No scrubs. No shoes. No serving.

the Ottawa Hospital has introduced a dress code that will require staff to wear uniforms prescribed by their respective departments and functions. The Ontario-based hospital may be the first to issue a formal, publicized dress code in the country. Put into effect in March, the code requires staff to don their scrubs and lab coats whenever they enter the hospital, and take them off when they leave, even for a quick trip to the convenience store. Hospital workers who do not deal directly with patients are obliged to wear business casual. The dress code, though, does not define professional attire other than to prohibit jeans, workout clothes and anything revealing — think crop tops and short shorts. “We wanted to make sure everyone is dressed professionally,” says hospital spokesperson Allison Neill. Neill says that patients often had difficulty distinguishing between various tiers of clinical staff, and for years, have written letters of complaint to the hospital stating that they couldn’t tell nurses apart from other health care workers. The confusion prompted administrators to develop the hospital-wide dress code (www.ottawahospital.on.ca/wps/wcm /connect/acc1d08045b4df838effee37f5 617b32/ADM+X+310-Dress+Code+% 282010%29.pdf?MOD=AJPERES). The move bucks a trend over recent decades toward more relaxed attire. But it also reflects a trend among hospitals to respond to patient feedback, says Pamela Fralick, president and CEO of the Canadian Healthcare Association. It’s “so that patients can tell who’s who,” Fralick says. Colourful, informal clothes demystify caregivers and make them seem more accessible. “The idea of seeing our health providers in less frightening and authoritarian uniforms ... has its merits.” But it also can confuse patients, she adds. Without uniforms or an enforced dress code, “you can’t tell who’s your physiotherapist, who’s your psychotherapist, who’s your nurse and who’s your doctor.” The national association has not taken a stance on dress codes, leaving it up to individual institutions to regulate what medical staff may and may not wear on site. The Ottawa Hospital’s dress code was five years in the making and involved several iterations and consultations with staff, hospital officials indicated. Administrators discovered there were few codes to imitate as most facilities in Canada or the United States lack codes or guidelines for attire. “Beyond something that could impact patient care, no standardized guidelines exist for dress,” Matt Fenwick, media relations officer at the American Hospital Association, writes in an email. Each hospital is responsible for developing its own policy, since their requirements would vary. To the extent that there are common elements among existing hospital dress codes, most prohibit T-shirts with highly visible logos or images, and encourage conservative forms of dress. They also recommend that piercings be limited (in one case, no more than two) and tattoos covered up. Women’s skirts must be at least knee-length, while long hair must be pulled back. Badges must be visible. The few hospitals that have dress codes typically do not make them available to the public but, like the McGill University Health Centre in Montréal, Quebec, circulate them internally. Other hospitals have codes for hygiene that can encompass some elements of attire or appearance. In some cases, they include reminders to keep hair neat and facial hair and fingernails trimmed. News CMAJ