Running head: THE WHITEBOARD

The Whiteboard: An Important Communication tool at Duke Regional Hospital

Camille Y. Southerland

University of North Carolina at Greensboro

Academic Integrity Pledge: I HAVE ABIDED BY THE UNCG ACADEMIC INTEGRITY

POLICY ON THIS ASSIGNMENT: Camille Y. Southerland March 31, 2018

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Abstract

Healthcare organizations must have effective communication to provide continuous quality

patient care, and ensure patient safety. However, in today’s ever changing healthcare market

there are still challenges such as shortage of staff, a lack of one to one nurse/patient interaction

due to the growth of a technology age which can have a negative impact on the ability to achieve

optimal communication amongst healthcare providers and their patients. Therefore, it is

imperative for Nurse Leaders to recognize how ineffective communication can affect the quality

of patient care, and thus have an impact on the patients’ perspective of their care. This is

associated with Nursing Administration because they have a significant role in ensuring that their

healthcare organization is meeting the appropriate standards for providing optimal quality patient

care. The evaluation of healthcare standards may be monitored by Press Gainey scorecards,

Joint Commission benchmarks, and patient satisfaction surveys. Nursing leadership is

responsible for managing and directing nursing care services, and ensuring that there is a positive

communication amongst their patients, and the nursing staff. The purpose of this research paper

is to show the reader how the whiteboard is a significant source for providing effective

communication amongst healthcare providers and patients.

keywords: whiteboard, patient, healthcare provider, Nurse Leader, Nursing Administration,

patient satisfaction scores, Press Gainey report, score cards

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The Whiteboard: An important Communication tool amongst healthcare providers and patients

at Duke Regional Hospital

Duke Regional Hospital (DRH) is small community hospital, located in Durham, North

Carolina. It serves the Wake,

Over the course of time, the hospital has achieved extraordinary levels of healthcare standards.

For example, DRH was recognized by they have over the course such as achieving Magnet status

in 2016. It has also been given Baldridge…… These achievements are very motivational in

ensuring that remain cognizant and aware. Nurse Leaders must be mindful of the impact that

patient satisfaction can have in achieving higher levels of patient care standards.

Recently, at DRH, there has been reports during shared governance meetings that whiteboards

are underused by healthcare providers and patients. As a result, this has created a concern by

Nursing Administration due to the possibility of a lack of communication amongst the healthcare

providers and patients. Communication is an essential component for the promotion safety, and

quality patient care in healthcare organizations. In fact, The Joint Commission on Accreditation

of Healthcare identified communication as the third leading cause of sentinel events between

2010-2012 (Hursh, Salsbury, Lenhart Doran, and Zadvinskis, 2013). Furthermore, Hursh et al.

2013 state that healthcare organizations that promote interdisciplinary communication and

collaboration benefit by establishing a culture of safety. show promote an environment A review

of the literature was conducted, in an effort by the researcher to demonstrate the importance in

maintaining the continual use of the whiteboard as a method to facilitate effective

communication amongst healthcare providers and their patients.

The whiteboard is a dry erase board posted on the wall in a patient’s room. It contains

information such as the patient’s plan of care i.e. patient’s name, date, phone numbers, physician,
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nurse, patient care assistant, daily activities. fixture that is placed in patients’ room to document

their care. It may also be referred to as a personalized care board, or communication board. The

whiteboard serves as a communication tool for the purpose in providing communication amongst

the healthcare providers and patient. The whiteboard is utilized to maximize communication of

patient-specific information, and may be used during bed huddles (Davis, 2015). Family

members may also play an active role in communicating on the board. The purpose of the paper

is to provide the reader with information about the use of the whiteboard as a tool to provide

patients with information about their plan of care. The use of the whiteboard is evaluated at

Duke Regional Hospital (DRH). The whiteboard serves as a tool to enhance and improve patient

communication.

Based on the review of the literature, the guiding questions are (a) How is the whiteboard an

effective communication tool? (b) How is the use of the whiteboard associated with Nursing

Administration (c) What is the future implication for nursing administration?

Review of the Literature

Although, the whiteboard has been used by healthcare organizations for many years, there has

been limited research conducted by researchers on its degree of usage among healthcare

providers and patients. The review of the literature will enlighten the reader in how the

whiteboard is an effective communication tool in healthcare organizations. Additionally, this

review will serve as a strategy to emphasize to Nursing Administration in how the whiteboard

should be used to its optimal potential in providing effective communication in healthcare

organizations.

How is the Whiteboard an effective Communication Tool

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Personalized care board communication as stated by Hursh et. al (2013) are a standardized

communication tool useful for sharing safe patient handling and mobility (SPHM) technology

recommendations. Specifically, the researchers recommended an increased likihood of using lift

equipment if it’s recommended by physical and/or occupational therapy on the PCB (Hursh et. al

(2013). The researchers conducted a study on a medical-cardiology unit with 50 patient beds in

a hospital that serves the central Ohio community. This unit was selected because it had the

highest number of patient handling injuries. Also, it had a solid shared governance structure in

place, along with a supportive nurse manager. The nursing unit consisted of 68 registered

nurses, 31 nursing assistants (NAs), one physical therapist (PT) and one occupational therapist

(OT). The results of this study revealed that 92% of the nursing staff found written

communication from therapy on the the PCB to be beneficial for conveying information between

professions regarding patient mobility and SPHM technology needs. Additionally, eighteen

months later the nurses and nursing assistants continued to report the PCB communication was

beneficial and that they were more likely to use equipment, which demonstrates sustainability of

the initiative.

A similar research study conducted by Wilson, Richards, Slavin, Seidell, Jagow, and Gomez

(2015) evaluated the need to implement early safe mobilization of the hospitalized patient and

prevention of injury to healthcare personnel. A research study was conducted by Beaumont

Hospital in Troy, Michigan. The purpose of this research study was to describe the development,

implementation, and effects of a quality improvement program entailing a decision-making

algorithm and associated bedside communication diagram related to patient mobility on four

nursing units. Similarly, Hursh et al. (2013) described communication of SPHM status utilizing

white boards in the patient’s rooms and noted increased compliance with mobility when updated
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by the interdisciplinary team. The participants in the study included RNs and NAs, employed by

BHTon two progressive nursing units. The staff were presented with a Stepping into Safe

Mobility program resulting from a quality improvement process intended to improve safety of

patients and healthcare workers who performed patient mobility techniques. The participants

completed an anonymous six question demographic survey and a 9 question survey regarding

confidence level and comfort in handling patient mobility. This study showed that hospital staff,

especially nurses and NAs need an efficient, effective, and accessible communication diagram

that displays the mobility status of a patient. Thus, the nursing staff reported an increase in self-

efficacy related to patient mobility when they were provided a diagram of the patients’ mobility

status. In comparison to Hursh (2013), this study has the potential to benefit other measures of

hospital care such as patient falls, caregiver injury, medical complications due to immobility, and

hospital costs.

Pimentel et. Al (2018)

The majority of the patients in the post-intervention group found the new whiteboard valuable.

For example, there was a significant increase in recalling the delivery resident’s name (36.7% vs.

20.8%. The patient satisfaction with care was significantly higher 93.3% vs. 82.2%. This study

revealed that the use of a well-designed whiteboard increases laboring patients’ knowledge of

their delivery physician’s name and may improve patient satisfaction with care on Labor and

Delivery. This study is very similar to Herbst et. Al (2013), because it describes how Labor and

delivery (L&D) are dynamic workplaces with quick turnaround of both patients and providers.

Therefore, it is often challenging for patients to recall their physician’s or nurse’s names, and

may have a limited understanding of their care. In comparison, this study utilizes a team

approach with establishing communication. In a study conducted by Hertzum and Simonsen

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(2015), the whiteboard was evaluated in the emergency department (ED) by the coordinating

nurse, who was considered as the main keeper of the whiteboard. The purpose of this study was

to evaluate how coordination of the whiteboard is accomplished through visual overview and

oral communication. Specifically, this study aims at identifying how oral communication serve

to clarify and elaborate patient information on a more detailed level in comparison to the

whiteboard information, to negotiate and reach an agreement about the decisions that underlie

the whiteboard information, and to prevent misunderstandings and errors. This study was

performed in the ED of a medium sized hospital in Denmark, from November 2010 to May

2011). It consisted of observing 10 patient rooms, which are considered acute areas for patients

arriving by ambulance, referral from their general practitioner, or a fast-track area for walk-in

patients. The ED’s whiteboard was located at the control desk, where the coordinating nurse was

positioned. The researchers observed the ED for 116 hours. During these observations, it was

determined that relying solely on the coordinating nurse to apply updates to the whiteboard,

allows room for error. For example, the coordinating nurse often becomes distracted before

applying updates to the whiteboard such as unexpected admissions, multiple phone calls. It was

also noted that the providers perceived the coordinating nurse and the whiteboard as a unit in that

frequently update the whiteboard by informing the coordinating nurse of the changes. The

researchers recommend that communication should be a shared understanding of the providers.

Furthermore, they recommend that the whiteboard contributes to communicative coordination

because it creates a place for clinicians to meet. They discuss how oral and visual overview have

a positive impact on creating effective communication efforts. In a similar research study

conducted by Donnelly, Cherian, Chua, and Thankachan (2016) explained how the dry erase

board in patients’ rooms facilitated team communication. The purpose of this study was
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demonstrate how the use of the dry erase board along with team communication could reduce the

incidence of prolonged mechanical ventilation, and to assess the sustainability of that reduction

over time. This study involved the use of lean management to a cardiac surgery unit within a

large academic medical center to decrease the incidence of prolonged mechanical ventilation and

the median time to extubation following coronary artery bypass graft (CABG). The healthcare

providers included multidisciplinary professional such as cardiac surgeons, anestehesiologists,

nurse administrators, advanced practice nurses, respiratory therapists, and pharmacists. The

outcome of the interventions including the dry erase board, resulted in the significant reduction

in the median hours of initial mechanical ventilation from 11.4 hours to 6.9 hours.

Gaps in the Literature

This literature review indicates that there are several gaps in the literature of this topic. For

instance, although there have been numerous studies on the whiteboard, there is limited

information regarding it’s impact on nursing administration. The studies indicated how it

affected the ability in having effective communication and the patients perspective. The studies

did not indicate how it affects the Joint Commission standards, or Press Gainey reports.

There is also no data found in how the whiteboards being underused in healthcare

organizations. It would be helpful for organizations to share this information to gain an

understanding in why it’s not being used. To better understand this process, it would be helpful

to conduct studies in the patients’ perception in documenting on the whiteboard. For example,

the patients may think the whiteboard is only for medical staff. For example, it may be helpful

for the patient to be shown what they can document on the whiteboard. The discovery of this

information may encourage other healthcare organizations to make using the whiteboard a more
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collaborative approach. Additionally, nursing administration should explore why nurses are not

using the whiteboards. This may signal the healthcare organizations to use email reminders, and

conduct townhall meetings on it’s importance.

The studies did not indicate the design of the whiteboard in the patients’ room. For example, this

could be a contributing factor to it’s use. For example, if the whiteboard is small in size, and

found in an inconspicuous place, this may have an impact on it’s use by the patients and staff.

The whiteboard should be at eye-level and have appropriate markers to make notes. According

to

There was limited information regarding the use of the whiteboards by other interprofessional

staff such as physicians, physical therapists. For example, they may perceive that the whiteboard

should only be used by nurses. Therefore, the interprofessional staff may need to be educated in

in how using the whiteboard should be a team approach to maintain optimal communication

amongst the healthcare providers and patients.

There is limited knowledge on when updates occur on the whiteboard. It would be helpful for

organizations to have a consistent method for noting the updates on the whiteboard. If a

whiteboard isn’t updated then errors could unintentionally occur. For example, a patient’s

mobility status could unexpectedly change to fall precautions, indicating increased monitoring by

nursing staff. Updating the whiteboard remains a very important aspect in providing effective

communication in healthcare organizations. According to Hertzum and Simonsen (2015), shared

whiteboards provide access to whiteboard content and the opportunity for updating it. Although,

it is less clear how the content remains current, attended to, understood, and acted on (Hertzum

and Simonsen, 2015).

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Additionally, the literature reviews did not provide specific information that would provided

on the whiteboard. For instance, they briefly described the whiteboard as including the names of

the physician/nurses. Other information such as mobility status, diet, expected discharge date.

There was limited data on information regarding patient confidentiality in the literature

review. However, this may be a concern when patients’ data is openly viewed in a patients’

room. Therefore, it may be helpful to have privacy standards for the hospitals to use.????on the

Additionally, there were the research studies were only conducted in the ED, medical-surgical,

and Labor and Delivery. There should be a variety in areas for the whiteboards such as

Behavioral Health, Pediatrics, Physical Therapy.

Application of theory/conceptual framework

The Donevan Theory framework supports this literature review, because it emphasizes a

Implications for Nursing Administration

The findings in this literature are important to nursing leadership because it indicates how

underuse of the whiteboard and it’s association with communication can have a negative impact

on patient satisfaction scores, Joint Commission standards. It may also affect the organization’s

ability to maintain or achieve magnet status. For example, if they lost their Joint Commission

rating this could mean????? Therefore, it is imperative for nurse leaders to be cognizant of the

ability of the organization to maintain effective communication standards. Nurse leaders should

closely monitor the results of the patient satisfaction scores in their facility. They should also

discuss their finding during shared governess meetings, and seek feedback from the nurses.

Nursing administration should make it a team approach by involving all members of the
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interprofessional team. In turn, this is a reflection on the leadership in an organization. The

whiteboard is an inexpensive tool to promote communication.

Methods

This research study was conducted at Duke Regional Hospital by using a quantitative design on

50 newly admitted patients on two medical surgical units to determine their level of satisfaction

with communication at the hospital. This study was implemented on April 1, 2018. The purpose

of this study was to show the Nursing Administration how effective communication on the

whiteboard has an impact in improving patient satisfaction. To evaluate their level of

satisfaction with communication, a whiteboard was used by the staff in their rooms. Although,

there are many aspects to consider in communication, the researchers felt like the whiteboard is a

simple inexpensive tool that could easily facilitate effective communication among the patient

and providers.

Population/Setting

The population consisted of a variety of male and female patients admitted to the

medical/surgical unit. Their age range was 21-75 years of age. Their minimum admission stay

was 3 days. If it was less, then they were excluded from the study. Since it was a Med/Surg

Unit, the patients would have a variety of illnesses. Patients who were unable to communicate

with the staff, and expressed a desire not to participate were excluded. The participants had to be

able to read and write. All healthcare providers on the medical surgical units were included in

the study. To facilitate compliance among all the healthcare providers, the researchers

established four workgroups, that were led by nurses to educate the interprofessional staff i.e.

physicians, physical therapists in using the whiteboard. There were assigned patient rooms for

the project. Each medical/surgical unit had 25 patient assigned rooms for the study. To promote
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randomization, the patients assigned to the rooms did not know they would a part of the project.

Additionally, they had to provide consent to participate in the project. The project was approved

by

Instruments

The whiteboard was used in all of the patients rooms that were involved in the study. The

whiteboard was a dry-erase board that measured 10 x 12. It was placed at eye level, and in a

location that was easily accessible by the patient and staff. There were markers available to be

used on the whiteboard. Upon admission, the nurses provided teaching about the whiteboard to

the patients. For example, they described the purpose and data i.e. physician’s/nurse’s names,

precautions, etc. on the whiteboard. They also invited them to participate in utilizing the board

by recording data. For example, the patients could record their desire to speak to the Dr. when

making rounds, requests to speak to certain healthcare providers, etc. Additionally, they

informed them that it’s okay for family members to document on the board as appropriately.

Importantly, the nurses should tell the patients that the board does not replace oral

communication with the providers. The board is only a supplement to enhance communication

among the staff and patients. To encourage use of the whiteboard to the healthcare providers,

email reminders and screen savers were implemented.

Data Collection Process

In order to collect data for this project, pre and post surveys were provided to the patients.

The surveys consisted of 7 questions to evaluate their outlook on the level of patient satisfaction

with communication at DRH. The presurvey was administered on admission. The presurvey

consisted of the following questions 1) ???The post survey was administered upon discharge. To

encourage compliance, the patients had to option to complete a written, or email post survey.
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Since, there may be different times for discharges for the patients, the data collection process

may be extended to two months.

Results

This project is expected to be complete on June 1, 2018. The anticipated results from the post-

survey should reflect increased scores, in comparison to the presurvey. The implementation of

enhanced education of the whiteboard should promote positive results. Monitoring will be

conducted by the researchers to ensure that the participants will stay consistent. For instance,

email reminders will be sent to patients to encourage them to complete the post survey.

Discussion

Increased patient satisfaction results will result in optimal performance in communication in

accordance with Joint Commission, etc. This project should demonstrate to Nurse Leaders how

a simple communication tool such as the utilization of the whiteboard could increase patient

satisfaction and communication in the hospital. The positive scores could also show how the

whiteboard should be used throughout the hospital to increase communication. This could result

in the Nurse Leaders showing other hospital departments how the whiteboard can help increase

communication.

The Donovian Theory relates to this by providing?????

Limitations

This research study demonstrates a lack in randomization because it was limited to one

hospital, and two medical/surgical units. This could create bias because it didn’t involve other

healthcare facilities such as rural hospitals, or other units in the hospital. Additionally, DRH is a

magnet hospital which could influence staff to provide positive results. It may be interesting to
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compare the results to other non-magnet hospitals. Since the post-survey was given to patients

on discharge this may inhibit the researchers from obtaining additional patient comments about

their experience with the study. This information may enable the researchers to correct

deficiencies in using the whiteboard.

Conclusion

Although, the manual whiteboard is a great communication tool; the advancement in

electronic technology may influence the way it’s utilized in healthcare organizations. For

example, electronic whiteboards are being utilized in facilities. Accordiing to ???? in the ER, an

electronic whiteboard is being utilized for communicating pt’s rooms, names of

physicians/nurses. Nurse Leaders should be aware of the upcoming changes in having electronic

whiteboards for their patients. For example, this may be a more convenient and efficient way for

them to document patient data. Therefore, it is important for Nurse Leaders to be aware of the

upcoming changes in the advancement of communication. Therefore, it is important for them to

be lifelong learners in obtaining data evidence-based literature. They should also understand the

importance in sharing this literature with other healthcare organizations.

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