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In the last few years, social media has influenced organisational communications as well as reputation management. However, little research has been done on how public-sector organisations such as hospitals perceive this changed communication landscape and how social media use is of relevance when it comes to reputation management. Therefore, this study aims to answer the research question: how do healthcare organisations perceive the importance of social media for reputation in the healthcare sector? To answer this research question, insights into the opportunities and challenge of using social media by healthcare organisation and how possible reputation risks can be mitigated is also investigated. Given the research aim of this study, a qualitative research approach was chosen. More specifically, in-depth interviews were conducted with 15 communication professionals associated with social media use by healthcare organisations or working in communications as ‘webcare’ team or online communication advisor of eight different hospitals in the Netherlands. Findings show that social media use was perceived as one relevant aspect within the overall communications by the hospital and as part of reputation management in terms of being able to monitor what is being said about the hospital by people online and branding purposes. Most of the hospitals participating in this study recognised the importance of having a social media policy and employee guidelines for social media use to mitigate possible reputational threats it is recommended by reputation literature. However, findings also show that several hospitals have yet to fully understand the possible reputation risks involved with using social media. Furthermore, hospitals remain behind in the developments when it comes to using social media more strategically for communication purposes. Overall, this study complements reputation management research by providing insights into a lesser explored industry, namely healthcare, and social media research by focusing on the influence of organisational social media use on reputation.