#TweetRegret?

I have been an occasional Twitter user for a long time. Indeed, I’ve used Twitter since long before you even knew Twitter existed. I say this with some confidence, as Jack Dorsey posted the first tweet in March, 2006. My first tweet was four months later in July 2006. I am Twitter user #1922. Today there are over 130 million twitter users.

Twitter is an effective medium to communicate short messages to many people.

It’s also an easy way to say something – or imply something – that you didn’t quite mean, or didn’t get to explain deeply enough.

Blogs are better.

This post is about why I should have blogged instead of tweeted.

In ~ 2004 there was a platform called blogger, created by Evan Williams. With Blogger, one could craft blog posts and plop them on the Internet for everyone to see. This was a new idea. I experimented (beginning in 1999) with the medium and found that it was a good way for me to communicate with people, provoke thought, and offer insight into the work I was doing. One day I posted an essay about EHR usability that (I thought) nobody read. Three months later, my boss called me and told me that the EHR company whose software I critiqued was unhappy with the post and asked me to take it down.

I declined.

The next day, the President of that company called me.

We had a wonderful conversation. Then he hired me to help fix his product. The rest is history. My life has been very different. This episode launched a career. Who knows what would have happened had I not posted that critique. I took a risk. I wrote something provocative and it worked out for the better.

Tweets are shorter and offer less context. A blog post (like this) gives us time to think, offer insight and provide background. Elon Musk has cost himself many millions with careless tweets, and some (many?) people have even lost their jobs due to things they have posted online.

But there’s a positive side too. A provocative tweet can have broad impact, can demonstrate thought leadership, and can generate conversations that make the world a better place.

Message: be a careful but provocative tweeter. If you choose to use this medium.

Yesterday I tweeted something (now deleted) that was provocative and perhaps not careful enough. It described a conversation I was having with an employee of a hospital who saw the work that our organization does to improve health in our communities (and reduce hospital volume) as deliberately “harming hospitals.” I asked if flu shots deliberately harmed hospitals too. He didn’t reply – and I thought I was oh-so-smart. Later in the day, I tweeted it, and a handful of people piled on about how hospitals are the problem.

But here’s the thing that I didn’t (couldn’t) say within the boundaries of a tweet. Hospitals are NOT the problem. Gosh – we need hospitals. We need hospitals to be healthy. We need hospitals to be able to invest in people, products, and infrastructure so that they are there for us when we need them – even though we hope we don’t need them.

There is a problem with the policies of how we pay hospitals today. Yes. There is a mindset that the hospital employee expressed that I wanted to question. Yes. Public policy that improves the health of our communities will result in reduced fee-for-service revenue for the hospital. This can result in “harming” the hospital, but I am certain that the intention is not that that the hospital be harmed. The intention is that the hospital migrate to new ways of doing business – to be more than a building with beds in it, but a part of the health (not necessarily the care) of a community. To one who is part of an organization that is being unintentionally harmed by the improved health of a community, this may seem intentional, and it may feel like the hospital needs to be compensated for this harm. My snarky response to this person (and tweeting it) was disrespectful. I wanted him to reconsider his thought process, but perhaps I should have reconsidered mine.

What’s it like to work in an organization whose purpose is to try to put itself out of business? We’ve not yet created a sound business model wherein the hospitals can survive in the context of falling fee-for-service revenue, but we’re asking them to do so. That’s not good policy, and this hospital employee was just describing the world from his perspective. This is a good thing. My next move should have been to listen, learn from him, affirm his position and then (perhaps – if he was in a position to learn from me) offer my perspective so that we could think together about how we might solve public health problems. Of course he doesn’t want people to be unhealthy so that they go to the hospital. It was unfair of me to imply this (even if it was a logical extension of what he said) – it was a move appropriate for a college debate competition, not a collaborative conversation. I’m a bit ashamed that I said what I said. In his defense – we’ve seen very good examples of the hospitals in our community changing for the better, and the hospitals we work with are indeed migrating their work toward better health and away from more care. It’s not easy, and I shouldn’t have poked my finger in the eye of someone doing their best to bridge the gap. #TweetRegret #honesty #humility #Alldoingourbest

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