FAQs – Tips for supporting staff in addressing high stress and building resiliency

January, 2014

Due to recent publications and press coverage, we have been receiving a lot of inquiries about Code Lavender®, a formalized rapid response program designed to dispatch a team to provide support for employees and physicians during times of high stress (e.g. after the death of a patient or difficult encounters). At the Experience Innovation Network, we have supported numerous healthcare teams in creating Code Lavender support programs.  Our most recent implementation resulted in a substantial improvement in employee engagement and loyalty as well as a decline of staff members reporting that they “do not feel supported” by any part of the institution from 24% to less than 3%. (You can learn more about the origin and concept of Code Lavender here).

Who leads the program?

Teams vary according to the existing resources and culture within an organization.  We have seen the program lead by palliative care, holistic nursing, licensed social workers, clinical psychologists, or pastoral care.   The ideal “lead” depends on what is most appropriate both culturally and based on resource availability.      It is important to consider the barriers of perception posed by the individual leading the program, for example if pastoral care is the primary contact it may be a barrier for those who do not consider themselves spiritual or if it is nursing led it may be perceived as being for nursing only.  Before implementing a program, have discussions or conduct focus groups or surveys with key staff members to understand preconceptions and barriers.

How do we position the program appropriately so it does not become trivialized or “overused”?  Has this been an issue at other sites?

Leaders often fear that the system will be overused or abused.  Historically this has not been a problem – if anything the opposite has been the issue.  There is often a cultural stigma in healthcare where asking for help when in times of high stress can be viewed as a sign of weakness.  Early in the implementation it is critical that team members feel not only welcomed, but encouraged to use the program.   As such, cases of “overuse” are best addressed on a case by case basis, but have not been an issue for prior organizations.

What measures should we use to assess the impact of the program?

Below is a list process and outcomes measures, both short-term and long-term, that organizations are currently using to assess the impact of Code Lavender.

Process and Pilot Measures (reported monthly or quarterly):

• Number of Code Lavenders called (trends)
• Cost of food and other supplies
• Reasons for Code Lavender (e.g. patient death, adverse event, difficult encounter, etc.)
• Program Quality – Did the Code Lavender program meet your expectations?
• Program Referrals – How willing are you to recommend the Code Lavender program to a friend or colleague?

Short Term Impact Measures (measured every 6-12 months):

• Staff Loyalty – On a 0-10 scale, how willing are you to recommend [organization] as a place to work?
• Staff Support – During times of high stress I feel supported (5 point scale – always to never; can list specific groups, e.g. colleagues, leadership, etc.)

Long Term Impact Measures (measured annually)

• Culture of Safety Survey – Show of support for staff during high stress should impact safety culture
• Burnout and Emotional Exhaustion – See the Maslach Burnout Inventory
• PTSD Assessments – See the Short Form PTSD Assessment
• Hospital Acquired Conditions – Reduced emotional exhaustion is linked to improved safety
• Patient Satisfaction – High employee engagement is positively correlated with high patient satisfaction
• Absenteeism – High employee engagement is linked to reduced absenteeism
• Presenteeism – Presenteeism is showing up without “showing up” which should decline (though this is hard to measure)

If you are implementing a Code Lavender program in your organization, we encourage you to share your experience and results below.