For the first few weeks everything is humming along like a well-oiled machine.  You engage regularly via Twitter, have quickly cultivated a base of patients on Facebook and have managed to churn out several blog posts.  Everything was going swimmingly as enthusiasm ran high.  But slowly, something changed.  The pace of followers decreased, posts don’t seem to come to life as readily and your Twitter engagement gets pushed to the backburner as that budget meeting looms.

What happened?

Your pharma social media strategy met the fate of many that have gone before it—a lack of content creation.  What started out well-intentioned and maybe even well-planned met its match.  Content creation: where pharma social media goes to die.

Social media programs often start out with the best intentions.  But what many people fail to realize is that social media is difficult.  It takes dedication.  It takes time and it takes internal resources.  It’s not as simple as simple as throwing up a couple of random 140 character thoughts every once in a while.

Content creation is a long slog.  Before you make the commitment to social media, survey the content you already have in house.  If you have a vault of videos that have gone untouched, that might be a good place to start.  Do you have an internal newsletter that might transition well to an external blog?  Think about using that as part of your content creation strategy.  And as rudimentary as it sounds, consider creating an editorial calendar to outline predefined topics for blog posts and assign authors.  This will create some accountability at the outset.  Eventually, you won’t need the calendar as a set of people will become engaged and motivated to post on their own.  But that won’t happen overnight and creating some urgency through a set timeline of posts will keep momentum moving forward.

Content creation is in many respects the linchpin of social media engagement.  It is a wonder then that it often spells the demise of many efforts.

That was a satisfying piece of information in the sense that I’ve long trumpeted the need for social media strategies focused on the Return on Health of the patient.  It’s always nice to affirm that you are not crazy.  It was frustrating because what I heard from the table was it was a need mostly going unmet. What became apparent to me during our dinner was that this is not a problem that can be solved by pharmaceutical companies in isolation.  Just like pharmaceutical social media engagement should not take place in a vacuum, creating a healthcare system where the patient is empowered to play a larger role in the decision-making process requires systems thinking.

Pharmaceutical companies can lead the charge in part because of their unique access to information but also because of their substantial sphere of influence.  Pharmaceutical companies have access to the best information available on treatment options, dealing with side effects and current research.  Like it or not, they also have pull on capital hill, with insurance providers, in the doctor’s office and with the patient.  Pharmaceutical companies must serve as the catalyst to empowering the patient.

But the process can’t stop there.  As agency people, we tend to focus our energies on swaying the folks that write the checks.  In order to truly empower the patient, we need to broaden our field of vision.  How can we expect the empowered patient to achieve a good outcome when doctors are incentivized to see more patients and not spend more time with patients?  What good is an empowered patient if she can’t find information on the latest clinical trials on her rare disease because search algorithms do not lend themselves to uncovering that information?  What’s the use of an empowered patient if doctors are not trained to take input?

I admit I am raising a problem far too complex for me to solve—something that requires brains far smarter than mine.  But I am smart enough to realize that pharmaceutical companies engaging in social media alone will not empower the patient—we need the collaboration of lawmakers, insurance providers, hospitals, doctors and patients.

Even with this complexity, it all centers on the patient.

(I wish I could remember who Tweeted that so I could give proper recognition, but alas, I can’t.  So to my stranger-Tweeting friend, thank you!)

It struck me as a particularly relevant comment for the world of pharmaceutical social media.  I’ve touched on the fact that pharmaceutical stumbles in social media are a good thing and that it is indeed possible to use social media for pharma crisis communications.  My contention has always been that each challenge along the way illuminates the fact that social media is not some fly-by-night marketing technique.  There are always stumbles in a marketing program, and there will always be challenges, the belief that social media would somehow circumvent that has always hurts its credibility.

As pharmaceutical companies have encountered struggles in social media it has sharpened all of our thinking on the best approach to engagement.  In the early phases of pharma social media—a company was praised simply for showing up.  As well they should have been at the time.  A pharmaceutical company showing its face online was a novel idea three years ago.  During this period, our thinking was never stretched and our approach was never challenged.  It was kind of like elementary school—everyone got a gold star just for trying their best.

No longer.

The recent string of pharmaceutical mishaps has been the crisis that will spur invention.  It will force social media pundits to take a closer look at the thought process behind an engagement and reevaluate the best approach.  More importantly, it will force pharmaceutical companies to ask the right questions before embarking on a social media journey, pinpoint the right goals and insist on outlining a strategy and crisis communications plan.

I recently watched a video on the kitchen-gadget company Oxo.  While you may not expect it at first glance, Oxo is widely regarded as a world-class product design organization.  It’s the kind of company that routinely thinks of ideas of the: “why the heck didn’t I think of that variety?”  The video was on the company’s design philosophy and had a quote that struck me as particularly interesting: “We are a culture of nitpickers; we have to be to get it right.”

The idea behind the nitpicking philosophy is that every product-design decision is put through a firing squad of questioning.  Only if you try to poke holes in your own concept will you ultimately create the best product possible—no detail is too small.  Of course, most people when pressed would say they loathe working with nitpickers.  They slow down the process, obsess over small details and can’t see the big picture are the common complaints.  But in pharmaceutical social media, a healthy does of nitpicking might be just what the doctor ordered.

Let me explain.  Ask a pharmaceutical executive to describe a typical social media person and you will get something that describes a person long on creative juices but short on strategy and project management skills.  This results in an abundance of “big ideas” with little idea of how to implement those ideas or the business drivers that make that a reasonable course of action.  This creates false promises and failed programs.

A culture of nitpickers would approach this process differently.  Once a big idea is pinpointed, the next question is: “does this make sense given the goals we have (presumably) outlined?”  This would be followed by a series of detail-oriented questions that delve into the minutia of a social media engagement.  Should we allow comments?  If so, should they be pre-approved or in real time?  What will the terms of engagement be?  What are grounds for deleting a comment?  How will we handle adverse events or a disgruntled patient?  You get the picture.

Creating a culture of nitpickers is not about stifling innovation—just ask Steve Jobs.  Jobs is the Grand Poobah of nitpicking and few would accuse Apple of a lack of innovation.  It’s about marrying the “big ideas” with the “little details.”  Pharmaceutical social media is too often happening with only big ideas and no concern for the details.  Maybe it’s time we start acting like the company that invented rubber-handled potato peelers and become a culture of nitpickers.

And while I did gather data for this post, my survey of healthcare Twitter accounts will be less focused on the analytical side and more focused on pulling out some general observations and putting them in the context of helping to move the industry forward.  Plus, I can’t put together graphs that are nearly as sharp as the ones Silja put together.

For my research, I relied mostly on Jonathan Richman’s unbelievably helpful Pharma and Healthcare Social Media Wiki to identify as many healthcare Twitter accounts as possible.  For the purposes of this post, I evaluated 39 Twitter accounts.  After pouring through the data, Tweets and usage, I was able to boil it down to a five key lessons:

1.)    People Care: The average number of followers for a Twitter account in my sample size was 1,290.  That’s a pretty healthy number when you consider that pharma accounts only followed 421 people back on average and had an average total Tweets number of 57.  The follow-back rate of 31 percent and infrequent Tweets does not warrant the hefty followers number that pharma has garnered.  So why the high number?  People care.  It’s certainly debatable what types of people are currently following the Twitter accounts of life sciences companies (marketers, social media advocates, journalists, etc…).  But it’s hard to question that there is a genuine interest in the foray of pharmaceutical companies into social media.  Take the Bristol-Myers Squibb Twitter account for example.  BMS has established a presence on Twitter with a corporate handle, but has yet to send out a single Tweet or follow a single user.  Despite that, 642 people have followed BMS based on the mere fact that it has set up shop in Twitter land.  People care—pharma just need to demonstrate it does as well.

2.)    Lots of Back Patting: It’s no secret that pharmaceutical companies are entering uncharted waters when engaging on Twitter.  This lack of familiarity is only compounded by the fact that regulatory challenges make the water excessively choppy.  The response from pharmaceutical companies has been to skew so far in the other direction that the value of their content is diminished.  Paralyzed by a fear of interacting with patients, encountering adverse events or mentioning a brand, healthcare companies have tended to stick to promoting “safe” content such as company press releases.  There is nothing wrong with directing people to your company news page on occasion, but the problem is that for many companies, this represents the majority of their Twitter account.  You should offer something of value on Twitter that is unique to that user group—not something that can be found by scouring the wires.

3.)    Single-Use Accounts Gain Ground: Perhaps it’s a product of an excessively fragmented industry, but what I will refer to as “single-use” accounts seem to be gaining in popularity.  What I mean is accounts that are geared toward a specific type of content (SanofiTV), or were established as a result of a specific event (McNeil Recall) or serve a single function (AZHelps).  This is not to say that single-use accounts are ill advised.  Quite the contrary.  If used properly, single-use accounts can have a very positive impact.  However, there is a danger with relying on single-use accounts for your foray into social media.  There is a potential to treat social media more as a campaign than a sustained engagement.  Social media requires a sustained effort to add more value to the community than you extract.  That’s tough to achieve if people know you are only there for a single purpose or for a defined period of time.  However, uses like the McNeil Recall example and AZHelps are good examples of companies acknowledging the unique platform provided by social media in being able to directly engage with the patient.

4.)    Corporate Accounts without Human Identity or Interaction: The large majority of healthcare Twitter accounts lack any type of personal identity.  This misses an opportunity to bring a human element to the brand.  Is it a coincidence that two of the best examples of pharmaceutical companies on Twitter (Johnson and Johnson and Boehringer) have individuals behind the account?  I tend to doubt it.  Not to mention, the follow-back rates of 44% and 63% of J&J and Boehringer easily outpace the industry average.  The lesson?  Engagement in social media demands some form of interaction.  When dealing with health, that interaction is almost always of a personal nature.  Without a personal side to your corporate Twitter account, you are missing out on a key benefit of social media.

5.)    This is Just a Test: The infrequency of Tweets and the general tone of the content suggests that most pharmaceutical companies are just testing the social media waters with Twitter.  That’s okay.  While it points to a flawed social media strategy in the short-term, it also maximizes chances of future success.  Why?  Because as I have harped on before, we need social media realists, not purists.  A social media realist understands that in order to gain general acceptance at an organization or within an industry, you have to play by their rules.  That means, taking things slow and proving the model before you fully immerse yourself in the world of social media.

So you’ve made the decision to jumpstart your social media efforts.  Good for you.  You’ve surveyed the scene, understand the relevant communities that have formed and pounded out a pile of useful content to share.  But then it suddenly dawns on you: “social media is hard work, I can’t do this alone—what should my internal team look like.”

Good question.  One of the most frequent questions I get is centered on how to structure an internal social media team for success.  For pharmaceutical and biotech companies, structuring a social media team involves a few wrinkles due to regulatory and legal restrictions.  The above is certainly a dramatization of the conversation that occurs, but it’s not that far from what most companies experience.  There is often an “internal champion” that fights the good fight, wins approval and then deals with the resource problem later.  It’s a survival instinct.  These internal champions realize that they are often fighting an uphill battle—one that will only become steeper with additional moving parts.

Admittedly, I am an agency guy.  By definition, I am part of the external team (a part that, as you might expect, I think is an integral cog in the wheel).  That being said, I think I’ve developed a broad enough view of the landscape to observe the “ideal scenario” and the “real-world scenario.”

If there is a so-called definitive piece of work on this topic, it comes from Jeremiah Owyang at the Altimeter Group.  Jeremiah places internal social media teams into three buckets: the tire, the tower and the hub and spoke.  Essentially, Jeremiah believes that social media teams either form on the fringes of a company (the tire), centrally located in isolation (the tower) or with a central source that facilitates efforts to relevant departments in a company (hub and spoke).  Jeremiah’s conclusion is that the hub and spoke is the ideal scenario for structuring an internal social media team.

My own anecdotal evidence supports that theory.  A hub and spoke model for social media teams allows for a more cohesive strategy that cuts across departments.  It also provides ample opportunity for a variety of customer touchpoints to get involved in social media.  As I have reiterated endlessly, social media should not occur in isolation and the hub and spoke model is one mechanism to prevent that from occurring.  It would like something like this:

That’s the ideal scenario, but is it feasible in the real-world? Yes and no.  Consider a pharmaceutical company embarking on a social media engagement strategy.  It would be great if that company were able to involve all key stakeholders right out of the gate.  But the reality is: many will be in “prove it to me mode” first.  As such, in a practical sense, the most likely (not best, but probably most efficient) way to start a social media engagement is in the tower model.  Generally speaking, that central command will be in corporate communications.  Corporate communications, by its nature, sits at the center of an organization and is in a unique position to get access to content.  This provides a bit more control, establishes a mission control and sets the benchmark and template for success for those “prove it to me” people.  The added benefit of having the tower located in corporate communications is that it can be easily transitioned into the hub of a better defined hub and spoke model.

Social media is in many ways still a developing medium.  Because of that, people are so laser-focused on the execution piece they neglect the resources needed to make that execution possible.  Social media takes time.  It takes resources and it takes commitment.  But you don’t have to tackle it all at once.  Start with the tower and you’ll find your way to the hub and spoke.

Marketing programs are often made of disparate parts

I’ve been preaching the importance of looking at biotech and pharma social media as part of an integrated marketing plan.  Often times this isn’t the case.  Part of that is because social media is still a fringe marketing tactic, and as such, tends to take root in isolation at the fringes of a company.  In addition, some marketers are lulled into thinking that social media is easy and devoid of strategy because of its ad hoc nature.  Effective social media engagements acknowledge that it is only one piece of the market puzzle and must be run in concert with those pieces—not in isolation.

Chief among those integral marketing tactics is boosting your performance in organic search results.  Want proof?  eMarketer today released the results of a study indicating 95% of organic search referrals to a Website come from the first page of search results.  What does that mean?  If your Website, or at least a piece of content from your Website, does not appear on the first page of search results it’s highly unlikely a person will find your page naturally.  If you consider that 80% of online sessions begin with search, that’s a chance you should not dare to take.

Does that mean you should drop everything and pour your entire available budget into boosting organic search results?  Of course not.  I point to this study as an illustration of two points:

1. Despite the frequency with which I write about social media—it is not the only game in town.  It is important, but without a full marketing plan that includes search engine optimization; it is useless.
2. More importantly, marketers need to not only be aware of other portions of the marketing mix, but incorporate them into their strategy.  Knowing that 95% of organic search referrals come from the first page of results should have a significant impact on your social media strategy.  Have you analyzed the keywords that are most relevant to your audience and incorporated them into your content creation efforts?  Does your social media content drive people back to its intended destination?  By answering some of these questions, you can ensure that your social media efforts align and bolster the SEO strategy.

It’s all well and good to talk about an integrated marketing plan and the importance of a coherent strategy.  But an integrated marketing plan doesn’t mean a “consistent brand message.”  That might be a small slice of the pie but the most crucial piece is evaluating how each tactic influences and augments the other.  This is not done frequently enough in social media efforts.  Social media can have a profound impact on SEO, PR, brand engagement and awareness and customer support.  Marketers first need to start linking these efforts together rather than allowing them to persist in isolation.

(Side note: every one of the above links is worth clicking on for a unique perspective on this topic.)

The debate on ROI for pharma social media has centered on the question of whether or not it is even the right form of measurement.  It’s a topic I have been railing against for months so I will be brief here. One major problem with ROI as it pertains to social media is that it is a lagging indicator. By its nature, it is designed to evaluate the success of a program, in financial terms, at a given point in time (usually the conclusion). There’s a fundamental flaw when you apply that approach to social media.  Social media is not a campaign—it’s an engagement.  ROI does a great job of measuring campaigns, but is a little less concrete when it comes to sustained efforts. When I measure a program, I want to know in process where there are shortcomings so I can adjust accordingly.  ROI fails to provide that ability.  It is useful as a tool to prove value after the fact and move forward. It also should not be dismissed off hand and certainly has a place in the measurement toolkit. Perhaps a better way to approach measurement is something I’ve termed Return on Health (ROH).  When developing an integrated marketing strategy, the first steps are less about concrete numbers and more about establishing a basic decision-making framework. The patient should be at the center of any pharmaceutical social media effort. With the patient at the center, you have established a framework that provides a clear and distinct guide as you seek to engage more actively in relevant communities.  Essentially, it boils down to a simple principle, have an outcome in mind and map your efforts based on how they will help achieve that outcome.

Let me be clear: social media should not escape measurement.  But to rely solely on ROI as the measure of success or failure is insufficient.  ROI is a point in time measurement.  More sophisticated measurements are needed to move the discussion forward when it comes to social media for pharmaceutical companies.

Social media focused on regulatory concerns only does not line up

Those of you that have read this blog more than once know that I have been beating the Return on Health (ROH) mantra lately when it comes to pharmaceutical social media.  The thought is that far too many social media programs start by considering how they will extract value and not how they can add value.

That’s a misaligned process.  Instead, marketers need to start by focusing on the patient with an eye toward how their interactions will enable access to more information and better health outcomes.  That’s the value you bring to the able as a pharma marketer.  That doesn’t mean you ignore your ultimate goal of building a brand that drives more revenue.  But instead of starting off with that at the forefront, you rely on a marketing principle that fosters long-term and authentic engagement.  It’s a significant shift in thinking but one that is critical if social media ever hopes to gain widespread adoption by pharmaceutical companies.

That shift in thinking is needed across the board and includes things like our fixation with adverse events and off-label usage.  I am as guilty as the next guy when it comes to spending an inordinate amount of time thinking about how to handle these very important issues in pharmaceutical marketing.  And we should continue to give careful consideration to where they fit into a social engagement strategy.  Dismissing AEs and off-label usage discussion as non issues demonstrates a clear lack of perspective.  These topics remain at the forefront of every pharmaceutical legal, compliance and regulatory department, and thus should remain a part of our conversation.

But we shouldn’t limit our discussion to solely focus on how to navigate the issues of adverse events and off-label usage in social media.  Why?  Because focusing the conversation in this area relegates the patient to the sidelines.  How many patients know what an adverse event is and even realize they are discussing off-label uses for a particular drug?  I would venture to guess is it a very small minority.  These types of issues, though important, are really geared at how a company can limit its liability with regulatory bodies.  It’s a necessary step and a conversation that needs to occur, but perhaps not at “stage one.”

The better approach would be to work from the patient out.  As pharmaceutical marketers, first ask yourself if there is a concrete reason for you to be engaged in social media.  If the answer is no—stop there.  Go no further.  Starting off the discussion focused on adverse events and off-label usage reverse engineers the process.  It starts with a company-centric point of view and eventually finds its way to the patient.

Successful engagements will start with the patient in mind and incorporate regulatory planning only if the first criterion is met.

Do you have a strategy to fit into the community?

As has become painstakingly obvious, the standard of communicating in the business world has changed dramatically over the last few decades.  First it was the advent of email and most recently the rise of what we’ll call “the digital communications era”—namely the ability to reach anybody, anytime, on any device.  Text messages, Twitter and Facebook have accelerated this dynamic and fed our appetite for smaller and smaller bits of content.

The ripple effects of this change are widespread.  Of course, the positive perspective is that work output is increased, productivity enhanced and the decision-making process accelerated.  In addition, as we have chronicled here, social media opens up an entire new toolkit for the marketer.  This is particularly true in the world of pharmaceutical marketing where customers are becoming increasingly wary of what they viewed to be nefarious efforts of pharma companies.  They craved a more authentic interaction with companies that would disband the ads that seem to strike fear more than they provide useful information.  Insert social media.  Social media allows pharmaceutical companies to introduce a different dynamic to its marketing programs—one built on trust and transparency.  In that sense, social media and micro content is a boon.  However, it’s not all good.

There is a fundamental disconnect between the types of communication facilitated by social media and strategic marketing plans.  The very nature of social media may be tempting marketers to put strategy on the backburner.  When you boil it down, a person’s interaction on a social network is ad hoc.  It’s not a planned, measured and calculated interaction.  This is a dynamic that many marketers have yet to solve.  How do you conform to the community norms of authenticity and put a strategic plan in place?

Unfortunately, too often marketers have opted for the wrong answer; either throwing strategy to the wind or going too far in the other direction and planning every interaction.  The flaw in both approaches should be obvious.  If a pharma marketer plans every single interaction he intends to have on social media his conversations will no doubt be manufactured.  His very presence will be loaded with ulterior motives.  However, if a marketer surveys the landscape and concludes that strategy and focus are not needed she too will fail.  Strategizing every interaction may not be needed, but having a reason for being there is imperative.  Rather than focusing on tactical plans to the minutest detail, pharma marketers should focus on decision-making frameworks that guide interactions in social media circles.  Empower the faces of your social media presence to act with confidence.

In the old days in business, the standard form of communicating a message to a large group of people was writing a memo.  Those memos were well-crafted, thought-out documents.  They had to be.  You couldn’t afford to be ambiguous in your message or marching orders—the medium did not allow it.  Social media does allow for ambiguity and poorly defined communication.

Perhaps it’s time we took a page out of the 1980 playbook and apply it to social media.