Power to the people is all very well, but what happens if the people turn out to be complete bastards?

What if they just sit behind their screens being unpleasant, dishonest, and anonymous? As one director of communications said to me, after a particularly bruising and abusive session defending her trust on a local forum, “Why on earth should I ever, ever put myself through that again?”

The economics of SHOUTING

One of the lessons we learned in 2012 is just how easy it is to do terrible things to people via the media. Just think how easy it was for a top-flight, BBC current affairs programme to accidentally traduce Lord McAlpine on Twitter.

Or for two radio jocks – apparently – to drive a dedicated nurse to suicide through public humiliation. Maybe it’s worth asking whether Andy Warhol got it wrong; perhaps it’s not 15 minutes of fame that awaits us but 15 minutes of infamy.

One way to think about social media in 2013 is to explore the underlying economics of the web. What does social media make cheaper? What economic forces drive Twitter?

The first and most obvious economic fact about social media is that the cost of having a public voice has dropped to zero.

Think back 20 years to a time when it cost real money to make a video or publish an article; and even more to get it distributed worldwide. Today, all that has changed.

Anyone with access to the web has a free public voice via blogs, Facebook and Twitter. Voice has been democratised and now everyone can broadcast their opinions to the world.

As economic night follows day so the falling the cost of voice has triggered a huge rise in supply. Tune into Twitter or the blogosphere and you’ll hear the result – a cacophony of voices all trying to be heard.

So one way to view social media is as a crowded market place where everything is free but the currency is attention. Under these circumstances it is no surprise that vendors try and attract attention by being the loudest, rudest or funniest.

Meanwhile, the quieter folk head for the door. This is why uncurated platforms always tend to the extreme and why ‘bad voice’ tends to drive out ‘good voice’.

Calming things down

If the drivers of social media are – at least in part – economic, are there any economic solutions that we could use during 2013 to help us to create platforms that select for saints (or at least normally nice people) not bastards?

For example, how can we raise the cost of bullying? Or increase the incentives for constructive conversations?

Happily, the web has decreased the cost of a lot of other things besides voice. Firstly, RSS feeds and other similar tools deliver highly selective hearing for free. Busy staff can tune-in to just that spectrum of babbling voice that relates to their own responsibilities.

Secondly, transparency comes free with the web. This can be disruptive to organisations used to doing most things behind opaque, ‘due process’ firewalls. But transparency is a free good that can drive new behaviours rapidly across the system.

For example, on Patient Opinion anyone can see how many staff at which organisation have read (that is opened the relevant email alert for) any given story.

This raises the costs of organisations not joining in. After all, do you want your organisation to be the only one to be seen as not caring what people think of it?

At the same time, it encourages thoughtful conversations. Why shout when you can see the people you want to speak with are already listening?

It also costs nothing to slow things down a bit. Part of the fun of Twitter its immediacy, but where speed does not matter giving people time to think, to pause before they hit ‘send’, often creates better conversations.

It also discourages the sociopaths. After all, bullying is less fun when it is done in slow motion rather than in real time.

So one piece of advice for harassed communications directors and others is to publish a quick holding response when necessary, but not to feel pressured into coming up with a full response at speed, unless there is a clear reason for doing so.

It’s good to talk…

Finally, check out the business model of any platform you are thinking of using. Generic platforms like Twitter and Facebook make money from knowing who your friends are and hence being able to direct highly targeted ads at them.

Their interest is primarily in the shape of the network, not the content flowing through it. So, they are great for monitoring who is talking to whom and taking the pulse of the social sphere.

By contrast, platforms like Mumsnet or patient support forums create value through relationships and content – advice, support, solidarity, gossip and so on.

This is where the most value resides for the NHS, since both the people working in it and the patients using it have a shared interest in safe, constructive conversations that enable the public to see who you are and how you react to praise and criticism.

This is why bespoke, content-focused platforms are – in principle – easier for NHS staff to use than Twitter or Facebook.

So, we are not simply at the mercy of these new tools because the economics of the web help predict how to shape our interactions towards the positive and away from the negative.

Given half a chance the public are not complete bastards; indeed most of them want to help. And the incentive that drives this conversational economy? Warm, human responses from front line staff.

None of this is rocket science. Treat on-line feedback with suspicion, assume the worst and force all replies through Comms or PALS and you will get stilted, limited conversations that the public does not trust.

Be open, welcoming and use platforms that encourage sensible conversations with selected front line staff and you will delight patients and public.

About the author: Paul Hodgkin is chief executive of Patient Opinion, a website on which patients, service users, carers and staff can share their stories of care across the UK. Patient Opinion is a not-for-profit social enterprise based in Sheffield.

Until 2011 Paul also worked as a GP and has published widely including in the BMJ, British Journal of General Practice and the Guardian and the Independent. Follow him on Twitter @paulhodgkin.