'Low-tech' whiteboard is still highly effective

Study lists key aspects of communications

As we move ever more rapidly into the age of electronic patient tracking systems, ED managers would be well advised to keep in mind the communication lessons offered by the low-tech whiteboard, say the co-authors of a new paper published online by the Annals of Emergency Medicine.1

What makes the lowly whiteboard such an effective communication device? "One thing we learned is that nothing on a whiteboard is useless, while on an electronic board you can't say that," says Yan Xiao, PhD, lead author and associate professor in the Department of Anesthesiology and director of research in patient safety, program in trauma at the University of Maryland School of Medicine, Baltimore.

"It's not that we are taking an anti-technology stance, but we want to stress how communications should be viewed," Xiao says. The whiteboard notations are not simply a listing of the number of patients, he says. "People communicate tasks to each other, as well as handoffs, challenges, and opportunities for finding additional resources." Because the whiteboard is so easy to use, a lot of people can provide input, Xiao says.

Mercy Medical Center in Baltimore now uses a computer, says Stephen Schenkel, MD, MPP, chair of the Maryland Patient Safety Center ED Collaborative, assistant professor in emergency medicine at the University of Maryland School of Medicine, and an attending ED physician at Mercy. "But one of the key lessons in this paper is the incredible flexibility of a handwritten system," Schenkel says. "For anybody to be able to reach up and modify, tracking gives it incredible versatility."

There are also social lessons taught by the whiteboard, he says. "In the ED, everyone is gathered around the white board; it becomes a social center," Schenkel says. "The benefit of a computer is that it disseminates information effectively, but you lose that social opportunity."

The study, which was conducted in a trauma center operating suite, uncovered several key principles of communication that are enhanced by the use of a whiteboard, including:

  • Task management. "The whiteboard gives you the ability to delineate what needs to be done," says Schenkel.
  • Team attention management. This is the ability to highly important facts. "You can put an item on top, and with an asterisk or circle, you can draw the attention of more than one person," Schenkel explains.
  • Task status tracking.
  • Task articulation. This is a list of what needs to be done.
  • Resource planning and tracking. "The goal is to always see what the whole 'stage' looks like," says Schenkel.
  • Synchronous and asynchronous communication. This requires being able to communicate important information from shift to shift.
  • Multidisciplinary problem solving and negotiation. "The whiteboard brings people together, since different people can go by the board and enter notes," Schenkel says. "It exists almost as a chart in miniature."

Forget electronics?

The authors do not argue that EDs should keep their whiteboards and eschew electronic tracking systems; rather, they say, ED managers should be aware of the strengths and weaknesses of the new systems to ensure optimal effectiveness.

If your ED is looking at an electronic system, Schenkel advises, "Think about your whiteboard, and know that these [principles] are things you are still going to want." Not everything can be duplicated, he concedes. "Very few people would say an electronic system creates a sense of camaraderie," he says.

Xiao says, "In the paper we describe a method of looking at how people communicate. You can use the same method to look at your own environment, which means looking at more than just hardware."

Also consider what is surrounding the display, how accessible it is, and how people use that display, Xiao says. "In the ED, for example, you must consider which bed has what patient and who is assigned to that patient," he says. "The other consideration is progress of care, which has implications for your co-workers." In other words, he says, you do not want to look solely at individual decision making, "but at how one person's work is connected with others."

How can electronic boards be made even more useful? "For one thing, you can place it side by side with other communication devices," Xiao advises. "If there is information that cannot be displayed electronically, perhaps you can use 'stickies' on the computer, as you might on a whiteboard."

Another important consideration, Xiao continues, would be the location of the screens, "so people can see these displays at as many cross angles as possible."

In addition, he says, your communication tools must be compatible with your work force. "This is especially true in the ED, where people are stressed and can have a high-intensity workload," he says. "A cumbersome tool may work at low-workload place, but definitely not in an ED."

Finally, Xiao cautions, "Don't underestimate seemingly low-tech devices."


  1. Xiao Y, Schenkel S, Faraj S, et al. What whiteboards in a trauma center operating suite can teach us about emergency department communication. Ann Emerg Med DOI: 10.1016/j.annemergmed. 2007.03.027.


For more information on effective communications in the ED, contact:

  • Stephen Schenkel, MD, MPP, Assistant Professor, Emergency Medicine, University of Maryland School of Medicine, Baltimore. E-mail: ssche002@umaryland.edu.
  • Yan Xiao, PhD, Division of Research in Patient Safety, Program in Trauma, University of Maryland, 22 S. Greene St., Baltimore, MD 21201. Phone: (410) 328-7179. Fax: (410) 328-7230. E-mail: yxiao@umaryland.edu.