UConn Health CMO: 'You Need to Listen More Than You Talk'

Scott Allen, MD, says patient safety must start at the top of a health system's leadership team and extend to the frontline staff.

The new permanent chief medical officer of Farmington, Connecticut-based UConn Health says listening is a key leadership skill in healthcare.

Scott Allen, MD, served as interim CMO at UConn Health for two years before recently being elevated to the permanent role. Allen joined UConn Health as a clinician-educator in 1994 and served as program director of the Primary Care Internal Medicine Residency Program for eight years. He then established the health system's Quality Department and served as chief quality officer before assuming the interim CMO role.

HealthLeaders recently spoke with Allen on a range of issues, including clinical quality, aligning physicians with population health initiatives, and the primary factors for CMO success. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are the keys to quality leadership at a health system?

Scott Allen: I refer to the old adage—two ears, one mouth. You need to listen more than you talk.

You need to listen to people and understand what they do. When I was the chief quality officer, I could not work on something unless I understood what the staff did and what their workflow was like.

When we do a safety event analysis I ask questions, not because I am pointing fingers, I just need to understand what happened. Sometimes, I go to the physical site where a safety event occurred to visualize the situation. To me, listening is more important than speaking, so that you understand where the other person is coming from.

Secondly, you need to focus on the patient experience. Quality requires putting the patient first. Part of that is the six Institute of Medicine aims—everything that we do should fulfill the six aims: being safe, effective, equitable, timely, efficient, and patient-centered. If we can keep all six of those aims in mind when we are working on a project or handling a particular issue, it keeps the patient experience in mind. Everything should be about the patient, and you should demonstrate that to everyone in the organization.

Thirdly, you should try to get buy-in from all clinical areas. For example, I have an initiative to try to get the institution to use scorecards. We are seeking to focus on metrics that are meaningful to the clinicians. The acronym that I use to get clinicians to think about these metrics is SMART goals—specific, measurable, achievable, relevant, and time specific.

HL: How do you align physicians with population health initiatives?

Allen: You need to make the case for the "why" for the providers. Why should they be engaged? All providers want to perform well—it is just the nature of being in healthcare—and they want their patients to achieve optimal health. You need to link both of those together. What are the population health outcomes that the doctor wants to perform well and what are the factors to help the patient be healthy—you put those two together and you engage the providers.

We have a population health department at UConn Health and many of the things that they do make it easier for the providers, so they are going to be more engaged.

HL: How does your daily Safety Huddle work?

Allen: We started safety huddles in 2008. At that time, it was called All Hands on Deck. It is a meeting that still occurs Monday through Friday from 8:30 to 9 a.m. Originally, we had all of the clinical units and some of the ancillary departments. The chief nursing officer and I would run the meeting. The CEO would attend. We would have quality reports and initiative reports.

We transformed the meeting and renamed it to the Safety Huddle. We reinforced the tools and techniques of high reliability because we were part of a collaborative with the Connecticut Hospital Association. When everybody went around the room to do their reports, everyone was in tune with the fact that the primary focus was safety.

The other important piece about Safety Huddle and how it has evolved over the years is that we have about 50 individuals who can present reports at Safety Huddle. We have all of the clinical units such as the emergency room and the inpatient units, and we have added many other units such as physical therapy, facilities, clinical engineering, and fire and police. Everybody reports out because every unit is important to patient safety.

HL: How do you get through 50 reports in 30 minutes?

Allen: It is quick. We have a safety event reporting system called Safety Intelligence, or SI for short. Any SI report that has been submitted in the previous 24 hours has to be brought up for quick discussion during Safety Huddle. Some of them do not require delving into details—some of them do. For example, if there is an elevator situation, facilities must report on that. If there is a problem with pharmacy, they must report out. So, the number of reports depends on the day.

HL: What are the keys to promoting patient safety?

Allen: It starts with leadership and your board of directors. It must start from the top. Structurally, our board of directors has a panel called the Clinical Affairs Subcommittee, which is charged with overseeing the medical center. The chair of that subcommittee holds us accountable. Being accountable to an invested board helps drive quality and patient safety because we must answer to the board.

The subcommittee meets publicly. We share our safety event rate. We have developed an institutional scorecard, with input from the board in terms of what they want to see, which is focused on safety. During that meeting, we have peer review. As part of that peer review, we delve into root cause analyses for serious safety events that require a deep dive.

Having the daily Safety Huddle is also important because leaders of the institution—right now it is the chief nursing officer, the interim chief operating officer, and myself as chief medical officer—show management at all levels the importance of safety. With 50 leaders reporting out and as many as 90 people on the call, the meeting demonstrates that all facets of the organization are important when it comes to safety.

The Safety Intelligence medical error reporting system is also important. We have done a lot of training around the SI system for reporting without blame. We want SI to be a reporting tool, not a blame tool. We have made it very easy to get into that system. It is a link within our Epic electronic health record, so all the clinical folks can just click on it, get into the system, and make a report.

Finally, you must involve the frontline staff. Getting the frontline staff involved in safety event analysis has been one of our initiatives. There is a tool that we call Apparent Cause Analysis—ACA for short. When we see the safety events that come in, some of them require a deeper dive so we can find out the causes and prevent them from happening again. This is not as deep a dive as a root cause analysis. We have about four or five ACAs per week and managers are assigned to a multidisciplinary meeting once a week to report out. We talk about the ACA and we come up with a corrective action plan.

We want to make sure that what we have learned from an ACA is getting back to the frontline staff. About three years ago, we created "ACA on the road." We do the debrief of the ACA with frontline staff. It is about a 10-minute meeting. We go over the ACA, which is presented by a nurse manager, then we talk with the frontline staff and get their input.

HL: What are the keys to success for a chief medical officer?

Allen: You must build trust and credibility. You are the bridge between the health system administration and the medical staff. You live in both domains. To play that role, you must be trusted by the health system administration and providers as well as the nurses and other departments that you are affecting. 

It helps to have small wins, so people see you as trustworthy and you are set up to take on the bigger battles that are coming.

My style is to lead quietly. I like to listen and understand, then communicate based on a level of trust and credibility. I want to get things done without being flamboyant or autocratic. That is how you build trust and credibility.

It is also important to understand the electronic health record. Everybody uses the EHR for everything. We use Epic. I still maintain some clinical activity, so that keeps me grounded. It helps me appreciate the role that our information technology department and Epic plays for our providers. It also makes me appreciate any changes to the EHR.