Bruce Marshall, Executive Vice President and Chief Medical Officer at the Cystic Fibrosis Foundation, has always led with an unwavering persistence to improve care and services for people with CF, their families and the thousands of healthcare professionals who share the same goal to find the cure for CF over several decades. Always the student asking curious questions and being open to new ideas and innovations. Bruce has encouraged and supported new improvement models and designs, including benchmarking visits to CF programs and the development of team coaches as "helpers" for busy frontline multidisciplinary teams. For over a dozen years, Bruce faithfully joined monthly improvement meetings despite his busy schedule to cheer on improvement teams, leaders and team coaches to show his support, keep his finger on the pulse of improvement at the frontline of care and offer valuable insights into the bigger picture of CF care. Always generous, Bruce warmly welcomed international improvement colleagues and other chronic disease colleagues to share the improvement innovations we have achieved and to learn about their journeys. As any transformational leader, Bruce admitted "forced self-reflection" when invited to teach Dartmouth graduate students, which led to many ideas and perspectives to consider in his leadership role. We began our partnership by improving care for pediatric populations, and as life expectancy increased, we moved our focus to adult populations, frontline leadership, and specific diagnoses in CF, including CF-related diabetes. Bruce has been responsive to the CF community as demonstrated by his leadership and expectations people with CF and their families are included as partners in improvement efforts. Learning and Leadership programs such as CF LLC, Adult QI, CF Fundamentals LLC, CFRD LLC, eLLC, CF Leadership LLC, CF Fun to One LLC, One CF LLC, Virtual Improvement Program LLC, and CF Lung Transplant and Transition LLC all represent thousands of individuals who have benefited from Bruce's leadership to find the cure by adding improvement to the robust CF strategy of research, drug development and clinical trials.

Bruce's legacy of leading improvement has set the expectation for science-based improvement that always includes people with CF, family members, and multidisciplinary healthcare professionals. Leading by example by showing up for meetings, publicly acknowledging improvement teams, leaders and team coaches along with private, quiet notes of appreciation, and always showing a willingness to be open to new ideas and improvement strategies in a changing environment are key attributes of a transformational leader.

Thank you, Bruce, for over 20 years of support for our team, including team coaches, to contribute to improvement as partners in the pursuit of the cure for CF. It has been a privilege to be part of the CF community you have led.