Code Lavender: Supporting Healthcare Providers Through Difficult Cases

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By Aishwarya Kumar

Edited by Kortni Ferguson

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In a time where television medical dramas run rampant, the cry of “Code Blue” accompanied by a frantic rush to grab a crash cart for a patient in need of medical resuscitation is something that most have experienced on their screens. Code Black probably reminds people of the now famous and heartbreaking episode of Grey’s Anatomy while Code Red calls back to a number of fire-related network series. Code Lavender, however, is a relatively new hospital code that began in 2008 with Earl Bakken at North Hawaii Community Hospital and has since been recently implemented in a variety of health care systems, such as the Cleveland Clinic, Stony Brook Hospital, Indiana University Health System, and Princeton Healthcare System. 1

Essentially, Code Lavender is a mental health initiative that hospital employees can utilize for themselves or others after a particularly stressful or traumatic work experience. Caregivers can call a Code Lavender in response to an acutely distressing event such as the death of a patient or fellow staff member, a difficult resuscitation event, or an upsetting experience with a patient or a patient’s family member. Calling the code signals to the Code Lavender team that an individual or group of individuals are in need of emergency psychological assistance. Those involved in carrying out the code come from a variety of hospital departments such as spiritual services, healing services, employee assistance, ethics consultation, and other wellness and therapy centers. Specific interventions may involve an open prayer by the chaplain, a debriefing of the situation by the nurses and employees, a facilitated conversation between participants, nutritional support in the form of hot teas or comfort foods, visual cues to acknowledge that a Code Lavender is in session, and a respite space for quiet relief. 1,2 Cleveland Clinic offers additional healing modalities such as manual massage therapy, reiki, art and expression-based therapy, and mind-body tools such as meditation, acupressure, holistic coaching, and guided imagery. The enactors of Code Lavender make sure to follow up with and check on the individuals involved in the coming week. 3

It is important to note that Code Lavender is meant to serve as an acute intervention to prevent post-traumatic stress disorder in employees as opposed to stress related burnout. 1,2 Although there is still a lot of ground to cover regarding a systematic assessment of the initiative, a 2017 study aimed to test the feasibility and effect of Code Lavender. They found an ultimately positive reception to the program, highlighting that 100% of participants found the program helpful and 84% of participants would recommend the program to others. Additionally, the article stated that employees felt more cared for in comparison to baseline, and the investigators received comments to expand the program. 4 This same study was redone two years later in 2019 by some of the same researchers. They found that in addition to 100% of employees finding the program helpful, 100% would now recommend Code Lavender to others. They also cited unprompted requests of emotional debriefings and the prevention of one suicide. The team, however, found no significant changes in job satisfaction or ProQoL score. 5

The normalization of a high stress, burnout prone, and less forgiving culture in medicine has seen far too many health care professionals report lower levels of job satisfaction, higher levels of mental health conditions such as depression and anxiety, or even lose their lives to suicide. A 2018 article cited statistics showing that 35% of physicians reported not seeking adequate mental health care for themselves, 50% of female physicians reported not seeking mental health care despite feeling like they meet criteria for a mental health disorder, and the suicide rate of physicians was 1.4-2.3 times higher than the general population. The article goes on to suggest that the stigmatization of physician mental health in medicine is a huge deterrent to health care professionals wanting to seek treatment for themselves. 6 This is where I believe Code Lavender can make a difference. Highlighting mental health at the forefront of an official administrative initiative will show health care workers that their emotional well-being is important and might be the first step in systematically destigmatizing psychiatric conditions and needs in the workspace.

Personally, I believe that mental health has been neglected within the professional medical space for far too long. Though I know I haven’t experienced the brunt of the issue as a second-year medical student, I feel as I have already encountered snippets throughout my journey in the forms of members of residency advice forums guiding applicants to avoid talking about their mental health on the interview trail, whispers about the normalization of “malignant” residency programs, and the sheer number of articles that come up for view after a quick google search of “recent physician suicide.”

In order to start your own Code Lavender initiative at a nearby hospital, the first step is to look into what support initiatives are already in place at your own institution. You can then look for outside resources online, as a way to improve systems that are already in place. A great place to start is by looking into Genesis HealthCare System’s presentation at the 2017 Excellence in Healthcare Conferences. They provided guidelines for starting a Code Lavender initiative at your own institution through a four-step model. The first step consists of contacting departments at your hospital such as campus coordination, behavioral health, volunteer services, ethics, and spiritual services. 7 From there, it is important to create an interdisciplinary team to start the planning process. Though as health care providers, we often put the needs of everyone else around us above our own, it’s time to start caring for our own mental health as well! Implementing Code Lavender on a national scale might just be the first step in creating that solution.

For more information, check out the links from the references below.

References

  1. Drummond, D. (2014, Apr). Code Lavender and Preventing PTSD in Health Care. HuffPost., www.huffpost.com/entry/code-lavender_b_4539009

  2. Stone, R.S.B. (2018, Apr). Code Lavender: A tool for staff support. Nursing, 48(4), 15-17. https://doi.org/10.1097/01.NURSE.0000531022.93707.08 

  3. Consult QD.  (2017, Jan). Code Lavender: Offering Emotional Support Through Holistic Rapid Response. Consult QD, www.consultqd.clevelandclinic.org/code-lavender-offering-emotional-support-holistic-rapid-response/

  4. Davidson, J.E., Graham, P., Montross-Thomas, L., Norcross, W., & Zerbi, G. (2017, May - Jun). Code Lavender: Cultivating Intentional Acts of Kindness in Response to Stressful Work Situations. Explore (NY), 13(3), 181-185. https://doi.org/10.1016/j.explore.2017.02.005  

  5. Graham, P., Zerbi, G., Norcross, W., Montross-Thomas, L., Lobbestael, L., & Davidson, J. (2019, Jan - Feb). Testing of A Caregiver Support Team. Explore (NY), 15(1), 19-26. https://doi.org/10.1016/j.explore.2018.07.004  

  6. Mehta S.S., Edwards M.L. (2018, Nov). Suffering in silence: mental health stigma and physicians’ licensing fears. Am J Psychiatry Resid J, 13(11), 2-4. https://doi.org/10.1176/appi.ajp-rj.2018.131101 

  7. Neff, S. (2017, Jun). Presentation: Bolstering a Culture of Care through Code Lavender.  Excellence in Healthcare Conference, Autin, TX, United States. PDF of Slides.