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#hcsmca: 5-year Retrospective and Looking Ahead

February 28, 2016

It’s been an amazing 5-year journey with #hcsmca. Here’s the retrospective that I shared at the #hcsmca Symposium on Feb 24, 2016. (Slides)

Who would’ve ever thought that 140 characters could change an industry? Health care is an industry built on science, art, evidence and communication. But the social Web and the networks we build are causing a paradigm shift in how health interactions are perceived.

Pat Rich tweetPat Rich said this exactly a year ago at the 2015 #hcsmca Meetup in Toronto. But look at the last part of the tweet. “No time to discuss that here.” Today, we have time. Today that’s why we’re here – in person and online.

Five and a half years ago, when social media were still quite new to most people in health care, I established the hashtag #hcsmca – Health Care Social Media Canada. While the first #hcsmca tweetchat was held in September 2010, the journey began weeks before.

I set out purposely to build a community. An inclusive open network of people who share a strong common interest, interact online and form relationships. First step: invite key first followers, people who would ensure that the community had a healthy mix that would model the inclusiveness and diversity I wanted this community to be built upon.

What is online community

I contacted people in my offline and online networks across the country from all walks of health care – patients, providers, communicators, educators, researchers, KT specialists and so on. If I wanted to attract multiple stakeholders and wide geographic representation to #hcsmca, then representatives of those people had to be the first adopters.

Remember this was 6 years ago when there were few clinicians or organizations on Twitter, and even fewer patients and caregivers.

Already by the second wildly successful chat I started to think, Wow we’ve gone from fledgling to a flourishing community in just 2 weeks.

Still I was rather surprised when Ujjal Dosanjh, former Minister of Health joined in and submitted this topic: How can social media help caregivers find good/solid advice when they need it most? Conversation about caregiver needs, usage of social networks and criteria for “solid advice” ensued. I’m not sure what the Liberal party had hoped to gain by participating in #hcsmca, but they definitely got plenty to listen to. @ujjaldosanjh’s final post before leaving for question period read: “this forum proves there are a lot of ideas out there. Great info to share with my #LPC colleagues esp when talking w constituents.”
Fledgling to flourishing

That same week the other 2 topics were submitted by Mike Martineau and Kathy Kastner, an IT specialist and a patient. This was the format of the chats for the first 2 years. People submitted their topic or question to a open Google spreadsheet; one topic per person, 3 topics per topics per week.

Six months in and #hcsmca was meeting its goal, making health care more open and connected. We were getting noticed outside the social media vacuum too. Canadian Press wrote this piece that was syndicated across Canada.

Metro news

Being included in the free public transit paper in several urban centres, #hcsmca-ers heard from their colleagues, friends and family – Is this what you’ve been talking about?

You bet it is. Let’s look at the numbers. Since 2010 we’ve had

  • over 90,000 participants
  • contributing 220,000 tweets
  • in 252 chats,
  • hosted by 95 moderators.

Offline events strengthen the the sense of community of an online network. Robyn Sussel recognized this when she and colleagues started Evening Rounds – a monthly meetup here in Vancouver. In Toronto, we’ve hosted 8 meetups of over 100 people, each event using a different format from panel discussion to speed dating to Pecha Kucha competitions. Today is the first full day event! Thank you Quality Forum for inviting us to be one of 3 pre-forum events!Activity

When #hcsmca was 2 years old, Anatoliy Gruzd and Caroline Haythornthwaite did a social network analysis sampling one month – November 2012.


I was thrilled with the picture this revealed: a well connected network with no central figure of influence. Meaning #hcsmca is not an audience, not a gathering, but rather an well distributed community of practice, sharing knowledge and expertise. The researchers’ analysis showed there was “no preferential attachment among people in the same professional group, indicating that the formation of connections among community members was not constrained by professional status.

It indicates a healthy sense of community where members have a feeling of belonging
and identity. The goals of members match those of the membership. Members feel they can influence and be influenced and that they share a history, experience and/or an emotional connection.[McMillan and Chavis, 1986]

It was because of #hcsmca’s strength of community that I was asked to contribute an essay in Mayo Clinic’s book “Bringing the Social Media Revolution to Health Care” called Twitter Chats Build Community.

Community Lifecycle

Every community has a lifecycle from inception, to establishment to maturity – many stay in this stage for years – and for some there’s a mitosis or death. As #hcsmca moves through its lifecycle, it’s been imperative to stay relevant, to evolve with the community, acknowledge and enable the roles people take on and challenge the collective into areas where they may not have thought to venture.

The first role that I was keen to enable was born out of necessity. It’s a lot of work to moderate a chat every week. So I invited people to help out. Over 95 people have moderated #hcsmca.


By the 3rd year, I changed the model of 3 questions from 3 people to make each chat based on a theme so we could dive deeper into a topic. The host would choose a theme for the chat, write a preparatory blog which brought focus and depth to the conversations. Another role that emerged were the summary creators. While there is a transcript for every chat, the summaries are short commentaries, infographics, storify’s. Other roles include the welcome wagonners, the data collectors, the event planning committee members and my moral supporters.

And then there are special projects. Take for example the revision of #hcsmca’s vision and mission. Last year, Shirley Williams along with Pat Rich and myself, led this incredible online consensus building initiative. For as #hcsmca grew and matured, and social media became practically ubiquitous, hosting a community focussed exclusively on social media no longer made sense and the scope was expanded to social collaboration for better health and health care.

Every #hcsmca chat shifts the needle in our understanding, perception, practice and empathy; sometimes a little, sometimes a lot.

Elise Bradt from the Council of Academic Hospitals of Ontario wrote to me after their chat about patients and research, “we are very proud and just delighted at the response we’ve received. In fact, I met with Dawn Richards the next day and we took much of our conversation from the chat into the real world, discussing CAHO’s 2015-2020 commitment to driving best practices for patient co-design of research. In my mind, this transition of dialogue (from virtual to actual) is the very purpose of the #hcsmca community.

Patients and caregivers have also hosted chats. Annette MacKinnon and Natrice Rese co-hosted chats about online vs. in-person patient support services and health advocates.

I, too, have brought the #hcsmca community knowledge with me to Medicine 2.0 in Boston and London, and flipped my MedX panel twice with you before going to Stanford Medicine X 2014 and 2015.

#hcsmca is a safe and trusted place to test out new ideas. Members know they have a community of people encouraging them to be innovative and to take risks; one that will applaud successes and help missteps become learning opportunities.

All of the 252 chats and their respective blogs are archived  – an incredible treasure trove of data.

In my opinion the single biggest achievement of #hcsmca has been to help people step back from their own area of expertise. When moderators submit their topics, often their questions need to be reframed to include everyone. While their goal may be to specifically get patient opinion or to feedback from physicians, I remind them that #hcsmca is a diverse and inclusive community and this has to be reflected in the questions. This is how #hcsmca dismantles health care’s silos and help creates pathways to connection – connections that less than a decade ago were thought impossible.

For the past 5 and half years, 70-100 people have gathered weekly, over 90,000 in total, making real connections, recalibrated their thinking and opening their minds. Yes, we can improve health care 140 characters at a time.

However, the time has come for me to take a bow. Starting in March, I will no longer be leading weekly tweetchats. But this is not the end of #hcsmca. The hashtag will live on. Today, I invite you to take up the #hcsmca baton and help create the road map of the next part of our evolution.

Thank you!


One Comment leave one →
  1. mikenstn permalink
    February 28, 2016 2:47 pm

    Wishing you much success in future endeavours. Hopefully our paths will cross again.

    Thanks for all your hard work in getting #hcsmca started.

    Michael Martineau


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