians to work, maybe they would choose to move some of their patients to Good Samaritan, Fox explains.
"It may sound like a cliché but we really embraced the win-win approach where we would become a better hospital and become more successful but do that hand-in-hand with physicians as they became more successful," Fox says.
He does concede that he has an advantage over many hospitals in the nation because his parent company's PHO, Advocate Physician Partners, is an innovator on pay-for-performance clinical integration. "We are in our eighth year of the P4P clinical integration program at Good Samaritan, and our physicians actually receive additional compensation for achieving quality, efficiency, and service outcomes," Fox says.
One of the first things that Good Samaritan did to achieve its vision was create much higher levels of alignment and accountability for performance with objective and measurable goals. Good Samaritan took the organization's goals, which it has in six key areas, and cascaded those goals down to directors and frontline managers, says Fox.
It then developed report cards for each of its managers—a typical manager would have eight to 13 goals, which would cover most of the organization's six focus areas. Good Samaritan also made the goal system transparent and put it on the hospital's Intranet. "Everyone in management could actually see performance plans for each of us, and we could also see the monthly report card result for each of us," says Fox, who distributes his performance to about 300 people each month.
This level of accountability launched the hospital in the right direction because for the first time all the members of management knew very clearly what the organization's goals are and what their contribution to the goals are, Fox explains. The goals were weighted to demonstrate priority, he says.
For example, if 20% of the organization's goal was on patient satisfaction— 5% for inpatient, 5% for the ED, 5% for ambulatory, and 5% for outpatient—and a nurse manager for one of the nursing inpatient units didn't have very good patient satisfaction rates, Good Samaritan would establish a weight for inpatient satisfaction of 25% on that unit.
It would score patient satisfaction on a five-point scale with anything over three being pretty good and four being really outstanding. "Everybody knows all the time how we are doing on achieving goals and that allows all of us to know, all year long, where we are doing well and where we are falling short."
Historically, Good Samaritan hired for skill and prayed for cultural fit. It decided to not only change the focus by screening for skill and hiring for cultural fit, but also include lower-level staff in the hiring decision. Good Samaritan adopted a peer-interviewing system. If the manager determines a candidate could be a good hire, they send the candidate to the unit for shift-based peer interviews.
"We've trained about 450 of our best associates on how to do behavior-based interviewing," says Fox, explaining that two to three staff members will interview the person and give feedback to the manager. "If they say to the manager 'This person is not a good fit for our nursing unit,' then most of the time the nursing manager is obliged to accept their opinion and keep looking," he says.
In addition, the organization established 27 standards of behavior that the staff must adhere to. A group of employees and managers created these standards that are representative of being a high performing and compassionate organization. "We said to the whole organization that we are going to live these behaviors and anyone—myself included—who doesn't live these behaviors will be asked to remediate," Fox says.
The resultshave been outstanding. Not only has Good Samaritan achieved higher physician, patient, and employee satisfaction rates, which are all in the 90th percentile, but it has improved clinical quality as well. For example, in 2004 Good Samaritan's outpatient satisfaction score was in the seventh percentile, Fox says. "No change happens without leadership saying we can do better, so we said outpatient satisfaction is going to be important."
Then Good Samaritan improved the technology around scheduling and registration, brought in new management where necessary to achieve higher results, adopted best practices for customer relations, and posted patient satisfaction results publically—weekly to the hospital staff and monthly on public boards in every department. By July 2006, outpatient satisfaction was in 99th percentile.
"We focused on culture, created standards of behavior, decided to hire people who are a cultural fit, and hold ourselves accountable to how we behave," Fox says. "As a result of these fundamental management moves, we really dramatically improved our performance over a short period of two to three years."
In 2003 only 40% of heart attack patients at Good Samaritan had door-to-balloon times shorter than 90 minutes. A physician took on the role of improving clinical quality around the cath lab, and the hospital required all ambulance companies it worked with to switch to a 12-lead EKG machine, trained paramedics how to identify a STEMI patient with the 12-lead EKG, and empowered them to call the ED and institute a cardiac alert, so the cardiologists at home could get to the hospital faster. In 2010, 99% of patients had door-to-balloon times under 90 minutes, with the average being 56 minutes, and recently Good Samaritan posted its lowest door-to-balloon time of 11 minutes.
Looking ahead, Good Samaritan, which launched a commercial accountable care organization in January 2011, is not waiting for the next evolution of healthcare reform from Washington, Fox says. "We need to maintain or improve outcomes while we lower the costs of care across the continuum," he says. "So we are moving forward in doing the right thing, which I think is improving the value and really reducing costs of healthcare for our community."
This article appears in the December 2011 issue of HealthLeaders magazine.
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Diane Whitworth, RN, CWOCN.
This profile was published in the December, 2011 issue of HealthLeaders magazine.
"It was a matter of realizing we did have an opportunity here and it was an issue across the country. And that we need to have the focus on what we can do here to make a difference."
Diane Whitworth, RN, CWOCN, began her healthcare career about 30 years ago as a candy striper—"back when candy stripers actually delivered patient care, such as helping patients eat and take a walk," she says. She then worked as a certified nursing assistant before starting her career as a wound ostomy and continence nurse roughly 22 years ago. During the past six years, Whitworth has become a champion in the nationwide effort to prevent hospital-acquired pressure ulcers.
"As I started seeing more and more pressure ulcers, that is what drove me," she says. "But in the back of my mind, I had my grandfather, who in his 80s, had to lose his foot because of a pressure ulcer." Her grandfather fell, fractured his hip, developed a pressure ulcer on his foot (which is common), and ended up having to have an amputation, Whitworth explains. "At the time it was an acceptable practice," she says. "Even being in healthcare, I thought, 'Well, that is one of the hazards of falling and breaking a hip.'"
In 2006, there were 503,300 pressure ulcer-related hospitalizations and pressure ulcers were the primary diagnosis in about 45,500 hospital admissions—up from 35,800 in 1993, according to the Agency for Healthcare Research and Quality. About one in 25 patient admissions with pressure ulcers as the primary diagnosis ended in death, AHRQ says. In addition, pressure ulcers are the second most common patient safety incident with a development rate of 36.05 incidents out of every 1,000 hospitalizations and HAPUs cost the healthcare system roughly $2.6 billion to treat, according to HealthGrades Seventh Annual Patient Safety in American Hospitals Study, which was released in March 2010.
In 2008, The Centers for Medicare & Medicaid Services stopped paying hospitals for the increased cost of care for stage three and four HAPUs, which it classifies as never events.
The statistics are staggering, says Whitworth. "These are patients that came to us without this issue, and this is what we have added on to their list of morbidities—if not mortality."
St. Mary's Hospital in Richmond, VA, part of the Bon Secours Health System, always looked at its HAPU statistics on a yearly basis, says Whitworth, who is the manager of the wound care team at St. Mary's. "But it wasn't a concentrated focus," she says. Then in 2006, some areas of the hospital were showing HAPU rates at 20%. The national average at the time was roughly 5%–6%, says Whitworth. "We said 'This is totally unacceptable.' We set up a goal and started our 'journey to zero.' It was a pretty lofty standard, but that was the vision."
Everyone in the hospital from board room and chief nurse executive-level to the bedside nurse is now focused on preventing HAPUs. Whitworth says there needs to be a commitment that the resources will be there for prevention. "For us, it is that we can have skin champions who can meet monthly for an hour and have skin care meetings," she says, adding that if a patient needs a different bed surface, the staff nurses are empowered to get it for them. They do not need to wait for approval from the wound care nurse, she says.
To ensure St. Mary's was doing everything it could to prevent HAPUs, it created an interdisciplinary team, including nurses, physicians, dietary, physical and occupational therapy, and quality staff, to review processes and guidelines. St. Mary's also brought in subject matter experts and conducted research reviews.
"It was a matter of realizing we did have an opportunity here, and it was an issue across the country—and that we need to have the focus on what we can do here to make a difference," says Whitworth.
When it comes to preventing HAPUs, making sure that patients are turned every two hours is a huge component, says Whitworth. The challenge is determining whether this is actually happening, or what to do for critically ill patients in pediatrics, for example, who can only be turned every 12–24 hours, she explains. Another area that is a huge concern is device related injuries such as oxygen tubing around ears. Lastly, making sure that the staff is onboard with the processes.
Historically, St. Mary's used what it calls a point prevalence and incidence report where, on a yearly basis, it examined everyone's skin across the whole hospital. It then came up with its HAPU rate—meaning these patients came into the hospital without a pressure ulcer and now they have one. It wasn't the best system, Whitworth concedes. "One snapshot, once a year is not the best way to determine what your patient population has." Now these evaluations are done quarterly.
In addition, as soon as a HAPU is identified, the wound care team and nurse manager are also notified. "We immediately start doing a review and make sure the interventions are correct or if we should escalate them," she says. The CNO also wanted to know about these events, Whitworth adds, so if one occurs it is included in the daily 10:30 a.m. huddle with the nurse managers, assistant director of nursing, and department heads. The huddle discusses what is going on throughout the facility, for example what is the ED looking like today.
If there is a HAPU, the staff nurse, nurse manager, and one of the wound care team show up and explain what is happening. "Within 24 hours, we already have a handle what we can do to prevent it—what process or education do we need," says Whitworth.
The hospital always had a skin and wound care committee that met monthly and focused on education and what the current HAPU issues were on the floor. But it wasn't focused on prevention, which is now its main focus, says Whitworth. It also expanded the committee to represent all units. It didn't have pediatrics, surgical services, or the emergency department represented, for example.
It is imperative for hospitals to identify HAPUs that are present on admission, she explains. If a patient comes into the ED with a heart attack, the focus is on the heart attack. But as soon as that patient is stable, St. Mary's set the standard that staff need to do a skin and risk assessment.
The hospital restructured its staff education process as well. St. Mary's wanted to know whether its staff could assess patients, do a grading scale, and score them appropriately. "If patients weren't scored correctly, we weren't putting in the interventions," says Whitworth. St. Mary's now has mandatory competencies and annual skills reviews solely on skin and pressure ulcer prevention.
Each unit also has a skin champion who performs process data collection on a weekly basis, she says. They look at the care of five patients on their unit and evaluate the processes the team excels in or needs to work on. Some units maybe good at turning but struggle with handoffs, Whitworth explains, so this brings it to the unit-level rather than setting a hospital-wide initiative to focus on turning.
Hospitals should ensure that HAPU processes are not duplicate work and that they are as user-friendly as possible, says Whitworth. For example, St. Mary's developed a list of interventions that staff should do based on the HAPU's level. The system is now automated in its electronic medical record, but they had a paper version prior to launching the EMR.
One of St. Mary's most successful initiatives to preventing pressure ulcers is its critical event analysis tool. Staff members use this tool immediately when a HAPU develops, while it is still a stage one or stage two. "We don't even get to stage three or four because we already determined that that was way too late," says Whitworth.
The tool helps staff determine whether they did everything they could do to prevent it. And what interventions they should be doing now. For example, did they get nutrition involved early enough? Did they do a risk assessment? Is the patient on a proper support surface?
The hospital's HAPU rates dropped from 20% in 2006 to 2% in 2007, and is now around 0.5%. "We started out on a six-lane highway. We had so much out there to improve—we got the low-hanging fruit and improved dramatically in a short amount of time," says Whitworth.
St. Mary's has also hit the elusive zero for a few months at a time. A key element of reaching that goal is knowing what you have in-house on a daily basis, she says. "I don't have to wait for quarterly visit. I can tell you I haven't had any [HAPUs] for 30 days."
This article appears in the December 2011 issue of HealthLeaders magazine.
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Jeanne Yeatman, MBA, BSN, CEN, EMT.
This profile was published in the December, 2011 issue of HealthLeaders magazine.
"If [paramedics] know what happens in the helicopter, they can better prepare the next patient."
Coping with the emotional connection to patients is one of the biggest challenges nurses who work at Vanderbilt LifeFlight and similar air-medical programs face nationwide, says Vanderbilt LifeFlight Program Director Jeanne Yeatman, MBA, BSN, CEN, EMT.
"You are invited into people's lives at their worst moments, so you become emotionally connected to the patients that you serve," she explains. "When you see someone with burns over 90% of their body who is talking with you and you know that you are the last person they will talk to, there is no training for that—no book on what to say. That emotional wear and tear is difficult."
MedEvac helicopters are most often used to transport patients who are gravely injured from severe trauma or suffering from time-sensitive illnesses such as heart attacks and strokes. Each year, MedEvac helicopters transport approximately 400,000 patients and MedEvac planes transport roughly 100,000 patients over longer distances, according to the Association of Air Medical Services. Roughly 46.7 million Americans live more than one hour away from a Level 1 or 2 trauma center.
As a young child, Yeatman's interest in emergency medicine was piqued after she witnessed an air-medical transport when a neighborhood child was injured. After graduating nursing school in 1989, she secured a position working at Vanderbilt Medical Center's emergency department in Nashville, where she witnessed LifeFlight nurses in action. "I got to see some of the amazing things that they got to do," she says. "So, LifeFlight, for me, was a natural progression of my career."
Flight nurses take care of a spectrum of patients, so there is a lot of extra certifications and continuing medical education that all of the flight crews have to acquire, says Yeatman. For example, the minimum requirements to be a Vanderbilt LifeFlight nurse include: three years of ED/critical care experience, more than 640 hours of pediatric experience, emergency medical technician certification, and either certified critical care nurse, certification in emergency nursing, or certified flight registered nurse training, among other requirements.
Yet one area that flight nurses usually aren't trained on is compassion fatigue, says Yeatman.
"In the beginning, no one had that conversation with me and said 'when you go home and lash out at your family, it might be related to the job,'" explains Yeatman, who started her career as a flight nurse in 1993. "It is something that people don't like to talk about," she says, adding that the people who gravitate toward this profession have take-charge personalities.
They believe they can manage anything. But there needs to be more self awareness in the industry regarding compassion fatigue, she says. "Each person is impacted in a different way and it changes depending on where you are in life."
To help her staff of more than 150 professionals who average more than 3,000 trips annually cope with the daily rigors of the job, Yeatman has tried to build a level of self awareness about the acuity of patients that LifeFlight transports. For example, when a flight crew has performed CPR or there has been a patient death, Yeatman has found chaplain Ray Nell Dyer, MDiv, BCC, from Vanderbilt Children's Hospital who is willing to volunteer her time and reach out to that crew and offer emotional support.
Yeatman is also developing programs at LifeFlight to help improve care coordination among flight crews, paramedics, and ED staff. Vanderbilt LifeFlight is one of the largest academic medical center-based transport programs in the country; it covers an area within an approximately 130-mile radius of Nashville, has a greater than $10 million annual budget, and five helicopters, one airplane, and three transport ambulances.
About one year ago, Vanderbilt LifeFlight launched its iFly program, which strives to help paramedics and ED physicians and nurses learn more about care delivery during the "golden hour in trauma," Yeatman says. For example, the program enables a paramedic to go right from the scene of accident with the flight crew to the hospital. "They can watch the entire resuscitation and we take them into the ED," she says.
It allows them to see the full spectrum of care. Similarly, an ED nurse who has been taking care of a sick child, for instance, can accompany that child as LifeFlight transports the patient to a different hospital and the nurse can follow the care progression.
Often healthcare workers get focused solely on the type of care that they deliver and this program aims to remove that silo impact, says Yeatman. "If [paramedics] know what happens in the helicopter, they can better prepare the next patient," she explains. "They now understand better this is what they do in the helicopter, and this is why they do these things."
The goal is, ultimately, to take better care of patients by improving how paramedics, flight nurses, and ED physicians and nurses work together. "We are all part of the healthcare delivery team," Yeatman says, adding that many healthcare professionals, herself included, are experiential learners who learn best when they can get in there, see it, and visualize it.
Currently, there are two EDs and five counties involved in the iFly program. About 100 people have enrolled and 24 people have actually gone on a flight. Paramedics and clinicians do need safety training to go up in the air, which takes about an hour to complete, Yeatman says.
Some of the lessons participants have taken away from the program are simple things—procedures that paramedics can do on the ground to help speed care along, such as removing unnecessary clothing.
Another example is following sepsis protocols and administering early antibiotics or ensuring that treatment protocols for the STEMI (ST segment elevation myocardial infarction) program are adhered to so heart attack patients can get to the cath lab sooner, Yeatman explains. "The helicopter crew is very checklist oriented," she says. "If you get to step two before doing step one, then you have to go back and you may not get to step three."
One of the great things about the iFly program, Yeatman says, is it showcases how trauma care is delivered. In the room every person has a place to stand and a role in care delivery. "It is like a large symphony," she says. "What the program really allows is that individual to step inside the symphony and see how it works because everything is done in an organized fashion."
This article appears in the December 2011 issue of HealthLeaders magazine.
Hospitals looking to connect with patients, grow market share, and increase awareness about their services are turning to physician videos as a means to accomplish those goals. It's also a way to engage the physicians, says Pam Marecki, assistant vice president of communications at Bayhealth Medical Center, a two-hospital system in southern Delaware.
"Research has shown that physicians who have a video gain more Web traffic," she says. In June 2010, Bayhealth started taping a video series titled "A Bit of Advice" at the same time it was completing video biographies about its physicians for its website, bayhealth.org. "We wanted to make our Website more interactive and engaging for the consumers," says Marecki, adding that they succeeded in engaging both consumers and physicians.
"Physicians with video links on their Web pages had three to four times more traffic, so it's a great marketing tool for physicians."
To date, Bayhealth, which has a medical staff of more than 400 physicians, has completed about 50 "A Bit of Advice" videos and will continue to add videos to the site periodically.
The video series was done at the same time the biographies were recorded, so there was no additional cost to the system because the video biographies were budgeted as part of the launch for Bayhealth's new website.
Initially, physicians' response to the campaign was a little slow, says Marecki, but interest has grown with the number of videos. To prep doctors for the video segment, Bayhealth asked physicians to consider what they would tell their patients if they could give just one piece of advice.
"We wanted them to think about it, but not script it out," says Marecki.
Immediate connection Similar to Bayhealth, Tufts Medical Center wanted to increase awareness, stand out in a very competitive market and cluttered media space, and offer consumers the chance to "meet" its physicians.
"We knew that once introduced to the services and physicians at the medical center, patients would be very interested in receiving care here," said Brooke Tyson Hynes, Tufts' vice president of public affairs and communications. "It was a matter of getting our foot in the door with more consumers so they could see the depth and sophistication of our services and the talent and compassion of our physicians."
However, unlike other hospitals that have added videos to their website, the Boston-based medical center built TuftsMedicalCenter.tv, a website that features the expertise of its physicians through videos. "TV gave us an immediate way to connect with patients and easily allowed them to contact us for more information and appointments," explains Hynes.
It includes health channels that offer information about specific diseases and service lines, such as cancer, heart conditions, and pediatric health. With these channels, consumers can learn more about atrial fibrillation, for example, by watching a physician video that explains its symptoms and treatment options.
The website offers videos that debunk common medical myths—for example, cold/wet weather makes you sick, breastfeeding is easy, and you can't have intimate relations after a heart attack. It also provides healthcasts on topics such as enlarged prostate or hip replacement that consumers can listen to live and submit questions by phone or via Twitter; they can also download an on-demand version of the show.
In addition, the website helps Tufts improve consumer education and wellness efforts, says Hynes. "These videos provide tips for staying healthy, dealing with illness, and making good healthcare decisions," she says. "We have received numerous e-mails from patients saying that they watched the video and finally truly understand their disease or condition."
Prepping the docs
The 415-bed hospital, which partnered with PARTNERS+simons to develop the look, tone, and content of the videos, is proud of the campaign, says Hynes. "As soon as it launched we had physicians contacting us about being part of the next round of videos."
TuftsMedicalCenter.tv, which launched in 2009, currently has more than 100 videos, and as of
2011 also added nurses to the site. In addition, there have been more than 100,000 unique visitors to the site, brand awareness and preference numbers are rising steadily, and appointment requests are up 150%, says Tony Cotrupi, president and director of brand development with PARTNERS+simons.
"We've scheduled a significant number of appointments directly through the site, and many of these patients are patients who had never previously had an experience with Tufts Medical Center," added Hynes.
What makes TuftsMedicalCenter.tv different from what other hospitals are doing in the realm of physician videos is the quality of the videos and the fact that there is a large quantity of videos on the website, says Cotrupi.
Part of the reason physician videos are so successful is they help patients feel more comfortable. For example, patients can look on the website and listen to a specialist at Tufts whom they have been referred to so when they meet this person they are already a bit more at ease, explains Hynes.
As one physician explained, the first patient encounter is like an interview, Cotrupi says—the goal is for the family to feel confident that the physician can take care of him or her.
"We saw the videos as a way to meet the physician and get their first consult," he says. "Our suggestion was that we don't want the physician to sell the hospital, but we want the physician to imagine that he or she is across the table from someone needing brain surgery." So what would that first conversation be like with a family member, and what questions should they ask?
Tufts recognized the potential of using such high-quality videos in other contexts, so it has looked for ways to incorporate that content into other marketing programs.
When you build a destination, one of the challenges is keeping the content fresh, says Cotrupi. "That is why we expanded it beyond the videos to medical myths and healthcasts. We are also creating content on the site that has promotional value." For instance, the hospital can use this content for the website and in print, radio, and TV advertising.
It is important that people visit the site, but it also essential to find creative and innovative ways to promote the valuable content on the site, Cotrupi says.
The National Commission on Certification of Physician Assistants (NCCPA) has launched a certificate of added qualifications (CAQ) program for certified physician assistants (PA) practicing in cardiovascular and thoracic surgery, emergency medicine, nephrology, orthopedic surgery, and psychiatry.
The nation could face a shortage of up to 150,000 physicians in the next 15 years, according to the Association of American Medical Colleges. One solution to help bridge this workforce shortage is to enable healthcare professionals such as nurse practitioners and PAs to work at their highest capability.
PAs are certified and licensed healthcare professionals who practice medicine as part of a healthcare team under the direction of a physician. This new CAQ program will help give physicians and executives hiring PAs added confidence in the PAs' knowledge and capabilities in these five specialty areas, thus improving their chances for employment.
"The CAQ recognition program was developed in response to PAs and physician groups that approached us from two different perspectives," said Janet J. Lathrop, MBA, president and CEO of the NCCPA. "One desire was to have some documentation to be able to show the hiring physician that they, as PAs, were in fact knowledgeable in certain specialty areas." The second desire was "to give the hiring physicians—this was especially true in emergency medicine—the assurance that these PAs had the experience in ED medicine to come and jump in at a level of acuity a little bit higher than the average person," she explains.
By earning a CAQ, PAs can build on their NCCPA generalist certification, which is a basic prerequisite for the voluntary CAQ program. The first CAQ exams will be administered in September. In order to complete the CAQ program, PAs must meet licensure, education, experience, and exam requirements.
The NCCPA is currently researching additional specialties that it could develop CAQ recognition for, says Lathrop, but the organization doesn't want to get ahead of itself.
"We just started advertising the program in January," she says, adding that the NCCPA already has a couple hundred PAs who have signed up for the program, which is right on target with its expectations.
"We look for products that show we are capable," said Carey Stratford, a PA practicing in Springfield, VT, who has been working in the ED for the past 30 years. "For someone like myself, who is established, it is unlikely to add upward mobility or salary, but demonstrates mastery. For less experienced PAs, however, it will have value to a lot who are in the first few years of their career and looking to transition to ED medicine."
Physicians also are very supportive and seem to universally back this program, says Stratford, who is scheduled to take the first exam in September.
"It provides a standard. Physicians know that they can expect a certain degree of competency from this individual. They look at it as being something that is core to the practice of ED medicine," he says. "As you are looking for candidates, you have a standard that you can look for and it supports the profession. They have said it will give the PA who has gone through this a leg up."
Lathrop agrees. "We seem to be a society that really appreciates the need for backup in this litigious world."
A PA fresh out of school is trained in general medicine, but then he or she goes off and works with physicians, many of whom are specialists.
It makes sense that the PA over the years would become specialized and therefore would like to have some form of recognition above and beyond his or her generalist credential, says Lathrop.
And it is not just physicians who are looking for assurance. "If I am a hospital credentialer, the more documentation and assurances I have from a national organization that someone is knowledgeable and capable, the better I feel," says Lathrop.
In the world of medicine, many healthcare professionals can earn multiple credentials after their name. But PAs currently have (and will continue to have) only one generalist credential. "It was important to deliver something that would satisfy [PAs' and physicians'] needs while maintaining our generalist credential," says Lathrop. But offering additional CAQ documentation that shows PAs' expertise in a specialty is essential to help them further their careers in the industry, she explains. This is something that the PAs have clamored for.
"We are also hopeful that it will help some PAs move into different areas that they may not have been able to move into easily before, such as psychiatry and nephrology," says Lathrop. PAs have struggled to break into those fields of care because they lacked confirmation that they had the knowledge and skills to work in these specialties. The generalist credential wasn't sufficient, she says. PAs in those two specialties asked for our [the NCCPA's] help to provide documentation that would demonstrate their specialty skills.
"Our hope is that now these PAs will be able to provide this recognition and that they will be more employable and hired in these areas," Lathrop says.
The number of people using mobile technology is on the rise. In 2008, the number of smartphone subscribers was 15 million. That number almost doubled in 2009, reaching 26 million, and is expected to grow to roughly 142 million in 2011, according to Nielsen Mobile, which tracks wireless trends.
So it’s no surprise that creating smartphone applications is an area that hospitals want to take advantage of. “It is another new way of marketing and interacting with patients and potential consumers,” says Barbara Mackovic, senior marketing manager at Louisville,
KY–based Jewish Hospital & St. Mary’s HealthCare (JHSMH). The world of communication is changing so rapidly, Mackovic says, that once you master one thing, it is already out of date. Mobile technology is “something that all marketers have to be aware of and figure out how that pertains to their target market,” she says.
Melissa Tizon, communications director at Seattle’s Swedish MedicalCenter, agrees. “At the end of the day, it is about what kind of experience patients are having with you. And if you can make that experience easier by putting something convenient on their phone, then those are the kinds of things that we want to do.”
Although mobile technology is an important feature that hospital marketers shouldn’t overlook, they also shouldn’t create an app just to be able to say they have one.
“There are so many [apps] that people download that aren’t used, so you have to think about what is useful,” says Tizon. Here is a look behind the two health systems’ mobile strategies.
Integrate mobile with other social media platforms
JHSMH is no stranger to social media: It already has a Facebook page, a Twitter feed, and a YouTube channel. But it was looking for another way to have daily interaction with its community, so in April 2010 it launched its mobile application. “We figured that this is a great way to communicate with [members of the community] on an ongoing basis and give them the tools that they needed, specific to our community and healthcare system, at their fingertips,” says Mackovic.
It was also an opportunity to take all of the social media tools that JHSMH was already using and tie them together in a single location. “To have an effective mobile app, it has to be a one-stop shop and bring together the entire social media plan all under a central element,” she says. “The more you can integrate, the better.”
When designing its free mobile app, JHSMH didn’t want a general app package that any hospital could implement. “We thought about what the community needed and what makes our health system unique,” says Mackovic, adding that one of the health system’s selling points is that it has seven emergency departments (ED) in the region and more than 200 employed physicians.
“We wanted to make sure people could find that ED or physician who was closest to them that meets the criteria that they are looking for—gender, after hours, specialty,” she explains.
With JHSMH’s app, people can search for services within a mile of their home, and the health system recently updated the app to include ED wait times. In addition, the app features current health news—not just JHSMH news. “Subscribers can see a feed of interesting health news, which is what we use our Twitter account for,” Mackovic says. The JHSMH app also includes a food diary and calorie tracker to emphasize the importance of a healthy lifestyle.
To promote the app, JHSMH used some basic media—a press release, an outdoor board on its campus, and some table tents in its cafeteria—but it has mostly focused on word of mouth.
“We haven’t done a lot of traditional marketing,” says Mackovic. “The thing about social media is it doesn’t make sense to advertise in a more traditional way, so we really utilized other social media channels.” For example, the health system posted an explanatory video about the app on its YouTube channel.
As of the end of March, more than 2,100 people have downloaded the app, which is available on iPhone® and BlackBerry® devices.
Focus on core services
Swedish Medical Center, a four-hospital system, also focused on promoting one of its core services and maintaining its relationship with patients when it launched its Kids Symptom Checker app.
The health system has a pediatric specialty care program and delivers more babies than any other facility in Washington, says Tizon. “We have all of these women who come into our facility to deliver their baby and have this incredible experience with us,” she says. “Then they leave and we don’t really see them again, so we have been doing a lot of work to try to maintain that relationship with women after they leave our facility after having their babies.”
To that end, Swedish has been providing health information on its website and now via its new mobile app, which launched this past fall on iPhone devices and was scheduled to be made available for Android™ devices this spring.
“It is really helpful to our family medicine physicians and pediatricians for their patients to have access to information, so I guess you could say that they were one of the biggest drivers for getting this information available,” says Tizon.
The app helps subscribers get quick advice about what may be ailing their child, and includes an anatomic index of topics, a pediatric drug dosage table, and infection exposure questions, as well as information on how to take a temperature and advice on when to call a doctor.
Swedish is promoting its Symptom Checker app through social media and with the help of its family medicine physicians and pediatricians, who are informing their patients about it. The health system plans to track the app’s return on investment by measuring its number of downloads and by tracking how many people heard about Swedish’s services through the app.
Making your mobile strategy a success
One of the key lessons JHSMH learned when developing its app was not to spend too much time on the front end trying to make it perfect. “We knew that we weren’t going to get it perfect the first time with version 1.0. It was not going to be the end-all app,” says Mackovic. “So we got it out there. People loved it, but they gave a lot of feedback.”
For example, subscribers wanted to search for available physicians and hospitals by mile radius, not ZIP code. Also, the initial version of the food diary had users search by food group, but users indicated that, for example, they would rather type in “hamburger” and have any food group that was in a hamburger pop up, she explains.
To solicit feedback, JHSMH set up a Zoomerang online survey when it launched the app. It also uses the social media tracking service Radian6 to monitor what people are saying in blog posts and on Facebook and Twitter. “We got it out there and got that feedback and then adapted it to make it the best,” says Mackovic.
“You need to think in small bites,” adds Tizon. “You can’t do it all and need to think about what is useful.”
Your first inclination might be to create a mobile version of your website,
Tizon says, but most hospital websites are huge, containing thousands of pages. Ask yourself whether people are going to use a phone for that, she says. Instead, Tizon suggests that health systems focus on small pieces of information such as pediatric health or way-finding.
“Rather than trying to put your arms around everything and making everything mobile, think about what are the small things that you can do that will be helpful,” says Tizon.