1. Code Lilac
Get a brief feedback of why people have decided to come today?

2. What is Code Lilac?
Code Lilac is volunteer interdisciplinary peer support team that responds to meet staff emotional support needs throughout the hospital.

3. Code Lilac Mission
To provide staff who are experiencing a stressful or emotionally and/or spiritually challenging crisis with a coordinated, immediate team response which facilitates a holistic and empathetic exchange to promote compassionate listening and a professional pause to gain clarity and perspective.
This approach would ideally promote optimal well-being and team cohesion in the hospital environment and foster personal and professional resiliency as well as prevent burnout.

4. Code Lilac Goals Promote healthy work environment/Burnout prevention
Staff Wellness/Health
Mindfulness
Foster team approach
Impact recruitment & retention
Assist staff/team members with processing thoughts, emotions & optimizing resiliency
Improve cost efficiency for healthcare organization
Facilitate a holistic & empathetic exchange to promote compassionate listening, professional pause & gain clarity and perspective!
Jan 2015 – Dr R. Phillip Dellinger in his Lifetime Achievement Award address at SCCM Congress titles “10 Things We Can (and Must) Do Better. Burnout in ICU Healthcare Professionals” was one of those topics. He addressed compassion fatigue and cognitive/technically focused training programs with less focus on development of emotional skills. He went on to say “hold more hands, talk to patients about things without reference to medical illness or disease states.”
Feb 2015 – Dr Sandra Lopez – Doctorate of Social work who spent much of her career looking at burnout presented on Vicarious trauma (cumulative effect of working with patients who are survivors of traumatic life events). Glenda McDonald & I began working on developing a structured process for implementing peer support here at CMHH.
Cimiotti et al 2012 in PA found in large multi-center study assessing nurse staffing and burnout on HC, that if the proportion of nurses with high burnout decreased from average 30% to 10% UTI & SSI would be prevented and lead to estimated 41 million in cost savings….

5. Why Code Lilac?
Burnout
Resiliency
The “Why?”

6. Why Code Lilac?
Overall, 60% of U.S. workers-not including government workers-reported stress in their current jobs, and 11% reported feeling “highly stressed”
69% of healthcare workers reported feeling stressed and 17% reported feeling “highly stressed”
More than half of healthcare workers say their workloads increased over the past year
25% of medical personnel plan to switch jobs in the coming year, the survey found
The Advisory Board Company: February 2014

7. Risk Factors for Burnout
Younger age
Female gender
Working OT
Time since last non-working week
Conflict with colleagues
Working in ICUs > 10 beds
Provision of care to dying patients
Lack of routine unit meetings
Risk Factors for Burnout
Female gender/ young age,
Number of patient shifts/month (staff working OT), time since last non-working week (vacation)
Conflict with colleagues
10 bed ICUs
Caring for dying patients/providing pre/post-mortem care
Lack of routine unit meetings
Negative correlators: Good relationship between nurses, Relationship with chief nurses, Staff with Resiliency traits (Measure by Mindful Attention Awareness Scale), Perceived stress scale, Connor-Davidson Resilience Scale)

8. Causes of Burnout
2013 workplace survey by Medscape assessing burnout

9. Signs & Symptoms of Burnout
Fatigue
Anxiety/Depression
Excessive anger/irritability
Difficulty maintaining focus
Erosion of energy & enthusiasm
Egocentric behaviors & thoughts
Excessive call-ins
Signs/Symptoms Burnout & Compassion Fatigue in HC arena: (Can develop gradually over time):
Erosion of employee energy & enthusiasm
Egocentric thoughts & behaviors
Difficulty maintaining focus / meeting deadlines
Excessive amounts of anger/irritability
Fatigue/sleepiness
Anxiety & depression.
Can occur with best & idealistic workers (the ones who care, no prior psych hx, went into a “helping” professions.)

10. Cost of Burnout Direct cost for HC organizations Physician turnover
Decreased quality
Decrease in patient safety
Personal employee dissatisfaction
HCO with 3K employees with average salary of 45K can save annually 1.3M with 1% reduction in turnover. (Studer 2006). For Memorial Hermann = over 10M for 1% reduction in turnover
Cost of replacing 1 departing MD can approx. the annual salary of that physician (150K-1M/physician) (Buchbinder, 1999). Lost time, lost services/patients/procedures/recruitment efforts, etc
Cimiotti et al 2012 in PA found in large multi-center study assessing nurse staffing and burnout on HC, that if the proportion of nurses with high burnout decreased from average 30% to 10% UTI & SSI would be prevented and lead to estimated 41 million in cost savings….

11. Code Lilac Promotes Resiliency
“What”
Resiliency is a dynamic process where people exhibit positive behavioral adaptation in times of trauma, stress, change or tragedy.
It can be learned/acquired and is a spectrum that vacillates based on life experiences, personalities and stress levels.
?Capacity to “bounceback” after disruption & reset future negative events & outcomes
Need to recognize & acknowledge burnout, identification of self & team members & develop quality metrices for burnout (not employee satisfaction/identifying & implementing measures to address burnout)
Awareness of topic. Learn to play, work & rest. Promoting connection to self, others & to something larger than ourselves. Reduce isolation.
Developing self-care, self-assessment, self-reflection, journal writing, talking with peers & friends
Encouraging balance. Provides stability, prioritization, relational issues, developing boundaries between work & home.
Signs of resilience:
1) Self-regulation- shifting from sympathetic response.
2) Perceptual maturation – accepting nature of work systems to always demand more than we can deliver, positive outlook/optimism
3) Support & connection – Cultivate trusted network of people, promote relationship building
4) Self-care – Eat healty, sleep, exercise & enhance spiritual connections
Resiliency rekindles sense of mission & compassion that attracted us to HC in first place.

12. How CMHH Code Lilac program works

13. Code Lilac Activation
Any staff member in the Hospital or Emergency Department may call and request a Code Lilac by paging the on-call chaplain who is in-house 24 hours, 7 days per week

14. Code Lilac Activation Unit pages chaplain to request Code Lilac
A Response Coordinator (RC) chaplain or other volunteer RC assess/triages with unit manager about which response would be appropriate (defusing, individual encounters, pause, etc.)
RC text messages entire team time, location, # of volunteers needed, and RC contact number
All scheduled volunteers for the day Respond to RC to determine who can respond
Get Cart, Set up Room, Lead Defusing
Sign In Sheet
Read disclaimer statement
Group processes
Closing remarks
Hand out “Take Care of You” Sheets
Clean Room, Return Cart
Questionnaire Sent

15. Possible Reasons for Code Lilac Activations
Death of a patient
Ethically charged cases/care which saps morale
Multiple deaths on a unit in a short period of time
Difficult patient and family scenarios
Community trauma and crisis
Sudden unexpected deterioration of patient with sub-optimal outcome
Death of a staff member or family member which impacts unit dynamics

16. Code Lilac Defusing Sessions
Is meant for those directly involved in the situation
Managers/directors/administrators would do better to assist with coverage rather than attend (staff may be afraid to share when administrators are present)
Not a clinical debriefing or quality evaluation

17. Code Lilac Defusing Sessions
Is meant for those directly involved in the situation
Managers/directors/administrators would do better to assist with coverage rather than attend (staff may be afraid to share when administrators are present)
Not a clinical debriefing or quality evaluation

18. Types of Code Lilac Responses Include
Pause
Individual Encounters/Unit rounding
Small Group Defusing

19. Post-Participation Questionnaire
1. Overall, how satisfied or dissatisfied were you with the Code Lilac experience?
Very satisfied %
Somewhat satisfied %
Neither satisfied or dissatisfied 0%
Somewhat dissatisfied 2.7%
Very dissatisfied 0%
2. Which of the following words best describe(s) The Code Lilac experience? [check all that apply]
Supportive 87.88%
Organized %
Unique %
Unhelpful 0%
Uncomfortable 3.03%
3. How quickly was a Code Lilac initiated in your area?
Too soon 0%
At the appropriate time %
Neutral %
Too far past the occurrence 6.06%
4. How likely are you to encourage your peers to participate in a Code Lilac
Very likely %
Somewhat likely %
Not likely 0%
5. Please provide suggestions on how Code Lilac Leadership can improve the process.

20. Leadership Officers, leaders meet Monthly Shared Governance Model
Periodic team meetings/trainings
Sign in Sheets, Minutes, Agenda
Discussion and practice scenarios

24. What it takes to start a program
Advocates
Funding
Administrative Buy In

25. Get a brief feedback of why people have decided to come today?