Why wont MY ‘thing’ go viral? by Ros Gray


Dreams are made when your great idea gets out there in this social world and goes viral. The very thought that thousands of people (likeminded as you) are looking at your good idea and thinking – “That’s a great idea, I could do that”
especially in our health and social care world when it isn’t necessarily the idea that’s new (although sometimes it is) but the ability to engage others to get them to follow your lead, for the benefit of patients and families.

So when things take off in this way, is it just good luck, or is there something we can learn? How does a good idea move from being MY great idea to something that a lot of other people want to do too?

In his New Yorker article ‘Slow ideas’ Gawande started my thinking on this topic (and a million other things!) when he discussed the evolution of surgical anaesthesia compared with the uptake of antiseptics to prevent sepsis. He described how the former spread almost worldwide in 7 years, the latter taking more than 30 years (and you might argue that the inability to clean our hands consistently even today means that we still haven’t cracked it).
It’s easy to imagine the difficulty undertaking any surgical procedure on a patient not anaesthetised (not least for the patient) – having your colleagues hold down the poor patient until such time as they (hopefully) passed out with the agony of the ordeal. Then you hear of an innovation where the patient inhales a gas and goes gently to sleep, allowing the procedure to be done with ease – a no brainer in terms of its likelihood to be adopted by others… and swiftly! The action of holding down the screaming patient and wrestling to undertake the procedure was clearly very personal and real for all those present.
However, the use of antiseptics to prevent an infection that the practitioner might never even see personally, leaves a lot to the imagination and limited personal cost, with the exception more latterly of professional reputation and in some quarters accreditation.
This situation was also exacerbated by the unpleasantness of the environment, where the practice of good antisepsis in the early days meant that theatres were gassed with antiseptics, hands scrubbed raw with early chemicals – all to prevent something that the practitioner might never witness… Perhaps, then, it’s easy to see why that adoption took longer than 30 years. Or is there more to it than that?

Gawande’s article goes much further and is very thought provoking but he fundamentally sets out how, if we want our ‘thing’ to be taken up by others at scale, then “…technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread.”
He goes on to say that while our new social world can get the ideas out there
as Rogers showed, “…people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.”

I think these might be key concepts for us to consider with our personal improvement efforts. How hard do we make it to do the right thing?

Looking around at some other recent great ideas gone viral that I have become aware of – I thought it might be helpful for us to take a closer look at these and consider their spread from this perspective – I thank Delivering the Future Cohort 11 for their help with my developing thinking #DTFcohort11.

And also to consider how would the business world more broadly consider this issue?
Great marketers certainly start with two concepts that absolutely relate to our world and reflect Gawande’s thinking:
Know your audience
Make an emotional connection.

So looking at 3 examples of great ideas that have gone viral a little closer to home, can we identify the critical success factors that made them work so that we can apply that learning to our own work?

Case 1 – What matters to me


Who Jennifer Rodgers @jenfrodgers Lead Nurse for Paediatrics NHS GG&C
What What Matters To Me (WMTM)

WMTM is a 3 step approach

1 Asking what matters

2 Listening to what matters

3 Doing what matters

Why “Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners — learning, in other words, how to ask, ‘What matters to you?’ as well as ‘What is the matter?’”
Where Yorkhill Children’s Hospital Glasgow – global
When Last 4 years
How Originally Jens’ Quality and Safety Fellowship project, building on the concept of Lauren’s list in the USA; national and international presentations, Used the Model for Improvement as the improvement method. Started by asking one child to draw what mattered to them, and staff making every effort to include and react positively to this information –  now used routinely as part of the paediatric admission process. Spread includes other specialties such as the Care of Older People and those with Dementia.

Case 2 Hello my name is…


Who The sadly very recently deceased Kate Granger (http://hellomynameis.org.uk @grangerkate) a young doctor battling at the time with terminal cancer, made observations about the human interactions she was struggling with at a very vulnerable time.
What Kate decided to start a campaign, primarily using social media initially, to encourage and remind healthcare staff about the importance of introductions in healthcare.
Why She made the stark observation that many staff looking after her did not introduce themselves before delivering her care. She felt it incredibly wrong that such a basic step in communication was missing. After ranting at her husband during one evening visiting time he encouraged her to “stop whinging and do something!”
Where NHS England – Global
When Last 3 years
How Twitter campaign initially – #hellomynameis has made over 1 billion impressions since its inception with an average of 6 tweets an hour.

Kate has left an incredible legacy with #hellomynameis that will continue to impact positively for patients.

Case 3 The Daily Mile


Who Elaine Wylie – Headteacher (recently retired) St Ninian’s Primary School, Stirling


What The aim of the Daily Mile is to improve the physical, emotional and social health and wellbeing of our children –regardless of age or personal circumstances.
Why It is a profoundly simple but effective concept, which any primary school or nursery can implement. Its impact can be transformational- improving not only the childrens’ fitness, but also their concentration levels, mood, behaviour and general wellbeing.
Where St Ninian’s Primary School, Stirling – global
When Last 3 years
How The Daily Mile takes place over just 15 minutes, with children averaging a mile each day.

Children run outside in the fresh air – and the weather is a benefit, not a barrier. 

There’s no set up, tidy up, or equipment required.

Children run in their uniforms so no kit or changing time is needed.

It’s social, non-competitive and fun.

It’s fully inclusive; every child succeeds, whatever their circumstances, age or ability.

Elaine demonstrated huge impact on eliminating obesity in her primary one class that had stated the Daily Mile in Nursery.

In each of the cases the idea started with one individual who had a simple, sensible, not necessarily unique idea, but certainly something that was a bit different from the status quo – perhaps even challenging and making the status quo uncomfortable.
Each leader had a degree of power and autonomy in their local context, for Kate this was as an informed patient, so some might argue her ability to influence would have been limited.
Each idea was simple and easy to try in different arenas.
Each was free or relatively low cost to implement, even at scale.
The impact on patients or children was obvious or in the course of early testing clearly demonstrated.
Each leader used social platforms as a spread mechanism.
In every case, the idea clearly feels like it was the right thing to do, or scandalous that it wasn’t happening routinely, something each of us would want to happen if we were the subjects in question. Perhaps even the standard we apply every day in our professional or personal lives and assume that everyone else does too.
So clear evidence to support Rodgers view that “Diffusion is essentially a social process through which people talking to people spread an innovation,” – Perhaps the easy access to social platforms in these cases made ‘people talking to people’ helped in these cases?
Each leader knew their audience and played to that strength – but also and perhaps most importantly in each case, the emotional connection is huge, but each from a very different perspective.
Is the emotional connection the critical success factor in these cases – and something we should consider carefully if we want our work to spread?
Which emotions might you tap in to when trying to engage folk in your great idea? Emotions described in pairs of polar opposites might give you some food for thought and a place to start with your great idea:
Joy or sadness
Anticipation or surprise
Fear or anger
Disgust or trust

You will have many more thoughts than time permits here, but I leave you with a thought of mine… perhaps we all have an opportunity to use a more considered approach to the scale up and spread of good intentions by learning from those that have done that well.
If not you, who? If not now, when?


Simple checklist
How simple have I described my great idea – Have I got my 1-minute ‘elevator pitch’ worked out to easily influence others?
Does it feel the right thing to do?
Is it relatively cheap or free? If not who will fund the idea, now and then at scale?
Am I convinced that it isn’t happening to every patient/family every time, reliably? Do I have the data that proves that?
Do I have the power to influence, or if not, who do I have to get on board?
Do I have the data and story to describe how it works and how easy it is to adopt, including the impact?
What social platform for spread will I use?
Which emotions are triggered, or will I aim to tap in to, in order to engage people to want to do things differently?

Ros Gray recently retired from her post as National Lead for the Early Years Collaborative. Prior to that post she was Head of Patient Safety for Healthcare Improvement Scotland.


One year on….by @kendonaldson


BlavatarIt was in November 2012 that a friend of mine, Ros Gray of the Early Years Collaborative, suggested that I start a blog for NHS D&G. I had become interested in Twitter and the power of linking to research articles, national documents and blogs and Ros knew that Derek Barron, Associate Nurse Director for Mental Health at NHS Ayrshire & Arran, had established his blog, www.ayrshirehealth.wordpress.com, earlier that year. She introduced me to Derek and from then on there was no going back.

Derek sent me a detailed email outlining how to set up and start a blog and tips on maximising readership. I must confess there then followed a few months of inactivity while I toyed with the idea before finally taking the plunge. After setting up the blog itself I had to ensure I would have some interesting blogs to publish. I also had to decide what sort of content NHS D&G desired and what the underlying ‘ethos’ would be.

Passing the buck

I therefore emailed a mixed bag of nurses, doctors, pharmacists, managers, therapists and Chief Execs asking if they wished to contribute. The remit would be “900 or so words, any topic you wish but related to healthcare and pictures if possible”. So basically the content and ethos would be decided by them, not me!

Ken 2By the time I had 14 willing bloggers I felt I could get started and set the date as March 22nd 2013. I had decided to emulate Ayrshirehealth and post once a week and as they posted on a Wednesday I decided to go for a Friday. I had booked a session on our Wednesday lunchtime meeting to discuss ‘Social Media in Healthcare’ but also launch the blog. This way I had no choice but to ensure everything was set to go.

Ready for launch

The final step was to obtain permission from senior managers and IT to use the DG2all email address so that I could email the link to all staff members of the health board weekly. @lauralougraham7 stepped up to the mark and agreed to provide me with our first blog, “Never underestimate the importance of safety briefs” and we were off.


In the past year we have had 50 blogs (2 weeks off for Christmas and New Year). 15 by doctors, 14 managers, 7 nurses and 6 Guest blogs. The rest are made up from IT, carers, AHPs etc. The most popular categories are person centred care, patient experience, communication, common sense and ethics.  We have had a total of 20,731 views and 263 comments.

If you access the blog from the email link then this is recorded as ‘Home page’ so, unsurprisingly, this is the biggest hit at 13,301. However if the blog is accessed via Twitter then that blog itself is recorded and the biggest has had 727 views with 474 second to it. This drops down to a few blogs in the 20s and 30s.

Ken 1We have had 19,365 views in the UK with 417 in the USA and 104 in Australia. New Zealand, India and Canada follow with 80, 65 and 59 respectively. There is a total of 87 countries worldwide where the blog has been viewed ranging from Tunisia to Trinidad and Tobago to Thailand. I am still impressed that we had a reader in the Philippines at the same time as Hurricane Haiyan was laying waste to the country. I would have imagined they had something better to do!

The year ahead….coffee

I think the list of categories above probably establishes what the ethos of the blog is but I have a slightly different take on things. Here in the Renal Unit in DGRI there is a longstanding tradition of starting the day with a cup of quality coffee. This involves general conversation that is extremely variable; the current headlines in the news, a new drug that’s been announced, the experience of a patient seen the previous day, an update from a meeting attended or just a funny story.

Ken 3I like to think of the blog as a similar experience for everyone in NHS D&G and beyond – have a cup of coffee (probably not as good as an ‘Isles Special’) and spend 5 minutes hearing the thoughts and opinions of a colleague. It will probably not change the World or indeed Dumfries and Galloway but it may make you think a little differently about your practice or realise what happens in different areas of the Health Board. Or it may just make you smile. Whatever, I intend to keep the blog going for at least another year and hope you will join me.

I would like to thank Derek Barron (@dtbarron) for all his help and support in setting up the blog. I would also like to thank Ros Gray (@rosgray) for the inspiration and encouragement. I am extremely grateful to all the bloggers to date and would be delighted if anyone reading this would be keen to contribute. Please email me on kdonaldson@nhs.net of you wish to have a go. Finally I would like to thank you Dear Reader for continuing to view the blog.

Ken Donaldson is a Nephrologist and Associate Medical Director at NHS Dumfries and Galloway