Every year has a few defining moments, but the paradigm shifts around the world in 2020 have been phenomenal with healthcare and the economy bearing the brunt of the crisis – one where there is no end in sight. In the midst of the inequities highlighted by COVID, June 30 marked Derek Feeley’s last day as the Institute for Healthcare Improvement’s President and CEO, the legacy he leaves is a greater questioning of the equity of healthcare improvement initiatives and ‘Who gets left behind?’ at a time of the rise of the global Black Lives Matter campaigns; a topic further explored by Dr Chris Bourke and colleagues looking at support for Indigenous health leaders.