- Email: [email protected]
The Social Media DNA of Mayo Clinic—and Health Care
ORIGINAL ARTICLE
INTEGRATING SOCIAL MEDIA INTO HEALTH CARE ORGANIZATIONS
The Social Media DNA of Mayo Clinic—and Health Care Amy L. Kotsenas, MD a , Lee Aase, BS b, Makala Arce, BA b, Farris K. Timimi, MD c, Matthew Dacy, AB, MA d, Colleen Young, BA e, John T. Wald, MD a Abstract Hippocrates’ admonition and the medical community’s aversion to risk have caused many physicians and institutions to resist participation in modern social media sites such as Facebook (Facebook, Inc, Menlo Park, California, USA), Twitter (Twitter Inc, San Francisco, California, USA), and YouTube (San Mateo, California, USA). However, because Mayo Clinic’s founders were champions of analog social networking, it was among the earliest hospitals worldwide to create official accounts on these digital platforms. A proper understanding of the traditional mechanisms of knowledge diffusion in medicine and of the nature of social media sites should help professionals see and embrace the opportunities for positive engagement in social media. Key Words: Social media, professional networking, Facebook, Twitter, YouTube J Am Coll Radiol 2018;15:162-166. Copyright 2017 American College of Radiology
INTRODUCTION Social media sites are a 21st-century innovation; if the major sites were persons, none of them would yet be old enough to vote, or even drive a car. YouTube (San Mateo, California, USA) will become a virtual teenager on February 14, 2018 [1,2]. Facebook (Facebook, Inc, Menlo Park, California, USA) is only a year older [3], and Twitter (Twitter Inc, San Francisco, California, USA) celebrated its 10th birthday in March 2016 [4]. Despite their youthfulness, these sites have massive societal impact, and the companies that own them are economic dynamos. Alphabet (Alphabet Inc, Menlo Park, California, USA), the parent company of Google (Google Inc, Menlo Park, California, USA), which acquired YouTube for $1.6 billion in 2007, is the second most valuable company in the Fortune 500, with market
a
Department of Radiology, Mayo Clinic, Rochester, Minnesota. Social Media Network, Mayo Clinic, Rochester, Minnesota. c Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. d Department of Development, Mayo Clinic, Rochester, Minnesota. e Mayo Clinic Connect, Mayo Clinic, Rochester, Minnesota. Corresponding author and reprints: Amy L. Kotsenas, MD, Mayo Clinic, Department of Radiology, 200 1st Street SW, Rochester, MN 55905; e-mail: [email protected]. The authors have no conflicts of interest related to the material discussed in this article. b
capitalization of $507 billion [5]. Facebook comes in fifth on the list at $321 billion, just behind petroleum giant Exxon Mobil (Irving, Texas, United States) [6]. Even Twitter, the poor cousin among the three, closed its first day of public stock trading in 2013 at a valuation of $25 billion [7]. Unlike Fortune 500 leaders Apple (Apple Inc, Cupertino, California, USA) and Exxon Mobil, social media companies produce no tangible products. They do not even charge end users. Instead, they profit through monetizing Metcalfe’s Law, which holds that the value of a network is proportional to the square of the number of its nodes [8]. Facebook has 1.86 billion monthly active users as of December 31, 2016 [3]. Facebook’s knowledge of the relationships among users, and its ability to target messages based on interests and demographic characteristics in the form of affinity data, have led to its profitability and enormous valuation. As Andrew Lewis observed in 2010, “If you are not paying for it, you’re not the customer; you’re the product being sold” [9]. To add to this user-as-product reality, many health care professionals may have concerns about improper online behavior, negative interactions, or the potential to compromise patient privacy when using social media sites. These fears often result in attempted risk mitigation via elimination, and many hospitals have blocked social media sites at the corporate firewall [10]. ª 2017 American College of Radiology
162
1546-1440/17/$36.00
n
https://doi.org/10.1016/j.jacr.2017.09.026
In an era when we all bring our own devices to work and with more than 80% of physicians using smartphones or tablets [11] with mobile data, this resistance may be futile. These devices with their cellular data plans typically have social media apps installed, rendering corporate firewalls impotent in blocking employee access to social sites. It is also counterproductive to the organizations’ business goals, because these devices increasingly are used to access electronic medical records and other data during clinical encounters [12]. Attempted blocking also fails to fully appreciate the ubiquity of employees, who represent our institutions online whether approved by the enterprise or not, and regardless of whether they post during working hours. It also hinders exploration of innovative applications of these tools. What is a responsible stance toward these platforms for medical professionals and their organizations? What if, instead of mainly being risky from compliance and brand or reputation perspectives, social media sites are really potential forces for good in health care? What if they could facilitate knowledge dissemination at a pace that would thrill our predecessors?
BACK TO THE FUTURE After a tornado ripped through Rochester, Minnesota, in August 1883, the head of the local Franciscan order, Mother Alfred Moes, approached Dr William Worrall Mayo with an offer: the sisters would raise funds to build a hospital if Dr Mayo and his sons William J. and Charles H. Mayo, who were physicians-in-training, would provide the medical staffing. The brothers had assisted their father in his practice even as young boys, and they came of age in what became the golden age of surgery. Improved anesthetics and the Mayo trio’s embrace of aseptic surgical techniques, aided by fastidious Franciscan scrub nurses, meant they were able to perform more complex and specialized operations for various indications. As mortality plummeted, excited patients returned home eager to tell of their experiences. Rochester’s rail line connection and the advent of the telegraph caused word of their exploits to spread rapidly. By 1893 patients from 11 states—from New York to Montana—had traveled to Rochester for treatment [13]. With medical knowledge advancing so rapidly, the Mayo brothers were among the first to recognize the need for specialization and teamwork, and this led them to invent the private group practice of medicine. To Journal of the American College of Radiology Kotsenas et al n Social Media of Mayo Clinic
facilitate this new model of multispecialty care, the Mayos’ associate, Dr Henry Plummer, invented the unified medical record as a way of gathering the observations of the diverse team of specialists involved in complex patients’ care and organizing the data to enable the best treatment recommendations [14]. This paper record, the forerunner of today’s electronic health record, was in essence a network for socialization of knowledge about each patient among the involved physicians and other members of the care team.
PROFESSIONAL NETWORKING The elder Mayo had regularly participated in regional and state gatherings of physicians, sharing his experiences and seeking to learn from others. As the pace of change quickened, his sons put an even greater priority on submitting case reports and series to medical journals, attending and presenting their data at physician gatherings, and traveling to observe and learn from other surgeons. As Helen Clapesattle observed in their definitive biography [13]: By the end of the 1920s Dr. Will could say he had studied surgery in every town in America and Canada of one hundred thousand population or more, and had crossed the Atlantic thirty times. Even though he died in 1939, before the era of air travel, Dr Will ultimately conducted this in-person, analog networking in 25 countries on four continents, from Australia to Russia and from Sweden to Argentina. The Mayo brothers welcomed physicians from around the world to visit them, too. The roster of the Surgeons Club, which was composed of physicians who had traveled to Rochester to observe surgery, named nearly 3,400 members who joined between 1908 and 1918 [15]. Analog social networking, whether among patients sharing their experiences with family and friends or in professional interchanges among medical and scientific colleagues, is part of the cultural DNA of Mayo Clinic. Understanding this made Mayo Clinic’s 21st-century venture into digital social media platforms a natural next step.
BRAND RESEARCH AND A NATIONAL MEDIA RELATIONS STRATEGY Mayo Clinic began conducting brand research in the 1990s to assess consumer and patient inclination to consider Mayo Clinic for diagnosis and treatment of 163
serious medical conditions. As the research team probed respondents to identify the sources of information behind these preferences, two key factors emerged: news stories in traditional media and word-of-mouth recommendations from satisfied patients and referring physicians, which drive reputation and brand awareness. In 2009, this led Mayo Clinic leadership to approve a national media relations strategy to cultivate and share more news media stories.
DO NOT JUST PITCH THE MEDIA. BE THE MEDIA With the advent of social media platforms, as well as blogging tools such as WordPress (San Francisco, California, USA) (free, open source), Mayo Clinic’s media relations team saw an opportunity to not only be more effective in outreach to traditional journalists but also to tell its own stories and reach patients and consumers directly. Initial forays were both opportunistic and reactionary, leveraging existing staff and resources. RSS (Rich Site Summary or Really Simple Syndication) is a format that enables web publishers to syndicate regularly updated content to various sites or electronic devices. Creating an RSS feed to list Mayo Clinic’s existing daily series of 60second radio segments in Apple’s new iTunes podcast directory in 2005 led to an 8,412% increase in downloads in a single month. In this early period, Mayo Clinic’s communications team also came to see the importance of owning its brand and protecting its reputation in these emerging online spaces. A music group from County Mayo, Ireland, calling itself “mayo clinic,” had established a page on MySpace.com and included decidedly “off-brand” images. This spurred Mayo Clinic to prevent recurrence by staking its claim on Facebook (2007) and Twitter (2008) and to work with Google to claim ownership of a previously created Mayo Clinic YouTube channel (2008). Some within the organization expressed reservations about participating in such open communications forums. A key concern was that those with complaints would be overrepresented. Those fears were not realized. In its first year, Mayo Clinic’s Facebook page received 130 comments, only one of which was negative. Early successes (some of which are outlined in a companion article in this issue) spurred further adoption of these new tools [16]. Mayo Clinic’s News Blog and Podcast blog were launched in April and June 2008, followed by Sharing Mayo Clinic (sharing. mayoclinic.org), a blog for sharing appropriately 164
consented employee and patient stories, in January 2009. Because this blog encouraged personal storytelling, its launch was accompanied by publication of participation guidelines for patients [11,12] and what we believe were the first social media guidelines for health care employees [17]. In this early period, social media enabled the Mayo Clinic media relations team to more effectively reach journalists while also helping medical specialists grow their practices by providing in-depth information directly to prospective patients, typically through YouTube videos in which they discussed diseases and conditions, demonstrating both expertise and empathy.
AN EXPANDED MANDATE FOR SOCIAL MEDIA In August 2009, Mayo’s incoming President and CEO, John Noseworthy, MD, considered whether a more strategic investment in social media was warranted. His vision was that Mayo Clinic would use social media not just in media relations and marketing but throughout the whole organization to improve patient care, advance medical research, and expand education. This led to hiring eight new employees dedicated to social media and establishing the Mayo Clinic Center for Social Media in July 2010, which became the Mayo Clinic Social Media Network (MCSMN) in 2015. One of the early projects of Mayo Clinic Center for Social Media was a yearlong series in 2011 entitled, “What Would Dr. Will and Dr. Charlie Tweet?” The Mayo brothers were known for their pithy sayings, which had been published in 1951 in a book entitled Aphorisms [17]. The 2011 series broadcasted this wisdom from the Mayo brothers via Mayo Clinic’s Twitter account and published the archive on Sharing Mayo Clinic [18]. The series’ goal was to share this wisdom with a new generation of health care providers and in a new medium to reinforce that using social networking platforms was not a radical departure, but rather was entirely consistent with the practices and values of Mayo Clinic’s founders. Today the eight-member Social & Digital Innovation (SDI) team in Mayo Clinic’s Division of Communications maintains the organization’s enterprise-level representation on major public social networking platforms as well as its own WordPress-based blogging and community platform. The SDI team is a catalyst for social media applications, publishing content from across the organization on enterprise accounts and consulting with Journal of the American College of Radiology Volume 15 n Number 1PB n January 2018
stakeholders interested in individual or specialty and departmental accounts. In the first quarter of 2017, posts on enterprise accounts such as Facebook, Twitter, YouTube, LinkedIn (Sunnyvale, California, USA), Instagram (Facebook, Inc, Menlo Park, California, USA), and Pinterest (San Francisco, California, USA) had more than 965,000 combined engagements (reactions, comments, shares, likes, and retweets), and specialty groups also published to 62 Facebook pages and 52 Twitter accounts. Mayo Clinic’s community and blogging platform, developed in collaboration with CareHubs, Inc (Beaverton, Oregon, USA), provides dynamic publishing capabilities and a customizable community experience. In addition to the pioneering Sharing Mayo Clinic, the platform currently hosts more than 40 blogs and focused communities, the largest of which are: n
n
n
Mayo Clinic Connect (connect.mayoclinic.org), a patient-to-patient community with more than 51,000 members Mayo Clinic News Network (newsnetwork.mayoclinic. org), which provides embargoed news releases and multimedia assets to journalists while also dynamically feeding news releases to relevant pages on Mayo’s flagship website MCSMN (socialmedia.mayoclinic.org), a global community for those interested in advancing health-related applications of social media tools
Following in the example of the Mayo brothers and The Surgeons Club, MCSMN is a vehicle for Mayo Clinic physicians and allied health staff to learn how to incorporate social media tools in their work. It also offers memberships, both free and fee-based, to non-Mayo colleagues worldwide who want to learn together. MCSMN has hosted annual social media summits, involving representatives from most US states as well as international delegates, to encourage colleagues to explore and share their experiences in health care social media applications. In collaboration with Hootsuite (Vancouver, Canada), MCSMN has produced the world’s first continuing medical education-accredited online certificate course in the basics of social media for health care professionals [19]. Mayo has offered a daylong course called Social Media Residency to provide immersive training since 2011. The release of the online certificate in 2015 made basic training accessible on demand and has become a prerequisite to Social Media Residency, enabling conversion of the daylong training into a more advanced course. Journal of the American College of Radiology Kotsenas et al n Social Media of Mayo Clinic
In May 2016, Mayo became one of the first academic medical centers to formally include social media scholarship in academic promotion criteria. Just as traditional activities such as publications in medical journals and presentations at medical conferences are categorized as low, medium, or high impact, social media scholarship efforts are given weight in accord with their reach, influence, and quality. Mayo Clinic recently published our conceptual framework and how-to guidelines [20]. Between 2014 and 2016, the SDI team invested in improving the user experience on its community platform and in active community management, increasing unique visitors to Mayo Clinic Connect by 85% and page views by 530% in 2016. The team has also collaborated with colleagues in marketing, who incorporate social media advertising with other digital advertising to meet demand generation goals.
NO TURNING BACK Social media is here to stay. Social media tools may be used in harmful ways, whether those users are intentionally malicious or not. For example, antivaccine advocates have used social platforms to sow fear and uncertainty among parents, which has contributed to public health crises such as measles and rubella outbreaks. Diet fads promoted online have advanced harmful health practices and contributed to anorexia and related disorders. The question is whether medical professionals and health care organizations will allow misinformation and disinformation to prevail or whether they will intervene to provide trustworthy, scientifically valid perspectives. Clapesattle leaves little doubt that the Mayo brothers would embrace the opportunity [13]: To such an extent as the prohibitions of the medical code would allow, the Foundation added medical education of the public to its functions. This was always a pet idea of both Mayo brothers. As Dr. Will once observed, “The quacks ‘educate’ the public. Why shouldn’t we?” If Dr William Mayo would travel by train to Vancouver and then for 30 days by ship to speak at a medical conference in New Zealand in 1924, we are confident he would eagerly take advantage of social media tools that enable instantaneous worldwide communication on important health issues, and that he would consider it a moral responsibility to do so. 165
Following in this example, Mayo Clinic has embraced social media as an organization and created MCSMN as an enabling resource for its own employees and for health care colleagues everywhere.
TAKE-HOME POINTS -
-
-
Health care organizations and physicians should recognize the importance of owning their brand and protecting their reputation in emerging, online social media spaces. Medical professionals and health care organizations should not allow misinformation and disinformation to prevail when we can use social media to provide trustworthy, scientifically valid perspectives. Using social networking platforms is not a radical departure, but rather is entirely consistent with the traditional mechanisms of knowledge diffusion in medicine.
ACKNOWLEDGMENTS The authors acknowledge the assistance of Sonia Watson, PhD, and Andrea Moran in editing and submitting the manuscript and Renee Ziemer for access to historical documents. REFERENCES 1. Wikipedia. History of YouTube. Available at: https://en.wikipedia.org/ wiki/History_of_YouTube. Accessed April 2, 2017. 2. DomainTools. Whois Record for YouTube.com. Available at: http:// whois.domaintools.com/youtube.com. Accessed April 2, 2017. 3. Facebook. Company Info. Available at: http://newsroom.fb.com/ company-info/. Accessed April 2, 2017. 4. Casti T. The history of Twitter, from egg to IPO. Mashable. Available at: http://mashable.com/2013/10/04/history-twitter/#.iQm2O4_hsqG. Accessed April 2, 2017.
166
5. Forbes. The world’s biggest public companies. Available at: https:// www.forbes.com/global2000/list/#header:marketValue_sortreverse:true. Accessed April 2, 2017. 6. Gandel S. These are the 10 most valuable companies in the Fortune 500. Available at: http://fortune.com/2016/02/04/most-valuablecompanies-fortune-500-apple/. Accessed April 2, 2017. 7. Demos T, Dietrich C, Koh Y. Twitter IPO: relief, riches and a $25 billion finish. Available at: https://www.wsj.com/articles/SB10001424 052702303309504579182403432312182. Accessed April 2, 2017. 8. Shapiro C, Varian HR. Information rules: a strategic guide to the network economy, Boston MA. Harvard Business School Press; 1999. 9. Lewis A. User-driven discontent [blog post]. Retrieved from http:// www.metafilter.com/95152/Userdriven-discontent - 3256046. Published August 26, 2010. Accessed July 29, 2017. 10. PRweb. 59% of surveyed Healthcare professional working in hospitals are blocked from accessing social media in the workplace. PRWeb. Available at: http://www.prweb.com/releases/2013/10/prweb11281848. htm. Accessed July 29, 2017. 11. Dolan B. In-depth: mobile adoption among US physicians. Available at: http://www.mobihealthnews.com/32232/in-depth-mobile-adoptionamong-us-physicians. Accessed April 2, 2017. 12. Cromstock J. Almost one third of physicians use smartphones to manage patient care. Mobile Health News. Available at: http:// www.mobihealthnews.com/45623/almost-one-third-of-physicians-usesmartphones-to-manage-patient-care. Accessed April 2, 2017. 13. Clapesattle H. The Doctors Mayo. Rochester, MN: Mayo Clinic Foundation for Medical Education and Research; 1969. 14. Modern Healthcare. Health care hall of fame 2016: Dr. Henry Plummer. Available at: http://www.modernhealthcare.com/article/ 20160312/HALL_OF_FAME/160309949. Accessed July 29, 2017. 15. Mayo Clinic. Mayo brothers’ wisdom. Available at: http://sharing. mayoclinic.org/mayo-brothers-wisdom/. Accessed April 2, 2017. 16. Kotsenas AL, Arce M, Aase L, Timimi FK, Young C, Wald JT. The strategic imperative for the use of social media in healthcare. J Am Coll Radiol 2017;15:155-61. 17. Mayo CH, Mayo WJ. Aphorisms. Willius FA, editors. Rochester, MN: Mayo Clinic Foundation for Medical Education and Research; 1951. 18. Mayo Clinic. Mayo Clinic social media account: comment policy. Available at: http://blogs.mayoclinic.org/comment-policy/?_ga¼1.187 94041.1622100855.1440708345. Accessed April 2, 2017. 19. Cabrera D, Vartabedian BS, Spinner RJ, Jordan BL, Aase LA, Timimi FK. More than likes and tweets: creating social media portfolios for academic promotion and tenure. J Grad Med Educ 2017;9(4):421-5. 20. Cabrera D, Vartabedian BS, Spinner RJ, et al. Using social media for academic promotion and tenure: more than likes and tweets. J Grad Med Educ 2017. In press.
Journal of the American College of Radiology Volume 15 n Number 1PB n January 2018
INTEGRATING SOCIAL MEDIA INTO HEALTH CARE ORGANIZATIONS
The Social Media DNA of Mayo Clinic—and Health Care Amy L. Kotsenas, MD a , Lee Aase, BS b, Makala Arce, BA b, Farris K. Timimi, MD c, Matthew Dacy, AB, MA d, Colleen Young, BA e, John T. Wald, MD a Abstract Hippocrates’ admonition and the medical community’s aversion to risk have caused many physicians and institutions to resist participation in modern social media sites such as Facebook (Facebook, Inc, Menlo Park, California, USA), Twitter (Twitter Inc, San Francisco, California, USA), and YouTube (San Mateo, California, USA). However, because Mayo Clinic’s founders were champions of analog social networking, it was among the earliest hospitals worldwide to create official accounts on these digital platforms. A proper understanding of the traditional mechanisms of knowledge diffusion in medicine and of the nature of social media sites should help professionals see and embrace the opportunities for positive engagement in social media. Key Words: Social media, professional networking, Facebook, Twitter, YouTube J Am Coll Radiol 2018;15:162-166. Copyright 2017 American College of Radiology
INTRODUCTION Social media sites are a 21st-century innovation; if the major sites were persons, none of them would yet be old enough to vote, or even drive a car. YouTube (San Mateo, California, USA) will become a virtual teenager on February 14, 2018 [1,2]. Facebook (Facebook, Inc, Menlo Park, California, USA) is only a year older [3], and Twitter (Twitter Inc, San Francisco, California, USA) celebrated its 10th birthday in March 2016 [4]. Despite their youthfulness, these sites have massive societal impact, and the companies that own them are economic dynamos. Alphabet (Alphabet Inc, Menlo Park, California, USA), the parent company of Google (Google Inc, Menlo Park, California, USA), which acquired YouTube for $1.6 billion in 2007, is the second most valuable company in the Fortune 500, with market
a
Department of Radiology, Mayo Clinic, Rochester, Minnesota. Social Media Network, Mayo Clinic, Rochester, Minnesota. c Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. d Department of Development, Mayo Clinic, Rochester, Minnesota. e Mayo Clinic Connect, Mayo Clinic, Rochester, Minnesota. Corresponding author and reprints: Amy L. Kotsenas, MD, Mayo Clinic, Department of Radiology, 200 1st Street SW, Rochester, MN 55905; e-mail: [email protected]. The authors have no conflicts of interest related to the material discussed in this article. b
capitalization of $507 billion [5]. Facebook comes in fifth on the list at $321 billion, just behind petroleum giant Exxon Mobil (Irving, Texas, United States) [6]. Even Twitter, the poor cousin among the three, closed its first day of public stock trading in 2013 at a valuation of $25 billion [7]. Unlike Fortune 500 leaders Apple (Apple Inc, Cupertino, California, USA) and Exxon Mobil, social media companies produce no tangible products. They do not even charge end users. Instead, they profit through monetizing Metcalfe’s Law, which holds that the value of a network is proportional to the square of the number of its nodes [8]. Facebook has 1.86 billion monthly active users as of December 31, 2016 [3]. Facebook’s knowledge of the relationships among users, and its ability to target messages based on interests and demographic characteristics in the form of affinity data, have led to its profitability and enormous valuation. As Andrew Lewis observed in 2010, “If you are not paying for it, you’re not the customer; you’re the product being sold” [9]. To add to this user-as-product reality, many health care professionals may have concerns about improper online behavior, negative interactions, or the potential to compromise patient privacy when using social media sites. These fears often result in attempted risk mitigation via elimination, and many hospitals have blocked social media sites at the corporate firewall [10]. ª 2017 American College of Radiology
162
1546-1440/17/$36.00
n
https://doi.org/10.1016/j.jacr.2017.09.026
In an era when we all bring our own devices to work and with more than 80% of physicians using smartphones or tablets [11] with mobile data, this resistance may be futile. These devices with their cellular data plans typically have social media apps installed, rendering corporate firewalls impotent in blocking employee access to social sites. It is also counterproductive to the organizations’ business goals, because these devices increasingly are used to access electronic medical records and other data during clinical encounters [12]. Attempted blocking also fails to fully appreciate the ubiquity of employees, who represent our institutions online whether approved by the enterprise or not, and regardless of whether they post during working hours. It also hinders exploration of innovative applications of these tools. What is a responsible stance toward these platforms for medical professionals and their organizations? What if, instead of mainly being risky from compliance and brand or reputation perspectives, social media sites are really potential forces for good in health care? What if they could facilitate knowledge dissemination at a pace that would thrill our predecessors?
BACK TO THE FUTURE After a tornado ripped through Rochester, Minnesota, in August 1883, the head of the local Franciscan order, Mother Alfred Moes, approached Dr William Worrall Mayo with an offer: the sisters would raise funds to build a hospital if Dr Mayo and his sons William J. and Charles H. Mayo, who were physicians-in-training, would provide the medical staffing. The brothers had assisted their father in his practice even as young boys, and they came of age in what became the golden age of surgery. Improved anesthetics and the Mayo trio’s embrace of aseptic surgical techniques, aided by fastidious Franciscan scrub nurses, meant they were able to perform more complex and specialized operations for various indications. As mortality plummeted, excited patients returned home eager to tell of their experiences. Rochester’s rail line connection and the advent of the telegraph caused word of their exploits to spread rapidly. By 1893 patients from 11 states—from New York to Montana—had traveled to Rochester for treatment [13]. With medical knowledge advancing so rapidly, the Mayo brothers were among the first to recognize the need for specialization and teamwork, and this led them to invent the private group practice of medicine. To Journal of the American College of Radiology Kotsenas et al n Social Media of Mayo Clinic
facilitate this new model of multispecialty care, the Mayos’ associate, Dr Henry Plummer, invented the unified medical record as a way of gathering the observations of the diverse team of specialists involved in complex patients’ care and organizing the data to enable the best treatment recommendations [14]. This paper record, the forerunner of today’s electronic health record, was in essence a network for socialization of knowledge about each patient among the involved physicians and other members of the care team.
PROFESSIONAL NETWORKING The elder Mayo had regularly participated in regional and state gatherings of physicians, sharing his experiences and seeking to learn from others. As the pace of change quickened, his sons put an even greater priority on submitting case reports and series to medical journals, attending and presenting their data at physician gatherings, and traveling to observe and learn from other surgeons. As Helen Clapesattle observed in their definitive biography [13]: By the end of the 1920s Dr. Will could say he had studied surgery in every town in America and Canada of one hundred thousand population or more, and had crossed the Atlantic thirty times. Even though he died in 1939, before the era of air travel, Dr Will ultimately conducted this in-person, analog networking in 25 countries on four continents, from Australia to Russia and from Sweden to Argentina. The Mayo brothers welcomed physicians from around the world to visit them, too. The roster of the Surgeons Club, which was composed of physicians who had traveled to Rochester to observe surgery, named nearly 3,400 members who joined between 1908 and 1918 [15]. Analog social networking, whether among patients sharing their experiences with family and friends or in professional interchanges among medical and scientific colleagues, is part of the cultural DNA of Mayo Clinic. Understanding this made Mayo Clinic’s 21st-century venture into digital social media platforms a natural next step.
BRAND RESEARCH AND A NATIONAL MEDIA RELATIONS STRATEGY Mayo Clinic began conducting brand research in the 1990s to assess consumer and patient inclination to consider Mayo Clinic for diagnosis and treatment of 163
serious medical conditions. As the research team probed respondents to identify the sources of information behind these preferences, two key factors emerged: news stories in traditional media and word-of-mouth recommendations from satisfied patients and referring physicians, which drive reputation and brand awareness. In 2009, this led Mayo Clinic leadership to approve a national media relations strategy to cultivate and share more news media stories.
DO NOT JUST PITCH THE MEDIA. BE THE MEDIA With the advent of social media platforms, as well as blogging tools such as WordPress (San Francisco, California, USA) (free, open source), Mayo Clinic’s media relations team saw an opportunity to not only be more effective in outreach to traditional journalists but also to tell its own stories and reach patients and consumers directly. Initial forays were both opportunistic and reactionary, leveraging existing staff and resources. RSS (Rich Site Summary or Really Simple Syndication) is a format that enables web publishers to syndicate regularly updated content to various sites or electronic devices. Creating an RSS feed to list Mayo Clinic’s existing daily series of 60second radio segments in Apple’s new iTunes podcast directory in 2005 led to an 8,412% increase in downloads in a single month. In this early period, Mayo Clinic’s communications team also came to see the importance of owning its brand and protecting its reputation in these emerging online spaces. A music group from County Mayo, Ireland, calling itself “mayo clinic,” had established a page on MySpace.com and included decidedly “off-brand” images. This spurred Mayo Clinic to prevent recurrence by staking its claim on Facebook (2007) and Twitter (2008) and to work with Google to claim ownership of a previously created Mayo Clinic YouTube channel (2008). Some within the organization expressed reservations about participating in such open communications forums. A key concern was that those with complaints would be overrepresented. Those fears were not realized. In its first year, Mayo Clinic’s Facebook page received 130 comments, only one of which was negative. Early successes (some of which are outlined in a companion article in this issue) spurred further adoption of these new tools [16]. Mayo Clinic’s News Blog and Podcast blog were launched in April and June 2008, followed by Sharing Mayo Clinic (sharing. mayoclinic.org), a blog for sharing appropriately 164
consented employee and patient stories, in January 2009. Because this blog encouraged personal storytelling, its launch was accompanied by publication of participation guidelines for patients [11,12] and what we believe were the first social media guidelines for health care employees [17]. In this early period, social media enabled the Mayo Clinic media relations team to more effectively reach journalists while also helping medical specialists grow their practices by providing in-depth information directly to prospective patients, typically through YouTube videos in which they discussed diseases and conditions, demonstrating both expertise and empathy.
AN EXPANDED MANDATE FOR SOCIAL MEDIA In August 2009, Mayo’s incoming President and CEO, John Noseworthy, MD, considered whether a more strategic investment in social media was warranted. His vision was that Mayo Clinic would use social media not just in media relations and marketing but throughout the whole organization to improve patient care, advance medical research, and expand education. This led to hiring eight new employees dedicated to social media and establishing the Mayo Clinic Center for Social Media in July 2010, which became the Mayo Clinic Social Media Network (MCSMN) in 2015. One of the early projects of Mayo Clinic Center for Social Media was a yearlong series in 2011 entitled, “What Would Dr. Will and Dr. Charlie Tweet?” The Mayo brothers were known for their pithy sayings, which had been published in 1951 in a book entitled Aphorisms [17]. The 2011 series broadcasted this wisdom from the Mayo brothers via Mayo Clinic’s Twitter account and published the archive on Sharing Mayo Clinic [18]. The series’ goal was to share this wisdom with a new generation of health care providers and in a new medium to reinforce that using social networking platforms was not a radical departure, but rather was entirely consistent with the practices and values of Mayo Clinic’s founders. Today the eight-member Social & Digital Innovation (SDI) team in Mayo Clinic’s Division of Communications maintains the organization’s enterprise-level representation on major public social networking platforms as well as its own WordPress-based blogging and community platform. The SDI team is a catalyst for social media applications, publishing content from across the organization on enterprise accounts and consulting with Journal of the American College of Radiology Volume 15 n Number 1PB n January 2018
stakeholders interested in individual or specialty and departmental accounts. In the first quarter of 2017, posts on enterprise accounts such as Facebook, Twitter, YouTube, LinkedIn (Sunnyvale, California, USA), Instagram (Facebook, Inc, Menlo Park, California, USA), and Pinterest (San Francisco, California, USA) had more than 965,000 combined engagements (reactions, comments, shares, likes, and retweets), and specialty groups also published to 62 Facebook pages and 52 Twitter accounts. Mayo Clinic’s community and blogging platform, developed in collaboration with CareHubs, Inc (Beaverton, Oregon, USA), provides dynamic publishing capabilities and a customizable community experience. In addition to the pioneering Sharing Mayo Clinic, the platform currently hosts more than 40 blogs and focused communities, the largest of which are: n
n
n
Mayo Clinic Connect (connect.mayoclinic.org), a patient-to-patient community with more than 51,000 members Mayo Clinic News Network (newsnetwork.mayoclinic. org), which provides embargoed news releases and multimedia assets to journalists while also dynamically feeding news releases to relevant pages on Mayo’s flagship website MCSMN (socialmedia.mayoclinic.org), a global community for those interested in advancing health-related applications of social media tools
Following in the example of the Mayo brothers and The Surgeons Club, MCSMN is a vehicle for Mayo Clinic physicians and allied health staff to learn how to incorporate social media tools in their work. It also offers memberships, both free and fee-based, to non-Mayo colleagues worldwide who want to learn together. MCSMN has hosted annual social media summits, involving representatives from most US states as well as international delegates, to encourage colleagues to explore and share their experiences in health care social media applications. In collaboration with Hootsuite (Vancouver, Canada), MCSMN has produced the world’s first continuing medical education-accredited online certificate course in the basics of social media for health care professionals [19]. Mayo has offered a daylong course called Social Media Residency to provide immersive training since 2011. The release of the online certificate in 2015 made basic training accessible on demand and has become a prerequisite to Social Media Residency, enabling conversion of the daylong training into a more advanced course. Journal of the American College of Radiology Kotsenas et al n Social Media of Mayo Clinic
In May 2016, Mayo became one of the first academic medical centers to formally include social media scholarship in academic promotion criteria. Just as traditional activities such as publications in medical journals and presentations at medical conferences are categorized as low, medium, or high impact, social media scholarship efforts are given weight in accord with their reach, influence, and quality. Mayo Clinic recently published our conceptual framework and how-to guidelines [20]. Between 2014 and 2016, the SDI team invested in improving the user experience on its community platform and in active community management, increasing unique visitors to Mayo Clinic Connect by 85% and page views by 530% in 2016. The team has also collaborated with colleagues in marketing, who incorporate social media advertising with other digital advertising to meet demand generation goals.
NO TURNING BACK Social media is here to stay. Social media tools may be used in harmful ways, whether those users are intentionally malicious or not. For example, antivaccine advocates have used social platforms to sow fear and uncertainty among parents, which has contributed to public health crises such as measles and rubella outbreaks. Diet fads promoted online have advanced harmful health practices and contributed to anorexia and related disorders. The question is whether medical professionals and health care organizations will allow misinformation and disinformation to prevail or whether they will intervene to provide trustworthy, scientifically valid perspectives. Clapesattle leaves little doubt that the Mayo brothers would embrace the opportunity [13]: To such an extent as the prohibitions of the medical code would allow, the Foundation added medical education of the public to its functions. This was always a pet idea of both Mayo brothers. As Dr. Will once observed, “The quacks ‘educate’ the public. Why shouldn’t we?” If Dr William Mayo would travel by train to Vancouver and then for 30 days by ship to speak at a medical conference in New Zealand in 1924, we are confident he would eagerly take advantage of social media tools that enable instantaneous worldwide communication on important health issues, and that he would consider it a moral responsibility to do so. 165
Following in this example, Mayo Clinic has embraced social media as an organization and created MCSMN as an enabling resource for its own employees and for health care colleagues everywhere.
TAKE-HOME POINTS -
-
-
Health care organizations and physicians should recognize the importance of owning their brand and protecting their reputation in emerging, online social media spaces. Medical professionals and health care organizations should not allow misinformation and disinformation to prevail when we can use social media to provide trustworthy, scientifically valid perspectives. Using social networking platforms is not a radical departure, but rather is entirely consistent with the traditional mechanisms of knowledge diffusion in medicine.
ACKNOWLEDGMENTS The authors acknowledge the assistance of Sonia Watson, PhD, and Andrea Moran in editing and submitting the manuscript and Renee Ziemer for access to historical documents. REFERENCES 1. Wikipedia. History of YouTube. Available at: https://en.wikipedia.org/ wiki/History_of_YouTube. Accessed April 2, 2017. 2. DomainTools. Whois Record for YouTube.com. Available at: http:// whois.domaintools.com/youtube.com. Accessed April 2, 2017. 3. Facebook. Company Info. Available at: http://newsroom.fb.com/ company-info/. Accessed April 2, 2017. 4. Casti T. The history of Twitter, from egg to IPO. Mashable. Available at: http://mashable.com/2013/10/04/history-twitter/#.iQm2O4_hsqG. Accessed April 2, 2017.
166
5. Forbes. The world’s biggest public companies. Available at: https:// www.forbes.com/global2000/list/#header:marketValue_sortreverse:true. Accessed April 2, 2017. 6. Gandel S. These are the 10 most valuable companies in the Fortune 500. Available at: http://fortune.com/2016/02/04/most-valuablecompanies-fortune-500-apple/. Accessed April 2, 2017. 7. Demos T, Dietrich C, Koh Y. Twitter IPO: relief, riches and a $25 billion finish. Available at: https://www.wsj.com/articles/SB10001424 052702303309504579182403432312182. Accessed April 2, 2017. 8. Shapiro C, Varian HR. Information rules: a strategic guide to the network economy, Boston MA. Harvard Business School Press; 1999. 9. Lewis A. User-driven discontent [blog post]. Retrieved from http:// www.metafilter.com/95152/Userdriven-discontent - 3256046. Published August 26, 2010. Accessed July 29, 2017. 10. PRweb. 59% of surveyed Healthcare professional working in hospitals are blocked from accessing social media in the workplace. PRWeb. Available at: http://www.prweb.com/releases/2013/10/prweb11281848. htm. Accessed July 29, 2017. 11. Dolan B. In-depth: mobile adoption among US physicians. Available at: http://www.mobihealthnews.com/32232/in-depth-mobile-adoptionamong-us-physicians. Accessed April 2, 2017. 12. Cromstock J. Almost one third of physicians use smartphones to manage patient care. Mobile Health News. Available at: http:// www.mobihealthnews.com/45623/almost-one-third-of-physicians-usesmartphones-to-manage-patient-care. Accessed April 2, 2017. 13. Clapesattle H. The Doctors Mayo. Rochester, MN: Mayo Clinic Foundation for Medical Education and Research; 1969. 14. Modern Healthcare. Health care hall of fame 2016: Dr. Henry Plummer. Available at: http://www.modernhealthcare.com/article/ 20160312/HALL_OF_FAME/160309949. Accessed July 29, 2017. 15. Mayo Clinic. Mayo brothers’ wisdom. Available at: http://sharing. mayoclinic.org/mayo-brothers-wisdom/. Accessed April 2, 2017. 16. Kotsenas AL, Arce M, Aase L, Timimi FK, Young C, Wald JT. The strategic imperative for the use of social media in healthcare. J Am Coll Radiol 2017;15:155-61. 17. Mayo CH, Mayo WJ. Aphorisms. Willius FA, editors. Rochester, MN: Mayo Clinic Foundation for Medical Education and Research; 1951. 18. Mayo Clinic. Mayo Clinic social media account: comment policy. Available at: http://blogs.mayoclinic.org/comment-policy/?_ga¼1.187 94041.1622100855.1440708345. Accessed April 2, 2017. 19. Cabrera D, Vartabedian BS, Spinner RJ, Jordan BL, Aase LA, Timimi FK. More than likes and tweets: creating social media portfolios for academic promotion and tenure. J Grad Med Educ 2017;9(4):421-5. 20. Cabrera D, Vartabedian BS, Spinner RJ, et al. Using social media for academic promotion and tenure: more than likes and tweets. J Grad Med Educ 2017. In press.
Journal of the American College of Radiology Volume 15 n Number 1PB n January 2018