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Experience. Insight. Practice.
“Systems should never forget the people they serve.”
“Systems should never forget the people they serve.”
Donna Harvin-Graham, MBA, PMP
Advisor | Practitioner | Architect of Accountability™
I believe the work of health equity is a promise we make to one another. For that promise to hold, it has to move beyond statements and show up in the way systems actually operate.
As the Architect of Accountability™, I work where human behavior meets the realities of how organizations function. My perspective comes from years of seeing how people navigate their roles, how the systems respond, and what happens when those patterns don’t align. That understanding is shaped by a Bachelor of Science in Psychology from Pennsylvania State University and an MBA from the College of William & Mary.
I bring the discipline of PMP‑certified project management to see how work moves, where it breaks down, and what helps structures hold over time. This approach guides my leadership as Strategic Director for the National Alliance on Ending Health Disparities (NAEHD) and supports my advisory work with Johns Hopkins Medicine and INOVA Health System, with a focus on strengthening the everyday work of care.
In addition to these initiatives, peer review is part of how I contribute to the academic side of this field. I take on this work when invited by journals that look for reviewers who bring practical insight and independent judgment to the evaluation of submitted research.
Advocacy In Action
Equity requires evidence. Below are recent contributions to the public discourse — from op-eds to major initiatives — that demonstrate how we move from conversation to impact.
📚 RESEARCH & REPORTS
Studies presented in this section examine structural challenges within healthcare systems and trace how those challenges affect the people who rely on them. The work spans national gap analysis, peer‑reviewed digital health research, and a published systems model, offering clear evidence and guidance for improving access, continuity, and equity across care settings.
The Invisible Patient: A Strategic Gap Analysis of Rural Health Equity (December 2025) National Alliance on Ending Health Disparities (NAEHD) A strategic gap analysis investigating systemic barriers to rural healthcare access. Using mixed-methods triangulation, this report identifies critical "Invisible Barriers" — including the Digital Wall and the Transit Trap — and introduces the "Rural Access Check," a proprietary toolkit for health leaders to diagnose and remediate accessibility gaps.
Read the Rural Health Equity Report via OSF
Upcoming Manuscript: Open Source Digital Health Tools for Rare Disease (Accepted for Publication in JMIR mHealth and uHealth) Co-Author with 4YouandMe (Chan Zuckerberg Initiative “Rare as One”) Contributed strategic guidance to a multi‑partner study developing open‑source digital health tools for rare disease communities. The work included co‑design of app features, early pilot evaluation, and creation of an open‑source guide to support future research into conditions such as Long COVID and sarcoidosis.
The Framework Inside the Care: A Portfolio Lens for a System Under Strain (July 2026) Project Management Institute (PMI) This piece looks at how small breaks in continuity reveal the structure behind a system under strain and shows how those moments gather weight as patients move through care. Drawing from lived experience and operational practice, the article explains how pressures related to flow, capacity, and dependencies resemble the challenges portfolio managers navigate in any complex environment. The work also highlights how uneven scaffolding across care settings creates variation that becomes inequity and offers a practical model for seeing the full landscape of activity rather than isolated tasks. The goal is to strengthen decision-making discipline, reduce hidden burden, and reinforce the architecture that supports care.
Read the Article on ProjectManagement.com
Full Research Portfolio: ORCID is a global, non-profit registry that provides a persistent digital identifier, ensuring that my research and scholarly contributions are permanently linked and verified across the scientific community.
🖊️ PEER REVIEW CONTRIBUTIONS
Evaluations completed for scholarly journals by invitation, reflecting trust in your judgment and your ability to review research for its scientific approach, ethical conduct, and alignment with journal standards before publication.
Quantifying and Addressing Racial and Ethnic Disparities in Lower Limb Prosthesis Prescriptions Among U.S. Veterans (May 2026) Medical Care
Navigating the Care Gap: How Municipal Transit Shifts Impact Medicare and Medicaid Access? (July 2026) Journal of Health Care for the Poor and Underserved
📑 THE SILENT SERIES
Analysis presented under this series draws on financial variance, operational measurement, project‑management discipline, and other system‑level methods to examine breakdowns that are often overlooked in healthcare. Each analysis follows an upstream failure and traces how it moves through budgets, administrative workload, and access pathways, creating measurable impact long before it appears in formal reporting. The series offers practical guidance for leaders and clinicians who need a clearer view of where systems stall and how disciplined readiness and navigation can prevent avoidable cost and delay.
The Silent Variance: How Patient Friction Destroys Health Care Revenue (March 2026) KevinMD Patient friction introduces unmeasured financial risk into 2026 healthcare budgets, distorting revenue performance long before it appears in financial reports. The piece outlines how missed appointments, access delays, digital barriers, and clinical trial attrition function as revenue leakage. It also describes practical steps for auditing access pathways and treating navigation as a core financial safeguard.
Read the Article on KevinMD.com
The Silent Burden: How Administrative Labor Quietly Shifts onto Patients and Clinicians (May 2026) KevinMD A narrative and operational examination of the unseen labor patients and clinicians shoulder when healthcare systems do not complete the work they were designed to do. The piece explains how missing authorizations, incomplete referrals, stalled paperwork, and fragmented communication create a secondary workload that is never measured, never staffed, and never acknowledged. It also explores how this hidden labor fuels burnout, delays care, and erodes trust, while offering practical steps for restoring administrative readiness and protecting clinical time.
Read the Article on KevinMD.com
The Silent Delay: The Access Cost Created by Breakdowns in the Path to Care (July 2026) KevinMD Systems‑level analysis of the operational failures that create extended access delays even in high‑capacity markets. The piece defines the Silent Delay as the upstream stall that occurs when referrals, authorizations, and administrative readiness break down, leaving patients waiting for the system to catch up to itself. It examines how these gaps distort throughput, erode clinician time, and signal design failures rather than staffing shortages. It also outlines the operational disciplines required to restore flow and rebuild reliable access.
📰 ESSAYS & OPINION EDITORIALS
The articles represented here span several media and reflect perspective formed through direct experience with people navigating care and those delivering it. These pieces examine issues that fall outside formal analysis and bring attention to the practical realities that emerge when systems do not complete the work they are designed to do. The writing encourages readers to consider how everyday choices within healthcare influence access and trust.
A Tale of 2 Virginias: Celebrating Progress While Remembering Our Rural Neighbors (December 2025) Richmond Times-Dispatch (Syndicated Statewide) An op-ed exploring the healthcare infrastructure gap between metropolitan hubs and rural counties. This piece advocates for creative solutions—such as medical-grade transportation networks — to ensure that geography does not function as a pre-existing condition for rural residents. Syndicated in The Roanoke Times, The Daily Progress, and others.
Read the Op-Ed in the Richmond Times-Dispatch
When the Personal Becomes the Project: Applying the PMBOK Guide to Your Own Healthcare (March 2026) Project Management Institute (PMI) Personal care should never function like a project where the patient is only “informed.” This reflection brings professional methodology into the reality of a medical crisis, showing families how to claim agency and step into the accountable roles they deserve.
Read the Article on ProjectManagement.com
The Journey Back to Me: How I Reclaimed My Voice When Everything Tried to Quiet It (July 2026) Women Thrive Magazine A personal reflection on the period when a medical disruption demanded a new look at long‑standing professional habits and the assumptions that shaped early career decisions. The piece connects that experience to the author’s current approach to leadership and advocacy, showing how disciplined assessment and lived experience guide the way she navigates complex systems today.
Meet the Team
Teddi, Chief Happiness Officer
Teddi, Chief Happiness Officer
While I’m busy building the architecture of your accountability, Teddi is busy managing the architecture of our office morale. As my Chief Happiness Officer, she takes her job very seriously.
She is a passionate advocate for balance, often voicing her 'expert' opinions with a few enthusiastic barks whenever she thinks I’ve been at the desk too long. Teddi is a constant reminder that even the most focused work needs a little heart — and that sometimes, the best way to stay on track is to take a quick 'paws' for a tail wag.
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