Code Lavender and Preventing PTSD in Health Care

Code lavender has been touted as a burnout prevention tool in the press. It actually serves a totally different function in the stressful world of the hospital.
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You have heard of code blue and code red. Well, there's a new code in town: code lavender.

Code lavender is a code the hospital staff can call for themselves when they are being overloaded by stress and traumatic events on a particular work day.

When code lavender is triggered, the staff member gets a chaplain consult, reiki treatment, some down time and a lavender ribbon on their arm to tell everyone they are having a rough day. Code lavender started by Earl Bakken at North Hawaii Community Hospital in Waimea in 2008 and has been reported on most recently in the Cleveland Clinic System.

Code lavender has been touted as a burnout prevention tool in the press. It actually serves a totally different function in the stressful world of the hospital.

Code lavender is a crisis intervention tool -- NOT a burnout prevention activity.

Code lavender does not prevent anything. It is a circuit breaker on stressful days. It allows any caregiver to trigger its holistic pressure relief valve for any member of the staff.

I was recently able to speak to Amy Greene, the director of spiritual care at the Cleveland Clinic. She told me that most of the lavender codes to date have been used for nurses, not doctors. They have also passed a significant milestone along the way. The organization appears to have largely gotten over stigmatizing the person who calls the lavender code as a wimp that is not tough enough for the job.

This is a big deal given the conditioning of all doctors and nurses to never show weakness. Asking for a break in extreme circumstances is normal in many other job settings, but not in health care. I for one am glad to hear this culture is changeable.

Code Lavender Shortcomings

It does nothing to lower the day-to-day stresses of being a caregiver in the organization. Remember, it is a crisis intervention tool. It has nothing to do with better patient flow or an easier EMR interface.

It has to be called by a caregiver, and doctors and nurses are often the very last to recognize their own stress and burnout. If you don't recognize the trauma and other feelings, you won't pull the code lavender handle

It flies in the face of the workaholic, superhero, Lone Ranger programming of our medical education. This is a double-edged sword. You have to expose the blind spots and programming to make change in the first place, AND this will prevent some physicians and nurses from calling the code and ensure others will stigmatize those who do.

Code Lavender Breakthroughs

It sends three signals to the entire staff, loud and clear.

1) This work is stressful

This acknowledgement alone makes an incredible difference for anyone in the Cleveland Clinic system to whom it is available. For the first time, there is institutional admission that this is stressful work, that you can get overloaded, and that it can impact the quality of care you provide.

2) You have needs that are important to us

Again, hugely important. The message is you matter to us and when you need it, you can have a break to regroup. Rather than the typical "never show weakness" programming we all absorbed in our medical education.

3) We can systemize support in cases of bad outcomes

One of the biggest things I have learned in my own experience of burnout and working with hundreds of burned out physicians is how often trauma and outright PTSD play a role in the doctor's distress.

What Code Lavender CAN Do Is Prevent PTSD

One of the key traumatizing events in many cases is when your colleagues fail to support you after a bad outcome. We all hope that our co-workers would reach out if there is a bad case at work, but in healthcare usually the opposite happens. I remember when I lost a baby during a delivery as a resident, it was the way I felt shunned and avoided -- like I had a contagious disease -- that sealed the trauma for me.

Code lavender institutionalizes the support, ensures you will be rallied around in the case of a bad outcome -- as long as the stress is recognized and the code called appropriately.

One situation from the Cleveland Clinic experience tells of a patient who had spent months in the hospital, coding and then dying on the day of discharge, with their family and multiple staff members in the room. That is a bad outcome in anyone's book, and I am so glad code lavender was there to help them all out.

Next Steps For You:

1) I encourage you to check out code lavender and see if it is appropriate for your hospital.

2) At the same time, do not stop working on creating your ideal medical practice and working on your own life balance.

Because bad outcomes are inevitable, code lavender will always be a welcome addition to the ways we can care about our brothers and sisters in health care, and it is not a tool to prevent burnout or help you reach your ideal practice by any means.

PLEASE LEAVE A COMMENT: Does your hospital use code lavender, and how is it going if you do?

Dike Drummond, M.D., is a family physician, executive coach and creator of the Burnout Prevention Matrix Report with over 117 ways doctors and healthcare organizations can work together to prevent physician burnout. He provides stress management, burnout prevention and leadership development services to physicians through his website,

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