Social media in health care: A crash course in how to use Twitter and how to develop a social media
strategy for quality
Ros Gray, Scottish Government @Rosgray Jo-Inge Myhre, MD, F2 in Family Medicine University of Oslo Medical School @joinge_
Christina Krause, British Columbia Patient Safety & Quality Council @ck4q Kevin Smith, British Columbia Patient Safety & Quality Council @Kevin4Quality
Before we get started …
Share what you are learning, ask questions
or chat with others on Twitter!
#M9
#quality2014
#M9 | #quality2014
@doctavic
@MetisAudit
@AnthonyStaines
@nicholda
@ltkalmar
@kinanmuha
@mathieulouiset
@profroland
@grangerkate
@sonjakersten
Who’s in the room on Twitter?
@LAS-QI
@ce_ikas
@MAVR_1
@Priv8hospitals
@ncollinsmd
@joinge_
@rosgray
@ck4q
@Kevin4Quality
#M9 | #quality2014
What we heard from you …
How would you rate your experience with social media?
a. I know nothing
b. Some experience
c. Lots of experience
d. I’m a superstar
#M9 | #quality2014
0 5 10 15 20 25
I'm a superstar
Lots of experience
Some experience
I know nothing
How would you rate your familiarity with social media?
#M9 | #quality2014
Impromptu Networking
Two minutes per person in pairs
Speak with 3 people you don’t know
Ask 2 questions:
- What are you passionate about in your work?
- How do you think social media can help you in your role?
#M9 | #quality2014
Overview of the Day
1. Driver Diagrams
2. Social media as a strategy for improvement
3. Case Studies – cool examples to inspire!
4. Getting started on your own social media strategy
#M9 | #quality2014
Driver Diagrams for Social Media
#M9 | #quality2014
What is a theory?
• A description of our best understanding about why things are the way they are
• Theories/beliefs in other contexts?
– Economics – game theory
– Biology - theory of evolution
– Physics – string theory
– Metereology – chaos theory
– Social media - ?
#M9 | #quality2014
How is a theory different from a belief?
• A theory can be tested scientifically
• Theories are predictions of the outcome of future events
• Theory is the starting place for generating new knowledge
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
do
study act
plan
do
study act
plan
#M9 | #quality2014
do
study act
plan
do
study act
plan
#M9 | #quality2014
What do we believe about why things are the way they are?
• Evidence – what objective evidence have we collected locally or is available to us through the relevant literature?
• Local subject matter experts – people who work at the frontline who experience the system day to day and have strong experiential beliefs about where change is needed
#M9 | #quality2014
Some guidance on creating a driver diagram
• Start with the outcome in mind – develop an aim statement that reflects the desired future state
• Primary drivers should be nouns that reflect the key leverage points in the system of interest from three areas: 1. Structures – physical, financial, administrative,
management and improvement, delegation and accountability
2. Processes – workflow of the system, how things are accomplished
3. Operating norms – written and unwritten rules that govern behaviour
#M9 | #quality2014
Some guidance on creating a driver diagram
• Secondary drivers must be tangible things where action can be taken on the system
• Change ideas should link directly to secondary drivers and should exhibit these characteristics: 1. Specific - each change idea needs to be clear
and concise and it must be obvious how its introduction is different from the status quo
2. How to - each change idea must include a statement about how and where it will be put into practice within the system
#M9 | #quality2014
SO CAN WE USE THIS APPROACH FOR OUR SOCIAL MEDIA STRATEGY?
#M9 | #quality2014
Communication
and engagement To provide country-
wide access to
insights and
information re early
years through virtual
collaboration with
children, families and
staff in pursuit of
system improvement
by December 2015
Developing social
content
Aim Primary Drivers Secondary Drivers
Finding and capturing stories, Video, PPT, Photos
Newsletters
Website development
Twitter strategy
Accessibility issues
Facebook strategy
Branding
Measurement of performance
Infrastructure
#M9 | #quality2014
Social Media Strategy for Improvement
#M9 | #quality2014
BCPSQC Vision
A sustainable health care system built on a foundation of quality.
#M9 | #quality2014
Our Mission
Provide system-wide leadership through collaboration with patients, the public and those working within the health system in a relentless pursuit of quality.
#M9 | #quality2014
#M9 | #quality2014
Pew Internet
#M9 | #quality2014
Pew Internet
#M9 | #quality2014
The Engagement Pyramid
Gideon Rosenblatt, Former Groundwire Executive Director #M9 | #quality2014
TRIZ
#M9 | #quality2014
TRIZ – First Step
In groups, make a list of “to do’s” in answer to your assigned question on a flip chart.
There is no wrong answer – GO WILD! 5 minutes
#M9 | #quality2014
Questions
1. How can we ensure privacy is breached on social media tools such as Twitter/Facebook?
2. How do we make sure no one is on Twitter?
3. How can ensure NO dialogue, learning or sharing occurs on online community of practice websites?
4. What could we do to ensure we do NOT succeed in using social media as a health care improvement tool?
#M9 | #quality2014
TRIZ – Second Step
Go down the list and ask:
“Is there anything on this list that we currently practice, even remotely?”
— Cross out the ones that you aren’t doing EVER — Circle the ones that you resemble something
you are currently doing
#M9 | #quality2014
TRIZ – Third Step Take one item at a time and ask: — How am I and how are we going to stop it? — What would be the first move? — What could I personally commit to stopping right now. — What could we do in the next few days? Next week? — Do we need leadership help? Organizational support?”
#M9 | #quality2014
Why use online tools?
#M9 | #quality2014
0 5 10 15 20 25 30
Other
Tumblr
SlideShare
Storify
Flickr
YouTube
What social media tools do you use now?
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
Adapted from Josh Bernoff's POST (2007)
#M9 | #quality2014
Adapted from Josh Bernoff's POST (2007)
#M9 | #quality2014
My organization has a clear social media engagement strategy:
a. SOS
b. Not so much
c. Pretty good
d. Absolutely!
Poll
#M9 | #quality2014
0 5 10 15 20 25
I don't
Entertainment
To share information
To connect with colleagues
To learn about developments in my field
Why do you use social media?
#M9 | #quality2014
BCPSQC Journey…just beginning!
Communications & engagement to …
1. Support efforts to improve quality of care
2. Build social movement thinking into quality
3. Engage at a wide scale – strong ties/weak ties
Through …
Engagement | Storytelling | Digital Strategy
#M9 | #quality2014
BCPSQC Communications & Engagement Strategy
Social Media Guidelines
Typically include:
- Information about the context and benefits of using social media.
- What to be aware of and a bit about the process to follow in using social media.
- Principles to guide the use of social media tools in your professional capacity.
- Useful links.
#M9 | #quality2014
Social Media Guidelines
Typically include:
- Information about the context and benefits of using social media.
- What to be aware of and a bit about the process to follow in using social media.
- Principles to guide the use of social media tools in your professional capacity.
- Useful links.
- CONSULT BOTH YOUR ORGANIZATIONAL & PROFESSIONAL GUIDELINES
#M9 | #quality2014
— Email newsletter using
— Targeted, personal emails
— Partner emails
Email Marketing
#M9 | #quality2014
1. The Look 2. Database Management 3. Two-way Dialogue (Engagement Pyramid) 4. Statistics
Newsletters ~ The Digital Way
#M9 | #quality2014
• Email client
• Open rate
• Click rate
• Time of day
• Day of week
• Subject line
• Engaging the subscribers
• Number of calls to action in the email
• Growth of the subscriber base
• Frequency of newsletters
• Content
• Subscriber & field analysis
• Segmentation
• Top forwarders strategy (champions)
• Template & format
• Measuring End Outcomes
Things we consider when sending emails:
#M9 | #quality2014
18-26% open
2-5% click
98% receive your email
2% soft or hard bounce.
a few mark as junk.
0.2-0.5% unsubscribe.
1-3% take action
How many people do you think read your entire email?
Courtesy of @mrbenjohnson
#M9 | #quality2014
UCL
LCL
10%
15%
20%
25%
30%
35%
40%
45%
50%
BC
PS
QC
…B
CP
SQ
C…
BC
PS
QC
…N
ov 8
…N
ov 8
…N
ov 1
5…
No
v 1
5…
nov 2
2…
nov 2
2…
nov 2
9/3
0…
nov 2
9/3
0…
dec 6
…d
ec 6
…d
ec 1
3…
dec 1
3…
dec 1
9…
dec 1
9…
Jan
4…
Jan
4…
QF
Reg
…ja
n 2
5…
jan
25…
Fe
b 1
3…
Fe
b 2
2…
Ma
rch 1
…M
arc
h 2
2…
Ap
ril 3
…A
pril 1
8…
Ma
y 1
…M
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5…
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201
3…
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9…
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6…
Ap
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0…
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3…
QF
20
14
…M
ay 7
…M
ay 2
2…
Jun
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1…
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8…
July
9…
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9…
Au
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4…
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ary
…M
arc
h 2
0…
Ap
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…A
pril 3
…#
N/A
#N
/A#
N/A
Newsletter Open Rates Percent
#M9 | #quality2014
UCL
LCL
10%
15%
20%
25%
30%
35%
40%
45%
50%
BC
PS
QC
…B
CP
SQ
C…
BC
PS
QC
…N
ov 8
…N
ov 8
…N
ov 1
5…
No
v 1
5…
nov 2
2…
nov 2
2…
nov 2
9/3
0…
nov 2
9/3
0…
dec 6
…d
ec 6
…d
ec 1
3…
dec 1
3…
dec 1
9…
dec 1
9…
Jan
4…
Jan
4…
QF
Reg
…ja
n 2
5…
jan
25…
Fe
b 1
3…
Fe
b 2
2…
Ma
rch 1
…M
arc
h 2
2…
Ap
ril 3
…A
pril 1
8…
Ma
y 1
…M
ay 1
5…
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201
3…
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lity…
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9…
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da
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ary
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8…
Ma
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8…
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6…
Ap
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0…
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3…
QF
20
14
…M
ay 7
…M
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2…
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1…
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8…
July
9…
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9…
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4…
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ary
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arc
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0…
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N/A
#N
/A#
N/A
Newsletter Open Rates Percent
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
0
2
4
6
8
10
12
14
16
BC
PS
QC
…B
CP
SQ
C…
BC
PS
QC
…N
ov 8
…N
ov 8
…N
ov 1
5…
Nov 1
5…
nov 2
2…
nov 2
2…
nov 2
9/3
0…
nov 2
9/3
0…
dec 6
…d
ec 6
…d
ec 1
3…
dec 1
3…
dec 1
9…
dec 1
9…
Jan
4…
Jan
4…
QF
Reg
eb
last
jan
25…
jan
25…
Fe
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3…
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2…
Ma
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…M
arc
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2…
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…A
pril 1
8…
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ay 1
5…
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201
3…
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201
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29
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13,…
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6…
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0…
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3…
QF
20
14
…M
ay 7
…M
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2…
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1…
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9…
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mbe
r 18
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13
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29
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3…
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17…
Ma
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0…
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…#
N/A
#N
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N/A
Newlsetter Click Rates Percent
#M9 | #quality2014
#M9 | #quality2014
0
2
4
6
8
10
12
14
16
BC
PS
QC
…B
CP
SQ
C…
BC
PS
QC
…N
ov 8
…N
ov 8
…N
ov 1
5…
Nov 1
5…
nov 2
2…
nov 2
2…
nov 2
9/3
0…
nov 2
9/3
0…
dec 6
…d
ec 6
…d
ec 1
3…
dec 1
3…
dec 1
9…
dec 1
9…
Jan
4…
Jan
4…
QF
Reg
eb
last
jan
25…
jan
25…
Fe
b 1
3…
Fe
b 2
2…
Ma
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…M
arc
h 2
2…
Ap
ril 3
…A
pril 1
8…
Ma
y 1
…M
ay 1
5…
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201
3…
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4…
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201
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da
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29
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13,…
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8…
Ma
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8…
Ma
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6…
Ap
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0…
Ap
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3…
QF
20
14
…M
ay 7
…M
ay 2
2…
Jun
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1…
Jun
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8…
July
9…
July
9…
Au
gu
st 1
4…
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mbe
r 18
…Jan
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13
…Jan
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29
…F
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3…
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17…
Ma
rch 2
0…
Ap
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…A
pril 3
…#
N/A
#N
/A#
N/A
Newlsetter Click Rates Percent
UCL
LCL
10%
15%
20%
25%
30%
35%
40%
45%
50%
BC
PS
QC
…B
CP
SQ
C…
BC
PS
QC
…N
ov 8
…N
ov 8
…N
ov 1
5…
No
v 1
5…
nov 2
2…
nov 2
2…
nov 2
9/3
0…
nov 2
9/3
0…
dec 6
…d
ec 6
…d
ec 1
3…
dec 1
3…
dec 1
9…
dec 1
9…
Jan
4…
Jan
4…
QF
Reg
…ja
n 2
5…
jan
25…
Fe
b 1
3…
Fe
b 2
2…
Ma
rch 1
…M
arc
h 2
2…
Ap
ril 3
…A
pril 1
8…
Ma
y 1
…M
ay 1
5…
QF
201
3…
Jun
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4…
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201
3…
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201
3…
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Jan
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ary
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8…
Ma
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8…
Ma
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6…
Ap
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0…
Ap
ril 2
3…
QF
20
14
…M
ay 7
…M
ay 2
2…
Jun
e 1
1…
Jun
e 1
8…
July
9…
July
9…
Au
gu
st 1
4…
Au
gu
st 3
0…
Se
pte
mb
e…
Se
pte
mb
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Se
pte
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e…
Se
pte
mb
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Octo
be
r 2…
Octo
be
r…N
ove
mbe
r…N
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mbe
r…N
ove
mbe
r…N
ove
mbe
r…D
ece
mbe
r…D
ece
mbe
r…Jan
uary
…Jan
uary
…F
ebru
ary
…F
ebru
ary
…M
arc
h 2
0…
Ap
ril 1
…A
pril 3
…#
N/A
#N
/A#
N/A
Newsletter Open Rates Percent
#M9 | #quality2014
Finding stories
― from staff, partners, call outs/campaigns
Documenting stories
― written/blog, video, photo, audio
Sharing stories
― via social media, web, email, partners
Storytelling
#M9 | #quality2014
1. Email Blasts
2. Sharing presentations
3. Blog Posts
4. Videos
5. Photos
6. Unique website and analytics
7. Twitter
An Example: Tools & Products
#M9 | #quality2014
286 presentations uploaded Example from Quality Forum 2013 — 4 plenary presentations — 102 breakout session presentations — 11 academic and quality pre-forum presentations — 7 patient & family centered care pre-forum presentation — 8 Heath Talks presentations
Slides via
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
Email Marketing, Blogs & Photo Strategy
Driver Diagram Work Time!
Unique opportunity to:
1. Engage with colleagues (strong & weak tie)
2. Disseminate ‘calls to action’ to large audiences
3. Increase awareness of issues
4. Build and strengthen communities
5. Promote learning from events
#M9 | #quality2014
Trusted voice on health quality
Support the work of our partners
Empower staff and those interested to use Twitter to grow interest and involvement in the health quality agenda
BCPSQC Approach
#M9 | #quality2014
@BCPSQC
@BCSQAN
@BCSepsis
@CLeARBC
@BCQualityForum
The
Co
nve
rsat
ion
Organization
Initiatives
Our Strategy on Twitter ( T H E J O U R N E Y S O F A R )
Staff
T W I T T E R S T R AT E G Y
@ck4q @sharimck @tweetvandijk
@Kevin4Quality @Kanneprocter @Meher4Q @SeniorsQuality @DrMarsBar @DrDavSweet
@CHochfilzer @crecsky @KimberMcKinley
Power of Collective Twitter Following
Following Followers
BCPSQC 2619 2927
ck4q 1066 1552
Sharimck 439 457
BCSQAN 372 296
BCSepsis 198 485
CLeARBC 82 60
BCQualityForum 131 310
Kanneprocter 385 186
Tweetvandijk 157 263
Kevin4Quality 311 332
Crecsky 364 120
Chochfilzer 167 107
Total 7094
#M9 | #quality2014
1. Follow organizations/individuals that align with our work
Helps build followers (~ 15-25% of those you follow, follow you back)
2. Engage with those who interact with us
RTing our partners, thanking for RTs, #FF
Active dialogue on relevant topics
BCPSQC Strategy
#M9 | #quality2014
3. Disseminate content in a way that is fresh and engaging
– Live tweet from events
– Keeping tweets short and witty
– Provide links to Council and partner events, documents or interesting information
#M9 | #quality2014
BCPSQC Strategy
Seriously?
It’s okay to have fun
#M9 | #quality2014
Being casual works, too
#M9 | #quality2014
Seriously?
#quality4 | #quality2013 @ck4q | @ajay4quality
via @danzarrella
Scheduling Tweets
#quality4 | #quality2013 @ck4q | @ajay4quality
via @danzarrella
— Leverage social networks to build social stories
— Based upon social media networks
Twitter, Facebook, YouTube, Flickr, Instagram, etc
— Provides opportunity to make sense of what you've pulled together
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
About #QualityChat…
#M9 | #quality2014
About #QualityChat…
#M9 | #quality2014
#M9 | #quality2014
So What Happened?
#M9 | #quality2014
And How’d it Grow?
#M9 | #quality2014
Objective:
• To increase the adoption and
compliance of sepsis protocols
Plan: • Every five protocols = 1 life
saved*
• Across BC: 750 patients treated = 150 Lives saved in 150 days!
• Encourage best practice and teamwork
*For cases of severe sepsis and septic shock
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
LET’S GET OUR HANDS DIRTY!
• Healthcare Pledge Selfie! @QualityForum Campaign
• Tweet your “healthcare pledge” and include a selfie to #quality2014
Tweet short (<120 characters) and include links
Use hashtags (but don’t overuse them)
Mention people
Three Main Things to Keep in Mind (checklist)
#M9 | #quality2014
Fidelma Fitzpatrick Ireland
@ffitzp
#M9 | #quality2014
Abhishek Bhartia India
@abhishek4q
#M9 | #quality2014
Grete Kistrup Denmark
@Gkistrup
#M9 | #quality2014
Driver Diagram Work Time!
— Promotion
— Storytelling
— Documentation
— Education
— vs
Video
#M9 | #quality2014
#M9 | #quality2014
What did the Canadian Patient Safety Institute try?
#M9 | #quality2014
A Hand Hygiene Video Contest!
#M9 | #quality2014
— It’s all about the people – “viewers choice”
— Videos posted to Facebook & YouTube
— Votes = Likes on Facebook
CPSI Campaign
#M9 | #quality2014
Hard Data
• 1025 votes cast
• 54,000 post views on Facebook (up 154%)
• Doubled Facebook followers
• 1300 comments (vs almost no comments on posts previously)
• ~3500 views
Overall
• Audience Engagement
• Social Spread
• Reward
Outcome of HH Video Competition
#M9 | #quality2014
University of Geneva Hospitals 226,000 views (April 3, 2014)
All time watched Hand Hygiene videos
Jefferson University Hospitals 207,000 views (April 3, 2014)
What is the all-time most watched video online?
#M9 | #quality2014
Most all-time watched video
PSY – Gangnam Style ~1.9 Billion hits! (April 3, 2014)
#M9 | #quality2014
PSY – Gangnam Style 1.9 billion views! (April 3, 2014)
The Next Sensation?!
Global Handwashing Day 138,000 views! (April 3, 2014)
#M9 | #quality2014
Desktop & Mobile Website
Internet Radio Service
Mobile web application and Smartphone Apps
Traffic Customer Care Line
VMS/Kiosks
Traffic Scotland Information
Hierarchy & Service Platforms Potential Audience Reach
Max delivered to date 115m page impressions in month of Dec 2010 equates to 1.1m distinct IP addresses Resilient to
spike demand.
At the peak can have over 100,000 contacts a month
Currently 286,843 downloads for iPhone/ Android/Blackberry/Windows 7 Stats feed through to TS website usage
Traffic Scotland Twitter has currently 32,000 followers and follows 542 partners
22,000 calls annually However dramatic seasonal and event driven spikes in demand
Automated messages includes Traffic Scotland Radio
203 VMS and currently 3 TS kiosks: Gretna Green (A74);
Ballinluig Services (A9) and Harthill Service (M8)
Pre-Trip/On trip
On-Trip
#M9 | #quality2014
#bestplacetogrowup
#M9 | #quality2014
Early Years Collaborative
-9 months to 1 year
1 year to 30
months
30 months
to
Primary school
Leadership 5 – 8 years
Scotland – the best place in
the world to grow up
#M9 | #quality2014
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
LS1 LS2 LS3 LS4
Nu
mb
er o
f Twe
ets N
um
be
r o
f Im
pre
ssio
ns
Learning Session
Number of Twitter Impressions and Tweets at Early Years Collaborative Learning Sessions
Impressions
Tweets
#M9 | #quality2014
#M9 | #quality2014
#M9 | #quality2014
Overall Strategy
Driver Diagram Work Time!
April 30, 2014 9 am PST/ 12 pm EST/ 6 pm GMT
Join us for our next #QualityChat!
May 28, 2014 9 am PST/ 12 pm EST/ 6 pm GMT
#QualityChat www.bcpsqc.ca/events/events-qualitychat.html
#M9 | #quality2014
Post-it Note:
What were your ah-ha moments?
Evaluation Survey:
#M9 | #quality2014
Thank you!
#M9 | #quality2014
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