Health IT & Quality: Social Networking: A New Tool to Engage the Clinical Community


March / April 2009
Health IT & Quality

Social Networking:
A New Tool to Engage the Clinical Community

Is your profile complete on LinkedIn? How many friends do you have on Facebook? Did you update your “What are you working on” at both sites? If not, you may be missing the “groundswell” a term coined by Forrester researchers Charlene Li and Josh Bernoff. In their book Groundswell, Li and Bernoff review the technology underpinning social networking and explore how it can be used to connect with customers, better develop service offerings, and further relationships with clients.

Many of the concepts covered in Groundswell apply to healthcare. The growth in consumerism makes the interaction and communication with patients even more critical. The capabilities of social networking facilitate that “connectedness,” which can lead to improved quality, higher patient satisfaction, and lower costs.

Types of Online Participants
Li and Bernoff characterized participants in the online social networking world into six categories. The types of online participants include:

Creators. The most active, sophisticated users of social networking applications, these online consumers at least once per month publish a blog or article online, maintain a web page, or upload videos or audio to sites like YouTube. Based on a 2007 survey, in the U.S. Creators represent 18% of the online adult population, in Europe 20%, and in South Korea 28%.

Critics. These online adults react to online content posted by others by posting comments on blogs or online forums, posting ratings or reviews, or editing wikis. There are many more Critics than Creators, encompassing 25% of U.S. online adults, 20% of Europeans, and 36% of Japanese.

Collectors. Acting to collect or aggregate information, these online participants save URLs and place tags on social-bookmarking services like, vote for sites on a service like Digg, or use RSS feeds on services like Google Reader. This effort works to help organize the tremendous amount of information placed on the Web by Creators and Critics. About 10% of adult Americans and Europeans are Collectors.

Joiners. These are the adults who participate in or maintain profiles on social networking sites such as MySpace, Facebook, or LinkedIn. More than 25% of American adults are Joiners, with levels above 40% for South Koreans. Joiners make up about 10% of online adults in Europe.

Spectators. Consumers of what others produce and “publish” on the Web, little effort is required of Spectators to participate. These adults read blogs, forums, and reviews, watch videos, and listen to podcasts. Since being a Spectator requires so little effort compared to the other types of participation, it makes up the largest group of online participants. About 48% of Americans, 37% of Europeans, and 66% of Japanese adults are described as Spectators.

Inactives. These are the non-participants in the online world. Amazingly, 48% of American adults who have access to the online world do not participate in any level of online social interaction as previously described. About 53% of Europeans and 37% of South Koreans do not participate. Of course, these numbers do not include those adult consumers who remain offline.

The sum of the percentages for each of the categories noted above exceeds 100% because consumers can fall into more than one category. Someone who posts reviews can also tag websites and listen to podcasts. That said, it is important to note that 56% of American adults are active participants in online social interaction.

Small Becomes Big
The advent of social networking and its impact on how information is exchanged will prove disruptive to the current processes used by physicians and patients to communicate. In addition, social networking greatly expands the information available about physicians and provider organizations, offering the consumer much greater data to use in making care choices. This added information, out of the control of the healthcare provider, may prove beneficial or harmful to their business. Therefore, it is critical that providers pay attention to this online world.

Before online social networking, only news of the most serious events reached large numbers of consumers. Less sensational events did not have the impact necessary to attract the attention of the mass media, the only effective distributor of information to large numbers of consumers.

All this has changed. Now consumers record even minor events and place them unfiltered in cyberspace for review by anyone at anytime. This “raw” information lacks any checking for accuracy, relevance, or completeness. Factual stories are posted beside inaccurate stories, communicating an unscripted image of an institution, group practice, or physician.

Consumers with similar experiences are also able to comment on postings, thereby adding credibility or contradiction to any story. Additionally, those mentioned in the postings can add further details or information to “correct” or enhance the story. Each posted story offers a forum for give-and-take, allowing all interested consumers to express their own facts or opinions. Consumers effortlessly share postings with others, therefore encouraging more people to contribute.

Organizations that fail to understand the influence of online consumers in their strategic and operational planning will surely be blindsided by some unanticipated event, and will be completely unprepared on how to respond. In addition, such organizations are missing an opportunity to engage these online consumers proactively. Actively working with these savvy online users while providing them with a social networking forum to express themselves greatly assists in any effort to enhance business models, improve service offerings, and publicize successes.

New Consumer Tool
Rather than a threat, social networks offer healthcare organizations a new tool to connect with healthcare consumers. As consumerism continues to take hold and consumer directed health plans become more commonplace, organizations need to remain in constant communication with the patients they serve to keep those individuals loyal to their facility or practice. Social networks allow for multifaceted, regular communication with healthcare consumers, which assists in building and maintaining this necessary loyalty. As consumer control over spending healthcare dollars increases, their behavior will more closely mimic their behavior in purchasing other products and services. Therefore, effective management of an organization’s online presence greatly influences financial success.

For any organization, engaging consumers utilizing the online world of social networking presents a difficult but manageable challenge. Experience in other industries highlights the enormous benefits and competitive advantage a successful strategy can deliver.

For the healthcare industry, the upside should prove to be even greater. After all, no industry encompasses services and products that exceed the emotional energy of the patient-caregiver relationship. By constructively interacting with consumers in the online world through social networking, healthcare organizations are likely to find motivated consumers who passionately work to enhance the quality and safety of care delivered to themselves, their families, and their communities.

Barry Chaiken is the chief medical officer of DocsNetwork, Ltd. and a member of the Editorial Advisory Board for PSQH. Chaiken is board certified in general preventive medicine and public health and is a Fellow, Board Member, and Chair-Elect of HIMSS. As founder of DocsNetwork, Ltd., he has worked on quality improvement studies, health IT clinical transformation projects, and clinical investigations for the National Institutes of Health, U.K. National Health Service, and Boston University Medical School. Chaiken also serves as an adjunct assistant professor in the Department of Public Health and Family Medicine at Tufts University School of Medicine. He may be contacted at


Li, C., & Bernoff. J. (2008). Groundswell: Winning in a world of social technologies. Boston: Harvard Business Press.