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Web 2.0 and its impact on health care quality improvement: the case of amalia kalyvinou

Athanassios Vozikis1* and Dorothea Mytilinaki2

1MSc, PhD, Assistant Professor, University of Piraeus, Department of Economics

2MSc, Researcher, University of Piraeus, Department of Economics

*Corresponding Author:
Athanassios Vozikis
Assistant Professor, University of Piraeus
Economics Dept. .80, Karaoli & Dimitriou street
18534 Piraeus, Greece
Tel: 210 4142280
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The social media (web 2.0) is radically changing the way we communicate, the information transaction and the relationship between consumers and healthcare professionals. The aim of this paper was to denote the continuously increasing power of the social media especially in the health sector and to propose reasons of this participating procedure for the quality improvement in health care. A thorough research in the Greek and international healthcare blogosphere was carried out in relation to Amalia Kalyvinou blog and its impact. The case of Amalia Kalyvinou, moved more than 400,000 people through the web, draw the attention of Greek politicians, as well as of national and global media and was the spark of social change and consciousness awakening as a new kind of social protest, which caused the immediate reaction of administrative and judiciary authorities.

Key words

Web 2.0, blogs, halth care, health care quality, patient empowerment


Innovations in the information and communication technology are constantly shaping new developments in the global communication scene. Social media and especially blogs, have caused a revolution concerning every aspect of social life. Blogs as a unique, self-publish tool in citizens’ hands, make blogo-sphere a creative public space for conversations concerning social interest, health and healthcare. [1,2]

In the present paper we have to face two challenging issues. The first one refers to the relation between social media and healthcare. The second one is to evaluate the impact and the movement Amalia’s Kalyvinou blog caused and to make propositionsfor enhancing the participation procedure and the dialogue platform concerning health care quality improvement, so as they lead to productive thinking and actions.

The aim of the present paper was to denote the continuously increasing power of social media, to approach the relationship between blogs and the healthcare sector, to study the dynamics of blogs and to propose reasons of this participating procedure for the benefit of society.

Web 2.0; definition and applications

Social media are radically changing the way we communicate and the information spreading into contemporary society. The term social media –web 2.0- defines websites and internet tools which allow the users interaction through information, ideas and thoughts sharing. Social media also creates societies and nets based on socialization and participation. Hundreds millions of users of different socioeconomic, political and national background worldwide communicate, using web applications and technology. [3,4]

There is a wide range of services and applications, representing social media, constantly increasing and so as leading to the development of internet society. Some of the main applications are blogs, wikis, tagging, multimedia shares, social networking sites and RSS. These applications help the communication among users by creating an open to all, accessible platform.

Physical and virtual space influences each other. Social media set new foundations for new forms of socialization, way of life, social organization, reactions and expressions. People create their own webs through internet according to their interests, values, preferences and plans. Online webs can build societies that engage and activate their members. [5-7]


Blogs are personal websites consisting of thoughts, information, photographs and personal ideas etc. arranged in chronological order with the most recent first. Most of the blogs allow visitors to add comments. Posting (texts, photos, songs) and commenting form direct communication between the blogger and the visitors. All comments are accessible and can easily be deleted, if the blog administrator wishes so. The current estimates say there are about 450 million “active” English language blogs right now, but that number varies according to the source. Technorati estimated over 200 million blogs at the start of 2009, with exponential growth since then. [8]

Although the use of social media in Greece is not that widespread as in other more technologically advanced countries, it gains constantly new fans as more and more users get familiar with the Web 2.0 applications. It appears that the Greek blogospere continuously grows and that there is an on-line society that discuss, argues and seek for information. We can refer to the massive protest about Amalia Kalyvinou, the protest about the fires in Parnitha mountain, the revelation about tortures in police departments, etc.

According to a Greek research, the majority of blogs are made of men around 30, living in Athens, with university education who post photos and texts. [9]

Blogging and health

The major change due to new internet technologies is the active participation of citizens as health issues are involved. Passive receivers of the health professional’s directions are giving place to active participants. Patients-health services consumers have at their disposal a huge tank of information which can be used to collect information, to compare and to decide. We could probably say that –predominant elements of the health market like asymmetric information (buyers and sellers have different levels of information) tend to be less intensive.

According to a study, Google (the most popular search machine in the web) is becoming a very important clinical tool for doctors, by helping at difficult diagnosis. [10] There is also the chance of using software in order to give advanced knowledge. [11] andthere is discussion about the improvement of the learning experience through a virtually learning environment. [12] Clinical Cases and Images – one of the most famous medical blogs- is a useful source with lot of medical knowledge trying to fill the gap between theory and practice. [13]

The Case of Amalia Kalyvinou

Blog Malpractice (neglect of duty, the dishonest use of a position of trust for personal gain) at was created at 27 July 2005 by Amalia Kalyvinou, a young woman. The last post was at 3 May 2007. Amalia passed away on May the 25th, 2007. She was just 30 years old.

The blogger had posted 18 texts sharing her story. Despite her numerous visits to doctors and several admissions to hospitals, no-one managed to diagnose her in time with the benign neurinoma. Seventeen years later, Amalia was told that the neurinoma had transformed by then into a malignant tumour. At her posts she describes the problems, the bureaucratic procedures and the financial exploitation she had to face in Greek National Health System. The blogger speaks about the corruption in health system and names every doctor she had to bribe.

According to the internet protest of friends of Amalia Kalyvinou: “Amalia's main aim was to tell her story, so that she could awaken as many people and as many consciences as possible. She mainly wanted to show that there are ways to resist not only the self-regulation and authority of dishonest and heartless doctors, but also the bureaucrats of the Health System" (Amalia's mother & sister).

It seems that she chose to react this way, because she thought by telling her story something may happen. As she wrote at her texts: «Ι only wanted to show some ways of resistance and one of them was to document my experience”.

The case of Amalia Kalyvinou had a great impact in the Greek blogoshpere. Comments of visitors for a single text posting had gone beyond 1,940. Visitors congratulated the blogger for her effort and her courage, reported similar personal experiences and commented on the Greek health system. The blog turned into a space of exchanging thoughts, experiences and feelings for the national health system.

After Amalia passed away Greek bloggers created a blog dedicated to her memory at to continue her effort. The blog consists of the document protest with Amalia’s story translated in various languages, relevant e-mails and links and the ranking and statistics of the internet protest.

Greek bloggers organized an internet movement at Greek blogosphere at June 1, 2007. Bloggers were invited to upload a document of protest with the story of Amalia, to send e-mail to organizations, politicians, ministries, to deliver the document of protest to hospitals, to medical schools, to health organizations etc, and to make protest calls to Minister of Health and to Medical Association. The document of protest was translated in English, French, German, Swedish, Dutch, Danish, Spanish and Italian. There was a second internet movement a year after, at June 1, 2008 with an e-petition of protest directed to the Minister of Health, to all ministers and representatives in the Greek parliament, to the European Parliament and to the European Committee.

Her blog had totally 58,568 visits (August 13, 2008). [14] The interaction of blog Malpractice with other blogs was also significant. A lot of other blogs refer to Amalia’s story until today. According to Google blog search, through which research in Greek and foreign blogosphere can be carried out, there are references to Amalia Kalyvinou in 1,702 Greek blogs and in 199 international (September 2, 2008). [15]

It was only natural for such a protest to draw the attention of traditional mass media, like newspapers and TV (a lot of popular newspapers and TV channels had articles for Amalia’s story and for the internet protest), but also the attention of politicians. Comments were posted in politicians blogs both for the story and for the government’s reaction as well. The answers of Ministers of Health and Labour were uploaded at webpages. The answer of Minister of Health was: “We inform you that the issues mentioned at the blog Malpractice are some of the major problems of health sector and public administration. Ministry of Health is studying the webpage. If specific issues come up, they will be examined”. [16] Minister of Employment talked about the criteria for the provision (importing) of drugs from abroad by Committees of organizations of social security funds and used the word “unfair” for bloggers’ reference to certain people of the committees. [17]

Though the Ministry of Justice ordered preliminary examination to find out the real facts, the Medical Association made no formal accusation for the doctors involved. According to Amalia’s Friends the internet movement of June 1st was the biggest one in Greece. Over 400,000 people participated with 56,116 visits at blog Malpractice, over 120,000 e-mails were sent from and to 30 countries during June 2007 to 120 international organizations, to 1,800 e-mails of people in charge. [18] According to Technorati, Amalia’s video was globally among the most popular ones at June 2, 2007. [19]

Results & Discussion

Blogs as a unique, self-publish tool in citizens’ hands, make blogosphere a creative public space for conversations concerning social interest, health and healthcare. Blogs for health and healthcare are the reflection of citizens’ thoughts, experiences and judgments. [20,21]

In contemporary societies where mass media are influenced from politico-economic interests, it is important to have critical thought and to collect information in order to evaluate the circumstances in health sector. Bloggers are ordinary people, who by posting comments at their blogs, react at the information from traditional mass media. [22] As new information technology is becoming a part of contemporary social mobilization, the traditional terms of recruiting and of local coordination groups are gaining a new meaning. [23] Online communities lay to internet for communication, for information sharing and for coordination to organize protest.

There is also discussion about the world wide action for justice through online mobilization. [24] However, internet has become the base for a lot of online societies which act as public spheres, where ideas about global justice are expressed. These ideas have laid up to rapid augmentation of several forms of mobilization. [25] Public debate and information about health issues through blogs seems to create conscious health professionals groups and conscious patients. The only hope would be the accumulation of a social “capital” of doctors, nurses and administration staff who are still willing to offer. [26] Blogs in the long-term might help to change the mentality as far as bribery and mingling of Greek health system are concerned. This change of mentality is the most important element for the change of the system.


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