“Behind almost every positive outcome in life, there was someone who cared more than they had to.”-Unknown

Next month it will be 20 years since my family moved back to Massachusetts after 25 years on the road in Los Angeles, San Francisco, Memphis and Cincinnati.

One of the reasons we moved back was that our mothers were still alive and we wanted to spend more time with them.

For almost 15 of the 20 years we've lived in Massachusetts, I was the Executive Director of the March of Dimes, first for Massachusetts, then for all of New England. In spite of that long tenure, I have not published many weblogs about my experiences in leading the non-profit. Not completely sure why. I didn't leave of my own volition (writers love to use that phrase), so maybe I didn't want to share? There are several dozen current or former employees of the March of Dimes who subscribe to the weblog, so this story is dedicated to you.

This month I received my first standing ovation, ever, and it was for something I contributed in my role with the March of Dimes, so I figured it was worth a weblog.

 Recently, I attended a statewide Massachusetts summit focused on maternal and infant healthcare quality improvement. More than 500 physicians, nurses, hospital leaders, researchers, public health officials, and healthcare professionals filled the ballroom for a day of presentations on policy changes, regulations, patient safety, and emerging healthcare challenges.

Somewhere between discussions of federal mandates and statewide initiatives, there was an awards presentation. And somehow, I was one of the honorees.

As I sat there listening to the presentations, I found myself thinking less about the recognition and more about the journey that led to it. The older I get, the more I realize that the biggest moments in our lives rarely begin as big moments. Most of them start quietly. Almost invisibly.

That realization sits at the center of what I am now referring to as Observational Leadership — the ability to notice the moment, take intentional action, and then stay with it long enough for something meaningful to happen.

The standing ovation I received that afternoon really started fifteen years earlier in a small conference room at WWLP in Springfield.

I was serving as the Massachusetts Executive Director of the March of Dimes. After a routine board meeting, the Springfield Board Chair, Dr. Glenn Markenson, approached me with concern about a newly released report from the Betsy Lehman Center regarding the prevalence of premature elective deliveries in Massachusetts.

At the time, unnecessary early elective deliveries had become a growing concern nationwide because of the increased risks to both mothers and infants.

Babies born even a few weeks early can face respiratory complications, feeding difficulties, NICU admissions, and developmental challenges.

Hospitals across the country were beginning to examine their practices more carefully. Glenn believed the March of Dimes should do something, anything, to help address the issue.

So we picked up the phone and called Dr. Lauren Smith, who at the time was serving as the Medical Director for the Massachusetts Department of Public Health. Before long, the three of us were tossing ideas around about how hospitals could work together instead of separately.

The discussion kept circling back to one idea.

“If we could just get all the hospitals in one room…”

The problem, of course, was funding. No budget. No sponsor. No infrastructure.

Just an idea.

The conversation drifted for a while as everyone talked about what could happen if resources existed. And then one of those tiny moments arrived — the kind that barely registers at the time but changes everything afterward. I remember saying four simple words. “We’ll pay for it.”

That was it. No strategic plan. No committee structure. No five-year roadmap.

Just four words. But suddenly the gears started turning. I didn't know where we'd get the money, but did some imaginative accounting and we found enough.

Within weeks, more than forty Massachusetts hospitals gathered together to share data, best practices, and strategies for reducing early elective deliveries. Instead of competing institutions working independently, hospitals began learning from one another. Momentum appeared almost instantly.

What emerged from those early conversations became the Massachusetts Perinatal Quality Collaborative — MPQC.

It consisted of the March of Dimes, the Massachusetts Medical Society, the Massachusetts Chapter of the American Academy of Pediatrics, the

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the Massachusetts Department of Public Health, and the American College of Nurse-Midwives

The name itself was created over coffee at a Panera Bread in Burlington with Lisa Ehle, then the Program Director for the March of Dimes (and, I’m proud to say, still a faithful reader of this weblog). Somewhere between coffee cups and notepads, the acronym “MPQC” was born. And it stuck.

Today, MPQC has become one of the leading maternal healthcare collaboratives in the country. Over the years, its work has contributed to improvements in maternal safety, reductions in preventable complications, enhanced obstetric care practices, statewide data-sharing initiatives, and collaborative quality improvement projects that have impacted thousands of mothers and babies across Massachusetts.

But the story didn’t end there.

I knew there was another organization doing remarkable work in neonatal care — NEOQIC, the Neonatal Quality Improvement Collaborative — founded by Dr. Munish Gupta and Dr. Alan Picarillo.

Their focus was improving care for critically ill and premature newborns in neonatal intensive care units across Massachusetts. I reached out to Munish and arranged to meet him at the NICU at Beth Israel Deaconess Medical Center.

I told him I had an idea. He smiled and said, “I have one too.”

What followed was one of the funniest professional exchanges I’ve ever had.

“You go first.”

“No, you go first.”

“No, really, you go first.”

When we finally shared our ideas, they were exactly the same.

We both believed there should be a statewide conference focused on neonatal quality improvement, supported by the March of Dimes, where hospitals could openly share outcomes, best practices, and lessons learned.

That was another moment. Another observation. Another decision to act.

And another example of what can happen when people commit themselves to staying with something bigger than themselves.

About a year later, I sat down for dinner at Tavolino’s Restaurant in Westborough with Dr. Gupta and Dr. Mark Manning from UMass Medical Center to discuss the possibility of merging efforts and creating something even larger. Ironically, the merger conversation itself went nowhere. But something better emerged from it.

Out of that dinner came the creation of PNQIN — the Perinatal-Neonatal Quality Improvement Network, an umbrella organization for both collaboratives.

And once again, momentum took over. 

PNQIN eventually became a nationally respected organization focused on improving outcomes for mothers and newborns across Massachusetts. The organization expanded into initiatives involving maternal health equity, opioid exposure in newborns, neonatal abstinence syndrome, sepsis prevention, obstetrical safety, and NICU quality improvement efforts.

Who knows how many thousands of lives have been impacted by the work? Every baby has two parents, four grandparents, other relatives, some have siblings. When you impact the life of a baby, you simply are changing the world.

Today, PNQIN receives millions in grants, plus federal and state support because its efforts have been so successful and the organization is driven to achieve. It has served as an influential voice in healthcare policy and quality improvement discussions for many years, influencing legislators, governors, and the Secretary of Health and Human Services. I know this, because I was there for many of the conversations.

But here’s the important part. None of the results happened because someone started with a massive organization.

It started because a handful of people noticed a problem, cared enough to act, and stayed with it through years of hard work. That’s what collaborations really are.

• People.
• Volunteers.
• Clinicians.
• Leaders.

Organizations like the March of Dimes willing to provide support before anybody knows whether the effort will succeed.

The professionals who built NEOQIC, MPQC and PNQIN into what they are today continue to amaze me. They fight every single day for healthier pregnancies, safer deliveries, stronger neonatal outcomes, and better futures for mothers and babies.

That is noble work. And they pursue it with extraordinary persistence.

During my acceptance speech at the Spring Summit, I shared pieces of this history and talked about persistence, determination, and the importance of continuing the work even when progress feels slow.

I also shared that gratitude surrounds their efforts, even if it is not obvious or always visible.

As I concluded, I referenced one of my favorite Calvin Coolidge quotes, the persistence one that ends “The slogan Press On has solved and always will solve the problems of the human race.”

I encouraged everyone in the room to keep 'pressing on' in their own work because the lives they impact will never fully know what was done behind the scenes on their behalf. Then I stepped away from the podium.

As I did, Dr. Gupta handed me the box for the award and quietly leaned over and said, “Turn around.”

So I did. And the entire room was standing. Five hundred people. Standing and applauding.

For a few seconds, I honestly didn’t know what to do with the moment. Because the truth is, none of this work was ever done for recognition. Nobody involved in those early meetings expected awards, public acknowledgment, or standing ovations.

We were simply trying to help. Trying to solve a problem. Trying to make things better.

And perhaps that is the real lesson in all of this.

Most meaningful accomplishments begin quietly.

They start with a conversation after a meeting, a cup of coffee at Panera Bread, a dinner meeting at a now-closed restaurant, or four simple words spoken at exactly the right time. “We’ll pay for it.”

• A small moment.
• A decision.
• Persistence.

And eventually, if you stay with it long enough, sometimes life gives you a standing ovation.

That’s a pretty good feeling.

Real leadership is often measured not in applause, but in the quiet persistence that made the applause possible.

Thanks, PNQIN. Press on.

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