Whiteboards: one tool to improve patient flow.

OBJECTIVE To describe the integration of whiteboards into ward routines in one Queensland health service district (HSD). DESIGN AND SETTING Case study involving placement of whiteboards in three inpatient wards (two medical, one surgical) in a university-affiliated regional teaching hospital and in a day clinic in the same health service district. Data collection methods included 45 hours of observation of four whiteboards and 62 staff over 2 months, 11 in-depth interviews with nursing and allied health staff, and photographs of the whiteboards taken at intervals. The study was conducted from March to August 2008. MAIN OUTCOME MEASURES Structures, processes and perceived outcomes of the use of whiteboards. RESULTS The physical configuration of the whiteboards did not vary, but their content and usage by various professional groups fluctuated. Whiteboards were most successfully integrated in the clinic, where they became an integral part of multidisciplinary rounds, and were updated and referred to several times each day. They were partially integrated into the two medical wards, with various health professionals updating and referring to the whiteboard. In the surgical ward, a nursing assistant updated the whiteboard, but it was not referred to by others. Staff in the clinic and on the medical wards perceived that whiteboards facilitated timely referrals, improved patient flow and enabled timely and better discharge planning, but surgical nursing staff described them as an imposition and a cause of conflict among clinical team members. CONCLUSIONS Whiteboards have the potential to improve patient flow, but a planned approach to their use is required. Issues relating to the use of whiteboards, including staff buy-in, discharge planning and patient privacy, need to be addressed.