Case Study: Potential use of Blogs as a communications device within specialist medical colleges

Note to Readers: This March 2006 case study prepared by Jim Belshaw explores the role that blogs and blogging might play as a communications device within the world of the specialist medical colleges. Because these colleges are distributed complex multi-purpose organisations, they illustrate many of the issues that must be resolved if blogs are to be used effectively for management or educational purposes. Jim is a former CEO of the Royal Australian (now Australian and New Zealand)College of Ophthalmologists.

Blogs and blogging have become very popular. Yet despite that popularity, or perhaps even because of it, there is limited available material on the use of blogs as a practical communication device within organisations.

Many senior managers or professionals still see blogs as belonging to the personal, to the domain of the blogging enthusiasts. Where business uses are seen at organisational level, they tend to focus on the role that blogs can play in supporting sales and marketing.

We have felt for a while that blogs can be a useful, practical communications tool within organisations. However, to be used in this way two critical conditions must be met. First, they must meet a real need as seen in the eye of users. Secondly, they must also take into account any user constraints.

To test our thinking, we decided to take the Australian and New Zealand specialist medical colleges as a short case study. We selected the colleges for two reasons:

• They are distributed multi-purpose organisations operating in a complex environment marked by many players. For that reason, they illustrate many of the problems that must be resolved if blogs are to be used effectively for management or educational purposes.
• They are also an area where a number of Group professionals have direct personal knowledge, making it easier toﾠcompleteﾠanalysis on possible blog uses without extensive on-ground research.

The analysis that follows does not pretend to be definitive. Our aim is simply to assist people to understand some of the issues involved.

Setting the Scene: Overview

The ANZ colleges are not for profit entities controlled by the Fellows. Fellows are spread across Australia and New Zealand. In addition, many colleges have Fellows in other countries. The Committee of Presidents of Medical Colleges (CPMC) web site (http://www.cpmc.edu.au/) provides an entry point if you want to find out more details on both the colleges in general and individual colleges.

The colleges have two core roles.

Role one is the training of future specialists. There are thousands of trainees in different specialisations working as registrars under the supervision of Fellows in hospitals across ANZ. In addition, some of the Colleges maintain training activities in other countries.

Role two is the advancement of medical skills and knowledge and the maintenance of professional standards. To this end, the colleges (among other things) publish learned publications, help fund research, encourage the spread of knowledge through special interest groups together with various scientific congresses and run systems for continuing medical education.

The colleges vary enormously in size from the Royal Australian College of General Practitioners with almost 11,700 members and the Royal Australasian College of Physicians (9,000 members) to the Australasian College of Dermatologists with 373 members and 60 trainees.

These size variations are reflected in variations in organisational complexity and in the resources available to support College operations.

With the notable exception of General Practitioners, colleges operate in both Australia and New Zealand. This means that they interface with and must respond to two national governments as well as Australia's eight state and territory governments. The practical effect is that at any point in time a college, and especially the bigger colleges, may be dealing with twenty plus issues and a dozen agencies spread across multiple jurisdictions. This adds to the complexity of College operations.

Reflecting multiple jurisdictions as well as history, the colleges combine a branch structure with central operations.

Setting the Scene: The Challenge of Change - Specialist Training

All the colleges face rapid change across the whole spectrum of college operations. This can be illustrated by taking the training of specialists as an example.

The exact structure of training operations varies to some extent from college to college. However, in broad terms, the colleges:

• define the training process
• set curriculum
• set and marks exams to test knowledge
• accredit training posts
• and supervise trainees and trainers.

These training activities depend heavily upon voluntary time contributions by Fellows. Within the colleges voluntary committees of Fellows oversight training in both academic and process terms, with staff in a supporting role. On-ground training in hospitals is also provided by Fellows, generally on a voluntary basis.

In recent years all the colleges have had had to respond to great challenges on the training side.

To begin with, there has been rapid educational change. Both medical knowledge itself as well has approaches to the practice of medicine have been undergoing rapid change. These changes have to be factored into training approaches, as do changes in approach in the broader education and training environment within which all colleges operate. As part of this change process, all Australian college training programs now have to go through a formal accreditation process managed by the Australian Medical Council (http://www.amc.org.au/).

This educational change has combined with equally rapid policy and regulatory change, a change process complicated by the presence of multiple legal jurisdictions. This change process includes:

• Rapid change in health policy as well as funding. Changes in health policy and funding at both national and state or territory level affect every aspect of college training operations. Funding of medical places at university determines the number of future potential trainees. Funding of registrar posts largely determines when and where people can can be trained. Changing approaches to the recruitment and assessment of overseas trained specialists affects assessment loads as well as supervision and training requirements. Government mandates as to what and how to teach affects both curriculum and training approach.
• Adoption by Government of new approaches to public administration including purchaser-provider models and the extension of competition policy. As part of this process, the college training programs have come under attack as anti-competitive. More information here can be obtained by search on the Australian Competition and Consumer Commission web site - see http://www.accc.gov.au.

These challenges have forced rapid and continuing change on all college training programs.

This blog contains one case study example of the change process - the development and adoption of ophthalmic competencies.

In this case, the need to respond to one regulatory change (the grant of prescribing rights to optometrists in one jurisdiction) led to the development of an initial approach to competency definition. The decision by the Australian Medical Council to introduce accreditation (an action combining education and regulatory change) led to the decision to extend the competency approach to provide a solid basis for new training approaches. The challenge then was to define the best way of doing this in the context of a dispersed professional group participating on a voluntary basis.

The Potential Roles of Blogs in Facilitating Management and Change

On the surface, all the issues of governance and management associated with running a distributed higher educational institution in a highly complex and changing environment would appear to make blogs a highly useful tool. For example, blogs might be used to:

• facilitate general communication among the membership thus aiding retention and a sense of belonging
• facilitate communication among college council or board members, thus improving governance
• assist the operation of special interest groups and divisions with geographically distributed membership
• network trainees
• facilitate the operations of a wide range of college committees
• support the operations of local college branches.

Again on the surface, adoption of blogs should be facilitated by the presence of a distributed and highly intelligent membership with an interest in ideas and access to technology.

The reality is in fact a little different. Our view is that blogging can be very valuable, but only if the application is targeted and managed in a very precise way. To understand this, we need to look at the main impediments blocking the effective adoption and use of blogs.

Impediment: Failure to understand Blogs and Blogging

We put this one first not because it is the most important problem - in our view it is not - but because it is the first entry level problem to be overcome.

Discussions with college people last year suggested that the way that blogging has emerged means that very few people see it as a potential management tool. Just as important was the instinctive reaction to see the matter as something for the IT department or web supplier when in fact the management issues are central, the technology secondary.

Impediment and Opportunity: Existing Communications Systems

Because we are looking at blogs as a communications tool, blogs must mesh with and complement or replace existing communications systems.

All colleges already use a variety of communications mechanisms including:

• Face to face meetings at both and central and branch level. The geographical size of Australia and New Zealand combined makes travel expensive and time consuming. For that reason, many college meetings are clumped with the annual scientific congresses since Fellows are expected to attend these anyway. Even so, travel and accommodation costs form an important element in college budgets.
• Phone hook-ups.
• Extensive use of email.
• A variety of newsletters and magazines.
• College web sites. These include password protected member sections.

Taking existing communications mechanisms into account, blogging will work as a tool if and only if it:

• meets a need not already being met at both user and organisational level
• or meets a need already being met in better and more cost effective way.

Impediment: Time, Need and Payback

Meeting user need is a central requirement.

When I was CEO of the Royal Australian College of Ophthalmologists (1998,1999), the College's IT committee was very concerned about the slow take-up in IT among the Fellows. The trainees were expected to be computer literate (among other things, they had to use an Internet based system to maintain their surgical log books), but many of the Fellows were not or, if they were, did not make great use of the new technology.

To help understand this, I flow charted the daily life of an average Fellow. I found that they generally worked very hard seeing patients. While a few entered patient details into the computer, most dictated patient notes into a recorder over lunch and/or at the end of the day before they went home. They did so because this was the most time efficient approach. Then when they went home, often quite late, they had family commitments. This meant that they could not get onto the computer until quite late in the evening. However, this time was also their time for personal and professional reading, for personal business and for personal relaxation such as just watching TV.

The bottom line in all this is that no matter what the advantage to the college, Fellows will only access a blog if the time return to them is greater than all other alternatives. Thinking about this, we concluded that there are three types of blog that might work at Fellow level.

Number one is short term project or working group blogs, blogs formed to facilitate communication within a project. I have not seen any blogging discussion in this area, but intuitively it is a potentially powerful use.

Number two we call, for want of a better phrase, spasmodic use blogs. Many college special interest groups only get together at the annual scientific meetings. For the rest of the year they tend to activate if and only if there is a need. So here we see a standing blog as a device not for continuous communication but as something that could be activated as a support if the need arose.

In thinking about blogs, we also looked at a the third type of blog, a continuous use blog supporting a college core on-going activity. With one exception, we concluded that this type of blog was unlikely to work unless managed on a special needs spasmodic basis. There simply wasn't sufficient need for continuous communication.

The exception was branch operations. Unlike central committees that can draw support from college staff, many college branches have little or no staff support and therefore dependﾠupon voluntary time contributions from busy Fellows to operate. A blog here may well be valuable in reducing load upon key Fellows.

Fellows vs Trainees

We concluded that the position was different when we move from Fellows to trainees.

While there are individual hospitals with largish numbers of trainees, trainees tend to be much more isolated. Colleges already have a range of mechanisms for communication with and networking trainees. Even so, we thought that two blogs might work, one focused on the trainees themselves at a personal level, a second on the training function itself.

In our view, a blog designed to facilitate communication among trainees is likely to work measured by use and outcomes (especially building a sense of community) because it provides a mechanism to help overcome isolation. However, we also believe that it will work if and only if it is seen by trainees as their blog. And this raises a new impediment, fear among college staff and some Fellows that the blog might be misused.

We also thought that a blog or blogs could be used to support the training function by providing a forum in which trainees could share knowledge and raise questions for answer by supervisors and relevant experts. For this to work, the blog needs to be moderated (we use this term in the sense of summary, not control), while relevant Fellows must be prepared to put in time to supply answers.

Impediment: Limitations on Staff Time

One major impediment identified during discussion lay in limited staff time.

The reality in most colleges is that limitations on Fellow time mean that action requires staff commitment. College staff are already over-stretched and simply shudder at the thought of an additional time commitment to first set up and then manage blogs. So any proposal to introduce blogs must have staff support. This means in turn that things must be made as easy as possible in terms of needs definition, set-up and management.

Impediment: Absence of Models and Case Studies

This brings me to the final impediment, the absence of models and case studies that can be used to identify issues and provide guidance. This case study is a small step in filling that gap.
In this context, and looking at it from a management viewpoint, the opportunities that we have identified all have one thing in common, the potential blogs are all one element in a communications armoury rather than an end in themselves.

Our analysis also suggests certain steps that need to be followed if blogs are to be used as an effective communications tool:

• The starting point is to define what you want to achieve from the blog or blogs.
• Step two is to look at the blog from the viewpoint of the user. Why should they participate given their limited time?
• Step three is to look at your other communication mechanisms. What are you already doing? How will the blog fit in?
• Step four is to look at the structure of the blog. How do you structure the blog so that it is easy for your visitors to use, to find past material?
• Step five is to look at the management of the blog. Who is going to manage, how much time will be required?

Conclusion

This case study has focused especially on the possible use of blogs as a communications tool within organisations, using the ANZ specialist medical colleges as an example. The colleges are an interesting example because the nature and complexity of their operations draws out some of the possibilities in regard to use of blogs within membership based organisations and as an educational tool as well as a more general management tool.

Our overall conclusion is obviously positive. We believe that blogs should be moved from the world of the blogging enthusiast into the normal tool kit available to management. However, for this to happen experimentation will be required to test and modify the form to meet specific organisational requirements.

Note on Copyright

The paper is copyright Ndarala 2006. However, it can be quoted, copied or reproduced with due acknowledgement. The following should be included for citation purposes: Jim Belshaw, Case Study into the possible use of blogs as a communications device within specialist medical colleges, Ndarala Staff Paper, March 2006.