Bloomberg Distinguished Professor of Health Systems, Quality and Safety
Get to know patient-safety expert Kathryn McDonald, who explores what makes for safe, affordable, and high-quality health care delivery systems and the factors that prevent health organizations from achieving that standard of care. Her research relies on close partnerships with frontline teams, including patients and families. As the Bloomberg Distinguished Professor of Health Systems, Quality and Safety, Dr. McDonald holds primary appointments in the Schools of Medicine and Nursing and joint appointments in the Carey Business School and Bloomberg School of Public Health. Dr. McDonald also has affiliations with the Malone Center for Engineering in Healthcare, the Armstrong Institute for Patient Safety and Quality, and Hopkins Business of Health Initiative. Before joining Johns Hopkins, Dr. McDonald was founding executive director of the Center for Primary Care and Outcomes Research at Stanford University’s School of Medicine and executive director of Stanford’s Center for Health Policy.
You have degrees in chemical engineering, business management, and health policy (organizational management) and have worked in both industry and academic positions. How does your varied expertise contribute to the overall goal of HBHI and its impact on health care?
I don't look at the world through one lens, for sure. The experiences I've had, whether it's an educational experience or work experience in these different domains, have kept me agnostic to any specific worldview. At HBHI, we are attempting to keep the balance between what we're trying to do for health and what we're trying to do for business and policy. The different lenses give me a chance to be involved in ways where I'm often seeing connections that aren't as easily seen by people who move within one world, whether a discipline or a work sector.
I know how to make semiconductor chips because my engineering background taught me to understand the world of something you can tangibly see. From my management experiences, I know how central decision-making is to that world. And as a social scientist, I’m aware of how everything that happens is being shaped by the so-called social world. These varied environments have a common theme of me trying to figure out how the world works to contribute to having an impact on health and health care.
What are some collaborative projects you’ve worked on with HBHI colleagues?
A lot of my HBHI activity is related to my role on the Leadership Committee. I’m very involved from a strategic perspective – how can we build this community in a way that we are able to produce more impact? There's the good science, but does the good science have real impact on public health, or health care delivery, or policy? I’m working with HBHI colleagues on deepening our understanding of knowledge-to-action gaps, especially ones that exacerbate inequities or limit safety and quality of care. I often find myself involved in foundational research that is needed to push an area that could use more research forward into the public eye. One example is work on patient-reported measures of diagnostic excellence. We currently lack good feedback systems on what is and isn’t working well to produce the best diagnostic experiences and outcomes.
Hopkins has such a strong healthcare and public health footprint and HBHI faculty have so many resources to draw from. It’s a very collaborative environment. As leaders, we’re trying to figure out how to make sure that HBHI is creating a greater chance that we will advance knowledge where it matters for producing a better health care system.
You started your tenure at Hopkins in March 2020 right before the COVID-19 pandemic shut everything down. From your perspective, how did COVID-19 change healthcare and what were the big takeaways?
During COVID, Hopkins was on our TVs, with the dashboard that the university’s scientists developed. There was research going on in the diagnostic space, research on healthcare workers, on the community, etc. The big takeaway, for me, is that our entire healthcare ecosystem is forever changed. There are the changes in terms of how people access care and how care is organized. The ability to do home testing and read your own test results has changed patient behavior. We have an opportunity to co-create a good health care system and co-create good health care policies with the public. We have a much more educated public. We’ve shared a common experience in the different phases of this continuing pandemic, even though there have been plenty of differences in people's opinions and groups that have been hit way harder than other groups. The delivery system has had to keep adjusting and responding and innovating and moving things into action. The public health system and health care delivery system have needed to work together very closely, and deal with the challenges of that. There are so many layers; you can no longer say, we’ve always done things that way and can’t change. We’re just in a whole new environment.
One of your primary appointments is in Nursing? Why is that?
Nursing was just this wonderful serendipity. My research fits very well with my colleagues in the School of Nursing; they have a very holistic view of the patient. They think about community. They're trying to make things work. I have a process orientation, which fits well with the nursing culture of rolling up your sleeves and getting things done. There's an appreciation for being rigorous in all research, but also an attitude of getting things done. The School of Nursing is leading the way in improving health through systems-oriented, equity-grounded, community-based research, and that goes really well with what I do and care about.
What current research projects are you working on related to Hopkins?
I have a pretty big range of projects. I do a lot on the diagnostic side of health care. It's an area of patient safety and quality that until recently wasn't receiving that much attention. I've been involved in very patient-focused research, trying to understand the patient's story–what goes wrong in getting a diagnosis and what goes right. What's going on for the frontline physicians.
I am also doing a lot in terms of disparities in care, and again, trying to understand how to intervene at the organizational level to improve care for everyone. We see a lot of innovation that is working at Hopkins, but why isn't it being done everywhere else? Why do half the patients get something they need, and the other half don't? There is a whole science, called implementation science, which hasn’t yet drawn enough from the management and organization field. I’m working across schools with others to address that.
In your opinion, where are the greatest opportunities to improving the American health care system? How can HBHI contribute?
The US healthcare context is complex and dynamic, but it probably has more silos than anywhere else. The American health care system needs more systems thinkers working across the entire healthcare ecosystem. Finding the greatest opportunities to improve the system is the first step, and requires both not-for-profits and businesses, a range of influencers such as professional societies, credentialing bodies, academic innovators, and the public via Capitol Hill, state and local policymakers, patient groups, and communities. HBHI has that broad view to inform what's working well, what's not, and what research and innovation are most needed for the various levers to improve the system. We have a wide range of expertise. We have people who are wonderful at doing research and using strong methods with incredible data sources. We have people who are excellent at community-based research, we have people who have been studying companies, whether it's supply chain or the management and organizations side, or finance or marketing. From a strategic standpoint, HBHI is looking at how we can build this community in a way that we are able to produce more impact. It's a huge puzzle to produce health. HBHI is sitting at the table, forging collaborations between Hopkins and those in the private and public sectors to put all the pieces together.
You’ve lived a large part of your life in California. How do you like Baltimore and what do you do outside of work?
I didn’t live near water in California but could get to it. I love water, and I like the fact that Maryland has a large coastline and Baltimore has its Inner Harbor. I'm still trying to get to know the city. I’m a big walker and I like walking everywhere to discover new neighborhoods. I love to travel too, so I like living close to the airport and train station. It’s easy to visit family and explore the East Coast more. I also enjoy games, puzzles and want to get back to playing tennis and maybe learning to sail.