Quality Improvement to improve patient safety and satisfaction: Effective whiteboard communication tool.

Muthu Sankari1*, Angel Roselin.S2

1HIC Nurse, Kauvery Hospital, Tirunelveli, Tamil Nadu

2Deputy Nursing Superintendent, Kauvery Hospital, Tirunelveli, Tamil Nadu

*Correspondence

Abstract

The patient room whiteboard serves as an effective communication medium to communicate with the healthcare team. Effective communication is crucial for both patient safety and satisfaction.

Aim: To improve patient satisfaction and reduce complaints from the patient and patient relatives.

Design and settings: The quality improvement by using visual control method to improve nursing rounds

Method: Visual hats- Thinking & pointing: Problem, counter measures and information. Plan do Study Act method (PDSA) in special ward for three weeks 2024.

Results: Patient and consultation information increased from 40% to 100% and patient complaints reduced from 10 nos to 1nos. Patient perception on the whiteboard was helpful throughout the admission and improved from 60% to 98% in 2024. Nurses’ compliance improved from 40% to 100%.

Conclusion: The whiteboard promotes effective communication and improves patients’ awareness on their condition and reduces the complaints from patients and patient relatives.

Keywords: Whiteboard; Communication tool; Improve patient perception; Goal/ Objective of admission; Nurses’ compliance; Nursing rounds.

Introduction

Communication is crucial for both patient safety and quality of care. According to the Joint Commission International (JCI), communication breakdown is the most frequently cited root cause for sentinel events [1]. Having good communication skills is essential to collaborating with your fellow nurses and colleagues from other disciplines. It’s also important to be patient-centered in care. Nurses who take the time to listen to and understand the concerns of each of their patients are better prepared to address issues as they arise, resulting in better patient outcomes. On the other hand, poor communication, or lack of communication in healthcare, can lead to patients misunderstanding directions and failing to follow treatment protocols. It can also lead to workflow breakdowns on the team, resulting in a medical error. A report by the joint commission found that poor communication in healthcare during patient transfers contributed to 80% of serious medical errors. On the other hand, poor communication, or lack of communication in healthcare, can lead to patients misunderstanding directions and failing to follow treatment protocols. It can also lead to workflow breakdowns on the team, resulting in a medical error.

Communication is the key to safe health care. When health care workers communicate effectively, fewer errors occur and people are more satisfied. Communication is related to patient safety; it has always been cited as an area that has opportunities for improvement. Patient satisfaction scores reflected that there were areas for improvement, specifically in communication between physicians and nurses, pain medication accessibility, and lactation education. This trend was noted throughout the hospital. Having patients actively participate in their care has been cited as an important part of ensuring patient safety. Whiteboard communication has proved to be an effective means of communication in improving patient-provider communication. The primary objective of the study is to improve patient safety and patient satisfaction with the overall care by providing updated information on the care plan, daily activity, and goal of the day. The secondary objective was to increase the staff’s compliance with the use of whiteboards and nursing rounds.

Material and methods

Study Design: Quality Improvement (QI) project using model improvement (MFI). The MFI framework is designed to support organization in answering fundamental questions. The plan for changing the nursing rounds using communication board Plan-Do-Study-ACT (PDSA) cycles methodology Discussed with team and designed a new communication visual display board installed inside the room to provide complete information for daily updates (e.g. pain score, positioning, diet, probable discharge date, etc.) and staff training given for frequent update (ward in-charge responsible for the update as per frequency).

Fig (1): Image of patient communication board in special ward

Fig (2): A communication board

Fig (3): Comparison chart nurse and patient communication method.

Setting and sampling: The quality improvement study conducted in our Kauvery Tirunelveli, Hospital for 3 months period in special ward. And random sample technique was used to assess the usage compliance among on the nurses and nurse rounds for every hour.

Challenges and Limitation: We have faced two challenges overall during the project period.

  • The communication board is designed in English, occasionally requiring translation. We encouraged nurses to orient the staff and patients about the board during the admission process itself to facilitate understanding.
  • Hourly rounds were challenging for the nurses and compliance required regular training and monitoring from the nurses in charge. Digital checklist was introduced to alert on the deviation immediately to the supervisors.

Results

Overall, the patient complaints have been reduced from 10nos to 1no during our study period. Other benefits include daily updates on patient information, and elimination of repeated inquiries from the patient and patient’s attender. Our VOP shows improved satisfaction and minimizes the nurse’s movement. Nurses’ morale and efficiency improved from 40% to 98%. The patients’ trust in our care has improved from 50% to 100% as there was a daily update.

Discussion

Our study revealed that the patient communication board is a simple and effective tool between the health care provider and. the patient. With the use of communication boards, many patients and their families knew their healthcare providers, which was consistent with the results obtained in previous studies. Improved provider identification, enhanced communication between the healthcare team and patient, and enhanced knowledge of their course of disease management led to improved patient satisfaction; these results aligned with studies done by Tan, et al. A similar analysis performed involving the use of whiteboards in labor rooms showed to improve patients’ knowledge of their delivery physician’s name and patient satisfaction with care on labor and delivery. However, there is a need to orient patients and their families to whiteboards and their proper use.

Conclusion

The patient room whiteboard is a valuable communication tool for patients/families and the healthcare staff by promoting effective communication, maintaining goal directed care for the patient, and contributing to a significant increase in the patient/family’s overall hospital stay satisfaction. It became a norm for nurses and physicians to engage the family in their care. Encouragement of a patient room whiteboard is recommended for continuous quality patient care and facilitating effective communication between the patient and the healthcare team.

Ethical considerations

The ethical consideration was done in our internal committee, and oral consent is received from the patient on every admission of the individual. Therefore, ethical approval was not required. Patient information is secure using a detailed assent form.

References

  1. Rutherford P, Lee B, Greiner A. Transforming Care at the Bedside. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004.
  2. The importance of effective communication in Nursing 20 May 2024.
  3. Interpersonal relationships “Professional communication skills for Nurses”-8th Edition Elsevier edition.
  4. White Boards: An Innovative Tool for Patient‐Centered Communication Vol-42 June 2013.
  5. Lynn J,Baily MA, Bottrell M. The ethics of using quality improvement methods in health care.
  6. Tan M, Hooper Evans K, Braddock CH, Shieh L. Patient whiteboards to improve patient-centered care in the hospital. Postgrad Med J. 2013;89(1056):604–609.
  7. Pimentel VM, Sun M, Bernstein PS, Ferzli M, Kim M, Goffman D. Whiteboard Use in Labor and Delivery: A Tool to Improve Patient Knowledge of the Name of the Delivery Provider and Satisfaction with Care. Matern Child Health J. 2018;22(4):565-570.
  8. Goyal A, Glanzman H, Quinn M. Do bedside whiteboards enhance communication in hospitals? An exploratory multimethod study of patient and nurse perspectives. BMJ Quality and Safety.
  9. Nowacki K, Gonzalez T, Mehnert J, Jacquemard A, Tyler A. Using Patient Whiteboards to Engage Families in Harm Prevention and Care Planning: A Quality Improvement Study. Hosp Pediatr. 2018;8(6): 345-352 Ann Intern Med. 2007: 146(9) 666-673.

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