Lessons from a Pandemic: Leading with Science

Joneigh Khaldun, BS ’02

Chief Medical Executive for the State of Michigan

April 22, 2021

Ahead of the Curve is a speaker series from the University of Michigan School of Public Health that brings conversations about public health leadership to our campus and beyond. Leadership is a critical component of navigating complex public health challenges and building a better future through improved health and equity.

Dean Bowman. Our guest today, Dr. Joneigh Khaldun, has been at the forefront of leading the state of Michigan through the pandemic. She provides overall medical guidance for the state as a cabinet member for the governor, and she oversees a variety of public health programs. And we look forward to learning more about how she has been leading with science throughout the pandemic.

To begin, I wanted to ask about your personal and career journeys that brought you to this point. You’ve had several educational and professional stops along the way, including medical school and dual positions as a practicing physician who also leads health departments. Now you are a leader at the Michigan Department of Health and Human Services. As you think about that long journey, what factors have most impacted your educational and professional growth?

Joneigh Khaldun. What has really motivated me in my career are things I experienced early in my life, talking especially about my own family. My grandmother on my mother’s side, may she rest in peace, had a lot of health problems when I was growing up. I was very close to her. I grew up in Ann Arbor, but my parents are from Detroit. Every weekend I would visit with my grandparents.

My grandmother had a lot of health problems, and she also smoked. She smoked a lot. I remember as a very young child—my earliest memories, quite frankly—are of me trying to hide her cigarettes. I would hide them under the couch. And I was starting to put together that: there’s a habit, something with the cigarettes makes my grandma sick, we have to intervene, we have to prevent her from getting sick. For me, that meant hiding her cigarettes, which didn’t work.

I tell that story because I think I’ve always been committed to the idea that with prevention you can improve the health of communities.

My parents growing up on Detroit’s East Side meant all the things that come with inner city life: fewer resources, preventable medical conditions. That excited me throughout my early years. I continued to seek out opportunities to grow and learn and have always followed my passions and interests. And I’ve had many amazing coaches and mentors throughout my educational and professional career.

Bowman. It is fascinating that you’ve been able to find a career you’re passionate about through personal experiences in your life, your family, and your community. Thinking about how you approach leadership at this stage, who among those mentors have really shaped how you approach leadership in your current role?

Khaldun. I’ll start with high school. I ran track at Pioneer High School. For my track coach, Bryan Westfield—a name familiar to many in Ann Arbor—track wasn’t just about track. Mr. Westfield cared about the entire person. He met with my parents. He cared about how I was doing in class. He knew I was interested in medicine, and would give me opportunities to explore my options and would call colleges for me and other students on his lunch breaks. What I learned from him about how to be a leader, coach, and mentor I try to emulate throughout my life.

In college, I worked with Richard Chenault—also well-known in the Ann Arbor community—at the University of Michigan Transplant Center as a perfusionist, which meant I traveled with the transplant surgeons to receive organs. I was young, didn’t have much clinical experience, and was somewhat overwhelmed by the job. Dr. Chenault took an interest in me and trained me. The way I scrub in today in the operating room is the way he taught me. He pushed me, supported me in going to medical school, and told me I was going to do great things. I remember walking the halls of the University of Michigan hospitals with Richard. He would know every person in the hospital, how they were doing, their children’s names. It didn’t matter if you were in environmental services or the chair of a department—he knew everyone, cared about them, and was quite committed to his job and to people in the community. When I think about my leadership style—how I try to lead by example and care about people as I’m doing the work I do—I think especially of these two people.

Bowman. In your current role, the state’s COVID response is the most visible part of your job right now. But you wear many hats between your role as chief medical executive for the state and chief deputy director of MDHHS. How would you describe all of the hats you wear in your current position?

Khaldun. Every day is very different. I do a lot of different things each day. I do a lot of public speaking engagements and press conferences. I work behind the scenes on operational details and strategy for COVID-19—vaccination rollouts, testing response, all kinds of details that go into the public health response. I oversee large teams that run everything related to public health in the state—epidemiology, the tobacco program. All of those things have budgets, staff, and goals, and grants to administer. We’re always tracking other public health threats, some that are ongoing, like our lead program.

More broadly as chief deputy for the department, I lead how we work with our Medicaid health plans to ensure people have access to quality care, our behavioral health system, our state hospitals. On any given day, I’m in meetings talking strategy to make sure operational work is going smoothly, understanding how public health, Medicaid, behavioral health, all those systems come together. On any given day, it’s a mix of public-facing and internal things I’m doing.

Bowman. That big portfolio would present management challenges at any time. Carrying such an extensive portfolio during a pandemic—one of historic proportions—must be particularly challenging. You’re already spread so thin on the COVID front. How do you go about setting priorities, budgeting your time, and leading your team to ensure you can accomplish what you need on behalf of the people in Michigan?

Khaldun. First and foremost, it starts with having a great team. I mentioned my responsibilities, but we have amazing senior deputies, bureau directors, other senior-level career managers in the department who make sure the details are taken care of and manage the programs on a daily basis. With COVID 19, as early as last February, we knew any day the entire department could be working on the pandemic. And that is what’s occurred. Whoever has been able to do work and has the right skill set, we’ve pulled them often into our COVID-19 response. From a leadership perspective, I believe in getting a strong team, getting experts around you, then letting them lead. Just because you’re not at the top or don’t have a senior position doesn’t mean you can’t lead every day in your particular role. I believe in empowering my staff. I believe that any decision my staff can make on their own that does not need me to approve it can be delegated, as long as everyone’s on the same page. In my role, I often just help to think about strategy and help remove barriers so my team can get their work done.

Bowman. That approach to leadership allows growth of individuals and also best outcomes, because you have contributions from so many different perspectives. You’ve been well known in public health for many years. But since the start of the pandemic, you’ve been extremely visible across our state—at press conferences, on the news on a nightly or weekly basis. For us here in Michigan, you’re a household name. What has that experience been like for you as you find yourself on stage participating in these national press conferences and similar events?

Khaldun. When I took this job—or even five years ago when I moved back from the east coast to Michigan—I knew it was to do public health work. When I asked my husband, who is not from Michigan, about the move, he said, “Absolutely, Joneigh. I knew this was your heart when I met you.” We met when I was in medical school. He said, “When I met you, you said you were doing all this work and wanted to be a doctor so you could go back home and help the people where you’re from.”

In these past five years—from health director in Detroit now to chief medical executive for Michigan—I’m doing exactly what I always wanted to do and what I needed to do. I’m incredibly grateful for this opportunity. I had no idea there would be a pandemic, but I do feel that the stars aligned and feel that this is part of my life’s work and that I was supposed to be here at this time. I’m truly trying to give it my all every day.

When it comes to “the fame,” it has taken some getting used to. I’m not someone who looks for attention or looks to get accolades, so it’s been somewhat humbling.

Quite frankly, I’m still trying to get used to it. I’m more than happy to be behind the scenes, to be honest. The one thing that’s really different is being recognized in public. I realized early on—after a month or two month into the pandemic, when we’d been doing the press conferences a few times a week—that people started noticing me. You know, I have a signature hairstyle. So going to the grocery store, going anywhere, became a thing where people would recognize me. And it does impact your personal life. Not that I go too many places because of the pandemic, but I’m very aware of people recognizing me. Sometimes when I go out, I’ll just say that I might have a disguise on, just so people don’t notice me and I can get my groceries and go back home.

Bowman. On the professional side of that, as you are making remarks, every word will be heavily scrutinized. People might find encouragement in something you say. Some might take issue with something else in your words. From a communication perspective, how much growth have you experienced over the last year and what lessons or strategies can you offer on how to approach that?

Khaldun. I had done some press conferences and interacted with the media before, especially as Detroit health director, but certainly not at this level where you’re on television multiple times a week and interacting with media, radio, written media multiple times a day. First, I just hope those who are judging me would say I’ve gotten better over the past year. And I think I have learned. I’ve watched the governor, who’s a great role model. In the beginning, I didn’t know how to put on my own mic for the various events—I had to ask her! In the meantime, I have gotten more comfortable with the camera.

But part of public health leadership is communication. As people are going through their training and growing into leadership roles, public health communication is a really critical skill. Whether I’m communicating with the governor, the media, or the general public, it is an important skill to be able to communicate facts, communicate them quickly, and let people know that sometimes you don’t know everything. That’s important to say as well, if you don’t know something.

I also try to make things simple. I still work in the ER. When I’m speaking to my patients, I can’t give them medical jargon. I try to keep things simple so people understand the issue, the risks, and what they can do to protect themselves. Succinct communication is really important. Again, I hope I’ve improved over the past year.

Bowman. In your role as an ER doctor, you bring perspectives from both public health and medicine. How has training in both fields helped you in your work? What would you say to young health professionals about approaching a career with flexibility and how to combine interests in a way that allows them to have an impact that aligns with their passion?

Khaldun. I understand resumes and job descriptions but I didn’t really know what a chief medical executive did. Even when I moved back home to Michigan, quite frankly, I wasn’t entirely sure what the job would entail. Going back to when I was a young girl and I decided to become a doctor, doing all kinds of volunteer work in medical school, always doing something in the community related to community health—I noticed pretty quickly in medical school that you can do only so much in your individual interactions with a patient. And I saw in these systemic problems—someone having a stroke because they ran out of medication or couldn’t get to it, homelessness, other social determinants of health—these societal issues all happen outside the walls of a hospital.

I’ve always sought to be engaged in places where I thought I could have an impact and where, if you fix the correct problem, you’ll be able to have an impact. I like fixing problems upstream. And I like fixing problems in the ER where you have that instant gratification—intubating someone, sewing up a laceration. I just like helping people heal, whether that’s individually as my patient or fixing the entire system. So I would encourage people in their professional endeavors to think not about the job title you want but about the type of work you want to do and the type of legacy and impact you want to have and get engaged in those things immediately.

It might be volunteering. I did a lot of volunteering early on. I would just show up and would be the only doctor in the room working with a lot of public health folks who shared an interest. So keep an open mind and focus on a degree or a title and more on the actual work.

Bowman. The pandemic has prompted us to focus on the field of public health and our infrastructure in the US, which I would submit was not as strong and sound as we would want it to be in facing a pandemic. As a public health leader, what do you think should be done to strengthen our local state and federal public health systems?

Khaldun. It is no surprise for many people in public health that the US has struggled with addressing this pandemic, for many reasons. But I think the main reason is a lack of public health infrastructure and investment in that infrastructure—disinvestment in staff, not having enough staff. In Michigan, some health departments don’t even have an epidemiologist. People now understand how important epidemiologists are and maybe even know what they do.

Some health departments don’t have a single contact tracer. We all know what that is now, but some departments have one or don’t have any for all infectious diseases. Contact tracing isn’t new and needs to be done for any infectious disease where there might be exposure.

We have a lack of investment in IT systems. Early on in the pandemic, we started building our data systems. And this is my interpretation—I get the sense that people think if you just push a few buttons you can know where every case is and know exactly where they got the virus, what school they went to, how many people are associated with the outbreak.

We don’t have all that detailed data. Some health departments are still using fax machines. Often our healthcare systems and electronic health records don’t connect in a robust way to our state health department data systems. This became a news story—we had to use SurveyMonkey to get information from local health departments, 

So the lack of investment in the workforce, infrastructure, and IT—those things had a significant impact on our ability to respond as quickly as we needed to, particularly in the very early days.

Bowman. Public health has been politicized during the pandemic in ways we haven’t really seen before. Public health workers at local, state, and federal levels have had incidents of mistreatment and threatening behavior just for doing their jobs—the public in public health means our intent is to serve the public good. We’ve seen push back from some over adopting public health guidelines. You’ve talked about the importance of moving beyond politics and focusing on the policies that will help keep us safe and healthy. What strategies have you used to navigate this terrain and refocus the conversation on public health policy.

Khaldun. This goes back to my earlier comments about communication. As a medical doctor, as a public health leader, we are in our particular positions because of the expertise we have. The onus is on us, first, to know the data, to be on top of the data and the science. Then, we have to be able to communicate that effectively to people who are not public health professionals. Terms like social determinants of health or mitigation strategies—many people don't understand what those mean. Many elected officials are not doctors or public health professionals. They might be lawyers or business professionals, but they need to understand information, need it presented to them in a succinct way and in a way that helps them see pros and cons of their particular decisions. And they hire us into these public health roles to give public health advice. 

I tell the governor this—I am not a political advisor, I am not an economic advisor. I understand, of course, that public health and the economy are intertwined, they don’t oppose each other. I come to work every day doing the best I can to understand the data and the science and to make sure the people I work for understand it as well, as they have to make very tough decisions.

In medicine, it’s the same thing. Sometimes I take care of people who are in the ER perhaps because they were in some type of altercation and perhaps will be accused of doing something bad . But when I’m taking care of someone, I don't use that lens. My lens is, I have a human being in front of me, I have special training to be able to help this human being, and I’m going to use my special training to make that human being as healthy as they can be. And I bring that same approach to my role in public health.

Bowman. How much does being grounded in the science help? Does it buffer you from some of the criticism that comes from living in a divided society or just from different perspectives or opinions about science? Does it help you maintain some conviction in your guidance, some firmness in what you’re recommending?

Khaldun. I think so. Some may disagree, but I don’t engage in the politics. Obviously, I’m an appointee of the governor, who is democratic. But for the things I recommend in talking about data and science and public health policies, it doesn’t matter. These are for public health regardless of your political affiliation.

I do think about this every day when I come to work. Unfortunately, COVID-19 has become political—basic things like wearing a mask and getting a vaccine now. Some data show that people of certain political affiliations are more likely to not want a vaccine. It’s unfortunate that basic ideas of just helping each other get through this pandemic as quickly as possible have become political. I continue to make sure my main goal as chief medical executive is to provide guidance to the governor on medical and public health matters, and that is what I stick to every day.

Bowman. As I think about your work, part of the challenge is to be effective at working with people from different backgrounds and disciplines and communicating effectively with the public in multiple communities. Can you talk about the term multilingualism, which you’ve written about? Why is it important for the work you do?

Khaldun. Earlier in the pandemic I wrote about this idea of professional multilingualism, something I’ve learned throughout my career. If you're talking to a physician, for example, you use all kinds of medical jargon, and in that context, others know what it means. As I teach my medical students and residents, when you’re writing discharge instructions for a patient, avoid the medical jargon. Say, you came in for stomach pain. Say basic things that the general public—who likely does not have medical training—would understand.

It’s the same thing when you are a public health leader—making sure you are saying things in very simple ways where people can understand the issues. In the beginning, I was offering training on what contact tracing means, what social determinants of health are. People don’t often understand that term. And often, policymakers in control of where dollars go don’t understand what social determinants of health are. But they do understand that someone experiencing homeless might have difficulty taking their medication, getting a job, avoid coming into the ER—and that might increase hospital costs or health plan costs. People understand that but might not understand “upstream social determinants of health.”

Being able to pivot in whatever environment you’re in is key. Almost on a daily basis I am translating between my medical training, my public health role, speaking to other public health professionals, speaking to the general public, and speaking to other political leaders who have to make really tough decisions. All of it is translating important information to leaders in a way that they can understand and be able to make good decisions.

Bowman. There have been many twists and turns in the road, if you will, with this pandemic. At any given time, it is difficult to project what things will look like six months or a year from now. We have widespread transmission of new variants and lots of promising progress in terms of vaccines. As you distill all of that, what do you think needs to happen for us to make significant progress toward ending this pandemic?

Khaldun. We’re all tired. It's been a very long time now—since January of 2020, public health professionals have been working on the response. What do I think we need to do as a society? I think we need to focus on the things that we know work. Masks. People hear it all the time, but I’ll just say it again—masks. Avoiding large gatherings, washing hands, social distancing, getting a vaccine. It’s very simple, actually. These are just the things that we have to do to get out of this pandemic as quickly as we can. It’s also important to understand that vaccines are the way to freedom, if you will. The CDC already has a list of things you can do once you get vaccinated—gathering in your home with other fully vaccinating people without a mask, not being tested after and before traveling, not needing to quarantine if you’ve been exposed and don’t have symptoms—things you can do.

I’m grateful to be fully vaccinated just for going on with life without feeling so concerned that you’re gonna get COVID and potentially end up in the hospital. Even if you get COVID, if you’re vaccinated—and that is still a possibility—it’s highly unlikely you’ll be hospitalized or lose your life. We can all focus on these basic things in our personal lives and think about it in the sense of where we do have control, things that we can actually do.

Bowman. COVID-19 has shined a spotlight on the health inequities we have in this country. It didn’t start with COVID, but the pandemic has shined more light on them. We have intersecting public health crises of infectious disease with continued manifestations of racism that foster inequity. You’ve been engaged in furthering efforts to promote health equity in the state and recently were appointed to a presidential task force. Can you tell us about some of that work you’ve been involved in?

Khaldun. As you mentioned, it's really no surprise that COVID-19 has impacted communities of color in the way it has. First, think simply about COVID-19 as an infectious viral disease you get if you’re exposed to someone else, and then about the fact that black and brown people are more likely to live in poverty because of historical policies and racism, lack of resources in communities, lack of educational opportunities. Then consider that starting a year ago, many of us were able to work from home, take paid leave, have their own vehicle—things that come with wealth and privilege.

Black and brown people were less likely to have that wealth and privilege, which meant they were more likely to be exposed—having to take the bus, having to leave the home to work when everyone else concerned about the virus can be in their home. If you have unstable housing, if you live in multigenerational housing—all those things contributed to COVID-19 spreading. Think about the size of homes, where initially the CDC guidance was to isolate and use a separate bathroom if you had a COVID case in the house. Well, not everyone has more than one bathroom in their home to isolate. That is all part of how we ended up with these disparities expanding throughout the pandemic.

A big rule of health science is that if you don’t measure it, you can’t identify and implement solutions. Since well before the pandemic, my epidemiology team knew that when we look at data, we will always look at it by race and ethnicity as best we can.

We were one of the first states to look at COVID-19 cases and deaths by race and ethnicity. And we found stark disparities—African Americans are 14% of Michigan’s population and accounted for 40% of COVID deaths. We looked at that data and published it. Then we worked with the governor and lieutenant governor to put it into action. We formed a racial disparities task force. We brought together community members so we’re not sitting in a bubble as leaders but are engaging the community, engaging community leaders. We implemented policies that put money and other resources into communities of color—masks, testing, communication efforts so people knew the risks and what to do. And we were able to bring that disparity down.

I’m very grateful now to be on President Biden’s health equity task force, and we are similarly looking at those specific recommendations that, if implemented, could impact not just COVID-19 but other current and future public health challenges.

Bowman. Those are great suggestions and strategies for tackling some of the inequities to mitigate and potentially eliminate them. As we talked about, these inequities didn't arise out of the blue. As you note, at some point we’ll turn the corner on COVID but there will be future health challenges. Are you optimistic that we can achieve structural change so that in the future we don’t see this disproportionate burden of who experiences those challenges?

Khaldun. I am optimistic. I think people are paying attention to it more now than before COVID-19, including leaders and other people who have power to make change. By power, I mean bringing resources, often dollars, to changing the structures and systems that create these inequities.

It is still a challenge. These systems have been in place since the US came into being. At every level of society or of an organization, we can start with training, like implicit bias training. We’re doing it in state government. We’re mandating it for medical providers for maintaining their license. And the training, we hope, helps people when they are interacting with someone. In a health care environment, for example, they are making decisions about what medications, treatments, or tests someone may get. And they need to see past their own biases to provide appropriate treatment. Collectively, if everyone does that, we will see better health outcomes.

Leaders in departments often determine who gets a job, how grants are given to entities like businesses, and so on. When you can change who’s in leadership positions—those who determine where money goes and how structures are set up—then as years go on, we will see some of those inequities change. I am concerned that when COVID-19 goes away, people will forget the tragedy that’s played out with inequities in black and brown communities.

Bowman. I view it on the academic side as something that should be embedded in our training. It has been, but COVID-19 can serve as a specific example for years to come to underscore that.

Crisis leadership is a different breed of leadership. As I think about it relating to your track background, it feels that public health leaders over the last year have been running a marathon but at a sprinter’s pace. What strategies have you developed for self-care and managing your team at moments with such urgency that we have to deliver but also thinking about well-being of the team members?

Khaldun. In high school and college, I was a sprinter, long jumper, and hurdler. And I feel like I’ve been asked to do a marathon and then 10 minutes later start another marathon. That’s how I'm feeling right now.

As for my team, I am so grateful for them. People often see me as the public face of COVID-19 in the state. But we have so many amazing public health leaders. You don’t have to be at the top to lead. We have so many amazing public health career professionals—epidemiologists, contact tracers—so many people in the department and outside the department. We have wonderful partnerships with the University of Michigan School Public Health and other schools helping us get through this pandemic. And people are tired. People are retiring. People have needed to take medical leave.

As a leader, I’ve tried to communicate that, while this is a public health emergency, every single thing we do—every minute of every day—is not necessarily an emergency. So I help my team understand and prioritize work. We get many requests every day, so we look at calendars and decide what things have to be done today versus next week. I also make sure people know that I don’t expect them to work through the weekend or into the evening unless absolutely necessary. I try to cut back on meetings and think about the timing of meetings. And I encourage people to take care of themselves. If someone has a doctor’s appointment or needs to do something for their child, I don’t even need to know. I know that you’ve got a life just like I have a life and have children and am trying to take care of them as well. I expect people to do that and try to do that in my own life.

Bowman. What is an example of one thing you do that serves as an outlet for you.

Khaldun. My bike. My husband got me a bike a year ago, and I do frequent bike rides. On particularly stressful days, I might take a 20-minute break between meetings and go on a quick bike ride, and it is helpful. I also just take time to be with my children. Two of my children have been on virtual school the entire year, including my one in elementary school. And that has been a challenge. But I take time for them. I actually read to his class for Reading Month last month. These little things keep me grounded.

I know this does not sound like self-care, but working in the ER, for me, is a little break. As busy as ERs have been, including my shift this past weekend, it’s very grounding. The ER is home for me—I trained in it. I’m not Dr. J to the staff, I’m Dr. Khaldun. I focus on the patient in front of me, and in many ways it is grounding and relaxing for me.

Bowman. Are there recent examples of things you’ve experienced during this crisis period where you drew lessons of leadership to get you through those tough moments?

Khaldun. It can seem like every day brings a tough leadership moment. I try to make sure I’m present for my team. When my team gets negative feedback—from a media story or maybe they made a mistake—I make sure to let them know it’s okay. They are human. I try to bring context to each situation and help ground people. We acknowledge we have a problem, then we discuss specific steps we can do to get through the problem. It might be bumpy but I’m here with you and this is how and what we are going to do now. This is what we need to do next, and tomorrow will be a new day.

The Johnson & Johnson vaccine pause yesterday—we didn’t know about it when we went to bed and in the morning, we found it out. Yesterday was a little hectic, but we said, “This is what we know. This is what we don’t know. Let’s do some communication efforts and move on.”

Bowman. Some of those challenges stem from the evolving nature of science. As you think about leadership, about science,and about your work, how do you try to stay ahead of the curve?

Khaldun. Some people close to me know this, and maybe it’s why I’m a good ER doctor and chose emergency medicine—I always anticipate the worst. I don’t assume that’s going to happen, but I anticipate it. With that, few things are surprises for me. Even with the Johnson & Johnson pause, we know there’s a robust monitoring process in place for these vaccines, with that process in place these types of things may happen, and I still feel good about telling people to get these safe and effective vaccines.

So yesterday it happened. We didn’t know that it was coming, but we identified the issue, communicated with our teams and with providers who had the vaccine, and now we’re moving forward. It’s about anticipating, thinking about the next steps if certain things come up. What are some worst-case scenario situations where we need to have a back-up plan? My brain tends to think like that, but anticipating a few steps ahead can go a long way.

Joneigh S. Khaldun, MD, MPH, is chief medical executive for the State of Michigan and chief deputy director for Health in the Michigan Department of Health and Human Services (MDHHS). She is adjunct professor of Health Management and Policy at the University of Michigan School of Public Health and serves on the national advisory board for the University of Michigan’s Institute for Healthcare Policy and Innovation (IHPI). As an undergraduate student at Michigan, Dr. Khaldun completed the University of Michigan Summer Enrichment Program (UMSEP).

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