Most importantly, the white board includes a goal of the day that the providers determine with patient. For example, Sehgal saw a patient whose goal of the day was to walk and take four laps around the unit. The family member wrote down a question on the whiteboard about the concern for the patient overextending himself. "When we talk about engaging patients in their care, we implicitly mean family members as well," said Sehgal.
Dusting off the whiteboard process
Based on their findings, researchers recommended creating an audit system of the whiteboard usage when the process is rolled out.
One survey respondent in the study said, "There needs to be specific training to make this a cultural norm across care providers and reinforced on a regular basis. If it's a priority, there should be audits, tracking for performance (accuracy and updated info), and feedback to providers. I would ask patients what info they would like to see, as [whiteboards] should be patient-centered, not provider-centered."
Designated auditors check the whiteboards in each room, measure compliance, and send feedback to the nurse managers. Through this auditing process, UCSF quickly found one of the biggest barriers to effective use was simply the need to buy more markers and fasten them to the boards.
How did the providers react to the new system? In general, nurses found whiteboards more useful than attending physicians or housestaff.
"With any additional task, there's always concern—whether it's a nurse or physician—that's it's just another thing added to their day. In some ways, the whiteboard just reinforces what they already do," said Sehgal about the providers' duties as patient advocates.
For institutions looking to replicate the UCSF's whiteboard system, Sehgal suggested starting small and then expanding.
"Like many things, it starts with the local culture. Start with a unit in which the culture would take on the whiteboard initiative," he said. It's also important to have multidisciplinary team with champions. "Then extrapolate to other units."
The investment—finances and time—could be small or large, depending the existing whiteboard system and the willingness of the staff.
Although UCSF is a large, tertiary academic center, Sehgal said that other institutions can also reinvent their whiteboard system to focus on patients.
"The whiteboard isn't unique to what type of hospital you are. I think all hospitals have a need of patients wanting to communicate with providers," he said. ". . . If the goal is to improve patient satisfaction, white boards are just one vehicle."