The healthcare and media industries have more in common than is widely acknowledged. Both are powerful institutions, rooted in hierarchies, and a command and control ethos.
Traditionally, neither industry has been structured for openness, transparency, or participation by those we are meant to serve. Both industries are perfectly designed to get the results that we do: in other words, there is great potential for things to go wrong. And yet we have traditionally been extremely defensive when this happens.
Nonetheless, the dominance of the fortress mentality is a large part of why I think a new initiative from ProPublica, an independent not-for-profit media outfit based in New York, is something of a landmark, for journalism and healthcare.
We share strict demarcations between professional roles. Forget about turf wars between the AMA and the Pharmacy Guild, or medical resistance to expanded nursing roles. In the media business, we define our roles very tightly, and the turf wars within institutions can be just as unseemly and unproductive as those between organisations. And heaven forbid that anyone might suggest journalists working with non-journalists, or doing community engagement and development as part of their professional roles.
Those traditional attitudes may be changing but the healthcare and media industries remain enormously resistant to change. We are not famous as innovators despite the many opportunities of the digital era.
Of course, these are sweeping generalisations, and there will be many individuals and organisations in healthcare and media that do not fit these characterisations.
ProPublica has established a Patient Harm Community on Facebook for patients who have been harmed by healthcare. It is also open to others concerned about this issue, including health professionals, regulators and service managers — and other journalists.
ProPublica says it wants this “experiment in social media” to build a community interested in discussing patient harm, its causes and solutions. It plans to post questions and answers with experts and provide links to the latest reports, research and policy proposals.
According to a report from the Nieman Journalism Lab, the initiative is not simply about enabling ProPublica to mine the site for stories but is a type of “service journalism” that aims to help develop a community of interest that participants can make their own.
In an email interview overnight, one of the journalists moderating the site, Marshall Allen, told me that it is already a success, drawing more than 500 members since last week’s launch. He wrote:
“One of our primary goals was to combine our platform as independent journalists with the medium of Facebook to see if we could get people connected. We’re encouraged by the results so far.
“We also want to use this as a method to have people tell us their stories in a way that we can organise, so we can identify trends and stories that we or other reporters might want to look at on a deeper level. To do this, we are asking people to fill out this ‘patient harm questionnaire’, which you can see here.
“We also want to use this group to raise the overall awareness for this important issue, and that’s already happening. So we have many things that are tracking in the right direction. But it’s just a start so we’re really curious to see where it goes.”
Daryl Sadgrove, CEO of the Australasian College of Health Service Management and a strong advocate for the use of social media in healthcare, says the site is an exciting development, though he cautions that careful moderation will be needed around such “emotionally charged” issues.
“There is great merit in highlighting the high rates of errors we have in healthcare,” Sadgrove said. “It is an incredibly big issue that isn’t really dealt with in what I believe are the most appropriate ways.”
As to whether the site should be seen as an innovation for journalism or healthcare, Sadgrove says it’s an approach that health services could adopt themselves.
“If they want to be innovative, they would get at the forefront and own this themselves,” he said. “Some might argue that it might taint the independence of the model, but it wouldn’t if you’ve got the right people for the right reasons doing this. You could end up with a more robust and accepted model where the health system is gaining respect for allowing the open discussion to take place and allowing feedback from the different players.”
However, Sadgrove says most health organisations are yet to embrace the potential of social media for fostering innovation, openness, transparency, communication and collaboration in health care.
Fortresses can’t be reinvented overnight. But perhaps the ProPublica project is a sign of crumbling edifice.