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Opinions in 140 characters

January 19, 2013

#140 characters or less

Have you ever taken part in a 140 character chat, online, with a diverse range of people from across the world?  Last night I did – in total around 140 people took part in the discussion which focused on the use and access to social media within an inpatient mental health setting.

Of course you may suggest that any conversation/discussion that takes place in only 140 characters (including spaces and the # tag) is superficial and cannot fully deal with the in-depth issues that a topic will raise.  You may be right, however that would miss the point, 140 people or so took part in a discussion, with significantly more people having access to what was being said.  hashtagsEveryone’s voice was of equal importance and of equal volume, the ‘playing field’ was absolutely level – 131 characters when you include the chat ‘hashtag’ #wenurses, less if you are responding to someone else’s tweet.  How much would a conference cost to have this level of input?  and how long to organise?

As a trending topic it also made over 1.7 million impressions during the hour long discussion, have you every been to a conference where >1.7 million people potentially heard the message/shared the conversation?

The conversation was fast and furious: to be honest it was pretty much impossible to keep up with every theme throughout the hour that the #chat was scheduled – in the real world the chat extended beyond an hour as participants were engrossed in discussion and the hour flew by.  You can access the full conversation at:

The ‘so what’ question of this blog is two fold:

Question 1. When engaged in such a free flowing and interesting discussion – what happens if you disagree with someone?  If you had more time would you be more thoughtful in challenging what is being said?  Is there a tendency to want to conform with the enthusiasm that is clearly evident?

Question 2. How to you take the experience of someone who has lived experience of being on an inpatient ward and learn from it when your experiences (or expectations) are vastly different, and reconcile the two?

Opinion 1.  I think there is a tendency for participants to want to fit in and therefore agree with contributors.  I guessing that this opinion isn’t going to be popular – no one wants to think that they are influenced like this.  I don’t mean, in anyway, to infer that anyone is insincere in what they are saying, or that there is a deliberate attempt to misrepresent their position.  However I was struck by the number of healthcare professionals (HCPs) who were willing to pitch into the ‘things that are wrong debate’.  I’m far from suggesting that everything is perfect, however where it isn’t perfect in my area, it’s my role to work with colleagues to put it right.  If it’s wrong in their areas, what are they doing to make it better?  When someone with lived experience says that things aren’t right, or were not right during their admission, I accept fully that this is what they experienced – however is that the same experience in every ward across the country(s)? – of course it isn’t, however, herein lies the danger: if we reject that experience as ‘it wouldn’t happen in my ward(s)’ – are we sure, of course its easy to see the fault in other areas, but are we really sure this doesn’t/couldn’t happen in our ward(s)?  and if it could, what are we doing about it?  Let’s remind ourselves that the Frances report records lack of courage as one of the reason for Midstaffs – where is our courage within our own areas?

  • So what? – my ‘so what’ is – before we simply agree with popular opinion during a #chat –stop– is that really your experience in ever situation, is the opinion balanced, both good and bad?

If you were sitting explaining to someone that they were to be admitted under a section would you say, ‘but you don’t want to go to that ward because …..’  and if you would, what have you done about it?

Opinion 2.  The person with lived experience brings with them an invaluable perspective of what it is like to be on a ward; what, in some instances, it’s like to have things done ‘to you’ rather than with you.  We ignore their experience at our peril.  However their experience and views are that of a person with lived experience, not the views of everyone who has lived experience.  Doyle et al (2013) in their systematic review of evidence linking patient experience – patient safety and clinical effectiveness were clear that there is a positive correlation between the experience and the outcome.   This underlying belief in listening to the voice of those that use our services is the foundation of NHS Scotland’s Quality Strategy, it runs through the Scottish Patient Safety Programme (SPSP) and has been championed at a national level in Scotland by organisations such as VOX (Voice of Experience), Scottish Recover Network (SRN) and a number of Associations for Mental Health that operational national (eg SAMH) and locally.  VOX, along with the SPSP Mental Health programme have developed and are piloting a ‘patient experience’ tool as clear demonstration of the commitment and importance of listen to the voice of those using our services.

The blog, upon which the tweetchat was based was a co-production between @chaosandcontrol and @victoriabetton (available: ) it’s a balanced view of rights and responsibilities, of good and not so good aspects of care provision.  I’d encourage you to read it, then ask yourself the question – what is my experience of being on a ward, as an HCP or as someone using the service?  If you are a ward nurse or service manager – which aspects of this story apply (or might) in your area?

Challenging question

My final thought relates to the tweets harvested into the storify post (available: ).

@chaosandcontrol posted a challenging question which evoked a positive response from four tweeters who I very much respect engaging with, but on this occasion I disagreed with them and because it’s ‘my blog’ 🙂 I can explain why I disagree (yes, they have a right to reply and I will post it if they do).

As we explore and introduce social media across health and social care I think we need to do so openly, we need to encourage HCPs to engage with it as a tool of value, something that can connect them directly to vast amounts of information and opinion, it can also connect them (us) with people who use our services, after all we all are users of services – try engaging with the senior charge nurse or with the clinical nurse manager when things aren’t right, as leaders and managers that it is their responsibility to listen and to take the appropriate action.  To encourage smartphones/camera phones as a tool to spy on staff (or others using our services) is unhelpful and unnecessary

– at least as a starting point.


Doyle, C., Lennox, L. and Bell, D (2013) A systematic review of evidence on the links between patient experience and clinical safety and effectiveness BMJ Open available at:[ ]

13 Comments leave one →
  1. January 19, 2013 3:57 pm

    Hi Derek. Thank you very much for this post – it’s reassuring that you’ve had many similar reflections to me! I agree with you that a TweetChat doesn’t begin and end with that one hour of frantic and furious tweeting. People were already deliberating a few weeks before the chat and have continued to do so (as we are now). I think the issue of photographing poor practice is an intriguing one. One person commented on my blog post with @chaosandcontrol (thank you for sharing the link in your post) that they had taken a picture of a nurse asleep on duty while she was supposed to be doing observations. Falling asleep on duty with a patient for whom there must be concerns about self-harm is a very serious issue and, as I understand it, a disciplinary offence. The other factor that is significant is the regular complaints by people using mental health services that they are not believed, alongside recenty criticisms from the CQC about institutional and blanket rules in mental health intpatient settings. I have to be honest. If I observed poor practice and was worried I wouldn’t be believed then I think I might well take photographic evidence. To give a trivial example, when I had a supermarket delivery of over-ripe bananas, the first thing I did was take a photo and email them my disatisfaction. They immediately apologised and refunded me twice over. I wasn’t intending to share that with anyone else. However, if they had acted differently I might have felt incensed enough to share it on a social media platform. I would always hope that in the first instance any concerns would be shared with staff and resolved at a local level and that people raising those concerns would be respected and believed. However, if I felt that I was unlikely to be believed then I would gather evidence – a photo would be one way of doing that. As a manager, I would want to know if a member of my ward staff was falling asleep on duty and I’d much rather deal with a photo than a tragic death.

    Investigative journalism has an important tradition of bringing injustice to the public eye. Now everyone can be a journalist – there are even courses to train people as community/citizen journalists. I’d always rather things were dealt with at a local level wherever possible but I think it is significant that that people do now have the power to take matters in to their own hands. I don’t think it’s a good or a bad thing. I think it’s just a fact.

    • January 19, 2013 5:36 pm

      Thanks for your comments, in some regards we are not that far apart, however the discussion highlights one of the reasons people resist change – fear, fear of the implications, fear of what if I get it wrong and someone is videoing me, recording me etc.

      There is no doubt that without the video evidence in several national scandals the abuse may very well have continued, that is unacceptable in any area of society far less than where we are allegedly caring for vulnerable people. My underlying point however is not to say it should never be used, it was more about not reaching for it as a first line option.

      Nurses sleeping on duty is not acceptable, nurses sleeping on duty when undertaking enhanced observations is indefensible – given that enhanced observations are not about guarding, they are about engaging and supporting the person to both be safe as well as feel safe at at tie in their life where they are considered vulnerable.

      In the past few weeks a relative came to me to discuss an issue re a ward, their relative who was an inpatient also highlighted an issue. The senior charge nurse and the clinical nurse manager both met with those involved and explored the issues, they then dealt with the bits that were issues and were able to share the parts that were related to the persons perceptions at that time. The family were content they had been listened to and the staff were able to address things we could do better. If we had simply resorted to picture evidence then barriers may have been raised and of course the picture may not be the whole story.

      Like you I had reason to make comment at my local (Morrisons) store – it was a passing comment that I was disappointed with the freshness of a product I’d bought the week before. Before I knew it I had a manager beside me, replacing the item and giving me back double my money – I simply engaged at a human level and got a human response: I hadn’t even asked for anything. Now, if I’d had to do that two or three times before being believed I might have resorted to photographic evidence.

      The thrust of the chat was about the use of SoMe within MH inpatient areas – we already know there is resistance, rightly or wrongly it is there. My approach would be introducing all the good reasons why it would be supportive for the individual, how it is already part of their lives and our role is to support them in their recovery, part of which is undertaking their normal activities. Additionally many people may have a support network via SoMe, it is therefore a positive aspect of their wellbeing that we support them keeping in contact with their network. That seems sensible we underline that SoMe can be a positive tool to support wellbeing, rather than saying it would be a good thing because people can take pictures of things going wrong – in fairness I know that’s not what you are advocating, but it’s a fear that people may come with.

      I’m not sure that investigative journalism is the same as taking a picture of something you think/know is wrong. The danger is in sensationalising events the essence of them is lost, as can be the truth. I think we have a strong tradition of investigative journalism, that in some quarters we are in danger of losing to half truths and innuendo – simply observing the recent BBC fiasco demonstrates what happens when half a story is perpetuated and somehow becomes ‘the truth’.

      The aspect of power differential you’ve highlighted is something we actively need to address, indeed have been addressing although it still exists. We’ve been working to address these over many years and must continue to address them – but we’ll only do it through person to person engagement. You may want to look at my first blog for Ayrshirehealth ( ) – there’s an excellent slide from Mary O’Hagan a New Zealand MH campaigner which describes the transitions of power.
      Thanks for the comments and your pre & post #wenurses chat blogs.

  2. January 25, 2013 10:44 pm

    I think my biggest issue with disagreeing with someone through Twitter is how cumbersome it can become with ping-pong tweets. It hasn’t happened often to the extreme, but significant dialogue through Twitter that is not constructive really grinds me down. For me it is a weakness of the platform, but clearly the benefits of a tweetchat for example outweigh the risks.

    • January 25, 2013 10:49 pm

      I think your right when the disagreement lacks respect – in the recent non-agreement discussion I think everyone respect the views of the others, that said I’ve seen disagreement on Twitter that I think ‘why bother’, the limitations of 140 characters doesn’t convey enough understanding. BTW I enjoyed your blog on live tweeting. Derek

  3. January 27, 2013 1:36 pm

    Hi Derek, both this and Victoria’s posts provide interesting insight and food for thought usefulness of twitter chats and the wider issues of what ever is being discussed.

    Slightly unconnected point but why do you not have the ‘like’ option available in your blog? Sometimes people will drop by and leave a like. even if they haven’t got a comment.

    • January 27, 2013 1:40 pm

      Just noticed it is available above the header image (on mobile). Usually appears at the end of each post too. Apols. Will ‘like’ it now.

      • January 27, 2013 1:45 pm

        Thanks Phil – I’m just formatting tomorrows blog at the minute, will have another look. I much prefer ‘like’ to appear at the end of each blog.

    • January 27, 2013 1:40 pm

      Thanks Phil – I have tried to have the ‘like’ on per post, but I can’t see what I’ve done wrong. I’ve tried to fix it a couple if times as I agree with the point you made. I’ve downloaded a WordPress tips app to see if I can sort it. I’ve got the same issue on Ayrshirehealth. Any tips?

  4. jonopatterson permalink
    January 28, 2013 8:30 pm

    TweetChats remind me of waterfalls and rivers. It’s so very easy to find yourself swept along with the enthusiastic energies flowing around. The pace of comments and variety of things passed over is extremely stimulating and interesting points get picked up and swirled around. Every now and then though, you wonder if you’ve just dropped off the edge of something… but then your back in the flow and it goes on.

    I think from that angle your point about it being easier to agree is right, though tweetchats do seem to generate a lot of generally (and genuinely) positive thought. I always find myself the next day having to just stop and meander around a bit before everything comes to a rest. Sometimes I change my mind on things or find that I play them back down. (What’s genius in a tweetchat is sometimes just common sense)

    Enjoyed the post!!

    • January 28, 2013 8:52 pm

      Thank you for the feedback – I very much prefer your picture of gentle “waterfalls and rivers” wish I’d thought of that. It also captures the risk of being taken along without realising. Reflection – now that is a sensible practice. Thanks for stopping by, hope you’ll do so again. Derek


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