Patients and family members perspectives on the use of bedside whiteboards and its implication to treatment outcomes and patient satisfaction: A pilot survey in general and tertiary hospitals in Makkah, Saudi Arabia

Introduction

Effective communication is vital in providing patient-centered care. Studies show that poor communication between healthcare providers and patients and their families affects patient outcomes and satisfaction (McCabe, 2004; Amoah et al., 2019; Anoosheh et al., 2009; Vuković et al., 2010; Kwame & Petrucka, 2021). Several factors might contribute to the poor communication between the healthcare team members and patients and their family members, including but not limited to patients’ medical condition, anxiety, pain, medication, and level of comprehension or misunderstanding. In addition, the health providers use technical jargon or medical/clinical language to patients, insufficient explanations given to patients, and lack of details or inaccurate instructions related to patients related to time constraints and competing demands faced by health providers (Ali, 2017). As a result, patients misunderstand their illness or the treatments that are being recommended that impacts patient outcomes. Due to the numerous communication challenges, visual tools such as bedside whiteboards to enhance communication have been widely implemented (Tan et al., 2013; Sehgal et al., 2010; Goyal et al., 2017). However, the exact utility of its use from the patient perspective is still understudied. Although various studies have examined different aspects related to bedside whiteboard use and patient satisfaction (Singh et al., 2011; Tse et al., 2014; Gonzalez-Shalaby, 2016; Goyal et al., 2017), evidence of the use of bedside whiteboards (WB) in facilitating effective involvement of the patient in various aspects of care and related decision-making process is also lacking. Thus, this study aims to determine the impact of bedside whiteboard use in facilitating patient’s involvement in achieving the goal for the day, adherence to the pain medication schedule and use, scheduled tests and procedures, engagement of patients and family with the health care team, and discharge plan of care. Through this initial pilot survey, recommendations about bedside whiteboard use in hospitals in Saudi Arabia can be drawn. Its implementation may improve the quality of communication between health providers and patients and their families and increase patient satisfaction.

Methods

Results

The findings presented in Table 2 indicate that mean score for the Goal of Day scale was 34. 61 (Standard deviation (SD) = 4.59), pain (mean = 34.54, SD = 4.68), patient and/or family engagement (mean = 34.19, SD = 4.69), Discharge date (mean = 29.89, SD = 4.26), Schedule test procedure (mean = 34.74, SD = 4.45), and Satisfaction (mean = 30.08, SD = 4.17) (See Table 2 and Figures 1–5).

Figure 1. Frequency distribution for the goal of day responses.

Figure 2. Frequency distribution for the pain medical schedule responses.

Figure 3. Frequency distribution for the discharge date responses.

Figure 4. Frequency distribution for the schedule test procedure responses.

Figure 5. Frequency distribution for the patient satisfaction responses.

Participants in the study were 335 selected from six hospitals. Males accounted for 50.1 %. Saudi nationals made up 86 % of the participants. The majority (56.7 %) were aged between 31 to 50 years. Table 3 also indicates that the majority of the participants (54.3 %) had an undergraduate education level. All patients were admitted for a period of more than three days. A high proportion of the participants were from the general surgery (20.9 %) and internal medicine ward (29 %).

The findings presented in Table 4 show that the mean scores for each question item ranged between 4.12 (SD = 0.862) and 4.44 (SD = 0.644). The median score was four for all the question items except for questions 21, 35, 36 that had a median score of five.

Regression analysis was carried out to evaluate how the goal of the day, pain, patient and/or family engagement, discharge date, and scheduled test procedure predict satisfaction. As shown by the r-squared value, the developed regression model made up of the five independent variables predicted a 61.9 % variation in satisfaction. The statistically significant F-value of 106.9 (p = 0.00) indicates that the model fits the data well. The findings shown in Table 5 indicate that except for patient and/or family engagement and the goal of the day, the other predictor variables had no statistically significant relationship with satisfaction. For the goal of the day, the findings indicate that a unit increase in the goal of day results in a 0.428 increase in satisfaction (p = 0.00). Regarding patient and/or family engagement, the findings indicate that a unit increase in patient and/or family engagement results in a statistically significant increase in satisfaction by 0.337 units (p = 0.00).

Findings presented in Table 6 indicates the outcome of the Pearson correlation between study variables. Table 6 indicates that satisfaction had a statistically significant and strong positive correlation with the goal of the day (r = 0.741, p < 0.005), pain (r = 0.602, p < 0.005), patient and/or family engagement (r = 0.713, p < 0.005), discharge date (r = 0.607, p < 0.005), and schedule test procedure (r = 0.574, p < 0.005). The goal of the day had a statistically significant and strong positive correlation with pain (r = 0.746, p < 0.005), family engagement (r = 0.711, p < 0.005), discharge date (r = 0.695, p < 0.005), and schedule test procedure (r = 0.681, p < 0.005). Pain had a statistically significant and strong positive correlation with patient and/or family engagement (r = 0.657, p < 0.005), discharge date (r = 0.705, p < 0.005), and schedule test procedure (r = 0.688, p < 0.005). Patient and/or family engagement had a statistically significant and strong positive correlation with discharge date (r = 0.732, p < 0.005), and schedule test procedure (r = 0.694, p < 0.005). Discharge date had a statistically significant and strong positive correlation with scheduled test procedure (r = 0.760, p < 0.005).

Friedman test was used to assess if there was difference in the patient satisfaction associated with the different elements of whiteboard including the goal of the day, pain, patient and/or family engagement, discharge date, scheduled test procedure (Table 7). Patient satisfaction was statistically significantly different for patient and/or family engagement showed (mean rank = 4.20, p = 0.000), goal of the day (mean rank = 4.41, p = 0.000), pain (mean rank = 4.33, p = 0.000), discharge date (mean rank = 1.75, p = 0.000), and scheduled test procedure (mean rank = 4.45, p = 0.000).

Discussion

The findings of this study show that patients and/or family members perceived bedside whiteboards as a useful tool to improve communication with the healthcare team member and essential to delivering the treatment plan effectively.

In terms of patient and/or family member engagement with the treatment plan, the study findings showed that bedside whiteboards could help to improve the quality of nursing care, and the patient and/or family member can communicate their concerns and issues with the healthcare team effectively and thus increases patient satisfaction to care. A systematic mixed-method review conducted by Tobiano et al. (2018) noted that bedside whiteboards help encourage patients to contribute to their plan of care for the upcoming shift or discharge, which is essential in enabling patients’ participation in the plan of care. Several studies also reported that bedside whiteboards are useful to improve patient’s knowledge, involvement in decision making and help to increase the satisfaction with the communication to the hospital staff such as nurses and physicians (Pimentel et al., 2018; Singh et al., 2011; Goyal et al., 2019). This medium of communication also reported that nurses’ adherence to interventions such as pain-management-related interventions increases (Alaloul et al., 2015). In addition, the study conducted by Sherman and Hilton (2014) indicated that an increase in patients and/or family engagement had a better impact on the clinical and patient outcomes, thus increasing patients’ satisfaction. Our study findings indicate that bedside whiteboards provide a great opportunity for patients and/or family members to share their concerns and issues with the health providers, enabling them to engage in the care plan, thus impacting the quality of care and patient satisfaction.

The use of bedside whiteboards was perceived to increase patient awareness and compliance to the pain medication schedule, impacting patients’ satisfaction, as revealed in this study. This is in concordance with the study of Alaloul et al. (2015), which noted that bedside whiteboard use would increase adherence to patients’ pain management-related intervention. The use of this medium allows documenting patient up-to-date pain scores, pain medication schedules, pain management options, and pain goals. The authors found that the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) score related to patient satisfaction with pain management improved after intervention implementation. In the study of Dearmon et al. (2013), whiteboards were considered an exceptional innovation that could improve patients’ outcomes. For instance, recording pain medication schedules in bedside whiteboards received positive feedback from patients and family members. Our study findings suggest that bedside whiteboards could help patients and family members adhere to pain medication and other related pain management.

Our study also found that bedside whiteboards increase collaboration between patients and the treatment team regarding scheduled tests/procedures. Patients and family members confer the importance of having a plan and schedule ahead of time to help them be aware of the scheduled tests/procedures to be performed. In the study of Goyal et al. (2019), both nurses and patients identified upcoming tests/procedures as important information to have on the whiteboard. However, the use of whiteboards may not be as equally useful for some patients who are unable to move due to their medical conditions. Therefore, it is suggested to enhance presentations of information to whiteboards by improving easy access/view, encouraging physicians’ daily use, and avoiding medical jargon. Although there is a lack of literature about the impact of bedside whiteboard use in the communication of the scheduled test and procedure to patients, several literatures indicate that effective collaboration between the patients, family, and the health care team is indeed important to ensure that the patient sufficient information and the awareness on the scheduled test and procedures to make the decision and for the health care team to execute the scheduled test and procedures effectively (Brandenburg et al., 2015; Kendall et al., 2015). Although this study supports the conclusions made by Parker and Mowry (2015) that the use of whiteboards for scheduled test procedures is associated with patient satisfaction, the study noted in regression analysis that the latter did not predict satisfaction.

Another finding of this study shows that patients and family members perceived the bedside whiteboard use encourages engagement in the goal of the day and helps in reducing readmission rate. Also, the communication between patients, their families, and the health care team will be improved, which will help them achieve their daily goals. Evidence suggests that documenting patients’ goals of the day on the bedside whiteboard enhances patients’ engagement in the treatment process (Burk, 2016; Ofori-Atta, 2015). Menefee (2014) noted that determining the patient goal of the day (GFD) and aligning the team’s goals with the patient goal of the day increases patient satisfaction and patient engagement and reduces the rate of readmission. However, Hesselink et al. (2014) found that poor information exchange, poor coordination of care, and poor communication between hospital and primary care providers, and between care providers and patients during endorsement lead to patient readmissions. Dunn (2017) also noted that obtaining the patient goal of the day at the bedside by asking the patient what their goals were and what they needed to accomplish in the given day enhanced patient engagement and positively influenced patient satisfaction. Thus, this activity is proposed to be prioritized in setting and addressing the patient’s treatment plan and meeting the goals of the day (Burk, 2016; Ofori-Atta, 2015). This study also supports the conclusions made by previous researchers regarding the positive influence that goal of the day has on patient satisfaction (Frazee, 2011; Ofori-Atta et al., 2015; Dunn, 2017). However, the outcome of this study is significant since it focused on how the use of whiteboards for the patient goal of the day influenced patient satisfaction.

Patients and their families perceived bedside whiteboards as an effective tool to improve their awareness about the scheduled discharge date. This will help speed up activities and provide the necessary supplies to leave the scheduled discharge date. Iversen et al. (2014) argued that identifying the expected date of discharge and communicating it to the patients increases the chance of no delays in accomplishing activities required for discharge, which results in no unnecessary prolonging of the length of hospital stay. Hesselink et al. (2012) carried out a study that focused on whether patients are discharged with care. The researchers concluded that the involvement of the patients and their families in preparation for discharge is important in ensuring that the patient’s needs are met. Hesselink et al. (2012) noted that the patients’ satisfaction with the discharge process is influenced by the level of involvement in the planning phase and whether their capabilities, needs, and preferences are taken into consideration in deciding the discharge date associated activities.

Furthermore, the findings of this study provide insights into how the use of whiteboards influences patients’ and their family members’ satisfaction. According to the study, satisfaction is strongly positively correlated with the five elements of whiteboards, which suggests that an increase in any of the five elements is associated with an increase in satisfaction. However, in terms of their ability to predict satisfaction, this study noted that of the five elements of the whiteboard, goal of the day, and patient and/or family engagement significantly predict satisfaction, with an increase in any of the two elements resulting in a subsequent increase in satisfaction.

Conclusions

Patients and families perceive bedside whiteboards as an effective tool for communication and collaboration with the healthcare team. It makes them aware of all the necessary information and instructions for their treatment process. Whiteboards were associated with patient satisfaction through two main variables: daily goals and family engagement with the healthcare team.

Data availability