Code Lavender and Preventing PTSD in Healthcare

Posted by Dike Drummond MD

Code Lavender and Preventing PTSD in HealthcareCode Lavender has been in the news lately as a Burnout Prevention Tool ... that is NOT what it is.

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 at work.

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.

This week I was interviewed along with Amy Greene, the Cleveland Clinic Director of Spiritual Care, on HuffPostLive on a segment titled:

Code Lavender: Healing One Doctor at a Time. You can watch the interview below.

In the remainder of this blog post (below the video frame) let me show you why Code Lavender is NOT a  burnout prevention tool and the function it actually performs.


Code Lavender is a Crisis Intervention Tool - NOT a Burnout Prevention Activity

Code Lavender does not prevent anything. It is a curcuit breaker on stressful days ... it allows any caregiver to trigger its holistic pressure relief valve for any member of the staff. After the HuffPostLive interview I was able to speak to Amy Greene, the Director of Spiritual Care at the Cleveland Clinic. She told me that most of the codes are for nurses, not doctors  and that, as an organization, they have found a way to get over the stigma associated with the asking for a break that a Lavender Code entails. 

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. 

In the video,  Katie tells the Cleveland Clinic story of a patient being coded and dying on the day of discharge, with their family in the room, after multiple months in the hospital. That is a bad outcome in anyone's book and I am so glad Code Lavender was there to help 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 healthcare AND it is not a tool to help you reach your ideal practice by any means.


Does your hospital use Code Lavender and how is it going if you do?


Tags: Physician Burnout, prevent burnout