Social media has certainly posted a challenge for communications throughout the NHS. The most rigorous strategies have been turned upside down with the expectation that communication teams need to manage the organisation’s reputation in real-time; spreading positive news and diverting any negative attention away in a matter of minutes, not hours or even days.

And the communications team’s challenge does not stop there. Faceless organisations, especially those that have previously hidden behind the NHS brand, now need a face, a personality, a leader, and they need one 24/7.

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The role of NHS leaders within communications is changing radically. For example, a chief executive’s involvement in a communications strategy can no longer be limited to cheesy photos in the annual report, an appearance at two or three events during the year and the signing off of a press release. This is forcing communication teams to work closer with the boardroom more than ever before.

The NHS Leadership Academy points out that senior positional leadership needs to ‘communicate their ideas and enthusiasm about the future of the organisation and its services confidently and in a way which engages and inspires others’ – but doesn’t say how. Is there a role for social media, perhaps?

In addition, a recent article by the academy’s deputy managing director Karen Lynas argues that the true power of social media lies away from leaders and is “giving a voice to people who previously had no platform. It has helped us magnify the weak signals of influence that come from groups that used to be seldom heard, and who are not always from the top.”

Of HSJ’s top 50 chief executives 58% do not have a Twitter account, slightly outweighing those who have signed up to the micro-blogging platform (42%).

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So why aren’t more leaders on Twitter? Is the fear of being humbled by patient groups, the NHS workforce and the general public preventing leaders from embracing social media?

Former NHS England chief executive David Nicholson claims that for a long time he was banned from joining Twitter because “corporately they were very anxious” in case there was “a lynch mob out there waiting for me”. And you can see why. Less than a month after experimenting with Twitter, Nicholson had to apologise to his own team for posting inappropriate tweets.

The difficulty for communications teams, and that of an organisation’s social media policy, is that Twitter is about people, not brands. This means that NHS leaders not only have to promote corporate messages, they also need to portray their own personality whilst doing so. It is a very tough skill to manage someone’s online personality on behalf of them, especially those that are in the public eye.

Take Lord Alan Sugar’s Twitter account for example. There are a mixture of tweets. Some around criticising his football team’s performance, some engaging with celebrity friends – and it is hard to judge whether these are managed by himself, or a very savvy, prepared and reactive communications officer. Then there are also overly obvious promotional tweets endorsing products Lord Sugar is associated with, which do hamper credibility of the content stream.

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In a time of continued reform for the NHS, which requires strong leadership, CEOs should be armed with an online communications strategy that monitors public opinion and engages with key groups around the clock.

Will the new NHS England chief executive, who looks to bring a renewed level of leadership to the NHS, join Twitter? In his inaugural speech this week, Stevens encouraged staff to ‘think like a patient, act like a taxpayer’, a very direct and engaging message. It also fits into a tweet with 99 characters to spare. Interesting.

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