Ugh, it’s distressing that I have gone weeks without posting. One of those times that “life happens,” I guess. Got busy one week, the following two weeks were spring break for my daughter, the week after that we were at the HIMSS15 conference in Chicago, the week after that I landed a new job… But now I’m back and ready to talk turkey. And I mean that quite sincerely, as I’d like to discuss the concept of plain language announcements in hospitals.
For those of us who have worked in the industry, we are familiar with “codes” that are called overhead through the facility’s loudspeaker, perhaps as well as tinkling lullaby music announcing the arrival of a newborn. The codes are not just the familiar code blue, of course, but things like code red for fire, code amber/pink for abducted child/infant, perhaps code silver for a person inside the hospital with a weapon, or code black for an internal disaster, code gray for inclement weather, the list goes on dependent upon your facility’s preferences. And usually every facility is slightly different, though not tremendously so. For example, one facility in which I worked actually had a code brown that made me chuckle because in nursing the phrase usually indicated a patient with persistent diarrhea.
Well, it would appear that there is a new trend emerging, which is to back of these code announcements and utilize plain language announcements instead. It is intended to reduce confusion and the need for memorization on staff’s part by using every day language that provides transparent, easily understandable information to team members. I’m on board with that, though my contention is that plain language overhead also alerts patients, families and visitors. Imagine that an announcement comes on overhead stating that an infant has been abducted, or that there is an armed person in the hospital. What does our social psychology tell us? Large numbers of people are inclined toward herd mentality, or mob mentality – people are acutely influenced by their peers to adopt behaviors. So, these announcements are made and all of a sudden people freak out and bombard the available staff with questions, demands, and panic, creating disorganization and chaos within operations. At the very outside, even if people didn’t freak out – which they inevitably would – staff are having to answer question after question regarding the status or outcome of the situation while trying to provide care, leading to interruptions, frustration, exhaustion, and possibly even resent or contempt for the organization and eventually misdirected toward our patients, families and visitors. Now, I might agree that having all eyes out for an abducted infant is a good thing, although I’m secure with the protocols facilities have in place to address that issue without involving non-hospital persons. And what if some of the eyes of our families and visitors turn to vigilante and a housewife manhunt by some tough guys or even a mob ensues? There are plenty of people who desire to be heroes, even if the means to do so require being indignant and irresponsible. Citizens groups can be very effective, though I don’t believe an (angry, scared, potentially hostile) ad hoc group for the purpose of helping locate an abducted infant within a hospital is an appropriate solution.
According to one organization’s release, Minnesota, Wisconsin, Iowa and Indiana hospital associations have recommended using plain language overhead announcements, though not all hospitals in those states have adopted them yet. I am aware of one Indiana organization, however, that adopted plain language announcements back in March of this year. Perhaps in a year I will reach out to that organization and see how that has gone for them. In that same release, it suggested that law enforcement agencies also encourage the use of plain language announcements, though my digging into the literature revealed little mention of plain language overhead announcements and no substantial findings. The release does not cite and sources, so I cannot say where they’re getting their information. If anyone reading this post has any knowledge about this, or is able to turn up some studies, please send them to me so that I may amend this post accordingly and attach those findings.
Okay, then why did I say I’m on board with that? I’m on board with plain language communications among staff and hospital personnel. Staff and hospital personnel ONLY. I think it would minimize confusion and the need to have an extra badge buddy or memorize more lingo. Those announcements should be delivered in closed circuit communications, though – via the people and devices personnel interact with routinely, such as unit secretaries, workstations, phones and voice devices, and smart devices. Healthcare personnel have one or more of these available to them at all times. Now, with plain language communication commitment, we also must be careful not to mince words – mix the old and the new. Kind of like that tim period where your organization was half way between paper charting and EHR. How awful was that?! The aforementioned organization who had the release on this matter listed a number of plain language terms that would be used, one of which was exchanging code blue for “medical alert,” and then went on to give the following as an example of its new format: “Medical alert, 5th floor, neuro intensive care unit, room 515. Code Blue team response required.” [Repeated x3] Ummmm… Do you see the glitch here? If the Code Blue team response is required, then why not just maintain the familiar code blue in the announcement? What is the point of introducing ‘medical alert’ when you immediately reduce it to noise?
I’m not berating this organization. In fact, I applaud the hospital organizations in these states taking this initiative and appreciate their efforts. I appreciate they’re being pioneers/early adopters of this change because it allows people like me and organizations like mine to scrutinize how this program could be implemented differently or how it could be better fitted to suit our needs. Change has to originate somewhere; therefore, someone must burden being the originator. This IS a good idea, once tweaked (like taking the ‘overhead’ aspect out), and my hat is off to those hospital organizations taking the lead.
Below is a list of commonly proposed plain language announcement terms. This is far from an exhaustive list, as I believe the number and meaning of plain language announcements is bound to be as varied and organization-specific as the common codes announcement are now (another potential complication of this initiative – but the need for standardized nomenclature isn’t to be explored here), but it provides a boots on the ground look. Maybe think about how you would modify the list or exchange these terms for ones you feel are more descriptive. For example, while I think “active shooter” is pretty descriptive, just “active threat” might leave your staff wanting or needing more. Another example might be to clarify “severe weather” by simply saying “tornado warning” or “large hail.”
Internal Disaster Alert
External Disaster Alert