By Caroline Kenyon
Social media is powerful – it is instant and can spread worldwide at astonishing speed, which is why it is so effective in leadership and influencing. But in the NHS it is viewed by many as a risk rather than a resource.
• How to create a patient community that improves people’s health
• How active engagement with patient feedback improves both services and staff morale
• How a GP reduced appointments through social media
Social media. Why do it?
With around 30 million people in the UK using Facebook and 12.6 million on Twitter, these internet behemoths dwarf the reach of any media outlet. And as social media can offer information and consultation beyond a clinician’s clinic or ward, the potential for its use to improve services is huge.
America’s top-rated healthcare provider the Mayo Clinic established its Social Media Network initially to support its own staff to use social media in their practice. It now has a worldwide membership who share learning and best practice to improve care.
Farris Timimi, Medical Director at the Mayo Clinic Social Media Network, said:
“The value of engaging in clear, open, two-way communication at every point of care has become abundantly clear. Active engagement between providers and patients, along with their caregivers, has a demonstrably profound impact on patient and provider satisfaction, patient compliance and improved clinical outcomes. Social media is helping to make much of this constructive engagement happen.”
Evidence that we’re not doing it
A survey by HealthChat* of 27 Trusts found that:
• Eight did not have a social media strategy and one believed implementation of a strategy was not achievable
• Ten communications teams interviewed had only a single person responsible for social media, mostly as part of a wider workload and social media was not prioritised
• Many of the Trusts did not have aims and objectives for social media
*HealthChat is a group of medical students who conducted a qualitative and literature review study into NHS Trusts’ use of social media from October 2016 to May 2017: Rosie Bhogal, Sonika Sethi, Nishma Gokani, Sharukh Zuberi, Susana Luengo, Shaneil Tanna and Jagvir Grewal, Imperial College London. Their paper will be published in late 2018.
In Greater Manchester a network of newly diagnosed renal patients was supercharged by the application of social media – with dramatic effects for some patients.
As part of her PhD thesis, Dr Cristina Vasilica co-created with patients a website, Twitter account and Facebook group for the Greater Manchester Kidney Information Network, GMKIN. 
She carried out a long term study of the impact on participants’ lives and found, in contrast to the small number of people who attended physical meetings, high levels of engagement - in particular in the closed Facebook group with 343 members.
Participants reported real improvements in health and well-being with an increase in self-support and confidence and better self-management.
She learned that:
1. For an intervention to work patients should be engaged. Patients engaged with GMKIN because of the information shared; it was local and they knew and trusted the staff
2. It provided information, enabling patients to recognise symptoms, understand the condition better and have hope for a brighter future
3. It triggered health improvements – an increase in self-support and confidence and better self-management
4. Social media contributed to social outcomes – people became less isolated, they cared for each other and became more interested in social activities. For example, participants indicated that they were keen to take on employment
FIGURE 1 GMKIN engagement
Other examples of creating communities in closed Facebook groups for patients with long term conditions can be found in North Staffordshire, where Marc Schmid of Redmoor Health helped primary care staff to set up Facebook groups for 64 of the 83 GP practices to engage with patients on issues such as flu vaccines, winter pressures advice and supporting care navigation.
Three condition-specific groups are run by clinicians at Royal Stoke Hospital covering multiple sclerosis, cardiac rehabilitation and atrial fibrillation and stroke, with membership ranging from 200 to 350.
It’s not only helping patients but also empowering staff to do more in ways they hadn’t anticipated.
Acting on patient feedback
At The Pennine Acute Hospitals,  it was the need to address low staff morale that led to the creation of a quality improvement programme in women’s and children’s services – including a new role of Patient Experience Midwife to focus on patient feedback.
Alongside the structured quality improvement work carried out by consultants Lisa Elliott and Vanessa Blanchard, midwife Samantha Whelan became the Trust’s pioneer in using social media to engage with patients about their feedback on the Care Opinion platform. 
Samantha responded to patient stories in real time and where they were praising staff – which was most of the time – she shared them with the staff directly and on Twitter and Facebook. The result was that more stories were being shared and more staff became aware of patients’ good experiences and thank yous – which lifted morale.
Supporting self-care and reducing demand
There are many examples of great social media messaging by comms teams to direct people away from A&E and into pharmacies or online to NHS 111. And some GPs and other clinicians are doing it for themselves.
Dr Andy Knox in Carnforth, Lancashire, produces videos advising people how to look after themselves and tackle problems ranging from nits to back ache.
His self-care videos on his Ash Trees Surgery website  and YouTube account are promoted through Twitter and Facebook and played in his waiting room. The most striking evidence of the impact of his mission to empower people to manage their minor ailments is evident in a reduction of appointments for earache; from 120 in the winter of 2015/16 to just 15 the following year - and he attributes this to his earache video.
A crusader for patient empowerment and the Director for Health and Wellbeing for North Lancashire, Andy is a strong believer in using social media and video to reach wider audiences.
A tweeting culture
If we agree that social media offers a powerful engagement tool to benefit patients, then we should try to overcome the fear and doubts which stop its use by the wider health community.
If we don’t, then we are missing a golden opportunity - and patients will create their own communities and misinformation - and #fakenews will be far riskier.
An organisation which positively encourages staff to use social media is the Welsh Ambulance Service @WelshAmbulance, where you will find a plethora of accounts on the twittersphere.
One of these is @WelshAmbPIH run by the patient experience team to engage with the public and gather feedback to improve services.
So how have they done it? It starts at the top, with the CEO and all the senior team using Twitter to engage with staff, partners and public.
There’s a fabulous Social Media Toolkit for Healthcare available from Skills for Health; download it via http://www.skillsforhealth.org.uk/toolkit-download.
Caroline Kenyon is Director of Communications and Engagement at the Innovation Agency, the Academic Health Science Network (AHSN) for the North West Coast. She runs #EngageWell events to promote the use of social media in healthcare; find presentations on the Innovation Agency’s YouTube channel and SlideShare.