About A Few Threads
A monthly newsletter for healthcare leaders navigating change, one honest idea at a time.
Some months it's a pattern I've been noticing. Some months it's a question I can't quite let go of. Occasionally, it's a practical resource I've created. Always, it's something worth sitting with.
Issue 1 · July 2026
The Question That Changed My Thinking
What if resilience isn't the only issue?
This month: alignment, and how sustained pressure changes the leader we become.
Have you ever reached the end of a week feeling like you accomplished a great deal, but somehow drifted a little further from yourself?
Sometimes the drift is almost impossible to see while it's happening. You hear yourself say yes to something you don't have the capacity for. You answer emails late into the evening even though you promised yourself you wouldn't. You finish another week feeling productive, but somehow less like yourself than you did on Monday.
For much of my career, the question I returned to most was: How can I become more resilient. Over time, a different question surfaced: what if resilience isn't the only issue? What if alignment matters too? I began noticing it in others, and eventually in myself: talented, committed people working incredibly hard and still feeling depleted, not from a lack of resilience, but from losing touch with what actually sustains them.
Underneath that was a harder question: why do we drift from alignment in the first place? Often, it's because we're living according to scripts we never consciously chose: what success looks like such as what makes us valuable, what a "good leader" is supposed to be. These scripts often served us well, once. They may have helped us build real careers and real relationships. But there comes a point when something feels off, when we're chasing goals that no longer feel like our own, and the drift is gradual enough that we don't always notice it happening. The problem isn't failure. It's that we're still living by a script that no longer fits.
Pressure doesn't remove your strengths.
Pressure adds a second layer. It doesn't just keep an old script running. Under sustained pressure, the strengths that once made you effective can begin to show up differently:
The same drive that made you dependable starts looking like an inability to say no.
The same calm that made you a steady presence becomes emotional distance.
Nothing was lost. It drifted.
When a leader drifts from themselves, it rarely stays private:
You hear it in the tone of a meeting.
You see it in how fast decisions get made, or don't.
You feel it in the way people start holding back instead of pushing forward.
Alignment isn't only personal. It shapes the room around you.
Noticing is the beginning of choice.
A script is not a fact. It's a story, and stories can be edited, rewritten, sometimes let go of entirely. It's difficult to change a script that we don't realize we're following. The moment we notice it, we create the possibility of choosing differently. So, once you notice, what do you do? There isn't one right way back to alignment:
Some leaders return to a set of reflection questions on a regular basis: what matters most right now, what am I tolerating, where do I feel most like myself.
Others talk it through with a coach or a trusted colleague as clarity often comes more quickly in conversation than it does in solitude.
Others prefer something more visual, exploring what they're moving toward instead of trying to define it in words. With clients, I sometimes use what I call an Action Board to map out what they're moving toward rather than simply naming it. There's something clarifying about seeing it in front of you instead of just carrying it in your head.
There's no single right pathway. What matters is that it becomes something you actually return to, often enough that misalignment gets caught early. Pressure doesn't just exhaust us. It slowly pulls us away from ourselves.
I believe coaching isn't about helping leaders become someone different. It's about creating space for them to reconnect with who they already are beneath the pressure, so they can grow with greater clarity, intention, and sustainability.
What I've been building
Over the past few months, I've been creating practical resources and tools around many of these ideas, not to provide answers, but to help leaders reflect more deeply, see their situation more clearly, and take meaningful action.
What Is Your Energy Costing You?: A two-week tracking practice for noticing what's draining your energy, and what's genuinely restoring it. It pairs naturally with everything above. Download it at michelletruppe.com/resources
Before Burnout: Burnout doesn't look the same across the org chart, and naming it early often makes the difference between recovering easily and running on empty for too long. Read the piece that started this conversation (LinkedIn link). It resonated with more healthcare leaders than I expected, and prompted some real conversations I didn't anticipate having.
One question I'm leaving you with this month
If you're honest, is the way you're leading right now closer to a script you inherited, or a choice you're actually making?