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Ruth McDonald

2007-08 Harkness Fellow Professor of Healthcare Innovation and Learning University of Nottingham


Harkness Project Title: Pay for Performance and Primary Health Care in England and California: A Qualitative Comparison

Mentor: Steve Shortell, Ph.D.

Placement: School of Public Health, University of California, Berkeley

Biography at time of Harkness Fellowship: Ruth McDonald, Ph.D., a 2007–08 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, is a senior research fellow at the National Primary Care Research and Development Centre at the University of Manchester. Her previous posts include research fellow/associate at Universities of Liverpool and Leeds. She also served as manager and hospital financial director in the NHS for 11 years. Her current and recent research grants include: the impact of incentives on the behavior and performance of primary care professionals, culture change in NHS organizations, and threats to patient safety in the operating theatre. McDonald has published in journals such as Sociology of Health and Illness, Quality and Safety in Health Care, Sociology, and Pharmacoeconomics, and has authored two books and numerous book chapters on topics including: patient safety and/or complexity, doctors' and nurses' views of clinical guidelines, management of change in a primary care trust, rationing, and empowering patients as consumers in the NHS. McDonald holds a doctorate in policy ethnography from the University of Liverpool and a master's degree in health economics from the University of York.


Project: McDonald sought to shine some light on the motivational drivers of doctors and staff in various practice settings with regards to financial and other incentives, and how their responses are impacted by organizational and systemic factors.  She conducted face-to-face interviews with physicians in primary care sites in Northern California representing a range of practice setting types.  She also conducted interviews with English primary care physicians to enable comparisons between the two settings.

Career Activity Since Fellowship


  • Professor of Health Science Research and Policy, Manchester Business School, 2014
  • Professor of Governance and Public Management, Warwick Business School, 2013
  • Professor of Healthcare Innovation and Learning, University of Nottingham, 2009

Current Position: (updated 10/2017)

  • Professor of Health Science Research and Policy, Manchester Business School

E-mail: [email protected]

Harkness-Related Publications

McDonald R. The impact of incentives on the behaviour and performance of primary care professionals. National Co-ordinating Centre for the National Institute for Health Research Service Delivery and Organisation Programme (NCCSDO) 2010. (In press)

McDonald R, White J, Marmor TR. “Paying for Performance in Primary Medical Care: Learning About and Learning From ‘Success’ and ‘Failure’ in England and California.” Journal of Health Policy, Politics and Law 2009; 34(5): 747-776.

McDonald R. “All in the mind? Paying for Performance in England and California.” Frontline 24 5-26-09:17.

McDonald R. and Roland M. “Pay for Performance in Primary Care in England and California:  comparison of unintended consequences.” Annals of Family Medicine, Mar 2009; 7: 121 - 127.