Did 2014 see the mainstreaming of social media in the NHS?

Did 2014 see the mainstreaming of social media in the NHS?


This week saw the publication of ‘on the brink of something special?’ the first report of its kind about the state of social media in the NHS. Earlier this year the Health Service Journal and Nursing Times presented their social media pioneers, and this new report comes courtesy of NHS Providers. Both aim to celebrate how social media is being utilised by people in the NHS as a force for change and transformation. There was a great Twitter chat on the subject of the most recent report on #nhssm this Wednesday which got me thinking…

The very fact that three established institutions have chosen to publish these reports indicates that 2014 was the year that social media hit the mainstream in the NHS. We now have a plethora of social media guidelines and toolkits which is quite a journey from a few years ago when I recall healthcare professionals fearful of getting the sack for using social media. Sanctioning of social media is still highly variable in NHS Trusts but this appears to be shifting and I’ve no doubt these reports will accelerate it.

However, both raise a couple of questions for me:  to what extent are could they be re-manufacturing hierarchy? to what extent could measurement create unintended consequences? I explain a bit more below…

Manufacturing hierarchy

Anyone working in the NHS will recognise that it’s institutions are imbued to varying degrees with hierarchies, command and control cultures, and established professional pecking orders. A transgressive affordance of online social networks is to interrupt those hierarchies. Blogs and microblogs have a low bar to entry and enable diverse groups to connect together. Whilst hierarchies that exist offline inevitably make their way into online settings, there is more potential for fluidity – you can have super star status online without any official status offline; you can be a powerful chief executive offline and very little impact online.

Both reports celebrate this potential but rather ironically elevate the status of some and manufacture a new type of hierarchy. I wonder if the sanction of institutions brings with it certain constraints – the institution is paying attention so should we circumscribe our behaviours so they are acceptable? Should we attempt to please the institution according to how it appraises social media use (as intimated in both reports) so we are recognised in a league table? I wonder if the institution watching in this way compromises the transformative potential lauded in both reports.

On a related note, when I was followed some time ago by the sinisterly entitled @DHMonitoring Twitter account which watched but didn’t tweet, it all had a bit of a Big Brother feel about it. I recall wondering if being on the list was something that should concern me – I was under surveillance… It certainly constrained my tweet frippery for a while until I forgot about it. After a less than enthusiastic reaction, the name was changed to @DHListening and now both accounts no longer exist. There is always a tension between the institution and people-driven conversational spaces and both reports are part of this picture.

Unintended consequences of measurement

Whether we like it or not, everything is measured in the NHS and we also know that some of those measurements can have unintended consequences – for example widely debated A&E four hour emergency waits.

So could there be unintended consequences to measuring people in the NHS using social networking sites? Might it inadvertently set institutional norms of behaviour and dialogue? Might it encourage people to follow certain people and behave in certain ways to get on to that list next year? Is there an underlying intention of  professionalising and corporatising social media measurement which will be sold back to the NHS? and if so, is this a good thing or a waste of finite resources?

It turns out my Twitter account was included in the top 50 NHS boat-rockers category, as calculated by the fact I follow five Twitter accounts considered by the report writers to be examples of boat-rockers and then I was ranked by number of followers and number of status updates. I can’t help but feel this methodology is quite arbitrary, for example, my choice of boat-rockers might be quite different to the ones chosen by the report writers. Quantitative measurement will always be problematic in conversational and relationship focused spaces.  It seems to me that mine or anyone else’s contribution is highly subjective.

I may be over simplistic (in fact it’s quite likely) but what I find rewarding about online social networks related to my work for the NHS is quite straightforwardly building connections and hopefully adding some value to people around me. Twitter is just another place where I do this in the way that I do offline on a daily basis, and the latter isn’t the subject of  formal measurement. Maybe it’s the relative novelty of social media which means we are giving it special status at this point in time.

And lastly…

The NHS Providers report highlights the the positive effect of online social networks:

The essence of social media in the NHS is networks of professional communities, organisations and individuals across the NHS willing and enthusiastic to voluntarily engage with each other, learn from each other and support each other.

My sense is that if we’re talking revolution or transformation then people talking to each other within the NHS, even if it crosses roles and professional groups and hierarchies, has limitations. The real disruption, in my experience, comes from making connections with people affected by and interested in the NHS, but not always formally part of it.

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  1. I tweeted these thoughts in response to Victoria’s blog above today:

    I think that for large organisation the recognition of power of social media comes with a sense of central power being lost.

    All of the industries around NHS rely on central power to function, so in interest of many to try to recentralise power.

    Impact measuring makes no sense for us as individuals making stuff happen via social media, but is vital for money/power.

    The sense of losing power and influence is driving some NHS #SoMe thinking, not idea of gaining new kinds of relationship.

    I’m not sure it is the mainstreaming of social media in NHS we’re seeing; more active promotion of one idea of what it is.

    And that’s where existing offline power swings into action to recolonise a space where it does not have power it expects.

    I said at the start of 2014 that I thought this would be the year where offline power would make a concerted effort to reassert itself in social media space. The sense that social media might be about the flattening of hierarchies and the building of new kinds of relationships in healthcare is anathema to people who operate within industries that are served by, or which serve, the existing hierarchical models of information and communication. As many of us know, there isn’t much company money to be made by forming a kind of connective tissue between people and developing the kinds of shifting communities that exist between people in social media.

    I think, for me, the idea of recolonisation is an interesting one to look at in terms of a concerted attempt by what it’s possible to recognise as the existing health establishment to grab some of the space from existing health communities online.

  2. Very pertinent comments from Mark.

    When I am working with organisations, I am very clear to say to them that social media is not just about another comms channel, it will fundamentally change the way you work, open up new forms of collaboration, disrupt hierarchies, and put some people outside their comfort zones. There is always the potential for the hierarchies to attempt to co-opt these processes, control them, and fit them within the structures they feel comfortable with. Personally, I don’t think they’ll succeed, using social media means doing things in public, and traditional command-and-control looks ugly when held up to the light, but that won’t stop them from trying.

    • Thank you for your comments John and apologies for not responding more promptly. I agree with you about the disruptive potential but the jury is out for me in terms of how disruptive they will be to powerful institutions in practice – I’ve seen apparent disruption be appropriated or just plain ignored by big companies. I do hope your prediction is correct though 🙂



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