Rounding, November/December 2017

QUESTIONS: As your hospital transitioned to plain-language emergency alerts, what process did you use to train staff and implement changes?
What, if any, reaction did you receive from the public and patients as your hospital transitioned away from color-based emergency codes?

Hendrick Medical Center, Abilene

Before we began to make changes and conduct training to move from Hendrick Medical Center’s Color Code Emergency Notification System to plain language, we first had to get buy-in from senior leadership. Here at HMC we made a conscious effort to not use the verbiage of "plain-language codes." When it was explained to leadership, we intentionally used as the topic of documents and presentations the words “Plain-Language Emergency Notification.” We felt that any reference to the word “code” would add to confusion. We made this simple by explaining that all emergency notifications over the hospital’s public address system and through other means such as radio and mass text messaging would all be sent in the clear with the exception of Code Blue. Once the approval was made to move from color codes to plain-language emergency notification by leadership, we sent information fliers to all HMC departments so that managers could start discussing the change to emergency notifications with their staff. Next we published policy and procedure documents and developed an e-learning education module that all employees had to take. Once all employees were trained in 2016, the new HMC plain-language emergency notification process was implemented on Jan. 1, 2017.

I think the old saying that nobody likes change is true in that we had some complaining early on when we were implementing the change. One department that had particular concerns was the telecommunications department (hospital operators). Many employees of this department had been there for many years and were used to broadcasting the color codes over the public address system. To alleviate this concern, we developed a laminated plain-language notification matrix document that the operators could use as a cheat sheet for the four plain language categories. Over time, the operators got comfortable with the plain language emergency notification format, and it is now the norm. For other departments or staff that had concerns about the move away from color codes to plain language, we made it a point to visit and explain the change and point out the positives to using plain-language emergency notifications. Overall it has been successful here at HMC and is now a normal thing to alert everyone to a situation using plain language.

Children's Health, Dallas


We transitioned to plain language across the Children’s Health System Oct. 1, 2017. To prepare our staff for this change, the information was presented through multiple committees throughout the system; information was provided to leaders to discuss at their staff meetings, and system communication tools were used to communicate to all employees. The month prior to the change all employees completed a competency- based training with the changes and education about plain language and our system changes. Since the roll out, we have not heard any negative feedback from our staff. In fact, we've heard only positive feedback about how staff appreciate how clear the information is and how it is easier to understand.

Texas Children's Hospital, Houston


At Texas Children’s, we began our journey toward plain language emergency communications in early 2016. Through the course of several active shooter, and other types of emergency exercises, we recognized the need for a communications strategy that would not add to the rainbow of color-based codes, but would instead enable us to communicate clearly and directly with our staff. Throughout 2016, we engaged with our Workplace Violence Task Force and our Emergency Management Committee to gain support for the initiative, ultimately creating an Emergency Communications Workgroup with broad institutional representation to draft language specifically targeting severe weather and active shooter situations. By August 2016, we gained executive approval for our initiative and began implementation Dec. 31, 2016. We rolled out a three-pronged initiative. First, we cataloged all institutional policies requiring updated language. Second, we updated all Annual Required Training and New Employee Orientation materials. Third, we worked with the marketing department to create news stories that appeared on the hospital’s intranet, and we also provided departmental in-service training to educate our staff. Throughout 2017, every emergency management exercise has included a plain language notification element.


Although there is always a degree of confusion with new initiatives, the feedback from staff and physicians has been overwhelming positive. The shift from codes to plain language is simpler than most people realize. When you provide useful, actionable information in a timely manner, no one seems to mind the lack of an associated color code.