• Patient satisfaction
• Patient-centred care
• Healthcare quality improvement
• Information technology
• Quality measurement

Social media usage has become a cultural norm in the USA. Overall, 76% of online adults in the USA use social media.1 And it is not just a phenomenon embraced by the young—31% of all seniors are on Facebook.2 With growing engagement across demographics, social media networks offer new platforms of digital interaction at a scale that is hard to comprehend—313 million active Twitter users sending half a billion tweets and 1.9 billion Facebook accounts uploading 350 million photos every day. SnapChat has created some of the country's youngest billionaires. All these activities, driven by the public's desire to curate and share life experiences, provide new opportunities to observe and understand lived reality in greater detail and closer to real time than ever before.

Concurrently, the concept of patient centredness, whether through better understanding of the patient experience, or better engagement with the patient in healthcare delivery, has gained increased importance in our perception of quality of care. For example, the ‘Hospital Consumer Assessment of Healthcare Providers and Systems’ (HCAHPS) is now required nationally in the USA, providing a standardised survey instrument and data collection methodology for measuring patients' perspectives on hospital care. The results are available to the public, and more importantly, directly linked to payment. But despite these patient-centred efforts and assessments, many healthcare organisations have struggled to transform their organisational culture from provider-focused to patient-centric, as well as learning from patient experience feedback to help determine how to better engage with patients at scale.3–5

Historically, healthcare has been managed mainly via interpersonal communication between the healthcare provider and the patient, one-to-one, and typically face-to-face; in this traditional arrangement, the information balance favoured providers more than patients. Today, patterns of interpersonal communication have been irreversibly changed by the internet and social media. Although there is no universally accepted definition, we think that social media can be defined as online technology for the creation and sharing of user-generated content. Its key features—public accessibility, interactivity and social connectedness—are the primary drivers of social media's prominence as a popular mode of modern communication. As a result, new social media platforms serve as alternatives to the traditional modes of patient–provider communication that exist and are increasingly being demanded by patients and healthcare consumers. Therefore, the healthcare industry needs to reimagine the way it engages with patients to forge a more collaborative relationship between the patient and the provider.

Other industries now use social media platforms and tools to better understand and respond to their consumers. Some techniques such as natural language processing scan social media forums to measure customers' experience of their products. Other approaches leverage crowd-sourcing feedback from social media to design and develop better services. Many large brands see the value of social media to gain instant understanding of consumer reaction to their products or services, while others use social media to demonstrate responsiveness to their customers at moments of insight, novelty or crisis.

Obviously, customers use information on social media too. Social media gives customers the opportunity to describe and rate their experiences with goods and services. For example, in the travel industry, websites such as TripAdvisor are now popular––35% of leisure travellers reported using a review website when making a purchasing decision. Industry players take these reviews seriously because of the significant impact on decision-making: if a hotel increases its review score by 1 point on a 5-point scale, it can increase price by 11% and still keep the same market share.6

Given the centrality of health to everyday life, it is not surprising that people are increasingly posting reviews and ratings of hospitals and physicians on the internet. These reviews are getting increasing attention—65% of the public are aware of physician-rating websites.7 The industry is responding—50% of hospitals in the USA are on Twitter, and 95% have a Facebook page.8 The reports left on these platforms and specific healthcare rating websites provide a new lens to view patient experience. Initial evidence has shown comments left on rating websites correlate with real-world outcomes and survey findings,9 and patients will certainly be using them to make decisions. Consistent with this notion, evidence has shown that monitoring social media provides useful, unsolicited and real-time data that might not be captured by traditional patient feedback mechanisms.10

More specifically, social media represents a new tool for healthcare providers to leverage in their continual quest to improve value and patient-centredness. Whereas traditional tools such as HCAHPS provide a narrow window into the entirety of a patient's experience, monitoring social media gives additional insight into the drivers of a patient's assessment of their experience during a healthcare encounter. Furthermore, social media platforms are oftentimes familiar to patients, thereby offering more trusted channels for user-generated content. Patient feedback on non-traditional metrics also gives providers information on what patients truly value in their experiences and offers nuance that is often lacking in standardised feedback forms. For example, Twitter or Facebook posts from patients about the distance they must walk between specialist appointments on a hospital campus may give providers greater insight about the reaction patients have to elements like walking distances during their healthcare encounter; a domain of patient experience that may not be captured in standard feedback tools. Using this information, providers may reorganise the deployment of resources like specialists to minimise the distance patients must travel between appointments. Beyond gauging non-care related factors logistics and convenience which still have obvious impacts on patient experience, providers may also monitor social media platforms to have a more holistic approach to gauging patient feedback and the quality of care delivered.

Healthcare organisations can now use a variety of social media platforms to gain real-time insight into patient experience and engagement. These online platforms have the potential to become important differentiators among healthcare organisations and providers and may have major future effects on customer behaviour and decisions.11 Healthcare organisations should be aware of and develop strategies to monitor and measure patient feedback through a variety of social media channels. Table 1 highlights the variety of platforms that providers can tap into to gain a greater understanding of their patients’ experience and engagement.

But beyond measuring experience, the real potential of social media is in engagement. Engagement of patients in new ways has been shown to directly impact patient behaviour that promotes positive health outcomes, patient satisfaction, care delivery efficiency and improved quality of care.12 Consistent with this notion, social media is creating new opportunities for patients and families to participate actively in their care, self-manage their medical problems, learn from those with similar conditions and improve communication with their healthcare providers.12

Social media also offers a new set of information that can help providers design and improve the delivery and evaluation of care. This is more than simple listening—it requires an active participation in conversation. It also requires trust by leaders of organisations that their staff will behave responsibly and the development of a culture and openness and public reflectivity. In addition, social media also present inherent advantages with respect to engagement. The approach is cheap, provides information in real time, and the authentic human narrative produced can be attractive and persuasive, possibly more so than most of the technical information currently reported in formal measures like HCAHPS.

At the same time, social media suffers from some important limitations. Despite increasing adoption across demographics, a selection bias towards the young, wealthy and technologically sophisticated still exists. Useful information signals within social media data can be drowned out by less relevant noise. Risk of gaming represents a serious concern, especially if social media results are used for assessment. Despite widespread social media use, content related specifically to healthcare is less common, and total number of comments or reviews can be low for a given hospital or individual.13 Converting the intent of natural language and nuance of social media discussion into useful information is also technically difficult. However, data-mining techniques in several industries are now being employed at enterprise levels to monitor public sentiment on several social media platforms, and the quality of this analysis for patient experience will increase as machine learning algorithms are refined and size of available datasets increases over the next few years. Natural language processing is a promising, though imperfect, tool that will become increasingly important for healthcare organisations as they look to apply it in measuring patient feedback.

Finally, social media in healthcare brings forth new concerns about privacy, stigma and patient consent that are not to be overlooked. For example, patient participation in peer support groups for those with a similar diagnosis may require new criteria for patient consent and confidentiality in order to protect the level of trust among group members and cultivate interaction that is truly beneficial to all involved. Furthermore, ethical issues surrounding online monitoring of social media platforms by providers is another challenge that will need to be resolved by balancing the desire to gain valuable user-generated feedback, protecting patient privacy. Still, these obstacles can all be overcome with the appropriate level of respect for the patient and a primary motivation to understand their greatest needs.

Social media represents an additional way to understand the voice of the patient. In many high-income countries, where established surveys of patient experience exist, this may represent a supplementary lens with which to view patients’ experience. Social media data can complement existing surveys, and may eventually make parts of them obsolete. However, in low-income countries—where few systems exist for understanding patient experience but social media usage is widespread—social media may provide an opportunity to gain a previously unattainable understanding of patient experience without implementing costly experience measurement infrastructure, analogous to what has happened with cellular technology and phones.

At the policy level, social media presents a tool which the system can use to understand the quality of care. For example, the National Health Service in England has actively monitored social media to look for trends in performance of services with online reviews as one of the measures monitored by system regulators.15

We imagine a future in which major healthcare organisations see engagement with the population they serve via social media as a matter of course—as most major consumer brands already do—and move their posture into an outward facing, listening and responsive mode. In this world, patients will be in constant, iterative discussion with their healthcare providers, sharing their experiences, and using them to better manage their own care, make choices and derive support from others. We envision patients using new social media data types, such as geotagging, from mobile devices (labelling the time and place of a comment) and new formats to better reflect the nuances that drive patient experience. The upshot is that information will come to the hospital's attention within minutes of the experience, and organisations will consequently be held more accountable by those they serve. In return, patients could be met with personalised health messages tailored to their needs, expectations, interests, concerns and existing connections—all within appropriate constraints of confidentiality and consent.

The explosive growth in social media usage shows the public's appetite to communicate and share their experiences. Meaningful engagement between patient and provider will require a reimagination of traditional communication norms, but the medium is a fertile ground to build these connections. Healthcare providers and administrators need to recognise this and embrace it—they should seize this opportunity.