Reframing organizations in the digital age: A qualitative study exploring institutional social media adoption

Research paradigm

We used quasi-deductive thematic framework analysis approach on the amalgamated perceptions of social media clinician educators and researchers to determine organizational components that fostered the utilization of social media, and used SRQR guidelines²⁵ while reporting the results. While we were sensitized to the work of Bolman and Deal, we did analyze and review the content with a fully inductive approach, and then sought to map our themes to the framework during axial coding. Themes that emerged outside of the framework are presented in addition to those that fit with the framework.

Research team reflexivity

The research team was comprised of five individuals: three of which used social media professionally in the contexts of scholarly advancement and practice, (YY, PT, TMC) and two who only used it for personal and recreational purposes (VT, BR). Furthermore, the composition of the team consists of a senior lead (TMC) who is a medical physician with expertise in qualitative analysis, free open access medical education resource dissemination and social media stakeholdership, a postdoctoral fellow who is an expert in qualitative analysis and social media education. Two researchers (TMC, YY) have publications utilizing qualitative methods. The remaining three members are research assistants trained in qualitative analysis but are neither experts in social media nor knowledge translation (PT, VT BR). Having a mix of people with different expertise and familiarity was key to ensure that our lead and senior author did not overinterpret the transcripts and bring in their own perspectives and experiences, in keeping with our selected methodology of the framework analysis. Gender composition of the team consisted of three females (TMC, PT, VT) and two males (YY, BR).

Context

The problem that we sought to answer required seeking experts on social media who had personal and professional backgrounds around knowledge working in AHSCs. Our initial participants were derived from the field of emergency medicine, as they were likely to have many experiences regarding social media knowledge translation and usage within academic and health institutions based on their extensive online careers²⁶. Bolman and Deal’s Four-Frame Model guided our study design which examined structural, human resource, political, and symbolic constructs in relation to social media and knowledge translation for organizations. This study is a sub-study that was defined a priori.

Participant recruitment

We contacted a random selection of 25 individuals from a previously published list of influential physicians²⁶ and contacted them via email or direct messaging on Twitter. The only individual excluded from this random selection was the Principal Investigator (co-author TC), who is listed in this paper. Based on the literature which identified influential online physicians using a complex set of analytics including network centrality²⁶, we determined the most influential social media users in emergency medicine and applied a purposive, snowball sampling technique to define our study group, as snowball sampling techniques are used for populations that are ill-defined. In this instance, the landscape of social media is constantly evolving with new platforms and new people. Therefore, snowball sampling is an appropriate method to employ to augment previous lists of influencers that may only hold past relevance.

Ethics

Hamilton Integrated Research Ethics Board granted ethics approval for the study with a reference number of HIREB-#5609.

Data collection and processing

We elected to perform interviews with our participants since we were interested in individual’s interaction with their organizations, instead of the interactions between various participants. We developed a semi-structured interview guide to assist with steering the interviews. Our interview guide was developed by two team members (EB, PT) based on the Bolman and Deal’s framework. This initial guide was reviewed by the rest of the team, then piloted with non-participatory individuals to ensure clarity. We did not modify the interview guide since our pilot testers thought that the guide was very clear, and the interviewers felt that we were able to elicit the types of answers required. The interview guide has been fully published²⁷ and is available for full review (see references, citation 27).

Two of the team members (AM, BR) managed the data collection procedures. Each research assistant completed a practice run of data collection with the senior research lead (TMC) preceding data collection. The research team reviewed groups of 2-4 transcripts before proceeding with subsequent interviews and refined the interview questions as necessary. This process enabled the interviews to be increasingly explorative. All the transcription files and their content were anonymized. We assigned a gender-matched name for each file using a random name generator.

We informed our participants about the research, data collection process, and confidentiality procedures. Informed consent was obtained from participants via email prior to the interview, who were then asked to complete a short demographics survey (See the interview guide in the extended data). Subsequently, we invited them to be interviewed via Zoom video conferencing software (Zoom Communications Inc., San Jose, CA, USA). We used Zoom’s local audio capturing feature to record all the interviews for transcription purposes. The recordings were transcribed verbatim into Microsoft Word files (Microsoft Corp., Seattle, WA, USA) by a trained medical research transcriptionist (EC).

Analysis

We followed the five-step process articulated by Ritchie and Spencer²⁸: 1) Familiarization; Identifying a thematic framework; 3) Indexing; 4) Charting; and 5) Mapping and interpretation. Throughout the interview period, our team collaboratively analyzed transcripts. The transcripts were analyzed in batches of 2-4 transcripts at a time using Google Docs (Google Inc., Mountainview, CA, USA) to create our codebook. Key quotations were recorded in the comment feature of Google Docs to augment our codebook. After a period of familiarization, we identified that many of the emergent themes aligned with that of Bolman and Deal’s Four-Frame Model and formally began indexing our themes according to this model. Once we analyzed all transcriptions, our research team had a final charting meeting to refine our coding structure and integrated the findings into Bolman and Deal’s framework. We then asynchronously collaborated to engage in mapping and interpretation of the data.

Rigor and trustworthiness

The research team ensured the trustworthiness of the study applying several techniques. All of the members analyzed the qualitative data and served as debriefers throughout the analysis. Concepts that the participants mentioned were identified and investigated at every stage of the analysis as well as the last coding stage. The final themes were confirmed with the frames of Bolman and Deal. While reporting, we used thick descriptions to ensure our participants’ voices were represented to the readers. Participants underwent a member check process by reviewing the results of the study to ensure they resonated with their interviews and experiences. Our results and discussion were refined based on their suggestions to better represent and resonate with their experiences.

Demographics

A total of 16 participants were interviewed, with an average age of 43.3 (SD=8.32). The interviews were on average 30.3 minutes long, ranging from 22.5 minutes to 42.1 minutes. This yielded a total of 180 pages of transcripts.

The majority of participants were male (n=10/16). Most of our participants clinically or academically practiced in Western countries: 7 (44%) practiced in the USA; 4 (25%) in Australia, and 3 (19%) in Canada. Furthermore, the roles identified by our sample mostly consisted of clinicians (15.94%), teachers 14 (88%), and researchers (12.75%) which aligned with our intended target audience of capturing the perceptions of clinician educators and researchers working within organizations. We captured: 13 (81%) were affiliated with a national or international organization; 8 (50%) were affiliated with a journal or publication; and 8 (50%) identified not being affiliated with a journal or publication. Our interviewed participants utilized a wide array of social media platforms to disseminate their scholarly activities: 15 (94%) used Twitter; 8 (50%) used ResearchGate; 8 (50%) used Google Scholar; and 8 (50%) had an ORCID profile. Our recruitment process was able to capture a diverse amount of organization affiliations, allowing us to gain multiple perspectives around different organization frameworks. A full summary of participant demographics is outlined in Table 2.

The Structural Frame

The structural frame includes the governance, committee structures, policies and procedures, and organizational hierarchies present in institutions. Overall, there were several structural elements within the organizations that tended to incentivize work across all contexts. These incentives were described by participants in two ways: financial incentives, and non-financial incentives. Examples of financial incentives included grants and salary support. Most participants noted that they had little-to-no financial incentives. As one participant highlighted: “The hospital doesn't pay me to use Twitter. They pay me to write papers and to be a doctor. And Twitter … in my view should be an embellishment.”

Social media can also be seen as a lost opportunity from currently acceptable forms of scholarly activities while spending time on social media. However, many participants highlighted substantial nonfinancial incentives which were thought to include opportunities to engage in research and scholarship, to learn about new literature, and to recruit participants into their own scholarship. A participant whose primary incentive for social media use was to familiarize himself with new literature added that it is “well worth the investment of time even though it is not compensated”.

Several structural elements were identified within organizations that supported our participants in their utilization of social media. These structural elements were grouped under three main themes: Hospital-based, Educational institutional-based, and Online organization-based structures.

There was a wide range in elements that were noted within the hospital-based structures, with more being structural barriers rather than enablers. For instance, some of the participants noted that hospitals tended to discourage their social media usage, while others were encouraged to have their own accounts. Mostly, if social media was permitted, it was usually not a high priority for organizations, and consequently participants felt that these roles were secondary to their other official roles. On the other end of the spectrum, one participant noted that their hospital had a fully integrated hospital-based social media team. Such hospitals clearly prioritized this type of communication in a fully structural way by creating infrastructure to support these activities.

Many of our participants also held roles within educational institutions that may or may not have been intertwined with hospitals. Within these organizations, it was felt that structures that helped included the development of transparent policies and guidelines for social media integration into the university. One participant describes his desire for his organization to outline what social media tools they value, why, and how they value social media for promotion:

Within this theme was the natural structural alignment between the institutional prerogatives for teaching and the methods by which this teaching could be accomplished via social media structures. Tweet chats or other online conversations or blogs for dissemination of content were seen as easy venues.

Online-based organizations tended to have the most non-hierarchical and organic structures. Participants described these structures as spaces to be creative. While some were described to have editorial systems (complete with peer review and editors), most of these organizations were outside the governance of hospitals or educational institutions. Mainly these groups arose as a mechanism to exist outside of formal structures, and yet over time had evolved to take on more structure, increasingly resembling the academic institutions with the evolution of distribution teams and some level of support/hierarchy for authors. Many had also evolved over time to go from more static entities (e.g. blogs) to more media-savvy entities that supported distribution across multiple platforms (i.e. a blog post is distributed across emails, Twitter, and Facebook), which required increased structures to support such processes. Figure 1 depicts the continuum in the level of perceived structures and policies pertaining to social media.

Figure 1. Continuum of structures and policies pertaining to social media.

The Human Resources Frame

The human resources frame describes how an organization fulfills the needs of its members and how the organization allows the worker to express their skills and ideas to create the optimal individual-organizational alignment that benefits both parties (see Figure 2).

Figure 2. Human Resources Frame.

Organizational roles. In our interviews, it became clear that organizational roles pertaining to social media usage varied from being informal and volunteer-based, to being delegated with responsibilities, specified tasks, and embedded leadership levels. In most cases, work relating to social media was unpaid and uncompensated. In one participant’s organization, their academic work position did not require blog-writing; however, junior residents were required and expected to write blog posts, with senior residents supporting the blog through administrative tasks and a committee of residents managing the website. The residency blog of their organization has delegated roles for content managers (e.g. “putting the graphics up”, “running the website”) as well as managing editors (e.g. “administrative tasks”, “emailing people”) for coordination of content generation within their team of residents.

Another participant described their organization as having “four levels of involvement” for social media use: 1) a core executive team of individuals who run the fellowship program, the blog, the social media account, the website, and strategic initiatives; 2) the editors who lead and coordinate a series and set of resources; 3) contributors who help produce podcasts and write blog posts; and finally 4) the supporting staff and junior editors who help upload, copyedit, and perform miscellaneous tasks. Further participants were also found to have unpaid social media teams with individuals who have significant number of followers on Twitter. They are indirectly compensated through the waiving of registration fees for scientific assemblies and unlimited access to various conference sessions to tweet and disseminate information.

Educational considerations of the human resources themes. Training of social media use by organizations through mentorship, role-modelling, and formal education programs within medical school curriculums are effective methods of supporting an individual’s capacity to learn and empowers members to feel supported and coached in these roles to encourage future participation in social media activities in academic work. These activities and programs are an example of how to address issues arising in the human resources frame such as how to keep individuals informed, involved, committed, and motivated in their work.

A participant noted their start with social media through the role-modelling of colleagues who are experienced social media users, who “showed [them] that the typical peer reviewed journals don't have as much dissemination as would be optimal”. With the motivation to promote further dissemination, they learned how to use Twitter and grow an audience, “specifically to promote the growth of the journal and alt-metrics”. Another participant added to this notion, and suggested role-modelling through weekly discussion of blogs and podcasts with junior doctors would encourage social media involvement and knowledge on the value of these tools. This participant explains:

One participant described how social media use is being integrated in curriculums for second-year students in the medical education scholarly concentration track; in these social teaching sessions, students are taught “how to utilize [social media] for their professional brand” and as a way of networking.

The Political Frame

The political frame articulates how various actors within the organization garner and wield influence and power. Our participants described different mechanisms and processes that influenced their behaviors surrounding social media utilization and their organizational influence, which are modeled in Figure 3.

Figure 3. Navigating the political landscape by accruing scholarly currency.

The accumulation of scholarly currency, which we define as the gradual acquisition of political stakeholdership and influence in the respective field of practice, are the drivers for this model. Pointed arrows originating from concepts in green are enablers that promote scholarly currency accumulation, while flat-head arrows originating from concepts in red are inhibitors. Our findings in our model highlight five progressive stages with respect to the online community of practice (CoP) which will be defined further in this section: the “Self” phase, novice member of CoP, intermediate member of CoP, Expert in CoP and acknowledgement in real life.

Community of Practice (CoP). Many participants described engaging, collaborating and networking with a larger network of “scholars” and “communities” on social media, as one interviewee eloquently puts it:

“Twitter allows you to have a community that you may not have even though you are in a job around similar, like[-minded] people. It allows you to develop an even larger or very strong, connected professional community. It allows you to, you have access to other experts you can learn [from], so something […] is given to you. That is a benefit of Twitter.”

As this concept frequently emerged in our interviews, we have decided to articulate these entities as the “community of practice (CoP)”, as we felt they were aligned with the concepts originally highlighted by Lave and Wenger²⁹. Participants described collaborations within the CoP to serve as the heart when building scholarly currency and academic stakeholdership. Interestingly, by fostering active communities around a given practice, organizations

The “Self” phase. Initial engagement of social media begins by developing a digital identity.Participants in this phase carry forward defined research interests and begin to generate forms of content related to their academic work. Utilizing social media’s ability to “reach a broader audience” and “get your message out there” allowed participants to start building an identity and status as a social media researcher. Participants primarily used Twitter as a “mechanism to promote any of the publications that [they] had at any given time.” Building metrics on other platforms such as Google Scholar or ResearchGate were also ways that contributed to solidifying an online research identity in their field of practice. As the digital identity is in its beginning stages, participants initially engage with CoP in forms of “partaking in…conversations and [getting] involved in conversations that other people have started,” “sharing articles that [they] find interesting” or “[commenting] on [the] interpretation of scientific articles.” Development from this engagement have resulted in early forms of collaborations in some participants, including sharing viewership and collaborating through “[recording] a podcast with other [podcast organizers].”

The rate at which online identity manifests was affected by the levels of organizational support received by scholars. Participants who experienced institutional support regarding their social media scholarship found their “organization keen to promote and amplify individual Twitter or individual social media outputs from people, particularly when it comes to highlighting publications,” which assisted in disseminating and promoting their work. Other participants however felt a described “lone wolf” status, where their home institutions did actively not support or engage with their scholarly social media work. These participants, despite valuing institutional support, expressed frustration in receiving lack thereof as one of our participants highlight:

Novice members of CoP. As the promotion of content continues, types of content and strategies that garner followers are identified and reproduced, leading to further frequent engagement and acknowledgement with the CoP. At this point, the researcher begins to realize their field of online engagement as a social media researcher and has reached the milestone receiving a novice membership in the CoP. Participants described their intention of continuing to engage with their respective CoP by using engagement strategies to promote discussion, as one participant describes: “When I see new research coming out of any of our journals that I think have a compelling point or merit for the dissemination then I will capture the URL. And send out a tweet with some questions trying to tag a few individuals who I think are in that research field.”

As production, consumption and engagement continue to build scholarly currency, participants begin to build a “network with people who are like-minded [that] increase the chance of collaboration and future grant success,” which can result in the collaboration of a “variety of projects, things like studies, educational endeavors and all sorts of different work.”

Intermediate members of CoP. Consistent engagement allows further establishment within the CoP, subsequently allowing the third phase of becoming an intermediate member of the CoP. In this phase, the researcher has also established a base audience or target following, and can identify a close group of collaborators. The roles of which participants took online towards their audience or CoP were diverse. One participant who runs an educational blog as a knowledge dissemination tool for other clinicians described:

Other participants established their platform as an education tool for the general public to teach or generate discussions. In one participant’s case, they used their professional expertise in toxicology to “teach about drug related topics” on Twitter. Utilizing the network and following now built, the previous transition mechanisms from stages 2 to 3 can be repeated to continually generate scholarly currency.

Expert members of CoP. When enough scholarly currency is attained, the individual will become recognized by the CoP as an expert, experiencing academic influence that bleeds and translates into the researcher’s identity in real life: “[Twitter] allows you to brand yourself as a leader in the field and it helps you to be established at your own institution.”

These influences also take the form of many scholarly outcomes. For instance, the opportunities from social media scholarship allowed participants “to talk at international conferences and get involved in international guidelines.” Others commented on social media’s ability to bolster faculty development and find international collaborators, as one of these participants highlight:

Our findings from our participants also noted one unconventional academic contribution to social media regarding a grant application as they describe:

Inhibitors of scholarly growth. Meanwhile, our participants described some negative influence towards social media usage. Organizations which were anxious to control their message and utilize their hierarchy to do so, as one participant highlights: “[Institutions] seem to be very nervous about their employees or the members of the organization using it because they don't really have control over that content. And that seems to make the organizations a little bit nervous.”

Political constraints of this type within an organization inhibit individuals from progressing through the various stages of their development from individuals to leaders in their academic spheres. Furthermore, this increases the learning curve for researchers unfamiliar with these platforms that are transitioning to use social media to augment their work. Similarly, the political ramifications (e.g. intellectual property concerns and copyright issues) around content generated within their academic or social media roles had an effect on scholarly growth, often deterring individuals from using social media platforms:

The Symbolic Frame

The symbolic frame represents the motivations or sense of purpose from members within an organization. This section provides insights on various ways that organizations can use or support social media to promote their citizens’ sense of purpose and promote their organizational mission. Our analysis revealed that participants had different symbolic values for the use and integration of social media. While some participants sought ways to integrate in their practices in traditional organizations, others found non-traditional groups to associate with. They also mentioned the ways of how intrinsic and extrinsic motivation enables them to contribute to the organization values. For example, enjoyment is worth mentioning as highlighted: “I would say that I do that journal club for free. I do it as a member of the editorial board of the journal, it is sort of a service that took up a couple of years ago and I like it. I don't get paid for it.”

On the other hand, some participants mentioned social media as a manifestation of their mission as a traditional aspect. They perceive that the transition to social media can be attributed to people as well as the organization itself depending on the situation.

The symbolic frame also seemed to have impact on either intrinsic or extrinsic motivations of individuals within organizations. Organizations who supported and rewarded their members in non-traditional ways seemed to be fairly better in generating success for those individuals within the social media domain – suggesting that by supporting and rewarding these individuals, they were providing some level of extrinsic motivation.

Others were less motivated by organizational rewards and support. Many of these individuals noted that it was the other people within the organization that were key to their continued participation. The opportunity to engage in forming new organic social relationships between like-minded people in real life were examples of non-traditional methods of fostering intrinsic motivation. One participant underlined the meaning of strong connection with colleagues here:

Traditions have a great deal of impact on social media, as participants mentioned. Organizational supports for social media enabled practices in workplace provide variety of options for their employees. For example, alternative communication options or cultivating communities of practices with organization support is found an important extrinsic motivator. This experience is described in this quote:

In more traditional organizations, social media was often deemed as added activity to be engaged in on individual spare time or perhaps as an adjunct to more traditional scholarly pursuits (e.g. to engage in gaining online engagement with one’s research article). Individuals in these organizations were extrinsically motivated to strongly align their social media work with other traditional roles (e.g. journal editor, researcher) that are already valued, so as to better reap the benefits of the organizations’ support. This participant quote highlights this perceived need for alignment:

Figure 4 depicts a 2 x 2 table that highlights how the traditional vs. non-traditional and intrinsic vs. extrinsic motivators intersect.

Figure 4. A 2 x 2 table that highlights themes that shed light on how the traditional vs. non-traditional rewards and intrinsic vs. extrinsic motivators intersect.

The non-organizational personal perspectives

Although the following topics were not considered in the scope of this study, we also found some non-organizational personal perspectives with regards to social media usage that were shared by some respondents. For example, not all respondents were convinced that social media was a useful tool. This might be related to another shared belief that social media promotes interaction without any real emotional investment. Finally, some reported that they are not sure how to use platforms such as Instagram, although they do consider them to be visually appealing.

Limitations

We worked on eliminating the limitations of the study. Our senior author (TMC) is a social media expert and is highly engaged in organization change strategies as administrator. She was not involved in data collection and was blinded to participants’ identities in this study. While her expertise helped to improve understanding concepts as a leader and social media user, we ensured that her interpretation was aligned with the participants’ views. Participants included international stakeholders who are members of international organizations. Potential cultural differences between organizational structures and hierarchies may affect direct transferability of our findings. Our sampling technique may also omit some emerging leaders on social media during the sampling process. Due to the rapidly changing landscape of users and conversations on social media, we may not have included other relevant leaders in our study.

Underlying data

Due to confidentiality reasons our institutional review board does not allow open data sharing of the qualitative data from this study (i.e. the transcripts). For those interested in accessing this dataset, please contact the corresponding author Teresa Chan (teresa.chan@medportal.ca), who will arrange access to our dataset after institutional protocols including a non-disclosure agreement and/or formal institutional inter-institution agreement are completed.