Summary of Findings

This study concludes that hospitals across the United States are not using Facebook to its capacity to engage patients or build hospital brands. Of those hospitals that do understand the potential value of Facebook, children’s hospitals appear to lead the way with innovative community-building activities and in several cases, large networks.

As hospitals face major changes in the coming healthcare environment, they are also subject to the same media and market fragmentation as any other business, and must recognize that the media landscape has changed.  It is clearly time for hospitals to recognize the opportunities that Facebook (in particular) and social media (in general) offer as hospitals seek to improve access to care and develop deeper partnerships with patients, families and communities.  It is also essential, from an investment point of view, for hospitals to recognize that the rise of social media impacts their marketing mix, and adjustments to media mix and marketing communications investments in terms of dollars and resources must be made accordingly.

For hospitals, today’s social media is also playing a particularly important role in building foundations now for the next generation of physicians and enhancing relationships with current physicians. Within the emerging world of Accountable Care Organizations we can only imagine the role social media might play in physician, hospital, insurance and patient relationships. Having grown up “digital” young physicians and their patients are going to be looking for innovative ways to provide care and manage wellness.

Indisputably, Facebook and the communities created there are essential to building hospital brand equity in these rapidly changing times.

Rationale for This Study

• The Internet has become a source of health information for many Americans, with 8 out of 10 searching for healthcare-related topics online. We wanted to better understand how people are making and changing the way they select 1) elective healthcare, 2) physicians, and/or 3) hospitals, for their own or their family’s healthcare needs. Research literature is just beginning to explore social media’s role in Americans’ healthcare hospital experiences.
• Medical sites like WebMD, MayoClinic.com, Vitals.com, Healthgrades.com and others offer unprecedented access to health information to feed this growing consumer appetite for health information. We wanted to understand why hospitals are not in a leadership role in solving consumers’ need for reliable, easily accessible information.
• Like many businesses, hospitals appear to be starting to leverage the power of social media to reach patients and expand their brand footprint. Yet it was unclear how well they are capitalizing on Facebook’s unique power.
• More American hospitals are turning to Facebook to reach patients and expand their brand footprint there and on other social networks. What we wanted to understand was whether hospitals are using the broad scope and depth of Facebook.
• Facebook, as with other social media, is a medium of engagement. We wanted to determine the type of and level of engagement with which hospitals are building communities and deeper relationships with their customers on Facebook.

Methodology

• In this study, we sought to better understand how hospitals across the United States are using social media, specifically Facebook. The study period took place December 15, 2010—January 12, 2011.

• We used observational research because of the lack of software or an automated program capable of assisting us with this study. We reviewed the Facebook presence of 120 hospitals of various sizes and types (academic medical centers, community hospitals and safety net hospitals) in all 50 states.

• Because we used human observers to review activity, we back-logged eight weeks of each hospital’s Facebook page presence to determine level and type of activities.

Limitations of this Study

We observed how hospitals and members in their networks behave on Facebook. We acknowledge that we do not know the role Facebook plays in each hospital’s overall marketing and outreach strategy, if it plays a role at all. We are also not privy to budgets or resource allocation which each hospital allocates to Facebook.

Acknowledgments

This study is a joint project of Simon Associates Management Consultants and Verasoni Worldwide.

Findings – Data Presentation

Hospitals are participating on Facebook regardless of their type of institution (academic, community or safety net) or their respective size. All 120 hospitals we selected for our sample had a Facebook presence.

Facebook Members[1]

Of the sample we reviewed, only 8 of 120 hospitals (7%) had more than 10,000 members. Very few hospitals had over 5000 members on their Facebook pages. Five hospitals (4%) had between 5,001–10,000 members. On the other hand, over 50% of the sample (70 of 120) had a very small base of between 0 and 1000 members.

Children’s hospitals when compared to hospitals in general have a very different member profile. We found that children’s hospitals had significantly more fans than non-children’s hospitals. Notables are Children’s Hospital of Boston with 465,073 fans, Seattle’s Children’s Hospital with 15,510 members, and The Children’s Hospital in Aurora, CO with 7,033 members.

We postulate that either parents, children, friends and family members are far more actively involved with a children’s hospital than adults are with a general medical facility or those children’s hospitals better understand social media and the role it can play in the lives of their patients, families and community.

Frequency of Posts

We looked at posts of healthcare information and hospital-related news and found that:

• Less than 40% (48) posted daily
• 24% (29) posted at least twice per week
• 23% (28) posted monthly (once per month)
• Of the rest, 3 hospitals posted less than once per month, while 6 had a presence but no activity at all on Facebook.

Many hospitals used the post function to deliver vaccine information or cold and flu prevention tips.

In frequency as well as membership, children’s hospitals appear to be quite active. Specialty hospitals like MD Anderson and national brands such as the Mayo Clinic and the Cleveland Clinic had a high level of post frequency. Several regional hospitals such as Lahey Clinic in Boston and St. Joseph’s Hospital in Atlanta also posted daily.

Use of Events Function on Facebook

We observed that only 5% of hospitals (6) used the ‘Wall’ to post hospital events. Less than 43% (51) did not use Facebook’s events calendar to post their events, while 52% (63) did use the function.

Use of Facebook Tools: Discussion Boards

Most hospitals did not use Facebook’s discussion boards. One hundred and three hospitals (86%) had zero topics in their Facebook’s Discussion Board pages, 15 had between 1 and 10 topics, and only 2 hospitals had more than 10 topics.

Use of Facebook Tools: ‘Notes’

In this category as well, we found that most of the hospitals sampled (98 or 82%) did not use Facebook’s ‘Notes’ capabilities to publish; 22 hospitals (18%) did utilize the function. ‘Notes’ can be used to push out news, health alerts, announcements, or messages relevant to the hospital’s Facebook members or to its strategic communication efforts.

Feedback: Solicited & Unsolicited

Despite the fact that Facebook is a foundation for building communities and engaged relationships, we found that 89 hospitals (74%) had no unsolicited feedback or questions on their pages, while 31 hospital Facebook pages (26%) included unsolicited feedback from their Facebook members.

The majority of hospitals did not actively seek feedback from their members about disease states, services, or other areas in which they might be engaged. On the other hand, hospitals that asked for feedback did so about service type, level, and solicited member opinions on particular topics related to the hospital.

Engagement Opportunities: Incentives, Games, Apps, Contests:

Only 5 hospitals had games, apps, contests or incentives, while 115 hospitals did not.

Engagement Opportunities: Photo Sharing

The majority of hospitals, 72 (60%), did not allow members to share photos on their Facebook page, while 48 hospitals (40%) allowed members to do so. Some hospitals allowed members to post photos of diseases with questions about their condition, which the hospital responded to. These hospitals then drove the member to 1) other health information or 2) asked them to call a number where they could get assistance. In the case of children’s hospitals, several members posted photos of their ‘well’ children, with notes of thanks to hospital staff for helping make their children better during their stay at the hospital.

Media Integration: Video

Only 49 hospitals (41%) uploaded video directly onto their Facebook page and 71 (59%) did not. We did not study whether hospitals in our sample had Youtube channels.

Media Integration: Offline Advertising

We found that 117 hospitals (98%) did not integrate offline advertising such as television, billboard or print advertising, and only 3 hospitals did.

Online Integration: Blogs

We found that most hospitals (92% or 110) did not integrate blogs into their Facebook presence. In general, hospitals did not blog. However, digging further into the sample base, we found that some of the hospitals that did not integrate a blog into Facebook did in fact have blogs—they simply were a separate channel not integrated into their Facebook experience. There were 10 hospitals that did integrate blogs into their Facebook presence.

Online Integration: Twitter

Twitter is a popular social micro-blogging site. Of the 120 hospitals on Facebook in this stufy, only 10 integrated Twitter into Facebook, while 110 (92%) did not.

Hospital Services & Facebook

When we looked for descriptions of clinical services that the hospital offered, we found that 96 hospitals (80%) did not integrate their clinical services into Facebook, while 24 hospitals (20%) did so.

Discussion of Findings

Hospitals are not engaging Facebook

Overall, the majority of hospitals in this study do not use Facebook to advance their mission and business goals. That said, children’s hospitals in this study seem to ‘get’ Facebook and their members use it in a wide range of activities that range from sharing with others the medical status of a child to giving thanks to a hospital years after its staff cared for a child.

The level of quality patient/family interaction on Facebook was without a doubt the highest on children’s hospital pages.

Facebook activity builds communities

On hospital pages where there was a high degree of interaction between the hospital and members, we found that the patients, family members, friends and members of the community used the hospital’s Facebook presence to share and connect. Facebook allowed people to tell their own stories of hope and struggle, and to share them with others who had similar concerns related to a health topic or a disease state.

Clearly, Facebook was doing its job for people looking for ways to share their personal experiences about their healthcare or hospital experience. This was especially the case in children’s hospitals but also was apparent in many pages of non-children’s hospitals’ Facebook presence. Patients, family members and caregivers used the Facebook pages to reach out and find others dealing with similar issues.

Children’s Hospitals are Leading the Field

We were very interested in how the children’s hospitals were using Facebook, or rather how their patients and families were using the children’s hospital Facebook sites.

There seem to be several key areas:

• Parents communicating with family, friends and others on the status or concerns related to a child’s condition
• Nurses, staff and others shown caring for a child
• Anniversary moments for parents to give thanks, perhaps years after a child was cared for by the hospital
• Simple inquiries about ‘how-to’ at the hospital, guiding people who were new to the hospital about how to navigate within it
• Patients using it to stay connected with their friends and family
• Fundraising was an important part of the Facebook experience
• The children’s hospitals were encouraging these interactions. These hospitals established the facebook environment and are allowing their user to nurture it.

To expand on these findings:

Children’s hospitals in this study have Facebook mass, meaning that the hospitals we studied seemed to be very engaged in Facebook. Their networks—the number of people on their pages—are larger than most hospitals in the study.

The hospitals utilized Facebook to engage their audiences and, in turn, they allowed their audience to be engaged. Activities ranged from patients and their families posting videos of their experiences at the hospital that demonstrated the quality of care they were receiving to how nurses, physicians or staff helped patients during their stay at the hospital. One video showed a nurse giving a 5-year-old girl a manicure to distract her from an uncomfortable test she was having. Another video showed a party the nurses threw for a young patient celebrating the patient’s final radiation treatment.

Activity by parents in support of the hospital was high. Many parents posted thanks or praise of the hospital many years after their child had been cared for at the institution. We noticed posts on the anniversary date of a surgery or treatment that saved their child’s life. Clearly these hospitals hold special meaning for these families. Facebook allows them to express it easily, then distributes it to a large audience.

There were several other patterns evident on these sites. Parents new to the hospital environment posted questions and concerns. Many seemed simply informational, such as the cost of parking or whether there were food discounts for family members. Regardless of the topic, the need to know and the opportunity to engage were key in building a relationship with a patient or family member. The services provided could have been achieved in other communication modes (the telephone or the web) but asking others on Facebook was ‘the way we do it’ and should be viewed as a powerful way to enable people to achieve their goals easily.

Moreover, given the number of sincere and helpful replies that were given, no person’s question was viewed as trivial by others that have been ‘in their shoes.’ The simple need to know and to share a prior experience is profoundly important to people when they or their child is in a healthcare institution. Many people used Facebook to offer answers to the particular question, in addition to well wishes and other advice.

Overall, when viewing all the broad range of topics and activity, it is clear that Facebook gives patients and their families a place to find support from others who are going through or have gone through similar situations. It removes the mystery that comes with having to deal with something unknown in an environment that is uncertain and forbidding. It allows families to express gratitude to the doctors and nurses that have cared for their children. And, through video and photos, they shared with others their appreciation of how well they were cared for and how they were doing when they were in the hospital.

For patients that are in isolation in the hospital because of their illness, the Facebook community allowed them to continue to connect with others inside the hospital and outside in their personal community.

Facebook also allowed children’s hospitals themselves the opportunity to broadcast their accomplishments to a targeted audience that believe in the work they are doing. Many of these used Facebook for fundraising efforts. They also used their pages to announce new technology the hospital had acquired or a new staff member who had joined them. And by posting general health information pertaining to their particular audience, such as vaccine information or cold and flu prevention, they develop viewers and fans who then turn to the hospital for repeat relationships.

Relevant Activity as the Key to Engagement

It is therefore correct to infer, as with other markets and businesses, that relevant activity is key to patient engagement on Facebook. Also, the growth of a hospital’s Facebook group membership reflects that relevance. Facebook presence is equally important for a hospital to use to turn individuals into a community that is more deeply involved with the institution.

Simply looking at the number of ‘Likes’ these hospitals have, compared to the size of the hospital (number of beds), gives a clear picture that patients’ interest and interaction continues long after they are discharged.

People dealing with illness—their own or that of someone they care about—are facing a traumatic period in their lives and need support. Why not get this support from the hospital they trust? Facebook offers them an implicit navigator or guide, as well as a way to express their feelings. These emotions are critical in the way they will feel about that hospital long after they have returned to their daily lives.

Hospital Activity and Relevance

Facebook activities on the part of hospitals must have a level of relevancy comparable to its network. While size of Facebook membership counts, it is the size of relevant membership that really matters in branding and marketing communications.

At the same time, having a large membership on Facebook without ‘working the relationship’ is meaningless. Page members need to be informed and engaged with activities relevant to their needs and lifestyles.

Is it Time for Hospitals to Engage on Facebook?

This study showed that for the most part, hospitals are dormant on Facebook. Facebook does represent an outlet for hospitals to expand their influence, reach patients and drive the mission through social networking. However, this requires a plan for growing the hospital’s network and keeping that network engaged. This plan must also be integrated into a hospital’s global marketing communications plans. Network size is important because a hospital’s Facebook members can expose the hospital’s brand (good or bad) to members of their own network.

The potential of social media to engage with healthcare and participate in the healing process is still emerging. Sites such as www.PatientsLikeMe.com and www.wearechrons.com are responses to people’s need to know more about diseases, to share personal experiences and perspectives, and to hopefully find better solutions to their situations. Patients and family members are certainly using their own Facebook pages to communicate and share their needs with their friends.

Serious Brand Implications

Social media is still young and emerging as a platform for hospitals to use to engage with and assist their patients, families, physicians, staff and communities and to address these individuals’ different but related needs to connect, support each other, and care for the sick, injured, and loved-ones’ caregivers.

Facebook’s scope is far beyond the surface level, and hospitals are just beginning to understand its implications and potential. This may well be the time for hospitals, physicians and patients to explore how to build better access to healthcare information and how to create the support that is needed when people are coping with health issues and illness.

There are serious brand and business implications in every marketing communications campaign, on Facebook or off. Like a website, magazine, or television advertising, Facebook properties offer visitors insights into a hospital’s culture and brand experience. The brand promise comes through its social media touch points. How a Facebook page is organized and the types and frequency of posts convey certain messages (positive, negative, or neutral) to the visitor. How well the hospital supports postings, comments and interactions on its fan page is not incidental but critical to how it wants people to see its services and its brand promise. Is it welcoming and engaging or off-putting? Technologically sophisticated, socially supportive, or both? Appropriate maintenance of information and content, or lack thereof, definitely have implications for the name and brand of any healthcare institution.

Our Take

As Facebook evolves, it will continue to provide a constantly growing and changing platform to achieve integration of off-line and online marketing efforts and growing public health awareness initiatives. Rather than passively waiting to see how others might mold this movement, hospitals would be wise to capture the moment and lead the healthcare industry in finding simpler and easier ways for people to access information that is trustworthy, to develop strong enduring bonds and loyalty to their hospital, and to see these institutions as important parts of their communities—when they are sick or injured and even when they just want to access them.

Why hospitals are just beginning to realize the vital importance of Facebook is as much a reflection of their own marketing strategies and community building philosophies as it is their understanding of their roles in the lives of those they serve.

---

[1] While we looked at 120 hospitals, 6 hospitals had Facebook presence but not an active account. We use 120 as the denominator all calculations of percentages calculations.