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Photo by NEC Corporation of America via Creative Commons license on Flickr


If you’re a healthcare executive, you well understand the bottom line burden – growing or maintaining your patient base to create revenue, and minimizing expenses, often in the form of penalties and fines. Good news – there are many examples of social media being used in the healthcare industry to support those bottom line objectives.

There are three main categories of social media for healthcare, or as we refer to it here at red balloon, “The Social Media Trifecta” – 1) social media used by your marketing team for business development and outreach, 2) social media used by patients, and 3) social media guidelines that should be in place for ALL employees.

Your organization’s social media guidelines and training should encompass all three of these categories, both for business development purposes and to avoid violations. Read on to learn more.

1) Social Media for Your Marketing Team

Social media makes sense for engaging past, current and prospective patients. A recent study by Mediabistro found that 40% of survey participants indicated that information found through social media affects they way they deal with their health. Your organization has an important part to play in providing meaningful and accurate information to those patients through social media channels.

Many healthcare organizations are shooting from the hip, though, allowing untrained or inexperienced employees to post to social media channels on the fly. Social media processes should be documented and all in-house and outsource marketing members should be trained on those processes. Consider planning posts in advance to ensure posts are well thought out and error free. Have a second employee review all posts before they are published to catch grammatical errors, typos and potential violations (for example, identifying a patient by publishing a photo without written consent).

Bonus Tip: Have a plan for dealing with a complaint or negative publicity on social media before it happens (it will).

2) Social Media Used by Patients

Mediabistro also found that 18-24 year olds are twice as likely to use social media for health related conversations than their older counterparts. You can bet on explosive growth in the numbers of prospective patients looking for information about conditions and treatments, or looking to connect with those who have similar situations in the years to come. Not only should marketing employees be meeting these patients where they are (on social media!), social media may play a valuable role in health and well being.

A manuscript published by the National Center for Biotechnology Information had this to say: “During the last 30 years, researchers have shown great interest in the phenomena of social support, particularly in the context of health. Prior work has found that those with high quality or quantity of social networks have a decreased risk of mortality in comparison to those who have low quantity or quality of social relationships, even after statistically controlling for baseline health status.” Further, a study cited in the publication found that those with lower social interaction and less social support were 1.5 times more
likely to have a myocardial infarction (heart attack) and were twice as likely to be readmitted to the hospital than patients with strong social support systems.

We will continue to see leading healthcare organizations encourage patient use of social media, and integration of social media into the healthcare environment.

Bonus Tip: An interesting note on the use of social media for giving support – those providing support also benefited; according to the publication, elderly individuals who provided social support felt more useful and experienced fewer incidences of disability and mortality.

3) Social Media Guidelines for All Employees

There are a number of cases of HIPAA and NLRA violations in social media in recent years. Take the case of Kathryn Knott:

“Babysitting a 36 yo 30pillxanax overdose and holding the urinal for him is definitely what I wanted to do today #winninglikeVegas.” – Kathryn Knott, ER Tech via Twitter

In the fall of 2014, she and two friends were arrested for allegedly assaulting another couple. During the investigation, a treasure trove of the stuff you do not want your employees posting was found on her Twitter account. In addition to the post above, she also published photos of patients’ x-rays, one patient’s severed fingers and more. Unfortunately, this is not a unique situation, there are many cases of nurses, techs and physicians who believe that they are in the clear when posting photos or intimate details of their patients’ conditions as part of sharing their days on social media sites.

Your social media guidelines should align with your code of conduct, should clearly define protected health information (PHI) and provide examples of professionals who paid the consequences for posting PHI.

Bonus Tip: Not only should employees receive training on avoiding HIPAA violations in their personal social media use, managers should understand how to avoid NLRA violations (for example, reprimanding an employee for posting about wages or workplaces conditions on social media).

Have questions or need help to succeed with the Social Media Trifecta? Contact me and set up a complimentary 30 minute phone consult. We have packages to fit many budgets and to serve several scenarios including consulting retainers, social media management that is effective and compliant, and corporate training on avoiding NLRA and HIPAA violations. Contact me at 480-270-5395 or

For a limited time, you can also download a complimentary copy of The Healthcare Executive’s Guide to Social Media, full of stats and case studies on how healthcare organizations are using social media and how to avoid HIPAA and NLRA violations as related to social media usage.

Jennifer MaggioreJennifer Maggiore is a nationally recognized social media consultant, author and speaker. She launched her company in 2005, quickly expanding her business as one of the country’s first social media consultants.

Today, she and her team work with public and private companies throughout the United States, offering social media management, strategy and training services, including a specialty in HIPAA and NLRA consulting for healthcare organizations.

red balloon was named a Top 10 Marketing Firm in her home state of Arizona, Jennifer was recognized as one of 35 Women Entrepreneurs in Arizona Under 35, and she was most recently interviewed for the show Roadtrip Nation.

KathrynKnottEmergency room technician Kathryn Knott was fired from Lansdale Hospital-Abingdon Health in Pennsylvania last year after complaining about patients on her Twitter account and posting pictures of them — including a severed finger — and in the process became a vivid example of how social media can go awry in health care. This and other incidents underscore the importance of implementing a social media policy.

“We can’t leave it up to chance,” said Jennifer Maggiore, CEO of Red Balloon Inc. in Phoenix. “Never assume employees will use the same good judgment that you would.” With the social-media revolution — Americans spend 510 minutes on Facebook a month on average, she said — compliance and privacy officers are considering how it implicates different laws, including HIPAA and the National Labor Relations Act (NLRA). Employers may assume that Facebook posts that bash or embarrass them are grounds for employee termination, but that’s not necessarily the case, says Minneapolis attorney Norah Olson Bluvshtein, with Fredrikson & Byron. The answer is it depends. If employees post a picture of themselves taking a bath in a sink at work, fire away, she says. “But other situations are more complicated,” with the National Labor Relations Board (NLRB) putting the cutting-edge fact patterns of social media through the prism of the 1935 NLRA. It probably doesn’t help that only one-third of health care organizations have social media guidelines, Maggiore said.

Front and center in social media use is the risk to patient privacy and potential HIPAA violations. Against a backdrop of respect for free speech, hospital and clinic employees are held to certain restrictions, says Nickie Braxton, privacy officer at Boston Medical Center. Health care workers may not mention patients or post photos of them on social media sites they use privately, she says. Employees may think it’s none of the hospital’s business because they use their own devices and personal accounts for Facebook, Twitter or other social media sites, and employees have blurred the lines sometimes between professional and personal. The superseding message: “What you learn in the hospital stays in the hospital,” Braxton says.

But it may sometimes seem like hospitals are talking out of both sides of their mouth. Hospitals have their own Facebook pages for communication and education, but they warn employees not to talk about their patients on their personal Facebook pages and, to some extent, the hospitals themselves. “On the one hand we are fostering the use of social media, and on the other hand we are saying, ‘you have to be very careful when you go on social media, and you can’t share patient information in any way or refer to patients in any way under threat of discipline,’” Braxton says. “It goes against the general cultural norm for employees who are so used to sharing their lives on social media.” In particular, nurses and other clinicians can form intimate relationships with patients and may be tempted to friend each other on Facebook or Instagram, she says. “The challenge is to help people understand there is a professional life and there is a personal life. In your professional life, you are expected to be friendly toward patients, but you are not expected to friend a patient,” Braxton says. “People come here not because we are friends but because we uphold a certain professionalism and standard of care that we are expected to maintain at all times.”

Pictures on social media are off-limits. Even when everyone has agreed to take pictures, there is still a risk. Maybe the patients misunderstood or changed their mind later, or unrelated patients in the background show up in the picture and they haven’t given consent, Braxton says.

Social Media Fires Up NLRB

Anonymous postings will not protect employees and physicians, a lesson learned in a blogger case, Maggiore said at a May 13 Health Care Compliance Association webinar. A Boston pediatrician, who was a popular, award-winning but anonymous blogger, shared his experiences in medicine. “People loved it,” Maggiore said. “Things took a wrong turn when he published blogs” about serving as an expert witness for the defendant in a wrongful death case. The blogger, known as “Flea,” revealed too much, she said. The blogger was outed in 2007 as physician Robert Lindeman, and he admitted it, according to The Boston Globe. “There’s no such thing as anonymity online,” Maggiore cautioned. People have the illusion of invisibility, and “that fans the fame of aggressive behavior.” Employees should be trained to post only items they can stand behind, she said. “Be proud of those posts, and if not, don’t post them,” she said. Employees also use social media to comment on hospitals and other employers, and how they react — firing employees for nasty posts, for example — may have consequences. The NLRB, which enforces the NLRA, may uphold the termination, or not, which means back pay for the employee and reinstatement. The NLRA applies to union and non-union workers, Bluvshtein says. Sec. 7 of the NLRA gives employees the right to discuss the terms and conditions of employment. It’s construed broadly, she says, and covers wages, other compensation and how their supervisors treat them. That means employees can talk to each other critically about management, she says. Social media is turning into a flash point with the NLRB, which is “heavily focused on social media firing cases,” Bluvshtein says. Here are a couple of examples:

American Medical Response: A paramedic was fired in 2010 after posting remarks on Facebook about her supervisor, Bluvshtein says. The paramedic wrote that “looks like I’m getting some time off. Love how the company allows a 17 to be a supervisor,” referring to a psychiatric-patient code. A colleague asked what happened, and the paramedic responded that the supervisor was being a jerk (using a vulgar word). “Chin up,” the co-worker said. The NLRB declared the paramedic’s termination unlawful, Bluvshtein says, because “employees have the right to criticize supervisors.” The NLRB protected her posts also because “her fellow employees posted support,” Maggiore said. “They voiced their frustration.” The lesson here, Maggiore said, is that managers and human resources are not grasping the fact that social media is another communication tool that’s often protected.

SkinSmart Dermatology: An employee was fired from the dermatology clinic after daring her supervisors to do it on a social media site, Bluvshtein says. The employee said the supervisors were full of it and seemed to be steering clear of her because she didn’t bite her tongue anymore. “She claimed the post was protected because she has a right to badmouth her supervisor,” but that was not upheld by the NLRB. “No co-workers joined in the criticism. To be protected, it can’t be a single employee,” Bluvshtein says.

Because social media is a popular forum to comment on jobs, Maggiore suggested employers ask their
employees to include a disclaimer with their posts. “The NLRB says you can’t require a disclaimer, but you may suggest it,” she said. The disclaimer can be very simple — “opinions expressed are my own” — and preserve the objectivity of the comments, whether positive or negative.

Boston Medical Center continually trains employees on social media, Braxton says. She distributes the policy, writes articles and does email blasts. “It’s not just about what you can and can’t do, but why,” she says. “It’s trying to let people understand the reasoning behind the rules.” Braxton attends meetings with the leadership forum — managers, executives and directors — to talk about compliance issues, including social media. “We have huddle cards sent every week to our hospital managers, which they discuss with their teams, and social media issues are on a number of them,” she says.

Contact Braxton at, Bluvshtein at and Maggiore at

Copyright © 2015 by Atlantic Information Services, Inc. Reprinted with permission from Atlantic Information Services, Inc., 1100 17th Street, NW, Suite 300, Washington, D.C. 20036, 202-775-9008,

courtesy Pixabay via Creative Commons

courtesy Pixabay via Creative Commons

A couple weeks ago, I had the privilege of going on a field trip with my second grader to the Desert Botanical Gardens in Phoenix. We spent the warm and sunny morning touring the grounds and learning about biomimicry. It was fascinating to discover how people have observed and gained insight from nature, copying the successful designs that have evolved over millions of years in the plants and animals around us.

Biomimicry is defined as a “new science that studies nature’s models and then uses these designs and processes to solve human problems”, according to (which is a cool site when you have a few minutes to kill, by the way). Just as the name would suggest, biomimicry is taking designs that work in the natural word (bio), and copying and applying those concepts (mimicry) to our own challenges.

For example, we learned about a quiet, aerodynamic train that swiftly and silently cuts through the air, inspired by the long thin bill of a bird that can quietly dive into the water to catch fish without making a lot of commotion. Another example was how funnels are best for catching more rainwater, which can be likened to the shape of the agave plant. It’s shaped in a way that allows rainwater caught on the outside edges of its long broad leaves to trickle in and down toward the plant’s roots.

Last night I had a little light bulb moment when I remembered an article about social media brands mimicking people. It asserts that the most successful brands in social media are those with personality, that are self-aware, understand hyperbole and make clever jokes with followers. For example, Tesco Mobile has a personable and sometimes biting tone depending on the interaction, and Taco Bell talks to followers like a friend (see image). This got me thinking about biomimicry in social media. There are more and more brands successfully employing personality and acting like one of your friends than a brand trying to sell you something.

Can we take social media mimicking relationships further than selling? In an online article published by the Mayo Clinic, the importance of social support cannot be overlooked in the healing process: “Taking the time to build a social support network is a wise investment not only in your mental well-being, but also in your physical health and longevity. Research shows that those who enjoy high levels of social support stay healthier and live longer.” Unfortunately, developing and maintaining a social support system is challenging for chronically ill patients. Chronic pain causes fatigue and depression; mobility challenges can make it difficult to get out with friends; and some patients are geographically isolated from friends and family.

Could that real world social support system be mimicked through social media? Would patients benefit as much from the virtual support and social connections when healing if a hospital integrated social media platforms directly into TVs along with on-demand entertainment and education? Or by providing Wi-Fi and charging stations for personal electronics, or even social media training and moderated closed patient groups?

A manuscript published by the National Center for Biotechnology Information had this to say: “During the last 30 years, researchers have shown great interest in the phenomena of social support, particularly in the context of health. Prior work has found that those with high quality or quantity of social networks have a decreased risk of mortality in comparison to those who have low quantity or quality of social relationships, even after statistically controlling for baseline health status.” Further, a study cited in the publication found that those with lower social interaction and less social support were 1.5 times more likely to have a myocardial infarction (heart attack) and were twice as likely to be readmitted to the hospital than patients with strong social support systems. Also of note, those providing support also benefited, according to the publication, elderly individuals who provided social support and felt more useful experienced fewer incidences of disability and mortality.

Mimicking in-person friendships and support systems for patients is the next evolution of social media. While brands sounding more like people will be the future of marketing success for the foreseeable future, we can take the true usefulness of social media further. The intersection of technology and healing are just being explored, and the concept of virtual support systems mimicking in-person relationships has the potential to revolutionize the way we look at healthcare and getting better.

Email me today to be added to the advance release list for my forthcoming publication, The Healthcare Executive’s Guide to Social Media,

I was invited to do the Tech Talk segment for Fox 10, explaining the exciting new Apple Watch, Apple’s new smart watch developed specifically for use with Apple products. Apple is expected to announce pricing and availability dates at the March 9th “Spring Forward” event, to include 3 models – a basic model (starting at about $350), the Sport version which comes with a highly durable synthetic rubber band, and the higher Edition version with 18k gold casing, predicted to start at the $5-$10,000 range for fine watch collectors and tech taste makers. All watches have a polished sapphire crytal protective face and “taptic” engine, which allows the watch to move with the use of apps or to send “taps” to other Apple Watch users.

While most users will probably not use the watch for extended conversations, calls may be answered, initiated and seamlessly transitioned to the iPhone for a longer chat. The Glances feature will boil apps down to the most important, paired back information from familiar apps for appointment keeping, maps, weather, email and social notifications. The watch is also set to compete with fitness products like the Fit Bit and Jawbone with heart rate monitoring and nutrition apps. Most exciting is the convenience of Apple Pay and Passbook, which allows users to make purchases and board transportation with the flash of a wrist. If your home environment is wired for control through apps, you can even set notifications if you forget to turn the lights off when you leave for the day.

Apple fans are excited to have a watch that is designed to specifically integrate with Apple phones, and we’ll likely see this reflected in responsive web development, with websites and apps designed not just for desktop computers, tablets and phones, but also for small watch-size screens.

While the Apple Watch will likely be met with much fanfare, there has so far been some criticism based on price, the typical Apple design and the fact that some people simply don’t need the redundant services now provided by an iPhone. Skeptics would do well to remember, though, that tablets had not yet been widely adopted prior to the introduction of the iPad – we’ll see what consumers think with the release of the Apple watch this spring.



NLRA and social media

Image courtesy NRLB,gov, read more about recent cases around the nation at


If you’re in leadership for a large organization, you may be bound by the National Labor Relations Act (NLRA), and you may be hearing about the growing concerns around the NLRA and social media.

The NLRA was enacted by Congress in 1935 because companies were growing by leaps and bounds. By the 1950s, about one-third of workers were part of a union. Today, about the same number of public-sector workers belong to a union, and their employers must abide by the NLRA. The National Labor Relations Board (NLRB) was created to enforce the stance of the NLRA, hear disputes, and ensure that employees and employers had a level playing field when it came to bargaining about wages, working conditions and benefits.

While the NLRA has been around for 80 years, only recently has the NLRB gotten involved in disputes involving social media. “Protected and concerted activity” is increasingly taking place over social media channels — that is, activities for which employees may not be penalized. This would include employees having group discussions over social media; criticizing or sharing concerns about compensation or safety issues through written word; and images or videos posted online. With or without a union, employees have a protected right to work together to improve working conditions without losing pay, benefits or being terminated for that activity.

For example, in 2008, Rain City Contractors, based in Lakewood, Washington, terminated five employees after they appeared in a YouTube video. The employees attempted to conceal their identities as they discussed their fears of working at a Superfund site, and the requirement to wear badges that identified them as qualified to work with hazardous materials when they were not. Within days they were fired, and in 2009 the NLRB brought suit against Rain City Contractors, who chose to settle the case and restore all back pay due to the employees.

In another case settled in early 2014, an employee of Hispanics United Buffalo, which provides low-cost services to clients, posted to her personal Facebook page about a co-worker who had criticized other employees for poor job performance. Several other employees responded to the post, defending their performance and sharing frustrations about working conditions, workload and other grievances. The employees were terminated for the Facebook communications, but were later awarded $58,000 in backpay when the NLRB found that the posts were protected and concerted activity under the NLRA.

In addition to harming their reputations, companies who don’t understand the NLRA’s role in social media will be forced to shell out for backpay and penalties. Additionally, they may  be required by the NLRB to update social media guidelines and provide training for leadership and staff.

Most organizations have wised up to creating social media guidelines, but they will need to be updated as settled board law is applied to new cases. Leadership at large organizations will also require ongoing training to understand what they can — and cannot — require of employees. Managers may not forbid employees from “friending” one another or communicating with each other through social media, and dictating topics to employees is muddy and dangerous.

If you have questions about your organization’s social media guidelines, or to be added to the advance release list for my forthcoming publication, “The Healthcare Executive’s Guide to Social Media,” which covers NLRA and HIPAA concerns relating to social media, email me at