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A key concern with using Social Media in healthcare business has been the reliability of the information. In a heavy standardised and regulated industry, there is a need for more significant moderation than any other sector for SM to be used successfully. There are too many barriers and tend to be risk-averse industry. See table 3 showing barriers to Social Media.

Table 6: Challenges and Barriers to using Social Media Marketing in Healthcare Organisations

Risks involved Ethical challenges Reputation Management Labour efficiently Presenteeism and loss

of productivity

Language and Culture

Budget Constraint Damage to health Source: (Maskell et al., 2010; Eccles, 2010)

Compare to other industries; healthcare organisations have been very reluctant to adopt Social Media. This reluctant has mainly been driven by concern for potential risks of privacy violations, inaccurate information becoming fact, loss of public trust, and undermining individual careers. Additional changes that have to be considered when a nurse engages in social networking are the security and safety of another staff

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member, the potential of identity theft, inappropriate use of personal information, loss of job and the potential for the employee or employer to be compromised by actions taken by a person. My concern is that few of us actually read that material and accept regardless of what it says. If we upload images of ourselves or others without their permission, we can put ourselves or those individuals in jeopardy in terms of employment or personal security and safety.

When Social Media is misused, accessing social media sites and reading and responding to personal email and text messages cause a distraction that puts patients at risks (Maskell et al.,2010).

There is also a risk associated with Children’s using Social Media, as shown by all the findings reported in Birks et al. (2013) research. Therefore, it is difficult to reach specific target individuals if their products or services are for children. In the findings, the main reason why it is a risk to children as they are vulnerable to cyberbullying, sexual exploitations, suffer psychological ill health and may misunderstand the particular promotional message.

Due to increased privacy laws and regulation, some healthcare organisation has been unable to tell a successful story or even allow their patients to share a success story on their social media platforms. Also though they could hide the individual identity, then these lose its authenticity.

It creates an ethical challenge for professional using SM to communicate with their clients (Eccles, 2010). They needed social network policies to guide the professional when interacting with the client on the platforms to prevent ethical and legal violations. Many professionals understand the ethical considerations for protecting client

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confidentiality. However, there is an element where the staff has to respect their colleagues or organisation when on those social media platforms.

It is vital for healthcare professionals to be mindful of when interacting online such concerns about confidentiality and unwarranted self-disclosure (NASW, 2008).

The most common barrier regarding the use of SM was a concern about compromised privacy and confidentiality (Clayton and Fisher, 2012). In their finding there, 46% of respondents who answered would prefer to use SM for healthcare cited privacy and confidentiality. There were also concerns about the lack of personal benefit and the expense of technology.

Patient privacy in the SM has raised concerns as it can distribute information instantaneously to broad audiences and unlike verbal conversations, it creates a permanent electronic record that cannot entirely delete and may be used against the organisation in court proceedings.

The former employee may sue SM to talk about the organisation and in doing so, may talk about former patients and may negatively talk about the organisation as they no longer work there. It would create fraud and abuse.

SM provides the organisation with a platform to promote their product or service to a broader audience. However, this also can allow their customers who may not be happy with their product or service to put flippant statements, e.g. around their experience. Even this could have been an isolated incident which can have significant consequences to the company’s reputation. The organisation may lose control over the content of the promotional message. Inaccurate posting of information in the SM settings poses a considerable risk to public health as a large number of people will

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view it in a short period. It is essential that organisation respond to criticism and complaint that originate from the outside the organisation must be accurate and reflect the organisation’s message, being respectful in all communication and does not harm the reputation. It is prevalent for an individual to publish any letters received from an organisation on social networks, which can cause damage to their status (Suby, 2013). There is a risk of non-clinical reduction in hospitals, which is in it not an attractive cost- cutting strategy. Health leaders Media intelligent (2013) has suggested that many organisations are looking to reduce the number of staff by 51 % by using enhanced technology such as SM which in itself can have a detrimental effect on the organisation if SM is not successful in maintaining the success level in terms of marketing. Allowing staff to use SM may increase the risk of team presenteeism, and according to the American Psychological Association Practice Organisation (2010), productivity is lost because presenteeism is almost 7.5 times greater than lost to absenteeism. A study by Detroit LLP (2009) found that companies that allowed their employees’ access to Facebook at work lost an average of 1.5 % in employee productivity.

Healthcare organisation will find it challenging to embrace SM as it is a new and evolving strategy that even the people that work in the organisation will find difficult to understand and therefore will less willing to implement also it may increase the profitability. It could be that the individual is from a different era and generation. SM remains more popular among young adult than an older adult who is usually the primary customer and decision-maker. Therefore it can difficult to reach the target audience. They are one of the groups that the organisation could benefit from an increase in interaction (Edwards et al., 2011).

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Even though several healthcare organisations and hospitals are adopting SM, the budget for the use of such media, including hiring dedicated employees for the purpose is relatively low. According to the study released by Graystone.net in 2010, 70% of around 100 healthcare providers participated in the survey have only three or fewer employees monitoring their social media operations. For SM to be successful, the organisation need to invest and making sufficient budget available. It is challenging for marketers to justify the return on investment of social media uses ad; there is relatively limited evidence to support its use.

An organisation using SM to promote product or service that could cause damage to their health, such as Tobago’s. It could lead to encouraging unhealthy behaviours and easy to project an image which can mislead to the general public (Armayones et al., 2012). Over the last decade, the presence of non-suicidal injury on the digital world has increased (Whitlock et al., 2007). It is mainly due to young people being avid consumers to such videos.