Let’s Save Patients by Standardizing the Standardized Colors


Update: The charity auctions that ended last night raised $420 for Friends of the Orphans. Thanks to all who bid and bought (and donated – Martine Ehrenclou, Kaizen Institute, and 5S Supply).

Color coding is a frequently-used visual management method — one that generally works great (unless you're color blind). Hospitals usually have a set of “codes” that are called on the PA system and staff are given a badge hanger as pictured at left. We have similar examples and cases where staff have applied “kaizen” thinking to improve the use of these color codes in our upcoming  book Healthcare Kaizen.

But what happens when the colors aren't the same at different hospitals and somebody works in different organizations? It happens…

This article from Louisiana caught my eye last week: “Hospital color codes still not standardized.”

From the story:

A hospital per diem nurse who worked at two different hospitals started her shift one night only to find a patient had gone into cardiac arrest. She screamed, “Code blue! Code blue!,” over the telephone-intercom, and instead of receiving assistance from other medical employees, she was surrounded by armed security guards within minutes. The nurse didn't realize that code blue at this particular Washington state facility meant security alert.

When seconds count in life-and-death situations, we can't afford errors like this. The article points out that many states don't have standardized codes for all hospitals, as somebody said, “Most hospitals will have their own standardized systems.”

Their own… standardized…. so it's standardized, but not really standardized in the big picture.

Again, from the story:

 As early as 2003, Maryland mandated all hospitals in the state follow the same uniform emergency codes per color. In 2009, both Washington state and Oregon hospitals standardized color-coded emergency response.

The article talks about “recommending” and “mandating.” How do we make this happen in our own states and our communities? Have you had any close calls due to this lack of standardization?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Your point is well taken Mark. Standards are there to reduce waste and variation in our system and to tell us when we can’t follow the standard so it can be problem solved and improved.
    To do this we need to have line of sight to the big picture or else we risk sub-optimizing at the local level.

  2. Mark,
    what a timely blog post. I recently switched positions from Stanford Hospital to UC Davis in Sacramento. Same state, 80 miles, private vs. public. And guess what: One of the very first things I noticed on receiving my badge is that the color codes are different!

    Time to start a safety initiative in California. Who do I contact in my State Government?

    • Great question Sonja, I’m not exactly sure how you pursue this. Here in Texas, I might start with the Texas Hospital Association. I’m not sure if you need a government mandate or just for the hospitals to reach agreement voluntarily?

  3. This is a very relevant question.
    I just wanted to add that you can still follow the colors in hospitals even if you are color blind. There is this system called ColorAdd (http://www.coloradd.net), that creates a standardized code for color-blinded people, so they don’t confuse the color.

    This system has been implemented in some portuguese hospitals, you can see it in http://www.coloradd.net/health.asp .

    This system can also improve the utilization of visual management tools in other facilities without excluding color-blinded people.


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