Erasing indifference: Do whiteboards increase patient activation?

From the 2021 HVPAA National Conference

Max Trojano (Penn State College of Medicine), Garrett Rucker, Brian McGillen

Background

Patient activation, which has been defined as having the knowledge, skills, and confidence to manage one’s own health, has historically been neglected in the inpatient setting, despite its strong association with improved health outcomes in outpatient studies. Whiteboards are an increasingly ubiquitous fixture in hospital rooms across the U.S. that could help to address this issue, as they represent a cost-effective, ready-made channel to engage patients in their own healthcare; thereby, serving as a patient activation tool. Yet, their efficacy has only been minimally explored.

Objectives

  • Assess the role of the patient in the patient-provider whiteboard communication process.
  • Quantify the impact of involving patients in the whiteboard completion process on patient activation by using the Patient Activation Measure (PAM), a validated 13-item survey used to gauge the level of patients’ knowledge for disease, skills, and confidence in managing their own health.

Methods

This is a cross-sectional study that used patient surveys as the primary method of data acquisition. Subjects were identified from the general medicine inpatient unit at the Milton S. Hershey Medical Center. Participants (N = 172) were asked a series of four questions regarding their experience in whiteboard communication during their hospital stay: 1) whether someone explained the purpose of the whiteboard, 2) whether their questions were recorded on the whiteboard, 3) whether the whiteboard was used for education and planning, and 4) whether they felt included in whiteboard communication overall. We then used these questions to dichotomize the patient sample into two groups: those who agreed to all four questions were said to be optimally involved in whiteboard communication (n = 101), while those who disagreed with at least one statement were deemed sub-optimally involved (n = 71). PAM scores from the two cohorts were then compared.

Results

Patients who were optimally involved in the whiteboard communication process had higher average PAM scores (M = 69.66, SD = 15.58) compared to the sub-optimally involved group (M = 61.40, SD = 13.07); t(170) = 3.65, p < 0.01. PAM scores did not correlate with any other explanatory demographic variable, including age, gender, race, ethnicity, employment status, or education level.

Conclusions

This study lends support to the structured use of whiteboards as an economical mechanism to improve patient activation and the value of inpatient care delivery.

Clinical Implications

Increased patient activation has previously been shown to lower readmission rates and reduce overall costs for healthcare systems. Accordingly, this study identifies whiteboards as a ready-made tool that could be leveraged to improve patient activation prior to discharge. However, limitations exist, as whiteboard communication carries a significant time burden, especially for physicians.